Stigma and Discrimination in Mental Health

Prof. Graham Thornicroft

Prof. Graham Thorniocroft (@ThornicroftG) is Professor of Community Psychiatry at King’s College London, Consultant Psychiatrist for South London & Maudsley NHS Foundation Trust, and Chair of Maudsley International.

Graham has authored or edited over 460 peer-reviewed papers and 30 books including “The Oxford Textbook of Community Mental Health“, and the book which forms the basis of today’s discussion, “Shunned: Discrimination Against People with Mental Illness”.

In today’s episode we discuss the origins of stigma, from the etymology of the word itself to historical depictions of mental asylums. We draw lines of distinction between concepts such as ignorance, prejudice and discrimination and how each of these manifests in the real world.

We explore how the media depicts mental illness, how stigma is actually measured and quantified by researchers, the importance of anti-stigma campaigns such as Time To Change and the ways in which they’ve proved successful.

We touch on the recent trend in anti-stigma campaigns aimed specifically towards men, we ask if discrimination is ever justified, and most importantly Graham gives a few tips on how people with mental health issues can navigate the potential minefield of disclosure.

 

Recommended Links

Time to Change – Let’s end mental health discrimination

Mental Health Awareness Week (UK) – Mental Health Foundation

Mental Health Month (US) – Mental Health America

Books Mentioned in This Episode

     

 

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Image courtesy: Mark Chinnick

3 replies
  1. Chris
    Chris says:

    I might have missed it due to busying around but I don’t think I heard anything regarding the huge elephant in the room regarding stigma?

    How can someone supposedly seriously looking at stigma and discrimination fail to take a critical look at their own profession and much of the mental health industry?

    How can we expect anything but stigma and discrimination in a system that pathologises the individual as ‘mentally ill’ or ‘disordered’. Except for the obvious suffering from loss and physical pain etc the mental health system largely ignores the source of our suffering from the various cultural disorders we’re all exposed and vulnerable to.

    We are in constant communication with our environment/culture and a lot of the harms can go under the radar – sometimes its obvious how the culture/environment has harmed us other times its really hard to see and its more like suffering through many paper cuts – the mental health system except for perhaps systemic therapy tends to focus on the individual obfuscating these broader culture harms. Treatment is about changing the person to fit in with the harm and ‘get on with it’

    We’ve had over 100 years of clinical psychology and now over 1000 ‘talk treatments’ we’ve got dozens of drugs and hundreds of labels or ‘mental illness’s’ and are we any better, getting better, improving? clearly not.

    This is also a great insight into the problems faced by mental health teams https://www.amazon.co.uk/Tales-Madhouse-critique-psychiatric-services/dp/1906254753
    these services are an utter shambles – after personally working for many years in community mental health teams and finally escaping into a related field i would hope never to return to such an awful work environment of relentless competing demands, stress and suffering. They are often the opposite of what one would imagine to be a ‘mental health’ team.

    Thankfully there are changes and a move away from personal pathology. Rather than asking what is wrong with the person more therapists are asking what has happened or is happening to the person instead.

    A recent BPS conference panel discussion gives me some hope for a future where we develop outsight to bring the awareness and changes needed in our world where human have a chance to thrive.

    Reply
    • Danny Whittaker
      Danny Whittaker says:

      Hi Chris,

      Thank you for commenting. You’re correct, this didn’t get covered in this particular episode. I certainly considered it though.

      I also had to leave out the topic of stigma for the people choosing to enter the profession. For instance, Prof. Simon Wessely has written about his experience of being asked “why a decent chap like you is doing psychiatry”, which he took to imply that so-called “‘decent chaps’ could do better than waste their time in that backwater.”.

      I’d love to go Joe Rogan-style and dive down the rabbithole for 2-3 hours with my guests, and go broad as well as deep, but as yet, I just don’t have the leverage to get people to sit down with me for that long. So, in the meantime, I’m afraid I have to remain somewhat parsimonious about which topics to cover in the time I get.

      In your comment alone you’ve identified half a dozen valid topics – the state of the mental health industry, the potential damage caused by psychiatry, the influence of culture and environment on the development of mental health problems, challenges faced by people working the front line in mental health services, the issue of personal vs societal pathology, and the future of the psychiatric profession – all of which I think would be given a fairer hearing in a dedicated episode.

      Please bare with me. I do intend to cover all of these topics and more in the coming months. Stay tuned.

      Thanks, Danny

      Reply
      • Chris
        Chris says:

        I understand Danny – hopefully in time things will expand for you – that first paragraph is interesting:

        ‘I also had to leave out the topic of stigma for the people choosing to enter the profession. For instance, Prof. Simon Wessely has written about his experience of being asked “why a decent chap like you is doing psychiatry”, which he took to imply that so-called “‘decent chaps’ could do better than waste their time in that backwater.”.

        This desire to gain professional acceptance on par with medicine seems to be a major driver in psychiatry- self-interest pushes so many unhelpful things in these cultures.

        Covering the shocking state of mental health provision would be great – It seems that most of the the entire system is looking mostly in the wrong direction in terms of what needs to be ‘treated’ not just for those in obvious suffering but for the staff many of whom are often bordering on burn out – something rarely talked about but obvious when you listen to people.

        This is the case in both primary (IAPT) and secondary services – IAPT has managed to sell the empty idea of ‘recovery’ by boiling it down to how someone scores on the self-assessment tick box of the PHQ9 and GAD7 –these tell us nothing other than someone’s best subjective guess at how they may or may not be feeling in a given moment. Life falling apart around you? – no matter, score below clinical and we have a winner and the government can then say ‘we’ve got X amount of people in recovery’

        How do we recover from disorders in the culture? through awareness and change through collective action but why change the culture when people can be badgered into taking responsibility for self-monitoring always on the look out for those pesky NATS and unhelpful behaviours and attitudes – its just the way you are looking at things, you are your own worst enemy- very helpful ideas to defuse legitimate anger and cultural suffering and obfuscating these distal harms in personal pathology, labeling and drugs.

        I’d like to see a discussion entitled:

        Diagnostic and statistical manual of mental disorders

        or

        Diagnostic and stigmatising manual of mental disorders

        Reply

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