6.2 Understanding Stigma

A Family guide to Concurrent Disorders - Part II: The impact on families

Many people are frightened of mental health and substance use problems. One of our deepest fears involves the loss of our abilities to think and communicate, to make our own decisions and to set the course of our own lives. Many people believe that people with mental health and substance use problems and their families may be strange, unpredictable, violent or dangerous.

I think a common belief is that people with mental illness are violent—you know how the media sometimes portrays people. And then you think, are my relatives concerned that my daughter will be violent? And let’s face it, she is often inappropriate and really angry when she’s not well, but she never gets violent with people . . . but a lot of people associate mental illness with criminal behaviour in general.

In fact, most people who are violent do not have mental illnesses. People who have mental illnesses are more likely to be the victims of violence—about 2.5 times more likely—than other members of society. This violence often occurs among those people who are also experiencing other factors such as poverty, homelessness and substance use. Unfortunately, recent research suggests that the public’s perception that people with mental illness are violent and dangerous is actually rising (Canadian Mental Health Association, 2003).

Family members worry about acknowledging their loved ones’ concurrent disorders to friends and acquaintances, and fear rejection by those who know. A main concern is that knowledge of the illness will reduce opportunities for their loved one.

What comes to mind when I think of stigma? My immediate thought is fear of exposure. You know, fear of people’s reactions. I mean, you're very fearful of a change in people’s attitudes toward you or toward your family member who’s ill—and whatever affects the consumer, affects the family.

Many people believe there is no hope for recovery or a future for someone with concurrent disorders. Family members often compare concurrent disorders to cancer. In the past, cancer was associated with stigma and avoidance, reactions that typically stemmed from fear. While cancer still arouses anxiety and fear, most people recognize that today many types are curable and others are treatable. Although concurrent disorders are similar to cancer in that a life of meaningful recovery is possible, they are often not seen that way.

The media

The media often misrepresent the link between mental health problems and violence, and present sensationalized, inaccurate and unflattering stereotypes of people with substance use and mental health problems, as well as of their family members.

Studies suggest that some types of discrimination have actually increased in the past 10 years, partly because of media coverage linking mental health disorders with violent murders (Canadian Mental Health Association, 2003). Media portrayals of mental illness emphasize its chronic nature, violence and criminal behaviour, while portrayals of substance use disorders emphasize poor self-control and hopelessness. Such misleading portrayals increase rejection, ostracism, harassment and victimization of people with mental illness, substance use disorders and concurrent disorders. Inappropriate or careless use of stigmatizing language is also common in the media.

I think the media is smartening up a little bit, but you still hear stuff all the time. I just heard someone on the news the other day say, “Oh, you'd have to be schizo to do that.” Language is tricky, it can really hurt . . . . The media . . . have to be responsible. And we have to make them accountable. I think it’s really important to make people be responsible for what they say and for the messages they put out about other human beings.

The average North American household watches almost five hours of television per day (Nielsen Media Research, 2007). Many viewers don't question the negative images and information that they see.

On a more positive note, the number of documentaries and movies with realistic and sensitive messages is increasing.

Blame

At least there’s more and more accurate information on television about mental illness, about schizophrenia and substance abuse, that at least portrays these people as people, shows their humanity, and the tragedy of their loss.

I compare mental illness and addiction to Alzheimer’s disease because my mother-in-law felt comfortable calling up all her relatives and letting us know that her husband had Alzheimer’s. No doctor blamed her. The community offered all kinds of support and I think that’s because they had known him to be a valid member of society, as a hard-working, neighbourly person for 75 years. And as people get older, we expect some mental degeneration, right? Whereas with mental illness . . . my mother was partially blamed for my sister’s schizophrenia so she started hiding it from people.

For the longest time, I understood intellectually what the disease [schizophrenia and problem substance use] was—but deep down I thought it was my sister’s fault, and if she really tried, she could have more self-control and could act better. But there comes a point when that way of thinking disappears, and you realize that people with mental illness didn't ask for this. This has to be the most horrible thing—to lose control of your own thoughts.

Several years ago, the prevailing explanation for concurrent disorders blamed families for causing and prolonging these disorders. Many parents in the study recalled hearing this from both health care professionals and society in general.

Usually a person with a physical illness is not expected to take on normal responsibilities or to get well purely by an act of will. When the problem is seen as resulting from personal choice, social expectations are often harsher. 

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