Stigma and Mental Illness: the “is” and the “ought”

Stigma can be a good thing

If a person’s so-called mental illness is a product of their chosen behavior, they deserve the stigma

By Richard E. Vatz

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     During an interview on the recent Fort Hood shootings committed by Army Spec. Ivan Lopez, who killed three people and then himself, CNN’s Chris Cuomo suggested that Post Traumatic Stress Disorder be referred to as just Post Traumatic Stress — leaving off “disorder” because of the “stigma” associated with the term.
     This is a clear example of the futility of eliminating stigma through rhetorical fiat. It simply cannot be done. The issue is decades old, and there is little, if any, reason to believe that there will ever be the elimination or even diminishment therein of stigma, defined as a source of infamy or disgrace.
     Mental health professionals and others wish to remove the stigma from mental illness because they believe it will motivate sufferers to seek help and reduce the threat that a tiny percentage of them pose to others.
     Last month, the Baltimore Sun reported that Maryland has funded a $1.2 million initiative, called the Center for Excellence on Early Intervention for Serious Mental Illness, for the purpose of getting “troubled people” help. (“UMBC study targets stigma of mental illness,” March 22).
     Their case in point is Darion Aguilar, who shot and killed two employees in The Mall in Columbia and who reportedly told a physician he was hearing voices. The physician recommended that Aguilar seek mental health counseling, but Aguilar never followed through.
     There is no evidence that fear of stigma was preventing him from seeking help. Nor is there much to suggest that societal changes could influence Aguilar or someone like him to talk with a mental health professional.
     In fact, there is no evidence that mental health professionals and counseling can reduce violence or even identify dangerous people better than laypersons can.
     Mental illness is a term which has been applied liberally to people with all kinds of problems. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, as with all of the diagnostic handbooks preceding it, includes disorders of such general nature that anyone can be so diagnosed in order to maximize “parity” with physical illness in insurance coverage. As a result, the National Institute of Mental Health estimates of mental disorder incidence now exceeds 50 percent, leading Paul McHugh, the former chief of psychiatry at the Johns Hopkins University School of Medicine, to  observe incredulously, “Are you kidding me?” In 2009, the American Psychiatric Association’s major journal, Archives of General Psychiatry, published the estimate that “Almost half of college-aged individuals had a psychiatric disorder in the past year.” These estimates cannot be proved or disproved, but they are accepted as indisputably true by most observers.
     The manual does not mention the words “mental illness,” preferring “mental disorder,” but in public language the former term is used prolifically. It is these terms that largely account for the stigma, and no change that perpetuates the notion of diseased thinking will likely remove the shame, undeserved or not, from those so labeled.
     No one who suffers a brain disease should be stigmatized, but many of the conditions labeled as “mental illnesses” involve behavior chosen through free will for which people should be held responsible. Substance-related and addictive disorders, for example — including habitual use of alcohol, marijuana and hallucinogens — and self-destructive behaviors, such as gambling, are arguably a product of freely-willed decisions. Psychiatrist Sally Satel wrote less than a decade ago, in a piece titled “In Praise of Stigma” in the work “Addiction Treatment: Science and Policy for the Twenty-first Century” (The Johns Hopkins University Press, 2007) that the issue is “whether addicts’ behavior can be influenced by its consequences (i.e., is voluntary). The answer is that it can.” She believes that addictive behavior should be stigmatized, but not the seeking of help or the treatment process.
     The answer as to whether mental illness can be destigmatized is probably “no,” and part of that is due to the medicalization of behavior through the terminology of “mental illness.”
     The answer as to whether mental illness should be stigmatized is probably “yes, in some cases; no in others.” Wherein mental problems are caused neurologically, brain disease should be viewed as all other diseases, but wherein problems are caused by individual choice, as in drug usage, people should be stigmatized to discourage their behavior.

Richard E. Vatz is a professor at Towson University and an editor of Current Psychology and USA Today Magazine. He is author of The Only Authentic Book of Persuasion (Kendall Hunt, 2012, 2013).

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