History of Mental Health Series: Stigmatization of Mental Health

Foreword

History of Mental Health Series is a set of articles that reviews the history of mental health from a sociological perspective: from the ancient to the modern understanding of the concept. Nowadays, mental health is one of the most widely discussed topics; however, it had a hard, alluring history of development through the centuries. The following six articles explore the history of mental health and some of the most fascinating and sometimes unbelievable facts about the topic, aiming to raise awareness about mental health and its importance of one’s wellbeing.

1. History of Mental Health Series: Mental Illnesses and Demons

2. History of Mental Health Series: Is there a Healthy Mind in a Healthy Body?

3. History of Mental Health Series: The First Asylums

4. History of Mental Health Series: Chlorpromazine and the Drug Revolution

5. History of Mental Health Series: Deinstitutionalization and Comunity Care

6. History of Mental Health Series: Stigmatization of Mental Health

7. History of Mental Health Series: Mental Health in an Unequal World

Stigmatization of Mental Health

"There is no country, society, or culture where people with mental

illness have the same societal value as people without a mental illness."

(Erwin Goffman, 1963)

Stigmatization has a long history, and it can be traced back to ancient Greece, where “stigma” was a brand to mark deviants such as criminals or slaves (Rössler, 2016). Stigma is now defined as a mark of shame or discredit that marginalizes a person with different characteristics from the rest of society. Despite advances in medicine and knowledge emanating into wider society, mental illnesses continue to be the most stigmatized and judged issues among illnesses, as they are still perceived as a sign of shame and weakness. Therefore, many mental patients suffer from prejudices and social exclusion, which deteriorates their illness - propelling both mental and physical conditions (Rössler, 2016). Because of this people tend to hide their psychiatric problems - the fear of judgment and stigmatization leads to repressed secrecy, which is one of the biggest obstacles in mental health treatments; it prevents the discovery of the illness in the initial stages and neglects the proper help an individual may need (Byrne, 2000).

Self-Stigma

Self-Stigma is the name given to the process when an individual internalizes the prejudices attached to certain mental illnesses. This process begins before the person is diagnosed with a mental illness; the initial stage involves getting familiarized with the prejudices; in the later stage, after finding out about their diagnosis, the person starts applying the ideas related to this illness to the self. For example, the “mentally ill have a weak character, thus I have a weak character too” (Rössler, 2016). Self-stigmatization is a dangerous phenomenon that influences one’s future. Sometimes, mental patients are passive in different fields of life. They at times think to themselves: “I do not need to try since I don't have any chances anyway” (Rössler, 2016).

Figure 1: The effect of self-stigma

Courtesy Stigma

Courtesy Stigma, or the notion of transferring stigma from an already stigmatized person to his/her family members, friends, and close people, was contemplated by Erving Goffman (1963). This type of stigma is mostly directed to the family members of the mentally ill person. For instance, some preconceptions suggest that one may develop a mental problem due to inappropriate conditions at home, or to factors (such as hereditary diseases, poor parenting/incompetent upbringing methods, insufficient attention to the mental illness on the primary stage) that contributed to the development of the issue. Courtesy stigma is even more pronounced if there are biological traits indicating that the person has inherited the parent's mental health problem (Byrne, 2000). Relatives also feel ashamed for their mentally ill family members - on the ground that they have contributed to the issue, or they could not have prevented it. In addition to the emotional burden, some families also struggle with social and economical problems as well. In worse case scenarios, some respondents stated that they wished their mentally ill friend/lover/son/daughter was never born, or that they had never met them (Ostman & Kjellin, 2002).

Overall, mentally ill people and their families have always been struggling with stigma; however, conditions were more alarming centuries ago. "If someone should be mad, he is not to appear openly in the city. The relatives in each case are to guard the persons in their homes,” wrote Plato, in The Laws (Plato, 1988). The stigma attached to mental illness in Christian Europe kept mentally ill individuals hidden in cellars, far from the eyes of people for centuries. To suffer from a mental illness was considered a consequence of the amoral actions of the past, which could harm the reputation of the family; similarly, In China, mental illnesses were considered the result of a “bad fate” that could harm anyone associated with the person, and, because of that, families would keep mentally ill members hidden from others to avoid complications with marriages and other forms of relationships within their society (Phillips 10, Blue 305).

Figure 2: At the Bottom of the Anxiety Swamp, by Jayoon Choi

Danger of Stigma

Secrecy and isolation were not the only struggles for mentally troubled ones. Prejudices and ignorant ideas about mental illnesses have destroyed the lives of thousands of people. As an illustration, at the beginning of the 15th century, the Church gained authority over medicine, trying to explain the cause of the hardships of the era (plague and heresy, for instance), Pope Innocent VIII declared “possessed people” as the cause of all the disasters. The result was a witchcraft delusion that spread instantly and lasted for approximately 300 years, killing and torturing around 50,000 people. The main targets of the witch-hunters were anyone who did not fit into society, therefore, together with women, a huge number of mentally ill people have been killed (Baton Rouge Behavioral Hospital, 2020).

Figure 3: Witch Trials

However, no action against mental patients has been crueler than the greatest criminal act in the history of psychiatry: the Nazi genocide of psychiatric patients. The great majority of people with schizophrenia who lived in Germany between 1939 and 1945 were killed or sterilized based on the belief that this violent act would “clean the society” from mental illnesses. The number of victims goes as high as approximately 220 000 – 269 5000 individuals (Fuller Torrey & Yolken, 2010). The roots of this inhuman action were in the ideas of Ernst Rüdin and Franz Kallmann, who believed that schizophrenia was a simple Mendelian inherited disease, passing down from one generation to another. Apart from the ideas of Rüdin and Kallmann, eugenics and “race hygiene” were actively promoted. In 1933, Rüdin led “the law for the prevention of progeny with hereditary defects.” His initial targets were people with mental illnesses such as schizophrenia, epilepsy, alcoholism, manic-depressive disorders, and other physical hereditary diseases and deformations (Lifton, 1986). The aim of the genocide and massive sterilization was to prevent these diseases in future generations, which, of course, was never achieved.

Figure 4: Mental Health prisoners, victims of the Nazi eugenics and euthanasia program

In conclusion, mentally ill individuals have not been suffering only from their disease, but also with the prejudices and stereotypes about mental illnesses. For centuries mentally ill patients were excluded from society, locked up in cellars, and tortured due to ignorance, or cruelty. Stigmatization reached its peak during the Nazi period when hundreds of thousands of mentally ill patients were killed or sterilized by the Nazi regime.

References:

Baton Rouge Behavioral Hospital. (2020, April 2). The Surprising History of Mental Illness Treatment. Baton Rouge Behavioral Hospital. https://batonrougebehavioral.com/the-surprising-history-of-mental-illness-treatment/

Blue, A. V. (1993) "Greek Psychiatry's Transition from the Hospital to the Community." Medical Anthropology Quarterly 7.3: 301-318.

Byrne, P. (2000). Stigma of mental illness and ways of diminishing it. Advances in Psychiatric Treatment, 6, 65–72.

Fuller Torrey, E., & Yolken, R. H. (2010). Psychiatric Genocide: Nazi Attempts to Eradicate Schizophrenia. Schizophr Bull, 36(1), 26–32. https://doi.org/10.1093/schbul/sbp097

Goffman, E. (1961). Asylums (First Edition). Penguin Books.

Lifton RJ. (1986) The Nazi Doctors: Medical Killing and the Psychology of Genocide. New York, NY: Basic Books. p. 25

Ostman M, Kjellin L (2002) Stigma by association: psychological factors in relatives of people with mental illness. Br J Psychiatry 181: 494–498

Plato, ., & Pangle, T. L. (1980). The laws of Plato. New York: Basic Books.

Rössler, W. (2016). The stigma of mental disorders. EMBO Rep, 17(9), 1250–1253. https://doi.org/10.15252/embr.201643041

Image references:

Figure 1: Healthyplace. (n.d.). Sel-Stigma [Illustration]. https://www.healthyplace.com/other-info/mental-health-newsletter/signs-of-self-stigma-do-you-stigmatize-yourself

Figure 2: Choi, J. (n.d.). At the Bottom of the Anxiety Swamp [Photograph]. https://www.theguardian.com/healthcare-network/gallery/2018/jan/17/eight-artworks-inspired-mental-health-problems-pictures

Figure 3: Witch trials. (n.d.). [Illustration]. https://www.bbc.com/future/article/20181221-can-an-auto-immune-illness-explain-the-salem-witch-trials

Figure 4: Author unknown. (n.d.). [Photograph]. Where do Holocaust euthanasia practices fit into the modern euthanasia discussion? (13th October 2017). http://researchersofemory.blogspot.com/2017/10/where-do-holocaust-euthanasia-practices.html