Dr. Val Farmer
Rural Mental Health & Family Relationships

Fighting The Stigma Of Mental Illness

May 8, 2000

Suppose you have a family member with schizophrenia (there are 220,00 in the United States and you were confronted with a lipstick line called "Skitz-O-Styx". The advertising includes, "For every one who relishes the multiple personalities that live inside of our bodies - each Skitz-O-Styx has all you need to change moods in an instant." It isn’t so funny. Nor is it accurate - multiple personality disorder is different from schizophrenia.

Or suppose you encounter a lollipop candy called "Psycho Pops" with names of "strait jacket" strawberry, "loco" lemon, "gonzo" grape or "rabid" raspberry. Wouldn’t you find that offensive or hurtful?

Did you see the E. R. episode on February that depicted a law student diagnosed with paranoid schizophrenia? Annoyed by a long wait, the law student stabbed two of the E.R. doctors, one of which died from her wounds. This story line contributed to the public myth that mentally ill people are more violent than the general population.

Perhaps you were exposed to a television show on March 30, 2000 and again on April 4, 2000. ABC television premiered a series, "Wonderland," set in a psychiatric hospital. The show aroused the ire of families, professionals and advocates for the mentally ill. The main objection was that the show promoted the ignorance and stigma of the mentally ill. The show presented a sensational and one dimensional portrayal that reduced people with mental illness to caricatures and stereotypes - subjects of humor or derision. A vigorous letter writing campaign and abysmal rating resulted in the cancellation of the show after two episodes.

When was the last time you read a headline, "Sane Man Murders Family of Five"? Despite abundant statistics to the contrary, people with mental illness are routinely stigmatized by the way stories are reported.

What are the facts? Are people with mental disorders truly more violent?

1. The risk of violence in those with schizophrenia appears to be very similar to that of the general population and is exceptionally small. Acts of violence are almost always committed by those who are not receiving proper treatment. They are far more likely to be violent toward themselves than toward others. Treatment and compliance with medication dramatically reduces the risk of violence.

2. When violence does occur, it usually occurs in combination with a substance abuse problem.

3. The risk of violence is much less for a stranger than for a family member or a person known to the person with schizophrenia. There is very little risk to a stranger from casual contact with an individual who has this disorder.

4. The contribution of those with schizophrenia to the overall incidence of crime is relatively small.

5. People with schizophrenia do not pose a risk to children.

6. Risk of sexual offenses associated with schizophrenia is low.

The Surgeon General’s report. Where does the perception come from? A recently released report on mental health by the Surgeon General of the United States traced the attitudes of the public regarding mental disorders. The report cites a 1997 survey comparing public attitudes about mental illness with attitudes from the early 1950s.

Research indicates that in the late 1990s, the general public has a much better ability to define mental illness and distinguish it from ordinary worry and unhappiness. The public better understands depression and anxiety as manifestations of mental disorders.

However, the disturbing news is that in 1997 the public’s perception of mental illness included more violent behavior than during the 50s. In 1997, 31 percent of those who identify "psychosis" as mental illness mentioned violence as a symptom while, in comparison, only 13 percent did so in the 1950s. Despite greater awareness and understanding, the stigma has increased as the public has come to believe that the mentally ill are violent. This media-driven stereotype encourages people to distance themselves from those with a mental disorder.

The consequences of stigma. The Surgeon General’s report describes these stigma consequences for the mentally ill, their families and the general public.

  • An increase in bias, distrust, stereotyping, fear, embarrassment, anger, and/avoidance. Stigma leads others to avoid living, socializing, or working with, renting to or employing people with mental disorders.
  • It reduces patients’ access to resources and opportunities such as housing and jobs and leads to low self-esteem, isolation, and hopelessness.
  • It deters the public from seeking mental health treatment for themselves or for family members.
  • Stigma prevents people from acknowledging their own mental health problems, much less disclosing them to others. The insidious effects of stigma keep family members from being open about their problems and not unifying with others to fight for appropriate treatment and to combat the stigma that keeps them isolated.
  • The public becomes more unwilling to pay for appropriate treatment.
  • It gives insurers - in the public sector as well as the private - tacit permission to restrict coverage for mental health services in ways that would not be tolerated for other illnesses.
  • In its most overt and dangerous form, stigma results in outright discrimination and abuse. It deprives people of their dignity and interferes with their full participation in society.

For more information, contact the National Alliance for the Mentally Ill (NAMI) at 1-800-950-6264 or through their website at www.nami.org.