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Jane,
Here are 2 posts and I need a response for each. Pretty broad stuff. It’s juts asking you to add insight about social change. Should be easy for you. Thanks!
Case 1 ANAST
It is unfortunate that a lot of people do not recognize how mental health is. Mental health has been looked at and it is a stigma that affects the people who suffer from the sickness. People with mental health are termed as being “crazy”, this is also seen a lot especially if a person is violent, but this is far from being the truth. Price (2014) tends to be different and states that with the utilization of psychopharmacological therapies, violence, and criminal activity can reduce in society if the patient with psychiatric issues is medicated. Society has developed a mindset of what they believe to be ordinary, any change from that is believed not to be fit. Advocating for our patients includes being able to protect them from harm, offering them information to make informed decisions and fostering collaboration, being supportive when they make choices, and communicating their likings Corrigan and Al-Khouja (2018). Wellness programs and Mental health seminars can be an outreach to teach about mental illness and how to enhance the individual’s quality of life while also improving society.
My hope is to be a social change by developing the literacy of the patients and the community at large as a nurse practitioner. The ability to educate the patients and their family members that mental illness is not a debilitating sickness and that someone can be successful in life even with a mental health diagnosis are important. Being able to educate about adherence to medication, follow up with doctors’ appointments, and even psychotherapy can all be used in managing a mental illness. According to Rosenthal and Burchum (2018), family and patient education could mean the difference between improved healthcare costs and at-home management. For this vulnerable population that undergoes so much discrimination in all settings, there must be strategic measures put in place. A lot of members in these stigmatized groups become fearful of how others will treat them thus they choose not to talk or tell about their diagnosis Dingfelder (2009). We as future NP’s using organizations like the American Psychiatric Nurses Association (APNA) to fight for and get the rights for mental health patients.
Promoting treatment engagement, rightful goal achievement, and the enabling of self -worth are the agendas that can be used to battle mental health stigma (Corrigan and Al-Khouja 2008). They further explained that participants with low self-esteem in the study reported that their rights and self-esteem were of more importance to them. Another way to teach the community about mental health and the stigmatization that is associated with it is the public health campaigns. As future providers, we should always strive to meet the goal of patient rights. It is not rare that we see patients getting discharged due to their decision-making abilities. Setting time aside to educate the patient and family members about the steps that can be taken to let the patient do as much as they can and allow them independence as much as possible. The participation of patient’s in their plan of care helps increase their compliance with medication Rosenthal and Burchum (2018). An additional way to advocate for change is going through the state representatives who can be able to advocate for the change to become law.
Reference
Corrigan, P. W., & Al-Khouja, M. A. (2018). Three agendas for changing the public stigma of mental illness. Psychiatric Rehabilitation Journal, 41(1), 1–7. https://doi-org.ezp.waldenulibrary.org/10.1037/prj0000277
Dingfelder, S. F. (2009, June). Stigma: Alive and well. Monitor on Psychology, 40(6). http://www.apa.org/monitor/2009/06/stigma
Price, L. H. (2014). Violence in America: Is psychopharmacology the answer? Brown University Psychopharmacology Update, 25(8), 5.
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
Case 2 KEEL
Positive social change entails participating in activities targeted toward improving the lives of people in a community. Nurses play a significant role in enhancing social change, especially for psychiatric mental health. They help promote and support an individual’s recovery, empowering them to be in control and more engaged in their lives and society. Mental health problems result from an interplay of factors such as social, psychological, and physical factors. There are several ways a nurse can foster social change for mental health, including building good relationships with patients, directly or indirectly advocating for healthy behavior in mental health patients, making timely diagnoses, and recommending relevant interventions. As a nurse practitioner, I intend to apply the approaches mentioned above to promote social change concerning mental health in my community.
Lack of knowledge on the range of mental illness symptoms and understanding the right course of action can significantly impact the treatment and management. This creates the need for nurse practitioners to assist in the recognition and treatment of psychiatric conditions. Most mental health patients are hardly aware of their disorders unless experts or individuals have identified them on their behalf. Additionally, a critical determinant that causes failure to manage and treat psychiatric disorders is an inadequate response attributed to limited access to mental health care (Lake & Turner, 2017). With sufficient knowledge of the array of symptoms and treatment modalities, I can help promote social change for mental health in my community. Therefore, assisting individuals and families in identifying specific mental illness conditions is the first step toward improving people’s lives.
Additionally, having excellent nurse-patient relationships plays a pivotal role in promoting social change for psychiatric mental health. Extant research proves that clients value therapeutic alliances with care providers in community settings because they are integral to the recovery process (Hartley, Raphael, Lovell, & Berry, 2020). Consequently, creating effective relationships with the individuals under my care maximizes positive outcomes. One of the approaches in this aspect entails encouraging openness with clients about the care plan and involving them in decision-making. Moreover, I will act professionally around them to build their confidence in my capabilities to help them heal. The vitality of establishing a good therapeutic alliance is highly significant in imparting social change on varying communal levels beginning with the family level.
The main impact of mental health illness is on an individual’s mood, thinking, and behavior, indicating the significance of reinforcing healthy behavior in patients. Some of the standard techniques effective in enhancing behavior change include self-monitoring, risk communication, and social support use (Van Achterberg, et al., 2011). Advocating for healthy behavior in mental health patients is vital in enhancing their treatment results. I commit to directly encourage good behavior by complimenting and acknowledging it in patients when I noticed and indirectly by giving assessment reports to them.
Overall, social change for mental health is a multifaceted endeavor that requires a collective approach to achieve a significant impact. As a nurse, my role in facilitating social change is in my direct interaction with patients. I aim to promote mental health change by building excellent relationships with patients, reinforcing good behavior, and assisting individuals and families at the community level to identify and effectively treat mental illnesses. Impacting an entire community begins with one individual.
References
Hartley, S., Raphael, J., Lovell, K., & Berry, K. (2020). Effective nurse-patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance. International Journal of Nursing Studies, 102. https://doi.org/10.1016/j.ijnurstu.2019.103490
Lake, J., & Turner, M. S. (2017). Urgent need for improved mental health care and a more collaborative model of care. The Permanente Journal, 21, 17-24. https://doi.org/10.7812/TPP/17-024
Van Achterberg, T., Huisman-de Waal, G. G., Ketelaar, N. A., Oostendorp, R. A., Jacobs, J. E., & Wollersheim, H. C. (2011). How to promote healthy behaviors in patients? An overview of evidence for behavior change techniques. Health Promotion International, 26(2), 148-162. https://doi.org/10.1093/heapro/daq050
Over the past decades, psychiatry has changed in many respects.
Of particular note was the acceleration of advances in neuro-
science and genetics during the 1990s, designated by the American
Congress as the ‘Decade of the Brain’, that helped increase our
understanding of the biological nature of mental disorders. Also
during this period, a second generation of psychotropic drugs
were introduced, which although not demonstrably more
efficacious have either fewer or different side-effects.1 Of equal
importance, in Germany, as in other European countries, the
provision and organisation of mental healthcare underwent
profound changes. As a result the out-patient sector has expanded
tremendously, accompanied by a substantial reduction in the
number of beds in large psychiatric hospitals, the opening of
psychiatric departments in general hospitals and an increase in
places in day hospitals.2,3 The question arises as to whether these
changes are reflected in similar changes in the attitudes of the
German public towards people with mental illness and mental
healthcare. It was hoped that the recognition of mental disorders
as brain disorders, the increasing integration of psychiatry to the
rest of medicine, advancements in treatment and the reform of
mental healthcare would have a greatly beneficial impact on both
the stigma attached to people with mental illness and the stigma
attached to psychiatry. The expectation was that as a consequence
the public would both reject less those with mental disorders and
accept more the help offered by mental health services.4,5
Data from two population surveys, conducted in the ‘old’
States of Germany (i.e. the old Federal Republic of Germany) in
1990 and 2011, provides us with the opportunity to examine
how public attitudes have developed over the past two decades.
More specifically, we will address the following three questions:
(a) are the German public now more inclined to endorse
biogenetic conceptualisations of mental disorders than in the early
1990s; (b) has the German public’s acceptance of mental health
treatment increased over the past two decades, i.e. is the public
more ready now to recommend help-seeking from mental health
professionals and to use psychiatric treatments than it used to
be in the past; and (c) have public attitudes towards people with
mental illness changed for the better, i.e. does the public react
more positively now to people with mental disorders and express
less desire for social distance than 21 years ago?
Method
Surveys
Our study is based on data from two population surveys among
German citizens aged 18 years and over, living in the ‘old’ German
States. The first survey was conducted in 1990 (n = 3067, response
rate 70.0%), the second in 2011 (n = 2951, response rate 64.0%).
In both surveys the samples were drawn using a random sampling
procedure with three stages: (a) sample points (electoral wards),
(b) households, and (c) individuals within the target households.
Target households within the sample points were determined
according to the random route procedure, that is, a street was
selected randomly as a starting point from which the interviewer
followed a set route through the area.6 Target individuals were
selected using random digits. Informed consent was considered
to have been given when individuals agreed to complete the
interview. Fieldwork was carried out in 1990 by GETAS
(Hamburg) and in 2011 by USUMA (Berlin); both companies
specialised in market and social research. Sociodemographic
characteristics of both samples plus the general population in
1990 and 2011 are reported in online Table DS1. Except for
containing slightly fewer people with a high level of educational
attainment in 2011, both samples can be considered representative
of the German population.
Interview
In both surveys, face-to-face interviews were conducted by trained
interviewers using pen and paper. On both occasions, the fully
structured interview was identical regarding wording and the
146
Attitudes towards psychiatric treatment
and people with mental illness: changes
over two decades
Matthias C. Angermeyer, Herbert Matschinger and Georg Schomerus
Background
Over the past decades, psychiatry, as a science and a
clinical discipline, has witnessed profound changes.
Aims
To examine whether these changes are reflected in changes
in the public’s conceptualisation of mental disorders, the
acceptance of mental health treatment and attitudes towards
people with mental illness.
Method
In 1990 and 2011, population surveys were conducted in
Germany on public attitudes about schizophrenia, depression
and alcohol dependence.
Results
Although the public has become more inclined to endorse a
biological causation of schizophrenia, the opposite trend was
observed with the other two disorders. The public’s
readiness to recommend help-seeking from mental health
professionals and using psychotherapy and psychotropic
medication has increased considerably. Attitudes towards
people with schizophrenia worsened, whereas for depression
and alcohol dependence no or inconsistent changes were
found.
Conclusions
The growing divide between attitudes towards schizophrenia
and other mental disorders should be of particular concern
to future anti-stigma campaigns.
Declaration of interest
None.
The British Journal of Psychiatry (2013)
203, 146–151. doi: 10.1192/bjp.bp.112.122978
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sequence of questions. At the beginning of the interview
respondents were presented with a vignette of a diagnostically
unlabelled psychiatric case history. Then, respondents were asked
a series of questions to assess their beliefs about the causes of the
disorder described in the vignette, their recommendations for
help-seeking and treatment, as well as their attitudes towards
the person experiencing this disorder.
Vignettes
Vignettes depicting an individual with schizophrenia, major
depressive disorder or alcohol dependence were used. The
symptoms described in the vignettes fulfilled the criteria of
DSM-III-R7 for the respective disorder. Before the vignettes were
used in the first survey, each was independently rated by five
experts on psychopathology, masked to actual diagnosis,
providing confirmation of the correct diagnosis for each case
history. The gender of the individual presented in the vignettes
was randomly varied. Respondents were randomly allocated to
receive one of the three vignettes. In 1990, 1053 respondents were
presented with the vignette depicting schizophrenia, 991
respondents with the vignette depicting major depressive disorder
and 1022 with the vignette depicting alcohol dependence. In 2011,
the respective numbers were 999, 985 and 967.
Beliefs about possible causes
Beliefs about possible causes of the problem described in the
vignette were elicited with a list of various causes, each of which
had to be rated on a five-point Likert scale anchored with 1
‘certainly a cause’ and 5 ‘certainly not a cause’. The items ‘brain
disease’ and ‘heredity’ were selected as representative of biogenetic
causes, the items ‘stressful life event’ and ‘work-related stress
(including unemployment)’ as representative of current stress,
and the items ‘grown up in a broken home’ and ‘lack of parental
affection’ as representative of childhood adversities.
Attitudes towards treatment
Regarding attitudes towards treatment a distinction was made
between healthcare providers and treatment methods since in
Germany a particular treatment can be offered by various profes-
sionals, for example psychotherapy provided by psychotherapists
and psychiatrists.
Help-seeking recommendations
Help-seeking recommendations were assessed using a catalogue of
the following six sources of help: psychiatrist, psychotherapist,
general practitioner, health practitioner, priest and self-help
group. The respondents were asked to indicate endorsement or
rejection of each source of help, using a five-point Likert scale
ranging from ‘would strongly recommend’ (1) to ‘would not
recommend at all’ (5) plus a ‘don’t know’ category.
Treatment recommendations
Using the same five-point scale plus a ‘don’t know’ category,
respondents were also asked to provide their treatment
recommendations, offering a list of six different treatment
methods, three representing established forms of psychiatric
treatment (psychotropic medication, psychotherapy, relaxation
techniques) and three ‘alternative’ treatment modalities (natural
remedies, mediation, acupuncture).
Attitudes towards people with mental disorders
Regarding attitudes towards individuals with a mental disorder,
we distinguished between emotional reactions and behavioural
intentions as indicated by the desire for social distance.
Emotional reactions to the person described in the vignette
were assessed by means of nine items, representing the three
empirically derived emotional dimensions8 ‘prosocial feelings’ (‘I
feel the need to help him/her’, ‘I feel pity’, ‘I feel sympathy for
him/her’), ‘fear’ (‘I feel uncomfortable’, ‘He/she makes me feel
insecure’, ‘He/she scares me’) and ‘anger’ (‘I feel annoyed by
him/her’, ‘I react angrily’, ‘I am amused by something like that’).
Respondents were asked to rate the nine items on a five-point
scale assessing their agreement or disagreement with the contents
of each item.
For the assessment of respondents’ desire for social distance
we used the scale developed by Link et al.
9
This scale encompasses
the following social situations: rent a room, work together, have as
neighbour, take care of a young child, have married into family,
introduce to friends, recommend for a job. Using a five-point
Likert scale respondents could indicate to what extent they were
willing or unwilling to engage in the proposed relationships.
Statistical analysis
As the ratings for help-seeking and treatment recommendations
included a ‘don’t know’ category, which also needed to be
included into the analysis, multidimensional logit models were
calculated. Therefore, respondents who endorsed the two points
on either side of the mid-point of the five-point scales (values
1+2 and 4+5) were grouped together into the categories ‘a cause’
and ‘not a cause’ (causal beliefs), ‘recommend’ and ‘advise against’
(help-seeking and treatment recommendations), ‘agree’ and
‘disagree’ (emotional reactions), or ‘accept’ and ‘reject’ (desire
for social distance). The grouping also had the advantage of
counterbalancing tendencies to preferably select or avoid the
extreme response categories. To estimate the difference in attitude
change between the three vignettes, an interaction effect between
vignettes and time point was included. To adjust the year effect
for demographic changes across samples, the regression analyses
controlled for respondents’ gender, age and educational attainment.
To illustrate the magnitude of changes, discrete probability
changes were calculated for the attitude items. A discrete change
coefficient is the difference in the predicted probability of a given
outcome between 1990 and 2011, calculated with controls held at
their means for the combined sample; it serves as an indicator of
the effect size of the change. The delta method was used to
compute 95% confidence intervals. To make adjusted predictions
comparable with unadjusted predictions, probabilities and
discrete changes were multiplied by 100 and can thus be read as
percentages of respondents choosing each answer category. The
calculation of probability changes and the testing for differences in
probabilities between two time points were carried out using the
modules prvalue and prchang
10,11
in Stata, release 12 on Windows.
Results
Tables 1–5 report the predicted percentages for 1990 and 2011 plus
changes between both years for the endorsement of potential causes
(Table 1), help-seeking (Table 2) and treatment recommendations
(Table 3), emotional reactions (Table 4) and desire for social
distance (Table 5). In these tables only results for the response
categories ‘a cause’ (causal beliefs), ‘recommend’ (help-seeking
and treatment recommendations), ‘agree’ (emotional reactions)
or ‘reject’ (desire for social distance) are shown. In online Tables
DS2–6 the complete results of the corresponding multinomial
logit regressions are presented.
Causal attributions
From 1990 to 2011, the probability that a brain disease was
endorsed as a possible cause of schizophrenia increased significantly,
147
Changes in attitudes towards mental illness over two decades
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Angermeyer et al
whereas the probability of negative life events being a cause
decreased slightly. A trend in the opposite direction was observed
for depression, with a decreasing endorsement of biogenetic
causes and a significant increase in the endorsement of work-
related stress as a cause. For alcohol dependence respondents
tended to opt less frequently for brain disease as well as for
negative life events as causes. Across all three disorders, the public
embraced less frequently the role of childhood adversities in 2011
than in 1990, with the role of having grown up in a broken home
showing the most marked change (Table 1 and online Table DS2).
Help-seeking recommendations
Across all three disorders, the probability of the public
recommending seeing a mental health professional increased
considerably, resulting in a majority of respondents in 2011
supporting specialty care for individuals with these three
disorders. In contrast, the probability of respondents endorsing
turning to a general practitioner (GP) increased only a little or
not at all. Using psychotherapists showed the most pronounced
increase in acceptance for alcohol dependence followed by
psychiatrists and GPs. Across all three disorders, the public’s
readiness to recommend joining a self-help group remained
unchanged but respondents’ reluctance to recommend seeking
help from a priest had increased significantly over the study
period (Table 2 and online Table DS3).
Treatment recommendations
Across all three disorders, psychotherapy showed marked increases
in endorsement by the public. A similar trend was observed for
psychotropic medication, and this was more pronounced for
schizophrenia than for the other two disorders. Whereas
relaxation techniques were less frequently endorsed for the
treatment of schizophrenia, there was no change for depression
and a significant increase for alcohol dependence. In the case of
schizophrenia, the public’s acceptance of ‘alternative’ methods
showed no or very little increase, which was significantly lower than
that observed for psychotherapy and psychotropic medication.
The increase of acceptance of natural remedies and meditation
for the treatment of depression and alcohol dependence was not
statistically different from that observed for psychotherapy and
psychotropic medicine (Table 3 and online Table DS4).
Emotional reactions
The changes in emotional reactions towards persons with mental
disorders were generally less significant. They were also less
consistent across the various mental disorders. Whereas in 2011
respondents tended to express more fear from people with
schizophrenia and felt more uncomfortable and insecure with
them than in 1990, they showed more prosocial reactions (need
to help, compassion) and reacted with less fear to people with
depression than previously. When confronted with someone with
alcohol dependence, respondents reacted with more anger and
annoyance than two decades earlier. Regardless of the condition
presented and at both time points, respondents most frequently
showed prosocial reactions, followed by fear and related feelings;
least frequently they reacted with anger (Table 4 and online Table
DS5).
Desire for social distance
In 2011, respondents expressed a stronger desire for social distance
from people with schizophrenia than two decades earlier. This
applied to all seven social relationships studied. With the other
two disorders no significant changes, or inconsistent changes, were
observed. In 2011 as in 1990, people with alcohol dependence were
facing the strongest rejection, followed by people with schizophrenia
and those with depression (Table 5 and online Table DS6).
Discussion
Our main findings are that between 1990 and 2011: (a) the
German public have become more inclined to endorse biological
148
Table 1 Changes in causal beliefs about mental disorders between 1990 and 2011 (multinomial logit regression)a
Predicted percentages
Schizophrenia Major depression Alcohol dependence
Response category: a cause 1990 20 11 Changeb 1990 20 11 Changeb 1990 20 11 Changeb
Brain disease 53 62 8 39 30 79 28 21 77
Heredity 40 43 4 40 29 711 28 25 73
Stressful life event 71 66 74 75 73 73 80 73 77
Work-related stress 60 61 1 70 80 10 76 76 0
Grown up in a broken home 54 31 723 55 26 729 66 40 727
Lack of parental affection 38 32 76 43 30 714 47 39 78
a. Statistically significant changes are in bold.
b. As a result of rounding the figures shown will not always equal the difference between predicted percentages.
Table 2 Changes in help-seeking recommendations for mental disorders between 1990 and 2011 (multinomial logit regression) a
Predicted percentages
Response category:
Schizophrenia Major depression Alcohol dependence
would recommend 1990 20 11 Changeb 1990 20 11 Changeb 1990 20 11 Changeb
Psychiatrist 65 81 16 54 67 13 43 52 10
Psychotherapist 65 86 20 58 74 17 46 71 24
General practitioner 69 74 5 74 77 3 73 83 10
Priest 25 15 710 28 15 713 23 13 710
Self-help group 60 58 72 59 60 1 81 79 72
a. Statistically significant changes are in bold.
b. As a result of rounding the figures shown will not always equal the difference between predicted percentages.
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Changes in attitudes towards mental illness over two decades
explanations of schizophrenia, whereas a trend in the opposite
direction was observed for depression and alcohol dependence;
(b) acceptance of treatment offered by mental health professionals
has increased; (c) attitudes towards people with schizophrenia
worsened, whereas attitudes towards people with the other two
disorders showed no clear trend.
Changes in causal explanations of mental disorders
There has been an increase in the German public’s endorsement of
biological causes for schizophrenia, however, for both depression
and alcohol dependence there was a trend in the opposite direction.
Whereas the first result is in line with findings from previous
studies, this is not the case for the other two disorders, where
other studies have also reported an increasing adoption of
biogenetic causal attributions for these conditions.12–14 One
reason for this discrepancy may be that previous studies covered
the time period up to 2006, whereas our study ended more
recently in 2011. A trend analysis in Western Germany between
1990 and 2001, based on a subsample that had been presented
with the male version of the depression vignette, also showed a
slight increase in the endorsement of brain disease as a potential
cause for this disorder.14 This suggests that the decrease in the
public endorsing biogenetic explanations for depression observed
in the current study is likely to have occurred between 2001 and
2011. We hypothesise that this new trend is the result of social
149
Table 3 Changes in treatment recommendations for mental disorders between 1990 and 2011 (multinomial logit regression)a
Predicted percentages
Response category:
Schizophrenia Major depression Alcohol dependence
would recommend 1990 20 11 Changeb 1990 20 11 Changeb 1990 20 11 Changeb
Psychotropic medication 30 53 23 26 35 9 14 28 15
Psychotherapy 66 82 17 57 71 14 51 67 16
Relaxation techniques 49 43 76 50 52 3 27 38 11
Natural remedies 20 24 4 21 27 7 11 20 9
Meditation 29 31 3 30 40 10 18 29 11
Acupuncture 13 17 3 12 19 6 10 16 6
a. Statistically significant changes are in bold.
b. As a result of rounding the figures shown will not always equal the difference between predicted percentages.
Table 4 Changes in emotional reactions to people with mental disord er between 1990 and 2011 (multinomial logit regression) a
Predicted percentages
Schizophrenia Major depression Alcohol dependence
Response category: agree 1990 20 11 Changeb 1990 20 11 Changeb 1990 20 11 Changeb
I feel the need to help him/her 65 60 75 61 68 7 55 53 72
I feel pity for him/her 59 68 9 60 67 7 56 56 0
I feel sympathy for him/her 23 24 1 27 32 5 13 18 5
I feel uncomfortable 40 49 8 37 30 76 45 42 73
He/she makes me feel insecure 32 30 72 24 21 74 27 25 72
He/she scares me 30 37 7 23 20 73 27 26 72
I feel annoyed by him/her 12 13 1 9 9 0 15 22 8
I react angrily 8 9 1 6 9 3 15 24 9
I am amused by something like that 4 5 1 4 3 71 3 4 1
a. Statistically significant changes are in bold.
b. As a result of rounding the figures shown will not always equal the difference between predicted percentages.
Table 5 Changes in the desire for social distance from people with mental disorders between 1990 and 2011 (multinomial logit
regression)a
Predicted percentages
Response category:
Schizophrenia Major depression Alcohol dependence
would reject 1990 20 11 Changeb 1990 20 11 Changeb 1990 20 11 Changeb
Have as neighbour 19 29 10 16 15 72 36 31 74
Work together 20 31 11 15 18 3 35 34 71
Introduce to a friend 39 53 15 33 37 3 56 60 5
Recommend for a job 44 63 18 40 45 5 62 66 3
Rent a room 46 58 13 37 35 72 62 61 71
Have married into family 56 60 5 52 41 711 75 68 77
Take care of children 67 79 12 58 62 74 80 81 1
a. Statistically significant changes are in bold.
b. As a result of rounding the figures shown will not always equal the difference between predicted percentages.
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Angermeyer et al
developments that have taken place during this time frame,
namely profound changes in working conditions in the wake of
the process of globalisation and the economic crisis that began
in 2008. Although Germany seems to be faring better than other
Member States of the European Union, the German public are
concerned by the crisis, as reflected by the results of a national
survey conducted in 2010 according to which over half of
respondents felt threatened as a result of the economic situation.15
This may have resulted in a growing awareness of the importance of
social forces in people’s emotional well-being. This interpretation
is supported by our finding that significantly more people in 2011
endorsed work-related problems, including unemployment, as a
cause of depression. Also of note, over the past 10 years there
has been a rise in the labelling of depressive episodes as burnout.16
Changes in help-seeking and treatment
recommendations
Across all three disorders, the German public’s readiness to
recommend help-seeking from mental health professionals has
increased since 1990. Similar trends have also been reported from
the USA, Australia and some European countries.12–14,17 It is
evident that consulting a psychiatrist or a psychotherapist has
become a less unusual and a more accepted way to deal with
mental health problems than it used to be in the past. The trend
towards greater acceptance of mental health services has also been
observed with regard to psychiatric hospitals; here too, public
attitudes have become more favourable over the past two
decades.18 However, it currently is not possible to establish what
accounts more for this trend – the improvements in treatments
offered by mental health professionals or the improvements in
the organisation of mental health services. It is apparent that
the German public has taken note of the reforms in mental
healthcare as in the 2011 survey we found that the majority of
respondents shared the view that the number of office-based
psychotherapists had increased over the past 20 years as well as
the proportion of people with mental illness being treated in
out-patient services instead of hospitals.19 The reforms may have
resulted in lower barriers to help-seeking from mental health
services, objectively in terms of a greater availability of such
services as well as subjectively in terms of lower stigma attached
to using them. This change in attitude was paralleled by a growing
number of people turning to mental health professionals for
help.
20
However, the increasing acceptance of mental health
professionals does not seem to be closely related to time trends
about causal beliefs as, regardless of whether biological causes
were more or less frequently endorsed in 2011, the public was
more ready to recommend seeking help from psychiatrists as well
as from psychotherapists.
Across all three disorders, the two best-established psychiatric
treatment modalities, psychotherapy and psychotropic medication,
showed the most pronounced increase in public acceptance. In
the case of schizophrenia the readiness to recommend psychotropic
medication grew significantly more than for the other two disorders.
It was also only for schizophrenia that the increase in endorsement
of medication was significantly greater than that for alternative
methods, whereas with the other two disorders there was some
overlap between the evolution of attitudes towards both treatments.
Schizophrenia was the only condition for which the willingness to
recommend relaxation techniques decreased significantly. This
perhaps should be considered in relation to the increasing
endorsement of a biological causation that we found, although
it remains unclear whether there is a causal link between both
trends or whether this is a coincidence. In support of the first view
are the results of cross-sectional analyses of the data from both
199021 and 2011 (unpublished results, details available from the
authors on request), showing a positive association between the
endorsement of biological causes and the propensity to
recommend medication. On the other hand, the finding that
psychotherapy has gained ground across all three disorders
independently of how causal beliefs have developed argues against
a close relationship between causal beliefs and treatment
recommendations. This trend is more remarkable given that over
the past decades the public has been increasingly exposed in the
media to information on biological research about mental disorders
and the pharmacological treatment of these illnesses, whereas reports
about psychological interventions have been rather rare.
22,23
Changes in attitudes towards people with mental
disorder
The marked trend towards greater acceptance of mental health
treatment was not accompanied by greater acceptance of people
with mental illness. Studies that have recently been conducted in
the USA, Australia and some European countries12–14,24–26 have
also found no substantial improvement in attitudes towards
people with mental illness. In our study we found that although
the desire for social distance from people with schizophrenia has
increased, no consistent trend was observed for depression or
alcohol dependence. There is an interesting parallel to the
development of biological causal explanations, which have only
increased for schizophrenia. Moreover, fear about people with
schizophrenia, prosocial feelings towards people with depression
and anger towards those with alcohol dependence have increased.
This corresponds with the increase in the adoption of biological
causes in the case of schizophrenia and the decrease in the cases
of depression and alcohol dependence. A cross-sectional analysis
of the 2011 data has revealed that biogenic causal beliefs are
associated with increasing social distance in the cases of
schizophrenia and depression but with a decrease in the case of
alcohol dependence.27,28 The increase in fear about people with
schizophrenia is also documented in the public’s growing approval
of compulsory admission to a psychiatric hospital for individuals
with persecutory delusion or in cases of public nuisance.29 This
trend appears to be supported by the finding that a growing
proportion of the public hold the view that psychiatric hospitals
are necessary to protect society from mentally ill people.18 Our result
is all the more sobering given that over the past 10 years great efforts
have been made in Germany to fight against the stigma attached to
mental disorders.30 However, these campaigns have been mostly
regional and probably therefore have less of an impact than a large
nationwide campaign, such as the one recently launched in the UK.
31
Strengths and weaknesses
With a time span of 21 years, our study is the longest vignette-
based trend analysis of public attitudes towards mental disorders.
Another strength of our study is the large sample size (nearly 1000
respondents each being presented with one of the three case
vignettes at each assessment point), allowing for complex
statistical analyses. To achieve maximum comparability between
both surveys we adhered to the recommendations of experts in
survey research32 as closely as possible, using the same sampling
procedure, interview mode and instruments. However, the
exclusive focus on attitudes may also be seen as a limitation since
it allows predicting behaviour with only limited accuracy.
However, rather than using them as a proxy for individual
behaviours public attitudes can also be conceptualised at a collective
level as a reflection of cultural conceptions of mental illness. Such
conceptions provide a cultural context that influences the way we
think about mental illness and the people who have them. As Link
et al have pointed out ‘as a context this cultural conception
150
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Changes in attitudes towards mental illness over two decades
becomes an external reality, something that individuals must take
into account when they make decisions and enact behavior’.
33
The
aim of our study was to document the variations in these cultural
conceptions of mental illness over time. For this purpose, the
comparison between two cross-sectional assessments at different
points in time appears to be the most appropriate study design.
Although also providing insights into the changes in people’s
attitudes at an individual level, a panel study would struggle with
the lack of representativeness of the follow-up assessment, due to
the huge attrition rate that can be expected over a time period of
21 years, and, therefore, this type of study is less suitable for
studying changes on a collective level.
Implications
In conclusion, public attitudes towards mental healthcare provi-
ders and the treatment offered by them has improved considerably
in Germany over the past 20 years. However, attitudes towards
those with mental illnesses have remained unchanged or wor-
sened. Seemingly, the changes that have taken place in psychiatry
over the past decades have benefited the image of psychiatry, but
have failed to improve the image of its patients. Further efforts are
necessary to combat the stigmatisation and discrimination of peo-
ple with mental illness. In light of our findings it seems advisable
to focus all available resources on this endeavour. In view of the
growing divide between schizophrenia and other mental disorders,
special efforts should be made to stop this disquieting trend.
Matthias C. Angermeyer, MD, Center for Public Mental Health, Gösing am Wagram,
Austria, and Department of Public Health, University of Cagliari, Italy; Herbert
Matschinger, PhD, Institute of Social Medicine, Occupational Health and Public
Health, University of Leipzig, and Institute of Medical Sociology and Health Economics,
University of Hamburg, Germany; Georg Schomerus, MD, Department of Psychiatry,
Ernst Moritz Arndt University Greifswald and HELIOS Hanseklinikum Stralsund,
Germany
Correspondence: Matthias C. Angermeyer, Center for Public Mental Health,
Untere Zeile 13, A-3482 Gösing am Wagram, Austria. Email: angermeyer@aon.at
First received 26 Oct 2012, final revision 19 Mar 2013, accepted 17 Apr 2013
Funding
The study was funded by the Fritz-Thyssen-Stiftung (Az. 10.11.2.175)
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Stigma: Alive and well
Despite decades of anti-stigma campaigns, people may be
more fearful of those with mental illness than ever. New
research, however, is pointing the way toward real progress.
By Sadie F. Dingfelder
Monitor Staff
June 2009, Vol 40, No. 6
Print version: page 56
10 min read
“Julie*” managed to keep her chronic depression at bay for two years, despite the stress
of attending a prestigious law school. But when she got into a car accident during her
third year, she experienced a brutal resurgence of anxiety, sadness and insomnia. In
search of sleeping pills, Julie went to a doctor. He recommended she see a therapist,
but she refused.
“I was afraid that I might have to disclose my medical records for bar admission,” she
says.
Julie’s worries were warranted: All 50 states’ bar associations ask about applicants’
mental health histories, and there are several cases of people being denied admittance
on the basis of mental health problems—even if they’ve been successfully treated.
Now a successful lawyer, Julie still keeps her depression from her co-workers for fear of
how they’d react.
That’s an all-too-common situation, says Bernice Pescosolido, PhD, a stigma researcher
at Indiana University.
COVER STORY
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“She had a good reason to worry,” says Pescosolido, principal investigator for several
major National Institutes of Health-funded stigma studies. “The two areas where
Americans are most stigmatizing are marriage into the family and work.”
Despite decades of public information campaigns costing tens of millions of dollars,
Americans may be as suspicious of people with mental illness as ever. New research by
Pescosolido, published in the Journal of Health and Social Behavior (Vol. 41, No. 2),
finds that 68 percent of Americans do not want someone with a mental illness marrying
into their family and 58 percent do not want people with mental illness in their
workplaces.
Some attitudes have gotten worse over time: For instance, people are twice as likely
today than they were in 1950 to believe that mentally ill people tend to be violent.
Of course, the vast majority of people with mental illness are not violent—though they
are 2.5 times more likely to be victims of violence than members of the general
population, according to a study published in 2001 in the International Journal of Law
and Psychiatry (Vol. 24, No. 6). And a new study, published in February in the Archives
of General Psychiatry (Vol. 66, No. 2) finds that mental illness alone does not increase
the chances that a person will become violent.
Since that fear of violence is not based in fact, it may stem from media portrayals of
mental illness—particularly in the news, says Patrick Corrigan, PsyD, a psychology
professor at the Illinois Institute of Technology and head of the Chicago Consortium for
Stigma Research.
“Every time something really bad happens, people think it must be because of mental
illness,” says Corrigan. “If a woman drowns her children, people speculate—the news
media speculates—that she must be off her medication.”
In addition to being inaccurate and unfair, such beliefs come at a major cost to society,
Pescosolido notes. An estimated one in four adults has a diagnosable mental illness,
according to the National Institute of Mental Health. That’s about 76 million Americans
who live with the fear that others may find out about their disorder and think less of
them or even keep them from getting jobs or promotions, she says. And people like
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Julie often avoid treatment due to the all-too-reasonable worry they’ll be found out and
discriminated against, Pescosolido says.
The good news: After decades of well-meaning but largely ineffective efforts to change
public opinion, researchers are now working to understand the underpinnings of stigma
and are even beginning to turn the tide of public opinion in American and abroad.
An insidious effect
The toxic effects of stigma are well-documented, says Corrigan. People with mental
illness often internalize society’s beliefs about them—that they are incompetent,
irrational and untrustworthy—and that can lead to distress that’s sometimes worse than
the mental illness itself, he says.
About half of people with schizophrenia believe that former psychiatric patients are less
trustworthy than others, finds a study by psychologist Birgit Kleim, PhD, of Kings College
in London, Corrigan, and colleagues. The patients who believed this tended to isolate
themselves from social support, a course of action that can increase the severity of
psychotic symptoms, according to the study published in the Journal of Mental Health,
(Vol. 17, No. 5).
“We know that social support of people with psychosis, for instance by friends or family,
is crucial for their recovery,” says Kleim.
Stigma can also keep people from taking their medications, finds a study by Hector
Tsang, PhD, a psychology professor at Hong Kong Polytechnic University, published in
the Journal of Behavior Therapy and Experimental Psychiatry, (Vol. 40, No. 1). That’s in
part because antipsychotic medication often has visible side-effects, such as tongue
smacking and grimacing, which can mark one as mentally ill.
“Medication-induced stigma is regarded as one of the principal barriers to compliance,”
Tsang notes.
Even high-functioning college students fall prey to the effects of stigma, according to a
study by Diane Quinn, PhD, a psychology professor at the University of Connecticut. In
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the study, published in Personality and Social Psychology Bulletin (Vol. 30, No. 7), Quinn
and her colleagues asked college students to take a portion of the GRE Analytic Test, a
difficult test of logic and reasoning. At the top of the test were several demographic
questions, and, for half of the participants, a question about whether they had any
history of mental illness.
Simply answering “yes” to that question caused some students’ performance to
plummet. Of the students who had a history of mental illness, those who had to disclose
it before taking the test did about half as well as those who were allowed to keep quiet.
“It’s really surprising that something as subtle as answering a question can effect
people’s performance,” says Quinn.
The result, she notes, is similar to one that’s found when students are asked to identify
their race or gender before a test. Identifying oneself as part of a stigmatized group
activates a fear of being stereotyped, and students must devote brainpower to pushing
that out of their minds, which results in poorer test performance.
In addition to test performance, stigma can harm the physical health of people with
mental illness, finds a study by Quinn, in press in the Journal of Personality and Social
Psychology. In it, she surveyed 235 people who kept some parts of their identities
secret to avoid stigma, including people with mental illness, rape victims and people
with criminal histories. The more stigmatized their secret identities, the more likely
people were to report symptoms of physical illness, Quinn found.
“Stigma is a day-to-day stressor, she says. “Little things happen every day to make
people feel devalued, and that can add up and affect people’s health.”
When information leads to fear
Such findings underscore the importance of changing society’s views of the mentally ill
—especially those beliefs that the mentally ill are incompetent. However, most anti-
stigma campaigns convey the message that mental illness is a disease like any other,
says Pescosolido. Specifically, they explain the biological causes of depression and
other disorders, emphasizing that people can’t just “snap out of it,” she says.
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That was the case for the National Institute of Mental Health campaign, “Real Men, Real
Depression,” which focused on how common depression is, and gave men information
to help them recognize it in themselves. Such information may encourage people to
seek treatment, but the campaign’s emphasis on how many people have a mental
disorder may have reinforced fear in the general population, says Corrigan.
“Mental illness’s impact is huge and omnipresent,” he says. “Everyone’s family in
America has a person with serious mental illness, and that spooks us.”
Canadian anti-stigma campaigns also tend to focus on the prevalence and symptoms of
mental illness, says University of Calgary stigma-researcher JianLi Wang, PhD.
In one sense, these efforts work: In a study by Wang, published in the Canadian Journal
of Psychiatry (Vol. 52, No. 7), 75 percent of Canadians correctly diagnosed a depressed
person as described in a story, and they agreed with statements about the biochemical
underpinnings the disorder. However, more than 45 percent of people Wang surveyed
in a follow-up study said they believed that depressed people are unpredictable, and 20
percent said that depressed people tend to be dangerous.
“You can hold the belief that mental illness is a real disease and still be afraid of people
with it,” Wang says.
Such campaigns may even increase stigma, says Pescosolido. In particular, the idea that
mental illness has genetic causes may make disorders seem incurable, she says.
“The ‘disease-like-any-other’ message was not an effective strategy, and it’s what we
used in the vast majority of anti-stigma campaigns,” Pescosolido says.
A recent campaign in Scotland called “See Me” tried a different strategy. It educated
reporters and editors about the harmfulness and inaccuracy of the stereotype that
people with schizophrenia are prone to violence.
The campaign succeeded in reducing the number of news stories linking violence and
mental illness, but had some unintended consequences, according to research
published in February in the International Journal of Health Promotion (Vol. 10, No. 1). An
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analysis of five years of newspaper articles showed that, over the life of the anti-stigma
campaign, coverage of people with mental illness became more negative—with stories
frequently depicting people with mental illness as objects of pity, for example.
Perhaps even more concerning was that newspaper coverage of mental illness
decreased overall, says study author Neil Quinn, PhD, a lecturer at the Glasgow School
of Social Work.
“One of our conclusions was that journalists became afraid to report about
schizophrenia full stop, because reporting did go down significantly,” Quinn says.
A new tack
A lesson of the Scotland campaign, says study co-author Lee Knifton, is that anti-stigma
campaigns can’t just focus on eradicating negative depictions of people with mental
illness. They need to tell positive stories as well, he says.
To that end, Knifton launched the Scottish Mental Health Arts and Film Festival, which
highlights the contributions that people with mental illness make to society by
showcasing music, film, comedy, literature and theater by people with mental illness.
The festival, which began in 2007, also sponsors a contest for films that depict people
with mental illness in realistic, holistic ways, says Knifton.
Last October, the festival drew 12,000 attendees and sparked 120 newspaper articles
that emphasized the fact that people with mental illness are generally active, useful
members of society, he says.
Such anti-stigma campaigns are more likely to work than the “disease like any other”
campaigns of the past, says Pescosolido.
“If you focus on the competence of people with mental illness, that tends to lead to
greater tolerance,” she says.
That’s also the goal of a new Canadian anti-stigma campaign, which tells the stories of
people with mental illness—stories like that of Candace Watson, who was diagnosed as
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bipolar after an unsettling manic episode. She’s since been successfully treated and
now works as a nurse.
“I know I’m a competent person and I have things to offer,” she says in a video that the
campaign has disseminated through public service announcements and a Web site.
The Canadian campaign is based on research by Corrigan showing that contact with
people who have mental illness tends to decrease stigma. For instance, one study by
Corrigan, published in 2002 in Psychiatric Rehabilitation Skills (Vol. 6, No. 2), found that
meeting people who have mental illness weakens people’s tendency to link mental
illness and violence.
It’s also important to stress the normalcy of many people who have mental illness, he
says.
“When the population gets a better sense of how many people with mental illness are
actually successful—if more people come out of the closet—perhaps the stigma of
mental illness will finally decline,” he says.
*Editor’s note: Julie is a pseudonym.
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Find this article at:
https://www.apa.org/monitor/2009/06/stigma
The content I just read:
IS RELEVANT MAY NEED AN UPDATE
C O M M E N T A R Y
The Anthropology of Psychopharmacology:
Commentary on Contributions to the Analysis
of Pharmaceutical Self and Imaginary
Janis H. Jenkins
Published online: 7 February 2012
� Springer Science+Business Media, LLC 2012
People are taking psychiatric drugs today more than ever throughout North America
and Europe as well as parts of Asia and countries of the global South, reflecting the
way treatment has been affected by the global dominance of biomedicine, sometimes
in seemingly incongruous ways. An anthropological account of this highly
consequential development requires a variety of strategies to explore the nexus of
the subjective experience of psychoactive pharmaceuticals and global processes that
shape psycho-pharmaceutical consumption. A fusion of perspectives is needed since
studies of global processes that address the problem of psychopharmacology often do
not consider the experience of medications for those who take them, while the limited
set of studies of the phenomenology of medication experience has thus far not given
due consideration to the economic and political dimensions of the problem.
In framing the theoretical and clinical contributions of my recent edited volume
addressing this issue. I proposed that our key terms must include the pharmaceutical
self, understood in terms of the subjective experience of psychopharmaceuticals,
and the contemporary pharmaceutical imaginary, understood in terms of the global
shaping of consumption (Jenkins 2011a, b). In the context of the contemporary
global culture of consumption and the arena of global capitalism in which giant
pharmaceutical companies operate, analytic deployment of these terms supports the
recognition that to some extent we are all already pharmaceutical selves. For those
treated for major psychiatric disorders like schizophrenia, these terms help toward
unraveling experiential paradoxes including the frustration of recovery without cure,
the persistence of stigma despite recovery, the blameless guilt of living with a
‘‘biochemical imbalance,’’ the choice of being ‘‘crazy or fat’’ due to medication
effects, and the strained coexistence of pharmaceutical management and psycho-
therapeutic treatment.
J. H. Jenkins (&)
UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0532, USA
e-mail: jjenkins@ias.edu
123
Cult Med Psychiatry (2012) 36:78–79
DOI 10.1007/s11013-012-9248-0
The contributions to this issue of CMP take up the challenge articulated in
Pharmaceutical Self to flesh out the cultural, political, and economic forces that
shape the lived experience and institutional processes of production and circulation
of psychopharmacology worldwide. Schlosser and Hoffer make a vital contribution
to anthropological understanding of the self/imaginary in the use of psychotropic
drugs to include antidepressants, antipsychotics, anxiolytics, and heroin. The social
life of this common yet poorly understood ‘‘cocktail’’ brings into play a complex
moral economy of psychiatric medications (‘‘good drugs’’) and illicit street drugs
(‘‘bad drugs’’). This innovative ethnographic study documents that, as a matter of
lived experience, the circulation of psychotropic knowledge and ingestion creates
personal expertise and conflict in soothing the torment of an unhappy life. The
ethnopsychological and cultural logic of normal/abnormal in this situation sheds
light on what is valued as a matter of routine or ‘steady state.’ The study also
provides first-person accounts of the trouble with drugs, subjectively discerned, as
dulling, transformative, or boring. Calculations of the worth of dampening
unwanted intrusions of voices must be weighed against unwanted weight gain
and loss of one’s customary and valued sense of self. The existential and
phenomenological stakes could not be higher. Kristi Ninnemann’s innovative paper
draws our attention to the critical yet frequently unrecognized verity of biogenetic
variation in metabolic processes and psychopharmaceuticals. Drawing on pioneer-
ing work from ethnopsychopharmacology, she takes a step forward in advancing our
understanding of the ways in which medications are shaped by complicated
interactions among culture, behavioral environment, and biogenetics. This contri-
bution is opportune as a counterbalance to appreciation of the recognition that
culture shapes nearly every aspect of mental illness. Culture is neither the only nor
even the primary source of human variation. The significant matter of individual
variation advanced some 80 years ago by Sapir applies with equal force. Finally, the
paper by Zhiying Ma offers an intriguing if uneven treatment of the pharmaceutical
self and imaginary in China. As also identified by our research group, Ma finds
ambivalence to be central to matters of intimacy, subjectivity, and the treatment of
mental illness. The cadence of ambivalence and paradox in the emergence of the
pharmaceutical self come together in this set of papers to make a significant
contribution to a newly emerging anthropological spotlight on the reciprocal
shaping of lived experience and institutional forces of globalization.
References
Jenkins, Janis H.
2011a Introduction. Pharmaceutical Self: The Global Shaping of Experience in an Age of
Psychopharmacology.
Santa Fe, NM: School of Advanced Research Press.
2011b Pharmaceutical Self and Imaginary in the Social Field of Psychiatric Treatment. In
Pharmaceutical Self: The Global Shaping of Experience in an Age of Psychopharmacology.
Santa Fe, NM: School of Advanced Research Press.
Cult Med Psychiatry (2012) 36:78–79 79
123
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content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s
express written permission. However, users may print, download, or email articles for individual use.
It’s no secret that mental health is routinely treated differently than physical health, but sometimes it’s difficult to understand how or why this affects us. This disparity can take many shapes and forms, ranging from negative societal perceptions to discrimination in health coverage for mental health. Consequently, this unequal treatment of mental and physical illnesses leads to unequal results.
If we don’t recognize mental illnesses as physical health issues, then we will never get people the treatment that they need. One of the few certainties that I have learned from living with a father with bipolar disorder is that mental health is just as important as physical health. In fact, mental health is physical health; the two are inseparable. It baffles me that many people continue to make a distinction between the two.
In an effort to better understand the subtlety of mental illness, I have sought out opportunities that have changed both my life and my perception of mental illness. I went from reading articles online in my free time to doing hands-on research about the physiological development of mental illness at Dr. Renee Reijo-Pera’s Stem Cell Institute and the Center for Mental Health Research and Recovery at Montana State University.
While our current generation of medication and treatment can be frustrating at times, I have seen how learning more about the underlying biochemical pathways holds great promises for the future. My journey has also become an adventure all across the nation advocating for a more humanistic perspective of mental health. The ability to speak up and share what I’ve discovered with people and the chance to connect with others in similar experiences have been some of the most fulfilling experiences in my life.
Ironically, the same fluidity and complexity of mental disorders that I find so fascinating has prevented those same disorders from gaining societal acceptance in the same way that physical illnesses have. They are just as real, but they are sometimes more difficult to understand. The social stigma that those living with mental illness experience essentially stems from this fundamental lack of understanding of mental disorders as physical illnesses. This is what makes living with mental illness so hard and is something that we all need to recognize to a greater extent, myself included.
Initially, I dismissed my father’s illness as simple craziness. In a manic state my dad hallucinated that he was dealing cards with Christ’s apostles and during his crippling depression he couldn’t lift himself from his bed for weeks. Even though my dad’s physical reality didn’t match my own, it was naive to ignore the fact that there are people behind these diseases, and that their illnesses don’t encapsulate their personalities. If I dismiss you as crazy, then how can we start a dialogue? We need to begin by empathizing and loving those who we don’t fully understand. Whether this takes the form of a quick post on social media or a late-night conversation with a loved one in desperate need of support, simply speak up. Speak out. Be heard. Show love. Listen well.
This change doesn’t come easy. In fact, it was only through understanding the complexity of my father’s mental illness that I gradually came to learn—through trauma, confusion, and grief—more about myself and the human condition than I had ever thought possible. My experiences with mental illness in my family challenged me to become a more compassionate and patient individual; through my father’s precipitous highs and seemingly endless lows, our collective vulnerability created an incredibly strong emotional bond between us.
From my personal experiences, my biggest takeaway has been that a fundamental difference between mental progress and debilitation comes from understanding your current situation. The thoughts and worries we all experience are real and important regardless of whether our situation conforms to others’ ideas of mental health. If we can accept our current state, then we can begin to move forward. Mental wellness is not a mind over matter issue—nobody claims it is—but it does involve a certain level of acceptance.
At the end of the day, however, I’m still a young, confused teenager trying to process what mental illness really means to me and my family. My greatest fear, however, is not that I am hopeless to change our society’s perception of mental illness, nor that I can’t adequately solve the world’s disconnect between mental and physical health issues. Instead, I fear that we possess a voice and a power to effect change, and yet we fail to speak out and bond together as equals.
If nothing else, everyone reading this can simply increase their familiarization with those living with mental illness around them to broaden their spectrum of receptive comfort. Hearing the stories of others can widen our capacity for love if we only allow ourselves to learn from a wider variety of experiences. We have all been given a voice and the ability to listen, please use these gifts to start affecting the way we perceive mental health.