Just thought I'd post this here so you can see what has kept me so busy!

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“Sticks and stones may break your bones but names can never harm you.”  How many of us heard that when we were kids?  How many of us had our feelings hurt when called names?  It’s been my experience that sticks, stones and soapboxes in speech class may break my bones and being called names hurts a hell of a lot.

We’ve entered the age of political correctness – as adults we try to watch what we say, avoiding anything that may be offensive to people of different genders, sexual orientations, races, nationalities, religions and abilities, to name a few.  Most of the world seems to be trying not to offend anyone – with one large exception.  There is very little political correctness surrounding mentally illness.

People use words like, crazy, whacko, nuts, psycho, schizo, emo and loony bin, without really thinking about it.  The Encarta Dictionary indicates that “crazy” is “an offensive term for someone with a psychiatric disorder.”  Key concept – at least one dictionary identifies this term as offensive, yet we use it every day.  I know that I do and I should know better.  For one thing, I worked for 19 years at a mental health center and have a Master’s in Psychology.  But I am also mentally ill – have been since my early 20’s.  I have bipolar disorder, considered one of the major mental illnesses, so I guess officially I’m a crazy person who has been in the loony bin dozens of times.  But this speech isn’t about me – it’s about the stigma attached to being like me – mentally ill.

A stigma is defined as “the shame or disgrace attached to something regarded as socially unacceptable.” According to an article written by the staff of the Mayo Clinic there are four components to a stigma:  “labeling someone with a condition, stereotyping people who have that condition, creating a division – a superior ‘us’ group and a devalued ‘them’ group, and discriminating against someone on the basis of their label.”  There is undeniably a stigma to being mentally ill.  With the glaring exception of HIV and AIDS, there is very little stigma to being physically ill.  There are no derogatory terms or jokes about having cancer – we don’t call a person who has lost all their hair due to treatments, “baldy.”  Yet we’ll call someone with schizophrenia a “schizo.” 

It certainly isn’t because people with mental illnesses are in the vast minority.  According to the National Institute of Mental Health’s website, an estimated 26% of Americans – approximately one in every four – have a diagnosable mental illness in a given year – this translates into almost 60 million people.  According the Surgeon General’s report on mental illness published in 1999, approximately one in five Americans will have a diagnosable mental illness in their lifetime.

So what causes this many people to be the brunt of jokes?  One reason might be that the jokes about mental illness are funny.  According to the National Stigma Clearinghouse as reported in an article by James Willwerth in Time magazine, one clothing store used a picture of a man in a straitjacket in their ads.  Their slogan was, “If you paid more than $100 for a dress shirt, might we suggest a jacket for you?”  I don't know about you, but I find that rather funny.  Unfortunately, mental illness is far from funny – not to the people who have it and not to the loved ones of those people.

Stigma actually goes further than just the jokes, though.  There seems to be a wide-spread lack of understanding about what mental illness is and what causes it.  The same article from the Mayo Clinic website states that mental illness has complex causes relating to brain chemistry, genetics and life circumstances – none of which are generally in a person’s control.  Yet there is a generally held belief that the person with mental illness is somehow to blame – that they are in control of their disorder.  This belief is seldom held about a physical illness.  How many people would tell someone with diabetes to “just snap out of it?”

Another factor, relating to this lack of understanding, is the fear factor.  People are afraid of people with mental illness.  A report from the Department of Justice as cited in an article by Carolyn Gard in Current Health extracted from the Daytona State College database shows that just 1.5% of all assaults committed during a 10 year period were committed by persons with mental illness.  Another report states that just 11% of mentally ill persons are prone to violence, roughly the same as the general population.   Yet the fear persists.  A study by researchers at the University of Pennsylvania was reported in the article by James Willwerth.  They found that despite the statistic of actual violence by mentally ill persons, approximately 70% of all portrayals of mental illness on television and movies show that person to be violent.

So we come to the real culprit – the media.  Actually, the misconceptions about mental illness have a much longer history than can be attributed to the media, but in a day and age where so much more is known about the causes of mental illness and the treatment of mental illness is so much more effective, the media is certainly guilty of perpetuating the stereotype.  And the news media is not exempt.

For example, how many of you were aware that in October of this year, Congress passed a law relating to the equal treatment of mental illness by health insurance companies?  Now, how many were aware that the gunman in the Virginia Tech shootings had a history of mental illness?  That is what makes the news – those relatively rare instances where someone with a mental illness commits a violent crime. 

Aside from the general wrongness of the stigma of mental illness, there are more serious implications.  It was reported by The Carter Center, a human rights organization in Atlanta and cited in the article by Carolyn Gard that while 90% of people with mental illnesses would benefit from treatment with medications, only 30% actually receive that treatment for fear of being labeled as mentally ill, for fear of being stigmatized as a result.  It is likely, then, that those relatively few people with mental illness who commit violent acts are not receiving treatment at the time of their crime.  Again, the Virginia Tech shooter is a prime example, as is Andrea Yates who drowned her five children after being diagnosed with post-partum psychosis, but discontinuing treatment.

When people with mental illness refuse to seek treatment for fear of the stigma surrounding it, they often are unable to maintain employment, particularly if the disorder is one of the serious mental illness.  The result can ultimately lead to homelessness.  A report by the National Coalition for the Homeless reports that 16% of homeless individuals have a mental illness.  Certainly the lack of funding and misuse of funds for community based treatment for the mentally ill has exacerbated the problem, but I feel that stigma has played a much larger role.

When persons with mental illness are not receiving treatment and are perhaps homeless, they often end up in jail, usually for non-violent crimes, such as disturbing the peace or failing to pay for a meal.  It was reported in an article published in the magazine America extracted from the Daytona State College database that there are between 200,000 and 300,000 people with mental illness in jail at any given time.  While in jail, they receive little or no treatment, are the victims of abuse by fellow inmates, and are eventually released to the same environment that led to their incarceration in the first place.

Worse than discrimination, worse than homelessness, worse than jail, however, is the number of persons with mental illness that commit suicide.  About five years ago, my niece made several calls to me about her brother-in-law.  When she described his behavior, it was obvious to me that this young man was experiencing symptoms of a psychotic episode.  He was delusional – convinced that people were spying on him through the television cable, that people were following him on the highway.  He needed treatment, desperately, but he refused, stating repeatedly that he was not “crazy.”  Finally, shortly before the birth of his first nephew, he took a gun and shot himself in the head, committing suicide in his family’s home rather than admit that he had a problem.  That is the effect of stigma.

So what can be done?  The answer begins with all of us.  There needs to be an awareness of mental illness that goes beyond the stereotypes.  If you haven’t already, take a psychology course and ask questions about mental illness.  When you hear news about a person with mental illness or see a television show or movie with a character with mental illness, consider that the report or portrayal may be slanted and inaccurate.  Remember the statistics – one out of every four people you meet probably has a mental illness, whether they are willing to talk about it or not.  When you hear a joke about mental illness, or hear someone referred to as crazy or a whacko or a nut job, consider who might be offended by it but are just afraid to speak up for fear of being stigmatized because they or a loved one has a mental illness.  When you are in a position to supervise other people, be the kind of supervisor that someone would be willing to divulge their mental illness to without fear of losing their job.  Be the kind of friend that someone would be willing to divulge their problems to without fear of losing your friendship.

You may be wondering why I started this speech my admitting my own mental illness.  While I primarily wanted to establish my credentials for talking about this topic, I guess I also wanted to put a face on mental illness.  Aside from my tendency to fall off soapboxes and running the risk of squishing you, I’m a pretty harmless individual.  In the not too distant past, I probably would have been “asked” by my family to live in the attic, not even coming down for meals – crazy old Aunty Karen who needed to be hidden away for fear of what the neighbors might think.  Well, I believe that if we want to be let out of the attic, we have to first come out of the closet and admit to having a mental illness.

I'm kinda confused...but that it did not make any sense..it was really good...but I didn't understand, not reallly. I guess there are alot of people like me , who dont know much about mental illness. like, i don't really understand how crazy can be offensive..but i suppose that is because everyone says the term crazy..
who is everyone? i guess the people I grew around. Like I say all the time,"you must be crazy". Maybe this doesn't make any sense..because I'm confused I guess..

But it was very eye-opening and made me see things I never thought of. It will be hard to change how I think and hard for me to convince others to do also.

-bobbie/bob/ :)

Excellent writing and oh, so true. I have a physical illness with ignorance and stigma attached to it. As a result I've ben left paralysed without food and water and no social or medical care in the past. The prejudice nearly killed me - not the disease and many others with the same illness have committed suicide rather than face laughter and neglect. Keep up the word!!!