Stigma, Prejudice, and Discrimination
Those of us with brain illnesses such as bipolar disorder, OCD, PTSD, and schizophrenia often speak of the stigma associated with our problems. It’s no wonder — stigma affects our lives in both predictable and unpredictable ways.
For instance, say you’ve become comfortable talking about your disorder. Then one day when you’re at a reunion or some other gathering, you happen to mention it and get the glazed-eyes-fixed-smile-back-away-slowly response. Sure, a lot of people don’t know what to say to you, but that reaction just makes it clear that you are different and, to that person, potentially a source of danger. Someone to be avoided. Someone not to engage with.
That’s stigma.
Prejudice is related to stigma. It’s just a short step away. Prejudice happens when people have a preconceived idea of what brain illness looks like. (That’s what prejudice means.) This could be a person who assumes that a serial killer or mass shooter is obviously “insane.” Their assumptions are reinforced when it’s revealed that the perpetrator had a history of psychological problems or had taken medication. They’re ignorant of the facts — that most killings are prompted by motivations such as rage, gender or racial hatred, jealousy, or fear. They don’t know that the mentally ill are much more likely to be the victims of violence than to be perpetrators.
People with prejudice against people with mental illness can also assume that psychiatric diagnoses are not “real.” They think people with these conditions can — and should — just “snap out of it,” “pull themselves up by their bootstraps,” or “get over” their problems. They look down on people who seek help. They make jokes about “crazies” and “lunatics.” They believe that anyone with a “real” mental illness is in a locked ward in an “insane asylum,” or should be. They don’t know that straightjackets aren’t used anymore and feel they’re funny Halloween costumes.
In other words, people who are prejudiced lack understanding and empathy.
Discrimination takes it one step further.
When people with brain illnesses suffer from discrimination, they lose opportunities because of their condition. If they are open about their diagnosis on applications, they may never receive a callback or an interview for a job. They may start receiving bad evaluations at work if they have to leave for doctor’s appointments or be let go for not getting along with other workers, many of whom may have prejudice against them. They don’t receive the accommodations required by the Americans with Disabilities Act (ADA).
Discrimination can also be involved with decisions from Social Security Disability. It’s not supposed to be that way, but people with mental illnesses are likely to have more difficulty “proving” that they have a disability severe enough to warrant supplemental income.
So what’s to be done? Education is the solution we always advocate. But it’s a hard ask. It’s difficult to get anyone to learn about the realities of brain illnesses. They don’t learn about it in school, and the messages they get from the media do little except reinforce the stigma surrounding the various conditions. In fact, they perpetuate much of the stigma.
Pushback is another strategy. We simply cannot let it pass when someone makes a prejudiced remark or demonstrates a lack of understanding. We can speak up about inappropriate Halloween costumes or assumptions about violence and the mentally ill. We can inform others that not all homeless persons are mentally ill. In fact, most homelessness is caused by a lack of affordable housing and low wages.
When it comes to discrimination, legislation and activism are often the solutions or at least the beginnings of them. Lobbying efforts regarding policy and treatment will help. Lots more needs to be done to inform legislators about the very basics, much less the possible ways to address the problems. Reporting violations of the ADA may not lead to resolutions, but it still needs to be done.
Of course, it’s difficult for many people with brain illnesses to do these things. We are frequently isolated and doubt our own abilities. Confronting legislators, educating them, and lobbying for their attention is daunting. Neurotypical people have trouble doing it, especially without an organization that gives them leverage. But it’s work that needs to be done. I admit that I’m not at the forefront, though these blog posts and my books are intended to help educate, and the groups I belong to try to do likewise.
It’s not enough. But it’s a start.
