The stigma of Mental Health Disorders

Depression is a broad and heterogeneous diagnosis, which is characterised by a depressed mood and/or a loss of pleasure in regular activities. The severity of the diagnosis is determined by both the number and severity of symptoms and also the degree of the individual’s functional impairment (NICE, 2009).

There are 4 different severities of depression that an individual could suffer with, they are as follows; sub-threshold depressive symptoms, which is when an individual suffers from fewer than 5 symptoms, mild depression, is if an individual has symptoms of the 5 required to make a diagnosis, and these symptoms result in a minor functional impairment. Moderate depression is the next in the severity chain, where a person’s symptoms or functional impairment are between ‘mild’ and ‘severe’, which leads on to the final severity of depression and that is severe depression. With severe depression, a person will be suffering with many symptoms, and these symptoms interfere with functioning. This can occur with or without psychotic symptoms (NICE, 2009).

There are different levels of the nature of interventions that are used, depending on the severity of depression, which is organised using the stepped-care model. It highlights the focus of the intervention which then leads to the nature of the intervention. There are 4 steps; each step is a different level of severity of depression and what interventions can be used to help individuals suffering from these levels of depression.

There are many different types of interventions such as, low-intensity psychological and psychosocial interventions, medication, high-intensity psychological interventions, combined treatments, electroconvulsive therapy, crisis service and a few others. All these interventions are described on which one goes with what severity of depression in an easy to understand model, ‘The stepped-care model’ (NICE, 2009).

When people are diagnosed with a mental illness, it can come with an unfortunate burden of a negative label, this is because of something called stigma. It is because of this stigma that people suffering from depression can sometimes suffer from psychological implications such as low self-esteem which can cause other implications in the sufferer’s life, whether that is in their relationships and/or job opportunities (Lai et al, 2000).

There are different definitions of what stigma actually is. Two examples are; one, stigma can be considered as an amalgamation of three coinciding problems, which is a lack of knowledge , therefore ignorance, negative attitudes, which is being prejudice and finally excluding or avoiding behaviours, which is discrimination (Thornicroft, 2006; Corrigan, 2005; Sartorius &Schulze, 2005, as cited in Rose et al, 2007).

The second being, that stigma is a social construction that defines people with a distinguishing characteristic or mark and therefore devalues them as a consequence (Jones et al, 1984; Crocker et al, 1998; Biernat & Dovidio, 2000; Dovidio et al, 2000, as cited in Dino et al, 2004).

Stigma, can be detrimental to people with mental illness’ such as depression, this is because people suffering from depression know the stigma that comes with being labelled with the diagnosis, which could lead to help-seeking avoidance, somatisation and misdiagnosis, and discontinuing treatment (Barney et al, 2009). But what is this stigma that elicits psychological implications like self-esteem issues, stress levels or worrying and in some cases anxiety to people suffering from depression? Many people believe that individuals with depression are hard to speak to, unpredictable in their behaviour and/or moods, and threatening to others, with some considering that depression requires no medical treatment and any given is unnecessary. Also people who seek medical treatment from a mental health professional are more unstable than those who do not, and viewed as unsociable and awkward (Barney et al, 2009).

According to a community sample found by Griffiths et al. (2006, as cited in Barnet et al, 2009), 53% of people believed that having depression is a sign of weakness, and 38% also thought that people with depression are dangerous. In 1998, the Royal College of Psychiatrists started a five year campaign to reduce the stigma towards mental illness, called ‘Changing Minds: Every family in the Land’ (James, 1998; Crisp, 1999, as cited in Crisp et al, 2000). However, two years during the campaign, Crisp et al, 2000 found that there were still negative opinions about mental disorder around. In a representative sample of 1737 adults of British adults found that responses were similar between men and women. The most negative opinion was, that people with mental illnesses were dangerous, where one quarter of the sample believing that people with severe depression are dangerous and one fifth saying that they could pull themselves together (Crisp et al, 2000). Crisp et al, (2005) carried another two surveys out with a 3000 nationally representative sample of Britain, with a completion sample of 1725 of 16 and overs. It was found that the most judgemental age group in the sample was the 16-19 year olds, whereon in three held overall negative beliefs about people with depression, whereas the statistic in other age groups was one in five.

But why is there stigmatism? How do people develop these beliefs? One reason would be the media. Media attention often focuses on the most negative attributes of mental illness (Philo, 1996, as cited in Crips et al, 2005). Also people observe or read about the evident problems in the minority of people who have chronic and severe mental illnesses. This then generalises people’s conclusions about mental illnesses and then assume that everyone that is labelled with a mental illness will be the same and suffer the same severe problems that they have been exposed to.

Conclusions can be drawn by simple reading about the stigma attached to a diagnostic label of having a mental illness, and how it would make a person with this label feel, but to get a better understanding of how individuals with a mental illness experience this stigma, researchers have carried out various studies to find out exactly what people feel. Dinos et al, (2004) carried out a study on people with numerous mental illnesses and found that stigma in regards to mental illness was a pervasive and serious concern to most, but not all participants. Stigma can take different forms and therefore experienced in different domains such as diagnosis, treatment, disclosure and social situations. Participants suffering from depression, anxiety and personality disorders showed that they were most likely to be affected by the feelings of stigma even in the absence of such overt discrimination. These participants also showed concern in regards with possible patronising attitudes from friends, family (Barney et al, (2009) and even work colleagues. However not all participants reported feelings of overt discrimination and actually stated that there were positive outcomes regarding their illness. The only participants who reported experiencing verbal abuse, a loss of contact with people and even physical violence because of their illness, were participants with schizophrenia, drug addiction and bipolar affective disorder. Although people with depression, anxiety and personality disorders did not express very strong views about the general public and did not appear to of gone through the same discrimination, they did not show any more ease in regards of their diagnosis and had to face many of the same challenges (Dinos et al, 2004). As mentioned, participants with depression and anxiety worry about patronising attitudes from fellow employees and with these disorders sharply increasing (HSC, 2004, as cited in Haslam et al, 2005), medication to treat these mental illnesses have also increased.

Laboratory stu
dies have shown that psychotropic medicines can impair memory, attention and motor coordination (Potter, 1990, as cited in Haslam et al, 2005). However a lack of treatment may also cause problems with people who have anxiety or depression, such as impaired performance due to fatigue and poor concentration. Research is needed to see how having these disorders can affect sufferers in the workplace with the added stigma. Haslam et al, (2005) carried out such research. They found that the physical and psychological symptoms of these disorders were reported to impair work performance and increased the risk of accidents. The side effects of medication were considered to be similar to the symptoms of depression and anxiety. This finding concurs with other evidence that indicates that newer generation antidepressants are by far from free of side effects (Glenmullen, 2000, as cited in Haslam et al, 2005). People in this study were unprepared for the fact that their medication could make them feel worse at the beginning. Respondents felt stigmatised and were reluctant to discuss their illness with people they worked with. The results of this study suggest that anxiety, depression and medication impact on an individual’s working life, causing problems such as impaired work performance, accidents and sickness absence (Haslam et al, 2005).

So what psychological implications could this stigma from the general public, family, friends and work colleagues, cause for people suffering from depression? There is a big impact on a sufferer’s self-esteem and motivation, where some may lose their drive to work, have difficulty with concentration and making decisions. What were previously manageable tasks could now be impossible tasks for depressed people. Unfortunately, they could find these decreases in functioning being blamed on them from other people for being “emotionally weak”, and “lazy” (Lai et al, 2000), which could further lower their mood, making them feel worse, and view themselves as having a self that has failed, needs to be fixed, or even replaced(Karp, 1994).

It is because of these circumstances like these and the stigma of being labelled with depression that people attempt to avoid telling people about their mental illness, whether that is personal relationships like family or professional relationships like a psychiatrist. This avoidance can result in stress, isolation and a sense of shame (Dinos et al, 2004). These increases in stress and feelings of conflict (Farina et al, 1974, as cited in Dinos et al, 2004) can result in further psychological problems such as anxiety (Farina, 1981, as cited in Dinos et al, 2004) and low self-esteem (Link, 1987, as cited in Dinos et al, 2004). Some even avoid or refuse help from fear of further stigmatism.

Therefore more research seems necessary to outline on how to reduce the stigma of mental illness, to help people who suffer from them (Schomerus & Angermeyer, 2008), as it is this stigma of mental illness that causes further psychological implications in people who suffer from depression. A better understanding of mental disorders such as depression is greatly needed; here is an account from someone suffering from someone with a mental illness: “Only the sufferers know how difficult it is, what it is like to be in a black hole with absolutely no emotion … (but) it is common to hear people say: ‘You look fine! What’s your problem? Do something!’ Have those people ever looked into the eyes of the sufferers, dull and lacklustre? Do they see a smile or a tear? No. They save their compassion for the physically afflicted.” (McNair, Highet, Hickie, and Davenport, 2002, p.1). A suggestion by Barney et al, (2009) is that since there appears to be an association between the term ‘mental illness’ and dangerousness, then it may be in the best interest for people suffering from depression, that the term should be avoided in labelling depression.

It is clear that there are negative attitudes that exist in today’s society towards people with mental illnesses (Ostman & Kjellin, 2002), which then attaches stigma onto a diagnostic label, making it more than just a label. This has adverse effects on many people suffering from mental illnesses, like depression, which causes further implications on their psychological health. Therefore in conclusion, the meaning of mental illness needs to be changed, to help improve the well-being of people who are already suffering and need no more pressure and stress added to their coping of their mental illness, and as this stigma is of social construction, it is therefore changeable (Lai et al, 2000).

Today both Asda and Tesco have removed two Halloween costumes from their web pages as they depicted mental health sufferers as dangerous and murderers. And as an apology both Asda and Tesco are donating money to mental health charities with Asda stating that they are donating £25,000.

So what is your opinion on mental health? Do you think there should be more awareness on mental health? Do you agree that Asda and Tesco did something wrong? Or should they be allowed to sell these costumes as it’s just for a joke and shouldn’t be taken seriously?

Let us know your opinion.