Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 1
Reducing Stigma
There is likely no simple or single panacea to
eliminate the stigma associated with mental illness. Stigma was expected to
abate with increased knowledge of mental illness, but just the opposite
occurred: stigma in some ways intensified over the past 40 years even though
understanding improved. Knowledge of mental illness appears by itself
insufficient to dispel stigma (Phelan et al., 1997). Broader knowledge may be
warranted, especially to redress public fears (Penn & Martin, 1998). Research is
beginning to demonstrate that negative perceptions about severe mental illness
can be lowered by furnishing empirically based information on the association
between violence and severe mental illness (Penn & Martin, 1998). Overall
approaches to stigma reduction involve programs of advocacy, public education,
and contact with persons with mental illness through schools and other societal
institutions (Corrigan & Penn, 1999).
Another way to eliminate stigma is to find causes and effective treatments for
mental disorders (Jones, 1998). History suggests this to be true. Neurosyphilis
and pellagra are illustrative of mental disorders for which stigma has receded.
In the early part of this century, about 20 percent of those admitted to mental
hospitals had“general paresis,” later identified as tertiary syphilis (Grob,
1994). This advanced stage of syphilis occurs when the bacterium invades the
brain and causes neurological deterioration (including psychosis), paralysis,
and death. The discoveries of an infectious etiology and of penicillin led to
the virtual elimination of neurosyphilis. Similarly, when pellagra was traced to
a nutrient deficiency, and nutritional supplementation with niacin was
introduced, the condition was eventually eradicated in the developed world.
Pellagra’s victims with delirium had been placed in mental hospitals early in
the 20th century before its etiology was clarified. Although no one has
documented directly the reduction of public stigma toward these conditions over
the early and later parts of this century, disease eradication through
widespread acceptance of treatment (and its cost) offers indirect proof.
Ironically, these examples also illustrate a more unsettling consequence: that
the mental health field was adversely affected when causes and treatments were
identified. As advances were achieved, each condition was transferred from the
mental health field to another medical specialty (Grob, 1991). For instance,
dominion over syphilis was moved to dermatology, internal medicine, and
neurology upon advances in etiology and treatment. Dominion over hormone-related
mental disorders was moved to endocrinology under similar circumstances. The
consequence of this transformation, according to historian Gerald Grob, is that
the mental health field became over the years the repository for mental
disorders whose etiology was unknown. This left the mental health
field“vulnerable to accusations by their medical brethren that psychiatry was
not part of medicine, and that psychiatric practice rested on superstition and
myth” (Grob, 1991).
These historical examples signify that stigma dissipates for individual
disorders once advances render them less disabling, infectious, or disfiguring.
Yet the stigma surrounding other mental disorders not only persists but may be
inadvertently reinforced by leaving to mental health care only those behavioral
conditions without known causes or cures. To point this out is not intended to
imply that advances in mental health should be halted; rather, advances should
be nurtured and heralded. The purpose here is to explain some of the historical
origins of the chasm between the health and mental health fields.
Stigma must be overcome. Research that will continue to yield increasingly
effective treatments for mental disorders promises to be an effective antidote.
When people understand that mental disorders are not the result of moral
failings or limited will power, but are legitimate illnesses that are responsive
to specific treatments, much of the negative stereotyping may dissipate. Still,
fresh approaches to disseminate research information and, thus, to counter
stigma need to be developed and evaluated. Social science research has much to
contribute to the development and evaluation of anti-stigma programs (Corrigan &
Penn, 1999). As stigma abates, a transformation in public attitudes should
occur. People should become eager to seek care. They should become more willing
to absorb its cost. And, most importantly, they should become far more receptive
to the messages that are the subtext of this report: mental health and mental
illness are part of the mainstream of health, and they are a concern for all
people.
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1 Murray & Lopez, 1996. 2 The Surgeon General issued a Call to Action on Suicide in 1999, reflecting the public health magnitude of this consequence of mental illness. The Call to Action is summarized in Figure 4-1. |
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