Changing Attitudes: Reducing the Stigma of Mental Illness

January 5, 2015
Blurb
 
Changing Attitudes: Reducing the Stigma of Mental Illness
A few short generations ago (pre 1960s), the greatest obstacles to the treatment of mental illness were the lack of effective treatments, unreliable diagnostic criteria, and the lack of a scientific understanding of mental illness. Today the main hindrance to treatment is not any gap in scientific knowledge or shortcoming in medical capability, but social factors – the stigma of mental illness and lack of awareness and confidence in psychiatric medicine. These distorted perceptions, have been stoked by the legacy of psychiatry’s past failures and its checkered history, which have earned it the (no longer justified) moniker as the stepchild of medicine.
Many signs, however, indicate that the nation’s attitude toward mental illness and health care is changing for the better. Consider the media. Despite its reflexive tendency to sensationalize the public discourse on mental illness and psychiatry, recently more credible spokespersons are coming forward, and constructive messages are being communicated. 
Movies in particular, have long been known to sensationalize and exploit mental illness for entertainment purposes. The Hollywood stereotype of the homicidal maniac was emblazoned in the public’s mind by the 1960 Alfred Hitchcock film Psycho in which the protagonist, Norman Bates, plays a psychotic motel proprietor who viciously kills his guests. Ever since Psycho’s commercial success, there has been a parade of psychotic murderers in cinema, from Halloween’s Michael Myers to Nightmare on Elm Street’s Freddy Krueger to Saw’s Jigsaw.
At the same time, movies have portrayed psychiatrists and other mental health providers as weird, ignorant, or cruel, starting with such films as Shock (1946) and The Snake Pit (1948), which depict the horrors of asylums, and continuing through One Flew Over the Cuckoo’s Nest, Silence of the Lambs (featuring a manipulative, arrogant director of a mental institution), Girl Interrupted (featuring a mental ward for young women where the staff are oblivious to the true problems of their patients), Gothika (featuring a creepy mental institution with a sadistic, murderous director), Shutter Island (featuring a spooky mental institution with staff who appear manipulative, arrogant, and violent), Side Effects (featuring manipulative psychiatrists and greedy pharmaceutical companies), and even Terminator 2 (portraying the staff of a mental hospital as cold and foolish rather than compassionate and competent).
But recently, Hollywood has begun to present another more accurate and constructive view of mental illness and psychiatry. Ron Howard’s film A Beautiful Mind tells the moving story of economist John Nash, who suffered from severe schizophrenia, yet went on to win the Nobel Prize. Another example is the hit TV series Homeland, featuring a brilliant CIA analyst – played by Clare Danes – who suffers from bipolar disorder, takes mood-stabilizing and antipsychotic medications and is supported by her smart, caring psychiatrist sister. Apart from the interesting plot and fine acting, the series is remarkable for its authentic and accurate portrayal of both the effects of her mental disorder and its treatment, even as it shows that mental illness need not limit someone from attaining a world-class level of professional competence. (See Homeland: A True Portrayal of Mental Illness.) 
The Best Picture-nominated Silver Linings Playbook offered a realistic portrayal of appealing characters with mental disorders. They live purposeful lives in which their illnesses do not define them, but instead are merely part of the fabric of their lives.  It is not so much a story of mental illness as it is about two people who happen to struggle with mental illness—among many other things--and their relationships with family and community. The fact that the protagonist (Brad Cooper) and his father (Robert De Niro) suffer from bipolar disorder and obsessive compulsive disorder respectively, and the love interest (Jennifer Lawrence) has engaged in reckless self harmful behavior following the loss of her husband, are simply aspects of their characters. Their illnesses don’t define their identities—nor are they even the main point of the story.  In coming together, they find the mutual support that enables them to contend with their respective problems and redirect their lives in a positive direction. With the support of his family, the efforts of his psychiatrist and the love of a good woman, Cooper’s character avoids the tragic outcomes of bipolar disorder that we unfortunately see repeatedly in our society, and achieves a new beginning. Even his psychiatrist is sympathetically portrayed as a competent, caring and regular guy. When Jennifer Lawrence accepted her Best Actress Oscar for her role in the movie she proclaimed, “If you have asthma you take asthma medicine. If you have diabetes you take diabetes medicine. But as soon as you have to take medicine for your brain, you are immediately stigmatized.”
Cooper’s role as a young man regaining his balance after a destructive bout of bipolar disorder inspired him to became an advocate for mental illness. What inspired his advocacy, he said at a White House Conference on Mental Health in 2013, was that “working on the film made me realize what an old friend who I knew in school and was mentally ill had been dealing with, and made me feel ashamed of how I offered him no support or understanding, only ignorance and indifference. The film made me wonder how many other people out there are similarly unaware as I was and that I can help bring them the same awareness that the film brought me.”
More and more, celebrities have become willing to talk about their own experience with mental illness. Jane Pauley, the former Today Show anchor, writes about the role bipolar disorder has played in her life in her books Skywriting and Your Life Calling. She recounts how in the small Indiana town where she grew up, no one knew about mental illness, much less talked about it. As a result, she never gave her frequent mood changes much thought until she landed in the psychiatric ward at the age of 51 after the steroid medication, prednisone, triggered a severe manic episode. This unexpected hospitalization finally compelled Jane come to grips with the suppressed history of mood disorders in her family—and the fact that she had unknowingly endured a mild bipolar disorder for years. Jane could have chosen to keep her condition private, but instead made the brave decision to speak out.
Robin Williams’ suicide at the age of 63 provoked a national discussion about mental illness and self-destructive behavior. People could not fathom how the life of the talented comedian who brought so much laughter and joy to the world could end in such a way.
In yet another indication of how our society’s attitudes are changing, Patrick Joseph Kennedy, the scion of America’s most famous political family, has emerged as a passionate spokesperson for mental illness. Patrick is the youngest child of Massachusetts Senator Edward Kennedy and the nephew of President John F. Kennedy. He served as Congressman representing Rhode Island from 1995 – 2011. 
While in Congress, his admirable legislative record became overshadowed by stories of intoxication and emotional instability. In May 2006 he crashed his car into a barricade on Capitol Hill. Shortly afterwards, he went to the Mayo Clinic for detox and rehab, and has been in psychiatric treatment for his mood and substance use disorders ever since. He subsequently decided to retire from Congress and devote his efforts to being an advocate for mental illness and addictions. Since then he has emerged as the nation’s most articulate and prominent spokesperson on the issue of mental health. 
These efforts, and the efforts and experiences of so many others, both celebrated and unsung, are finally beginning to reduce that debilitating stigma that surrounds mental illness, increase the likelihood that those suffering mental illnesses will seek and find treatment, and lead fulfilling and productive lives.
 
Jeffrey A. Lieberman, M.D. 
Lawrence C. Kolb Professor and Chairman of Psychiatry, Columbia University College of Physicians and Surgeons, 
Director, New York State Psychiatric Institute 
Psychiatrist-in-Chief, New York Presbyterian Hospital-Columbia University Medical Center