The tendency of labelling a mentally sick person mad has got to change if we are to progress

I AM a student of nursing and during my mental health nursing clinical rotation, I came across a few patients who were brought to psychiatric ward after they condition had worsened. On inquiry, I knew that the root cause of their late arrival was stigmatization of mentally ill clients by society.

This is when I realized that there were still a few unresolved queries in my mind. What is stigma? How is mental health dealt with in Pakistan? What are the few important causes of stigmatization of mentally ill clients? What are the effects of stigmatization on mentally ill clients? And, what one can do to reduce stigmatization on mentally ill clients? So, I set out to answer these questions and this is what I found.

Stigma is a term used to describe a process where a person is denied full and equal social standing with another person. This process of stigmatization begins by labelling and distinguishing the people ‘normal’ or ‘well’ from the ‘abnormal’ or ‘sick’ people.

Ancient Greeks used the word ‘stigma’ to refer to body marks or brands on people to be avoided. Moreover, stigma is the use of stereotypes and labels when describing someone. To conclude, stigma means a mark or sign of shame, disgrace, or disapproval, and being rejected by others.

Being a citizen of Pakistan, one quite well aware as how is mental illness taken in our society. According to Dr Abul Faizi, Chairman of Department of Psychiatry at the Aga Khan University Hospital, mental illness is taken in our society as aasaib, saya and jadoo etc. Consequently, the mentally ill in our society are labelled mad and dangerous. The concept of mental illness has not fully developed in our country. According to some experts, mental illness in Pakistan carries such a stigma that to accept its presence in a family is like disclosing a shameful secret. As a result very little is done for the mentally ill, other than locking them away. In short, people here are usually reluctant in seeking psychiatric help due to stigmatization of mental illness prevailing in our country.

There are two basic causes that give birth and reinforce the stigmatization of mentally ill clients. These two basic causes are myths and misconceptions, and media.

One of the key causes of stigma is the development and reinforcement of myths and stereotypes. A great deal of stigma results from public mistrust and misunderstanding. In its literal meaning, a myth is a ‘purely fictitious narrative’, whereas, misconception means ‘erroneous belief or false belief. The root cause of myths and misconceptions is ignorance, lack of knowledge, misunderstanding, or inaccurate knowledge regarding any matter or subject.

There are many myths and false beliefs that create hindrances in the treatment of mentally ill clients. Some of the common myths are:

Mentally ill people have a flawed or weak character. Therefore they are dangerous.

They should be kept in isolation, away from the community.

These people also have an intellectual disability or a type of a brain damage.

Mental illness cannot happen to me.

Mental illness is untreatable. Mentally ill people can work low-level jobs but are not suited for really important or responsible positions.

Marriage is the cure of mental illness.

Mental illness is not like other ‘physical diseases’.

These myths and misconceptions have lead to the stigmatization of mentally ill clients that make them feel disgraceful and prevent them from seeking help.

The other basic cause of stigmatization of mentally ill clients includes role of a media. As media is a very powerful source of information, today whatever is being broadcast by the media, it has prominent effects on the lives of the viewer. According to a study done by Glasgow University Media Group in 1993, suggested “public reported that media was the source of their belief regarding mental illness association with violence.”

According to an expert, research also shows that media depictions of mentally ill people as violent homicidal characters has a marked influence on public attitudes and contributing to stereotyping. Furthermore, media is believed to be responsible for many of the misconceptions that persist about people with mental illnesses. Newspapers often stress a history of mental illness in the backgrounds of people who commit crimes of violence. Television news programmes frequently sensationalize crimes where persons with mental illnesses are involved. Comedians make fun of people with mental illnesses, using their disabilities as a source of humour. Also, national advertisers use stigmatizing images as promotional gimmicks to sell products.

In media, mentally ill characters are usually portrayed as aggressive, dangerous and unpredictable. Mental health issues are poorly represented in the mass media, especially in our country. It is clear, that there is a growing body of evidence indicating that the mass media propagates negative images of people with mental health problems. The same situation exists in neighbouring India where media like cinema, television or press, is responsible for the discrimination and stigmatization of mentally ill clients.

To conclude, mental illness is shown by mass media as something to laugh at, or something that is scary or unusual. As a result of these negative images portrayed by media, the stigmatization is reinforced and mentally ill clients avoid seeking mental health treatment, and families and friends avoid them also.

Lets explore the effects of stigmatization that are more prevalent in our society today.

First of all, as mentioned by Dr Abul Faizi that due to the stigmatization of mental illness, people are reluctant to take proper treatment and feel ashamed to go to a psychiatrist. This results in any of the two consequences. Either they go to faith healers and quacks for the treatment of mental illness, or they are isolated in homes. Both these conditions result in delay of seeking psychiatric treatment, which in turn, worsens the disease and client’s condition also.

There another detail that needs to be looked at. Mentally ill clients have to face financial problems, even after their recovery. As Dr Musarrat Hussain said, “feature of stigma related with mental health issues results in reducing patients’ access to resources and housing and job opportunities besides leading to low self-esteem, isolation and hopelessness.”

The greater cost is the emotional one paid by those individuals with mental illnesses who are shunned by society, unable to find jobs or appropriate housing and are permanently labelled by their illnesses. The loss of job and lack of job opportunities of mentally ill clients, makes them financially insecure and less confident about their capabilities, and in turn, lower their self-esteem too.

Last, but not least, the effect of stigma is social isolation and rejection from the society, faced by mentally ill clients. Social isolation and social rejection result in loneliness, hopelessness and decrease self-esteem of a client. A number of research studies have found that the majority of the public still has difficulty accepting mentally ill people as employees, tenants, spouses or neighbours.

Stigmatization of a mentally ill client leads to the delaying of the treatment, worsening of disease, lack of job opportunities or loss of job, or barrier in getting new job or higher position. This lead to a feeling of loneliness, hopelessness and decrease self-esteem too.

In order to reduce and eradicate stigmatization, I have few suggestions on basically three levels to work on. Individual level of working, an institutional or an organizational level of working and governmental level of working.

 

INDIVIDUAL LEVEL OF WORKING:

This starts with us.

* Make our misconceptions and myths clear about mental illnesses.

* Stop discriminating the mentally ill clients. * Stop making fun of mentally ill clients as I have observed that we, as health care professionals, were used to label them by calling them as pagal and laughing at their attitude.

* Stop others, like family members, friends and colleagues to call mentally ill clients as pagal.

* Health care professionals should educate adults and children also, because children will be adults in a few years and will carry the myths and misconceptions with them, provided if these are not corrected at their childhood.

 

INSTITUTIONAL LEVEL OF WORKING:

* All health care professionals should join their hands together on the platform of an institution/organization in order to reduce stigmatization on mentally ill clients.

* They should start running awareness campaign for the reduction of stigmatization of mentally ill clients.

* They should mail to media authorized persons in order to stop portraying of negative images of mentally ill clients.

 

GOVERNMENT LEVEL OF WORKING:

* Health care professionals should mail government officials and health ministers to start running television talk shows featuring the subject of mental illness and mentally ill clients and provide accurate information through media like television, newspapers, magazines, radio, pamphlets, etc.

* They should propose effective and realistic changes and clauses in the making of mental health ordinance in order to reduce stigmatization on mental illnesses and mentally ill clients.

In the end, I would like to emphasize that as a health care professional, particularly nurses, it is our responsibility to take the right steps for combating stigma, in order to give the holistic care to our clients.