Combating Stigma by Redefining It

To the Editor: I agree with Dr. H. Richard Lamb's (1) statement in the June 1999 issue that no problem has been of greater concern to mental health professionals, families, and people with mental illness than the stigma of mental illness. However, I differ with him on his solution of increased involuntary intervention in the lives of already devalued people.

First, let's do away with what is euphemistically referred to as stigma and call it what it really is: discrimination. Bigotry, injustice, and intolerance are what we need to fight, not the individuals who do not find traditional mental health treatments useful. It does not make sense to address any form of discrimination with more discrimination. Anyone who carefully reads the Bellevue study on involuntary outpatient commitment (2) can see that we who use the public mental health system are happy to participate in outpatient programs that make sense and are meaningful to our personal goals.

"Involuntary treatment" is an oxymoron. Mandated programs not only are an infringement on our rights but also they simply do not work. Those of us considered most severely mentally ill with histories of substance abuse and violence will steer clear of any system that sees the solution to our difficulties as belittling what little dignity we have managed to retain. The result will be less therapeutic intervention. If Dr. Lamb were talking about forcible treatment of homosexuals, there would be a public outcry.

It is time that the psychiatric community became acquainted with the name for the kind of discrimination that it is so quick to espouse. It is called ableism—the systematic oppression of a group of people because of what they can or cannot do with their bodies or minds (3). Using a term like stigma instead of discrimination only serves to justify it.