Stigma: ‘I Need to Tell You Something I’ve Never Spoken to You About’

In her passionate speech at the Convocation of Distinguished Fellows at APA’s 2015 annual meeting in May, Nora Volkow, M.D., director of the National Institute on Drug Abuse, disclosed her personal experience with stigma. She emotionally related how she was summoned to her mother’s deathbed. Her mother, weak from her fight with cancer, said, ‘“I need to tell you something I’ve never spoken to you about.’ ” It was then, decades after the fact, when Dr. Volkow first learned that her grandfather had been addicted to alcohol and taken his own life. What she was told as a child and believed ever since—that he had died suddenly from cardiovascular disease—wasn’t true.

As I heard Dr. Volkow speak, I was reminded of the death of an acquaintance who was at the top of her career when she died suddenly after complications from surgery, according to her obituary. I later learned that she had died from suicide, possibly in response to her struggle with chronic pain and resulting depression.

Stigma serves as a barrier to seeking treatment because of fears of discrimination. A few years ago, a patient requested that I not keep any records and wanted to pay me in cash. He was concerned that if his psychiatric records were ever discovered, his career could be negatively impacted. Were this man’s concerns legitimate? I am reminded of Sen. Tom Eagleton, who was forced to withdraw as a candidate for vice president after it was discovered that he had suffered from depression and undergone ECT.

According to the Merriam-Webster Dictionary, the definition of stigma is a set of negative and unfair beliefs that a society or group of people has about something; it is a mark of shame or discredit.

How can we begin to address stigma? Here are several ideas: We need courageous spokespersons who are willing to come forward and talk about mental health issues that they or their families are experiencing. Former Rep. Patrick Kennedy is one such champion. He has openly discussed his struggles with mental illness and substance abuse and how treatment has helped him lead a productive and rewarding life.

We can learn from the LGBT community and their struggles with stigma and negative stereotypes. They have taught us that “coming out” by public figures and celebrities can decrease stigma.

Another way of combating stigma is for all of us, as psychiatrists, to take responsibility for closely monitoring the language that is used by the media and others in our society. Words such as “lunatic,” “crazy person,” or “maniac” convey images of people who are out of control and dangerous rather than people who are suffering from a mental illness and deserve our compassion and support in getting effective treatments. Changes in language and terminology have been an important factor in modifying perceptions about women, LGBT groups, and ethnic and racial groups. Part of our role as psychiatrists should be to write articles for local news sources, letters to the editor, and letters of complaint when the media use stigmatizing language. We can make presentations to local churches, synagogues, schools, and community groups. In addition, we need to hold our entertainment industry accountable for portrayals that reinforce negative stereotypes about people who suffer from mental illness.

As I said at the annual meeting as I was outlining the year ahead as your president, there is no health care without mental health care. Almost everyone will suffer from a mental health problem at some point in his or her lifetime. A host of issues—marital or employment stress, problems related to a loved one, or a medical issue—can result in some psychiatric symptoms. But for people to be willing to access the mental health care they need, we have to continue the fight against stigma.

If we are successful in addressing stigma, and we must be, then not only will we change the conversation, we will also change people’s lives and change the culture. We will finally reach the point where all of us can openly talk about someone’s death by suicide and encourage people with mental health problems to seek the help they need without fear of judgment or harmful repercussions. ■