mental health stigma

Two kinds of mental health stigma

Content note: This post contains both criticism of and respect for the mental health system. If you find one or the other upsetting, this post will likely bother you.

There are two basic kinds of mental health stigma: dismissiveness, and dehumanization. Mental health conversations tend to have trouble acknowledging both at the same time — usually it’s at most one.

Dismissiveness stigma is when people deny the reality of mental illnesses. This plays out in a number of ways. One classic example of dismissiveness is “antidepressants are just a tool of capitalism to stop people from noticing that things are wrong”, or “Stop complaining. There are people with real problems”. There are many other examples.

Dehumanization stigma is when people deny the humanity of people with mental illnesses. A classic example of this is people who believe that the purpose of mental health treatment is to reveal the real person underneath — and that therefore, any objections they might make to the treatment “aren’t the real them talking”. There are many other examples of this as well.

Dismissiveness and dehumanization are both major problems. They’re both real, and they both do a lot of damage, even up to the point of costing people their lives.

People tend to perceive the mental health system very differently based on which kind of stigma looms largest for them. For a lot of people, it’s much easier to see one type than the other.

People who mostly experience dismissiveness often see the psych system this way:

  • No one took my problem seriously
  • I was scared to turn anywhere for help
  • Once I finally took the leap and went to therapy, things got so much better
  • Or, once I finally stared medication, things got so much better
  • (Or even: medication and therapy saved my life).
  • (Or even: I’m so glad people finally pushed me to get treatment; they were right.)
  • I wish people wouldn’t be so afraid. I wish everyone had access to this.
  • We need to fight stigma so that people can get the help they need.
  • (And to reform laws so that everyone has access).

People who mostly experience dehumanization often see it more like this:

  • When I entered the psych system, people treated me like I wasn’t a person
  • They forced me to take medication I didn’t want to take
  • The drugs didn’t work, and had harmful side effects
  • When I complained, they treated it as a symptom and raised the dose
  • They forced me to be in therapy I didn’t want to be in, and that made me worse
  • When I tried to advocate for myself, people treated it as a symptom, and no one took me seriously
  • Things only got better for me when I stopped therapy and/or medication and started a different approach
  • (Or even: stopping therapy and/or medication saved my life)
  • I wish people wouldn’t be so uncritical of a system that hurt me
  • I wish “unmedicated” wasn’t used as a slur implying that people who make the choices I make are all terrible people
  • We need to warn people, and reform the laws and systems that allow people to be treated this way

Some people’s experiences in the mental health system are positive in ways that nothing else is; some people’s experiences are horrifying. (And for a lot of people, things are more mixed). Neither type of experience is universally representative; both are real and common. Both matter, and need to be part of the conversation.

When most of someone’s experiences are with dehumanization, it can be hard to understand that dismissiveness is also a problem. Or why anyone would regard mental health care as positive, or lack of access to it as a problem. They may also find the terminology of “mental illness” repugnant, and have a strong preference for “crazy”. But it really is the case that for some people, mental healthcare including therapy and medication is a really good thing. And that for some people, the biggest problem with the system is difficulty accessing it (either because others discourage it, or because it’s too expensive.)

When most of someone’s experiences are with dismissiveness, it can be hard to understand that the dehumanization experiences are also real. (Particularly for people who were really afraid of mental health care and then had a transformative good experience with it.) It can be hard to understand why someone would prefer an apparently pejorative term like “crazy” over an apparently-netural term like “mental illness”. It can seem like people must be exaggerating, or that these things only happened in the past, or something like that. But dehumanization is still a problem now, and fighting treatment stigma will not address that problem.

Both dehumanization and dismissiveness are important barriers to people being treated as they ought to be. Because of both types of stigma, people lack access to help they vitally need. For some people, that help is treatment. For others, it’s access to resources like housing, respite, and assistance with food. For a lot of people, it’s both. People’s very real mental health struggles should not be dismissed; neither should the humanity and human rights of people with mental illnesses be denied.

tl;dr There are two types of mental health stigma: dismissiveness, and dehumanization. Dismissiveness is when people deny the reality of your condition; dehumanization is when people think that your condition makes you less than human. Dismissiveness is often made better by the mental health system; dehumanization is often made worse. People whose experience is primarily in one category often don’t understand that the other category exists. Both matter, and both need to be part of the conversation.

"You're just looking for a quick fix"

squidids:

realsocialskills:

confide—nemini:

realsocialskills:

bluebirdofgrumpiness:

realsocialskills:

If you use medication to make your life easier or better in any way, some people might object, and say “you’re just looking for a quick fix!”.

This is a mean and unhelpful thing to say.

Medication isn’t the right answer for everyone who has cognitive or mental health problems or pain or other reasons people take medication, but it can be game changing for some people. If you try medication and find that it makes your life easier, that’s a good thing, and it’s ok to be happy about it.

It’s ok to want your life to be easier. It’s ok if it turns out that there’s something that works quickly that makes things better. Using an effective strategy to make your life better isn’t being lazy; it’s being efficient.

bluebirdofgrumpiness said:

Setting aside the fact that working out the correct medication and dosage is often anything but quick, it irks me when people condemn the desire for mental illness to be treated as quickly and painlessly as possible as some kind of moral failing. 

If you have pneumonia or a broken leg, do you request the slowest, most character building treatment available? No? I didn’t fucking think so.

realsocialskills said:

Actually, this happens to people with chronic illnesses a lot too, particularly if they are also fat and in pain.

People often pressure them into treating everything with diet and exercise, even if that’s not an effective treatment. And people who want actually effective treatments for physical conditions are often told that they’re just looking for quick fixes.

It doesn’t happen so much when people without disabilities or chronic conditions need treatment for an acute issue, because those people are socially valued and not blamed for their conditions.

confide—nemini said:

I don’t shame anyone for taking medication and I do believe that it is right in many circumstances. But, as someone who suffered from massive health problems from taking medication and as someone who knows about all the corruption between doctors and the pharmaceutical industry, I have some massive reservations. Just watch John Oliver’s “Last Week Tonight” episode on drug reps. One of the medications I was on is featured during the segment.

One medication made me lose 50 lbs and I was NOT overweight to begin with. I was skin and bones until I stopped taking it. Other medications made me sleep at least 12 hours everyday, making classwork and attendance almost impossible. I did not have this problem after I stopped.

I know fuckyeahlimerence suffered from similar problems though our views on the subject aren’t exactly the same. 

Message me if you want to know more.

realsocialskills said:

I am not familiar with that episode, so I can’t comment on that specifically.

I agree with you that there is a massive issue with lack of regard for the physical risks of psychiatric medications, particularly neuroleptics. (Especially when they are prescribed to control aggression or psychosis.)

Doctors often do not inform people of physical risks in any meaningful way, and often are dismissive of people who want help deciding whether or not the risks are worth the benefits. Further, when people who take psychiatric medications express concerns about side effects they’re experiencing, this is often treated as a symptom of mental illness to be addressed through counseling or a higher dose, rather than a physical symptom needing physical attention.

And it’s not at all uncommon for people to be prescribed medication that is flat-out inappropriate for their actual circumstances. (Eg: It’s fairly common for women to be misdiagnosed as depressed and prescribed SSRIs; it’s fairly common for autistic people who are aggressive during puberty to be prescribed neuroleptics to control their behavior.)

All of that is a huge problem. Medication is important for a lot of people, and so is avoiding inappropriate or harmful medication. Generally speaking, access to respectful, consensual and medically responsible mental health care needs to be far, far more widespread than it is. Far too many people only have access to needlessly dangerous care, often against their will. That’s as much of a problem for people who should take medication as it is for people who shouldn’t take medication.

I don’t want to be dismissive of any of that. Stigma is by no means the only important problem facing people who take psychiatric medications. 

squidids said:

The thing is, every single thing that has effects, has side effects. Literally every kind of thing, not just medication but also herbal stuff, and yes, even diet and exercise changes. Even meditation. If it is capable of doing a real thing to your body, then it is highly likely that it will also do other things to your body. I’d also even argue that lifestyle effects - such as cost, loss of time to do other things, or whatever - can also be just as side-effect-y as other physical effects like dry mouth or weight gain/loss.

It’s good to be aware of the side effects and to know one’s alternative options. And yes, when doctors have perverse incentives, then sometimes that can be hard. 

realsocialskills said:

Yes, exactly. Everything that has effects also has side effects. Those side effects matter. Sometimes they’re dealbreaking; sometimes they’re not, but they always matter.

It can be particularly hard to make good decisions when you’re surrounded by people who have some rigid ideology or other about medication. It’s hard when you’re surrounded by people who try to convince you that medication is bad and that no side effects are worth it at all, ever. It’s also bad when you’re surrounded by people who try to convince you that any medication a psychiatrist might want to prescribe is just like insulin for a diabetic and that there can be no valid question about whether it’s a good idea to take it. 

Decisions about psychiatric medication are complicated and personal. (That’s generally true for physical health treatments as well.) It’s important to acknowledge that reality in both directions.