I am currently reading an absolutely amazing book and even though I haven’t yet finished reading it, I want to share a bit about it. The book is titled Written Off: Mental Health Stigma and the Loss of Human Potential, and is written by Philip T. Yanos, Ph.D. Written Off explores stigma in relation to mental illness. I am currently about to start chapter 5, so this week I will discuss the first 4 chapters. I will go into rest of the book in part 2.
In the first chapter, Dr. Yanos talks about why it is that stigma matters by looking at examples from newspapers; he take a look at Margot Kidder, an actress from the 70’s and 80’s who, in April 1996, experienced a psychotic episode during which she wandered LA streets afraid that her ex-husband was going to kill her. Her psychotic episode quickly became national news and destroyed her career. Margot Kidder has Bipolar disorder and has expressed that, “If I were a cancer patient, I would today be considered cured – I haven’t had an episode in 14 years.”
Towards the end of the first chapter, Dr. Yanos writes:
“…the association between stigma and help-seeking is certainly important, it is not, I will demonstrate, the main reason why stigma is a major issue. Rather, the main reason why stigma is important is because it diminishes people’s participation in community life, and inhibits them from achieving their full potential as people.”
In the second chapter, titled “Does Mental Health Stigma Really Exist?” The reader gets an in depth look at the history of mental health treatment and cultural opinions. This chapter begins with a stark quote that left me angry and confused, an unidentified psychiatrist at a professional meeting in 2015 said: “There is no problem with stigma – these are inferior persons.”
(Let me take a break from discussing this book for a moment to address this unidentified psychiatrist. Sir or madam, I am anything but inferior, you, however, are an inferior psychiatrist and likely an inferior person. We could debate for hours what makes a person inferior or not, but I would say that someone who says something like that about the people they are supposed to be caring for has inferior compassion and an inferior education on the topic of their profession, at the very least.)
Okay, back to the book. There was a lot of historical information in chapter two. For example, before the Holocaust, Hitler “tested” poisonous gas and mass cremation on those he deemed as “life unworthy of life”, which came down to “residents of public and private hospitals, psychiatric institutions, and nursing homes…” those included had dementia, psychiatric, or neurologic disorders and were seen as being incurable. This was known as the “T-4” program and caused the death of 80,000 to 250,000 people, including an estimated two thirds of schizophrenic Germans.
There was so much more in chapter two, but for the sake of time, I’m going to leave chapter two here.
The third chapter explores what stigma looks like. Microaggressions was a large part of this chapter. “Microaggressions are defined as subtle communications that exclude, negate, or nullify…psychological thoughts, feelings, or experiential reality.” Dr. Yanos gives several study results in relation to microaggression for example:
“We found that community members most commonly endorse a willingness to use ‘patronizing’ microaggressions. Specifically, in one of our studies, 62% of participants endorsed that, if someone they were ‘close to’ had a mental illness they would ‘talk to them more slowly,’…”
Discrimination was also a large and impactful part of chapter three. In this section I learned that obtaining housing can be difficult if one mentions their mental illness. In a study Dr. Yanos refers to, participants call landlords about adds they see; some participants mentioned having a mental illness, and others did not. Other than shared mental health status, their scripts were the same. Landlords gave a negative response about the unit’s availability 60-70% of the time when mental illness was mentioned, and only 17% of the time when it was not.
In chapter four, which is titled “Who Stigmatizes?” Yanos takes a look at what factors contribute to likelihood of an individual or group stigmatizing those with mental illness. This chapter looks at things such as education level (more education is associated with less stigma), personal contact (those with friends and family with mental illness are less likely to stigmatize), cultural groups (Asian-Americans and Eastern and Southern Europeans are more likely to stigmatize), and lastly, political ideology (those with socially conservative and authoritarian views are more likely to stigmatize).
Chapter four goes into depth about each of the above mentioned groups, so for more information read Written Off.
I am going to take some time to finish this book and then I will write about the rest of the chapters. I highly recommend this book to anyone who is interested in stigma and mental illness.