Fighting the stigma of mental illness
There's no doubt about it, the persistence of stigma is still a major challenge when it comes to tackling mental illness.
We can see it at work not just in the community generally but also within the minds of those who are ill and needing treatment. Indeed it can be a major barrier for people needing to present for treatment.
How, then, should we understand this phenomenon?
A useful starting point is the generally held view that we have about human nature and the freedom of the will. All too often when confronted with mental illness in the community we may think to ourselves "why don't those who are ill pull themselves together?"
On the other hand we may picture it as a simple case of overwork and advise those who are suffering to "take a few weeks off and re-charge your batteries".
For many these are the logical things to say as they too experience mood swings or even bouts of anxiety associated with the "ups and downs" of life and learn to cope by "getting on with it" or "re-evaluating priorities'.
What is not appreciated here, of course, is the all-embracing nature and intensity associated with mental illness which makes medical treatment a must.
The right question to ask is "why do many who need treatment not seek it?" Indeed it is when treatment is sought that those who are ill start to recognise the meaning of "freedom" and the self-awareness needed to give it meaning.
All too often, however, this is not the option chosen and sufferers keep their pain to themselves fearing that openness will only make matters worse. That they think this is a measure of the power of stigma and the shame it creates.
Another starting point is an analysis of how we view society and what is necessary for it to work properly. All of us rely on the "reasonableness, intelligibility and predictability of people we, directly or indirectly, communicate with" in our everyday life (Dusan Kecmanovic, Australasian Psychiatry, vol. 20, 2012).
It's all about trust and it follows that unintelligible, unreasonable or chaotic behaviour will be deemed "disorderly", "threatening" or even "dangerous".
What happens is that we characterise all mental illness and all who mentally ill in these terms. Ingrained attitudes, popular culture and the media all play their role in this stereotyping.
It starts early in life and is hard to shift even when knowledge is gained. Portrayals range from "the violent and unpredictable" to the "pathetic victim" (Peter Byrne, Advances in Psychiatric Treatment, vol.6, 2000).
Byrne goes onto make the point we don't have a word for prejudice against the mentally ill. We use words like racism, sexism, homophobia, and religious bigotry but have no equivalent for prejudice against the mentally ill.
He suggests "psychophobic" to describe such an individual so prejudiced but it's hard to imagine that word taking off in everyday discourse. Still his point is very well made. The challenge, he says, is to "confront the stigmatiser with his or her irrational beliefs" and enable direct contact with "one of them".
So it is then that tackling stigma is a most complicated business that goes to the heart of our social relationships and how we understand them - it's an existential as well as an intellectual issue. Yes there are certain features common to the human condition but still each of us is, in an important sense, unique in biological make-up, social experiences and character.
It follows that we won't react and respond the same way to all that surrounds and impacts on us, including the way we live, work and play. Even medical science battles with the reality of these differences in amongst the sameness that is revealed by statistical and scientific research.
Human beings find these differences and the ambiguities associated with them difficult to imagine-and not just in relation to mental illness and the many forms it takes.