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Stigma - the mark of shame

Marion Scher

Educate your friends and family about your problem –ignorance may be bliss, but it's often hurtful …

In ancient times the word stigma was defined as 'A mark burned into the skin of a criminal or slave, a brand.' This inhumane treatment was metered out to criminals and anyone felt to be a threat to society. Have we really come so far today? Just mention depression or worse Bipolar to most employers, family or friends and the reaction's generally a negative one. Here are some comments received from callers to the South African Depression and Anxiety Group's counsellors.

Susan* (45) Domestic Worker – suffers from depression."I've gone from job to job in the past few years. None of the people I've worked for understand my condition and their expectations of me have simply been too high. Mostly I'm fine but there are days when I really have little energy and am feeling down – this is where the trouble starts. And with only two days off a week, getting treatment is almost impossible."

Carol* (43) Housewife – suffers from Panic and Social Phobia. "My husband and family treat me as if I'm diseased. They call me 'crazy and unstable' and leave me out of family activities. My husband feels I just don't want to change and refuses to pay for my treatment. The other day I overheard a neighbour comment 'there goes the freak.' I'm feeling so isolated."

Joe* (29) Paramedic – suffers from severe depression."Nobody understands my illness. The people I work with think 'I'm faking' when I take time off. My wife tells me to 'get a grip.' My friends have tried in the past but they're tired of hearing my problems."

These are just a small sample of the many calls received by SADAG on a weekly basis – crying out for help a understanding. So how is it at a time when so many medical advances into psychiatric illnesses have been made that there is still such ignorance out there? Mention that you have diabetes or cancer and you'll get sympathy –mention that you have a mental illness and you'll more than likely be given a wide berth or a look that says why aren't you locked up?

In the black community where tradition and superstition plays a large role, a person suffering from mental health has added burdens, either being identified as the victim of a curse, or being outcast as having been possessed.

What people don't understand that just as any other part of the body can become diseased, so can the brain.Perhaps it's the fact that the symptoms are harder for others to deal with – extreme sadness and irritability or even hallucinations and total withdrawal.

In a recent article in Treatment Today, American psychiatrist Dr. Paul Fink, a past president of the American Psychiatric Association and champion of antistigmatisation, says "People are afraid of the mentally ill. This has grown out of the feeling that they were witches in the 16th Century. Stigma is born out of ignorance and in an endless cycle, stigma perpetuates the ignorance. Unfortunately it is our nature to fear that which we don't understand. Sometimes mentally ill people, when they are sick and incomprehensible – that scares people."

Dr. Fink believes a major reason it persists, in spite of significant advances in scientific research and medical understanding, can be found in media portrayals of mental illness. "There has been a tremendous amount of media hype that the mentally ill are violent. It turns out that 3 percent of the mentally ill are really violent, and yet 77 per cent of mentally ill people depicted on US television are depicted as violent." This grossly disproportionate representation is inextricably linked to the prevalence of violence in movies and television programs. "It is often used as a reason why a person is violent– because they are crazy."

The media are also partly to blame for people's attitudes, using mental health as a source of humour. Headlines like 'Madman onthe loose' or 'Crazed housewife shoots husband' don't help, especially when a background of mental illness features in the story of people who commit violent crimes.

So what's the answer for mental health patients? How can you help the situation? According to Zane Wilson, founder of SADAG, "Youhave to explain to people that you're still the same person they've always knows, you're still there for them, but that you're experiencing problems with everyday living. Explain to them just as cancer patients need chemotherapy your brain needs realigning. Whether it's a child, friend or relative be there –give them support."

The World Psychiatric Association has recently implemented "Open the Doors" as an international effort to erase stigma. Each of these programmes has used education, protest, and contact to change public opinion so that people with mental illness will no longer experience the prejudice and discrimination that rob them of many life opportunities. Stigma is a barrier to people getting help when they need it.

At the same time in the USA a campaign has slowly been unfolding with people 'coming out' about their experiences with mental illness. These include celebrities such as Patty Duke, Rod Steiger, Margot Kidder and most recently Brooke Shields. In our country well known actress Lillian Dube, herself a sufferer of depression uses every opportunity she can to talk about her illness and how she copes. But research in the States has shown that it's when ordinary people, your co-workers, neighbours, friends and family talk about their experiences that the antistigma effect is the greatest. It's then that people realise that they are in fact just like me …

*Names have been changed to protect identities.

Copyright 2006.Used with permission from the South African Psychiatry Review.

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