The Evolution of the Stigma

When I ask you to think about mental illness, what do you think about? Maybe your first thought is someone lying on a couch talking to a therapist, or maybe it is of a cushy mental hospital where patients are cared for. Perhaps after this, your mind might wander to thoughts of an insane asylum where patients are practically tortured. If I were to ask someone from Massachusetts in 1962, they might say a witch. In Medieval Europe, a demon. These thoughts help inform us into the stigma or perception of the mentally ill during that time. The stigma surrounding mental illness is extremely important as it influences the perceptions of the mentally in addition to our own willingness to treat our own mental illness because we don’t want to be thought of a certain way. From demonic to unsafe and unpredictable to finally weak, the stigma of mental illness has evolved over time, and this evolution can be directly related to the knowledge and treatment of mental illness.

THE STIGMAS OF THE PAST

Prior to informed medical practices and knowledge, mental illness has carried with it the notion of impurity or some kind of demonic possession. This notion can be clearly observed from European Middle Aged practices to treat mental illness and how women with mental illnesses were viewed during the Salem Witch Trials of 1692. In the middle ages, a common treatment for illness was purging or bloodletting where doctors would cut the patient to draw blood which they believed would let impurities and demons out of the body. (1) This practice is one of the earliest known treatments to mental illness, and its reasoning began formation of the stigma surrounding mental health. The image of being impure or possessed by a demon caused most to be afraid of mental illness and reluctant to accept it as natural and a part of life; it is the work of a non-Earthly demon after all. This concept of impurities and demons persisted in the minds of the people, and when Europeans settled in America, they brought these ideas with them. Here, this fear grew to such an extent that some women who suffered from a mental illness were accused of being a witch or possessed by a demon because they acted differently from others. As a result, they were killed in an event which is now known as the Salem Witch Trials. Throughout the Witch Trials, over 200 people, even those who did not suffer from a mental illness, were accused of being a witch. This mix of sexism, ignorance, and pervasive stigma led to these innocent women being killed. These actions did nothing to ease the worries of the people of the late 1690s. Now, not only are those mentally ill seen as impure or possibly demonic, you can now be murdered for it.

INSIDE THE ASYLUMS

Eventually, people came to the conclusion that those afflicted by a mental illness needed to be removed from society. As a result, facilities that became known as insane asylums were formed. Although they can be dated back to the 19th Century in America and the 17th Century in Europe, they reached their peak in the 1930’s. These asylums took those deemed as mentally ill, and they separated them from everyone else to ensure that people were kept safe. Within these asylums, the treatment the patients received was horrific. They ranged from inducing comas, causing seizures, and lobotomies to simple prolonged isolation and physical restraints. Isolation and physical restraints were used mainly because a patient was acting up or became violent, so to keep the doctors and other patients safe, they were removed to a secure location. Comas, seizures, and lobotomies were all used to eliminate the symptoms from a person by rewiring the brain. Although all three of these treatments have a success rate of around 80 percent, and their side effects and risks were significant. (2) In insulin induced comas, the patient may not respond when doctors use glucose to wake them up, and they enter a prolonged coma. For the treatment to induce seizures known as the Metrazol Therapy, for five minutes the patient violently seizes and, as a result, suffers from torn muscles, broken bones, and other side effects. In a lobotomy, the patient will have connections between parts of the brain cut to remove one symptom, but they will oftentimes experience new symptoms and impairments to mobility. (3) This treatment created in 1936 by Egas Moniz won the Nobel Prize in 1949 for his procedure. (4) Because of the worldwide acclaim of these treatments and the lack of other safer methods, people viewed mental illness as something that can only be cured through extreme measures such as these treatments. Now imagine you are someone in the 1930s who suffered from a kind of mental illness. Would you want to seek help if it meant experiencing these kinds of treatments? Of course not. As a result, it became taboo to speak about mental illness as the implications of the word were too severe. As the fear of mental illness grew, so did the stigma surrounding it. Those who had relations with a mentally ill person were shunned, and even those who recovered from a mental illness continued to be seen as abnormal. In addition, the family of a mentally ill person was stigmatized because people thought that one mentally person in a family meant the whole family was not normal. Not only that, but the recovered patients found it difficult to live normally as people did not want to have anything to do with them. They were unable to find jobs or anywhere to live because they were still seen as tainted and unfit. The stigma surrounding mental illness was infectious, and because of it, people were scared to talk about their health, and those who had a mental illness were pushed away from society. Not only that, but the stigma surrounded the families of mentally ill people, and they eventually found it difficult to live a normal life despite being mentally healthy; a truly wicked problem.

The use of insane asylums is now a thing of the past, but why the change? Three major causes allowed for the transition known as deinstitutionalization from insane asylums to our more modern practices in the 1960s: knowledge and medicine, societal outlook on those who were mentally ill, and finally, federal funding.(5) The knowledge and medicine that simply evolved with time as technology improved had improved results with less risks and side effects. No longer were doctors using lobotomies and seizures, but instead, a medicine known as chlorpromazine and clozapine. Chlorpromazine is used to treat the symptoms of diseases like schizophrenia and clozapine is used if other treatment options fail to reduce the suicidal urges in patients. In both medicines, the side effects are not like those from the older treatments. Instead of physical impairments, patients may see symptoms like weight gain, agitation, or nervousness. (6) With better treatments available, the need for insane asylums decreased. Another factor in the deinstitutionalization of asylums was the societal outlook on mentally ill patients. This change in outlook came after World War I and II. Soldiers who, when they left for battle, were thought to be the peak and ideal man at the height of their masculinity, but when they returned, they were shells of their former selves with many suffering from Post Traumatic Stress Disorder (PTSD). (7) Seeing these people come home from war now dependent on others for simple tasks revealed to most that mental illness is not something reserved for crazy psychos, but everyone. Finally, as a result of the better technology and society’s opinion, the government defunded insane asylums in favor of community mental health centers where patients can be properly cared for.

THE MODERN STIGMA

As modern practices developed, one stood out as the most common and effective: therapy. Simply talking about one’s emotions have yielded astounding results on aiding those afflicted by a mental illness. “Nearly half of American households have had someone seek mental health treatment this year” and 82 percent of people who do receive therapy say that it is helpful to some degree or another. (8) Along with this treatment, mental illness became less synonymous with illnesses like schizophrenia, bipolar disorder, or dissociative identity disorder(having multiple personalities) and more with depression and anxiety, something that roughly one in four people suffer from. Although therapy yields results, many people who have problems with mental illness still do not seek help. This is due to a new stigma surrounding it. This stigma is unlike the others because instead of patients being seen as impure or unsafe to be around, they are viewed as weak, and as a result, unfit to do work. As a result, people who need to seek mental health treatment do not because they do not want to lose their job or seem different from their friends and family. Along with being seen as mentally weak, people don’t want to be labelled with a medical term for mental illness as it sets them apart from other people, and many find it inherently stigmatizing. (9) Due more information about this topic being revealed, however, this stigma has seen a decrease. In 2004, a survey of 1,000 random Americans was conducted, and “47 percent stated that the stigma surrounding mental health services has decreased in recent years.” (10) Now, a major factor in finding treatment for mental illness is more on the cost of treatment and not on the stigma surrounding it. Although the stigma surrounding mental illness is still present, these signs of a decrease are optimistic for the future of mental health care.

Along with more information and knowledge about mental illness, a new problem has surfaced especially among younger people who are more passionate about the problem of mental illness. At first glance, more knowledge and more passionate people about mental illness is something that would help people. This is definitely the case as the conversation surrounding mental illness is becoming normalized, and we are more comfortable talking about it than before. There is a problem that has resulted from this, however. Because people understand that many people suffer from a mental illness, they will tend to invalidate their own personal troubles. They may know about people who suffer severely from a mental illness, so, in comparison, they view their own mental illness as insignificant and not worth seeking treatment for. Another problem arises when people are placed in high stress situations, like in college or a job, where everyone seems to have troubles with their mental health. Thus, they may view their mental health challenges as normal and not treat it. In these ways, many people who suffer from mental illness go without treatments.

With the knowledge we have available today, we know that mental illness is natural, unavoidable, and not uncommon. Although they range in severity, many people deal with a mental illness in some sort of aspect in their life. Unlike in the past where mental illness was taboo to speak about, we now understand that this is not the case, yet a stigma still persists, and people still refuse to seek treatment either because they are scared of what society will think or they invalidate their troubles. This is not okay as many suffer from the illness and all mental health problems are worth seeking help for as it can truly help you. So I ask you to end this problem. Either try and help someone who is struggling with a mental illness by stating a conversation about it, or if you need treatment yourself, get treatment. No one should have to suffer from mental illness.

Bibliography

(1 & 2) “A History of Mental Illness Treatment.” Concordia University, St. Paul Online, October 14, 2016. https://online.csp.edu/blog/psychology/history-of-mental-illness-treatment.

(5) Amadeo, Kimberly. “Learn About Deinstitutionalization, the Causes and the Effects.” The Balance, n.d. https://www.thebalance.com/deinstitutionalization-3306067.

(6) “MedlinePlus Drug Information.” MedlinePlus. U.S. National Library of Medicine, n.d. https://medlineplus.gov/druginfo/meds/a682040.html.

(8 & 10) Monitor on Psychology. American Psychological Association, n.d. https://www.apa.org/monitor/julaug04/survey.

(7) Museum of Health Care. “Mental Health: Tracing the History of Stigma.” Museum of Health Care Blog, July 15, 2014. https://museumofhealthcare.wordpress.com/2014/07/15/mental-health-tracing-the-history-of-stigma/.

Stefanovics, Elina A., Hongbo He, Maria Cavalcanti, Helio Neto, Angelo Ofori-Atta, Meaghan Leddy, Adesuwa Ighodaro, and Robert Rosenheck. “Witchcraft and Biopsychosocial Causes of Mental Illness.” The Journal of Nervous and Mental Disease 204, no. 3 (2016): 169–74.

(4) “The Nobel Prize in Physiology or Medicine 1949.” NobelPrize.org. https://www.nobelprize.org/prizes/medicine/1949/moniz/article/.

Vann, ByMadeline R. “The 10 Worst Mental Health Treatments in History — Everyday Health.” EverydayHealth.com. https://www.everydayhealth.com/pictures/worst-mental-health-treatments-history/.

(9) Weinstein, Raymond M. “Labeling Theory and the Attitudes of Mental Patients: A Review.” Journal of Health and Social Behavior 24, no. 1 (1983): 70.

Wright, Annemarie, Anthony F. Jorm, and Andrew J. Mackinnon. “Labeling of Mental Disorders and Stigma in Young People.” Social Science & Medicine 73, no. 4 (2011): 498–506.