Dear Elizabeth Day,
I started reading your Guardian piece on Robin Williams and the ‘stigma’ of mental illness with great interest.
It started well. You acknowledged the media’s tendency to invade the personal lives of the deceased, often speculating and searching for some rationale or explanation. You also point out that “depression is not a logical disease”. We’re in complete agreement at this stage.
However you then move on to suggest that the “chatter” and “buzz” through social networks was evidence enough that stigma is no longer a problem for mental illness. This point was further made by ensuring mentions of the word stigma were contained in quotation marks, suggesting the concept of stigma has no application to mental health.
I could not disagree with you more.
As you asked “what does ‘stigma’ mean, anyway?” I thought this might be a good place to start.
Erving Goffman (20th century sociologist) first wrote about stigma and described it as:
The phenomenon whereby an individual with an attribute which is deeply discredited by his/her society is rejected as a result of the attribute. Stigma is a process by which the reaction of others spoils normal identity
So in summary, if something is a) attributed to an individual and b) perceived negatively by others, stigma is generated. Goffman further suggested that stigma can be felt or enacted. Felt stigma occurs when individuals anticipate or fear discrimination due to their attribute; for example someone with depression choosing not to disclose their illness to an employer. Enacted stigma refers to how others react to attributes, and can incorporate prejudice, discrimination and disadvantage; for example when @Badlydrawnroy was fired hours after telling his boss that he suffered from depression.
Don’t get me wrong, I like the sentiment here. Mental illness should not be perceived as scary, strange nor a weakness. However you are suggesting that this view is shared by everyone. That just isn’t the case.
The brilliant Time To Change team did a survey of around 4,000 service user and carer experiences of mental health stigma and discrimination in 2008 (Stigma Shout). They reported that 9 out of 10 service users (87%) had experienced stigma. Not only this, but two-thirds stopped doing things because of either the real or anticipated stigma and discrimination. The graph below, taken from Stigma Shout, shows what activities service users have stopped doing because of stigma and discrimination.
Where more than 30% experienced discrimination from friends and more than 40% experienced discrimination at work, its clear that both felt and enacted stigma can not be ignored.
What about public attitudes? Research by Evans-Lacko et al found there was an overall improvement between 2009 and 2012 regarding attitudes towards people with mental illness. Although this sounds promising, their research found no improvement in either public knowledge about people with mental illness, or reported behaviours towards those with mental illness. Despite the reported improvements in attitudes showing a shift in the right direction, unfortunately there are still many people with very negative and discriminatory views. For example:
These are not trivial statistics. They suggest public stigma is rooted in fear (e.g. the 1 in 10 people would not want to live next door to those who have mental illness) and misunderstanding (e.g. the 1 in 10 people who think people with mental illness shouldn’t be given any responsibility). Issues which hopefully Time To Change (and other campaigns) will continue to challenge.
The main point of your article (from what I can gather) is to suggest that the stigma surrounding mental health has reduced, therefore to continue referring to mental health as a stigmatised condition is to create a self-fulfilling prophecy. And although I can appreciate your point, I just don’t think we’re there yet.
Stigma is still alive and well; affecting how people with experiences of mental illness live their lives, and how others perceive them. Your advice to stop referring to mental illness as a stigmatised condition ignores and belittles all the many real experiences taking place.
I’m really glad for you, Elizabeth. You’ve declared that you’ve experienced mental distress, and yet you (I assume) have had little or no experience of associated stigma or discrimination. However, just because you haven’t experienced it, doesn’t mean it doesn’t exist. That logic is as ignorant as suggesting that Barack Obama being President is evidence that racism no longer is an important issue.