The Tragedy of Mental Illness Stigma
People with mental health difficulties remain among the most stigmatized groups.
In the mid 1950’s, when Stephen Hinshaw was five, his father mysteriously vanished.
“Dad was a professor of philosophy at Ohio State University, Mom became an instructor of English . . . From outside appearances, it was an idyllic Midwestern family,” the now UC Berkely professor of psychology told me during an interview on Radio KPFA’s About Health. “But Dad would disappear—for three months, six months, at one point when I was in third grade, twelve months at a time—as though someone had abducted him.”
In fact, over the next decade of Hinshaw’s childhood, his kind, soft-spoken father would vanish half a dozen more times. “No one ever talked about it before, during, or after,” he recalled. “I didn’t know if he was dead or alive. And then he would be back one day, as though nothing had happened”
Hinshaw’s father suffered from a severe form of Bipolar Disorder, a condition often characterized by alternating episodes of depression and mania. Unlike many people with milder forms of the disorder, however, he experienced psychotic symptoms during his manic phases. Once, when Hinshaw’s father was himself a boy, he developed the delusional belief that only his behavior could stop Hitler and the fascists from taking over the world. He believed that, if he extended his arms, they would become wings, and his flight would inspire the leaders of the free world to take action. When he jumped off the trellis of their family home, the flight ended in his first six-month hospitalization.
About half of people in the United States are estimated to have a diagnosable mental illness at some point in their lives. Whether we’re talking about major depressive disorder, bipolar disorder, OCD, schizophrenia, or a host of other mental health conditions, this accounts for more than 160 million people in this nation alone. These are people like you and me. They’re people we encounter everyday—those who teach our children, fix our plumbing, bus our tables, pilot the aircraft we ride on, and write the books we read. In fact, we may actually be talking about ourselves.
Despite the fact that excellent medications and therapies exist, only about half of people with mental health difficulties will ever get treatment, even people with serious mental illnesses like Hinshaw’s father. There are many reasons why people don’t get care, including cost and lack of access to qualified providers. But a major reason people don’t seek treatment, even when access and funds are available, is stigma.
People with mental health difficulties remain among the most stigmatized groups in the world today. It’s the reason Hinshaw’s family never talked about his father’s absences. People are often worried that if their friends, family, or employers found out, this could mean the end of relationships and the loss of jobs. And these concerns are warranted. In half of U.S. states, admitting to a history of mental illness can lead to loss of a driver’s license, inability to serve on a jury or run for office, or even potentially loss of custody of a child.
During Stephen Hinshaw’s childhood, even the healthcare profession stigmatized mental illness. In his recent memoir, Another Kind of Madness, he writes that his father once asked a psychiatrist how to broach his mental health issues with his children. “Never discuss mental illness with your children,” he was told. “Any such knowledge will permanently destroy them.” As a result, when Hinshaw finally worked up the courage to ask his mother where his dad had gone, she tersely replied, “Your father is resting in California. It’s best if you ask no more questions.” This deafening silence didn’t help. In the absence of real knowledge, Hinshaw blamed himself. Perhaps his dad’s disappearances were his fault, he thought. Perhaps his dad needed a rest from him.
It’s tempting to think that the stigma of mental illness has improved a lot since the 1950’s. But consider the heartbreaking case of Kate Spade, the iconic fashion designer who committed suicide just a few months ago. According to some reports, she hesitated to seek care for her mental health issues for fear that it might endanger the brand. Recent research shows that most people still hold inaccurate and stigmatizing stereotypes toward people with mental health difficulties. A majority of the public continues to express an unwillingness to work closely with people with mental illness, let alone have them move next door or marry into the family. Approximately 60 percent of people continue to believe that individuals with mental illness are violent. This perception is spurred on by the media’s focus on mental illness in their reports of horrible tragedies like school shootings, ignoring the fact that most violence is committed by people without mental illness. In fact, people with serious mental illness are more likely to fall prey to violencethan to commit it.
It’s not just the public who stigmatizes mental illness. People with mental health issues can internalize these toxic attitudes, developing self-stigma. When people with mental illness are afraid of being judged by others or hold such attitudes themselves, this can discourage them from seeking care. Even when people with many mental health conditions do seek treatment, however, they wait on average a decade or more after symptoms first appear. The cruel irony is that most mental health conditions are treatable with appropriate care.
As Steven Hinshaw writes in his memoir, “Stigma breeds shame. Stigma breeds silence.” His solution: Talk about it. During the 1950’s, the general “wisdom” was to avoid talking about mental health issues for fear of making things worse. The truth is just the opposite: Particularly in families, talking helps. Psychiatrist William Beardslee has developed a brief intervention, known as Family Talk, designed to help families speak with their children about one or both parents’ mental illnesses. Over a small number of sessions, parents are encouraged to talk about their illness with the children in order to foster mutual understanding. Contrary to many parents’ fears, research shows that not only does this conversation provide a sense of relief to the children, but actually decreases the children’s longer-term psychological difficulties.
When Stephen Hinshaw returned home from his freshman year in college, his father finally broke the silence. “Son,” he said. “Perhaps it’s time you heard about some events from my history.”
“Now I had at least some explanation,” Hinshaw told me. “So it was a relief. It wasn’t my fault.” Shortly afterwards, Hinshaw changed his major to psychology.
Today, as a professor of psychology at UC Berkeley, Hinshaw has dedicated his career to combating the stigma of mental illness. “All the facts in the world aren’t going to replace when people with mental health issues and their families talk about it,” he reflected. “Now we start to get the dialog going, and society can no longer sweep the issue under the rug.”
He hopes his story helps accomplish just that.