These are devastating, heartbreaking illnesses, the effects of which ripple out to tear apart families and whole communities. Would anyone tell someone living with these conditions, “It’s all in your head—just get over it” or that “you have to choose to get better”?
As ridiculous as these statements sound, this is the daily reality of stigma faced by people living with serious mental illness (SMI), such as schizophrenia, bipolar disorder, or depression. The Centers for Disease Control and Prevention (CDC) reports that 1 in 25 Americans live with SMI. Still, society seems to expect them to conceal, self-heal, or just ignore their conditions, unlike the waves of support given to those with Alzheimer’s and Parkinson’s.
Of all the obstacles associated with mental illness, stigma is the most pervasive and challenging to overcome. Mental illness is, by nature, inward, often invisible, and frequently isolating. A disease of the mind can be cloaked in a smile and obscured with activity and achievement. To function in the world, many people put on a false facade to camouflage the depth of their suffering.
Yet the suffering remains—and often deepens with time.
Have you ever heard someone with poor vision asking their ophthalmologist when they can taper off their eyeglasses so that they can “try to do it on their own?” Or someone with Type 1 diabetes insists that insulin is a crutch, only to be used by the weak?
These are ridiculous suppositions, of course, but they are sadly ones that I hear daily from patients in my office regarding their psychiatric medications.
The pervasiveness of these attitudes isn’t out of nowhere—they are directly related to the way we as a culture treat mental illness and those who live with it in the US. While Alzheimer’s and Parkinson’s are widely accepted as brain diseases requiring treatment, we downplay bipolar disorder and schizophrenia—also brain diseases—and put the burden of healing squarely on the patient.
As clinicians, we know that the shame and guilt of stigma can lead to people not taking their medication as prescribed or not seeking treatment at all. These illnesses, if untreated, stand to adversely impact every aspect of life—from family relationships to longevity.
But the burden of stigma remains.
The stigma of mental illness dealt my family a direct blow just last year. My uncle battled major depressive disorder for most of his life, though he had finally found medication that helped him manage his condition for the previous year or two. A few months ago, after a long and tiresome battle, he stopped taking his medication—largely because the stigma around mental illness made him feel like he shouldn’t need it anymore. My uncle’s mental health quickly deteriorated, and he tried—unsuccessfully—to get back on his medication, But it was too late. He died by suicide on August 15, 2020.
There are millions of stories like his—and one is too many.
Stigma is a deadly poison to wellness, so we must ask ourselves: What is the antidote to stigma?
Education about the medical model of psychiatry — that the disorders we treat are legitimate brain illnesses — is critical, but it’s only part of the equation. Research into measuring mental health stigma, including the use of the Mental Illness Stigma Framework (MISF), may provide a basis for common terminology, improve research in the field, and offer additional directions to address and research in the future.
That’s blaming the victim. People don’t fail medications; the medications have failed them.
It is on us as healthcare providers to advocate for our patients in ways that may go beyond simply caring for their minds and bodies.
This may include supporting systemic changes that could improve access and quality of care to all those in need. We have the power to address societal misunderstanding and break down false beliefs about people with mental illnesses and begin to treat brain disorders without shame or judgment.
The antidote to stigma is compassion. Only by practicing empathy can we truly appreciate the daily challenges of those living with mental illness. While it may be painful to walk a mile in those shoes, we cannot afford to skip that journey for our collective well-being.