I wonder how many of you, when you read the webpages Chapters One to Four assumed mental illness. (If you didn’t make it through then I definitely won’t hold this against you). Probably most of you will have thought psychiatric issues, especially given the URL and the overall flavour of the blog. However I wrote these pages carefully to mix things up and maybe make you think cancer. Why did I do this? Well to see if reading my story with the illness cancer compared with Bipolar Spectrum Disorder would make you think differently.

For those of you, who being honest with yourselves, felt you would treat me the same, I genuinely applaud you. Why? Because despite advances in mental health awareness and understanding, stigmatisation is still rife.

So why do we stigmatise mental health still. After all you can’t open a paper at present without a story of a celebrity admitting their experiences of poor mental health.

Stigma has various definitions but one that stands out from the USA in the 60s is a mark that signals to others that an individual possesses an attribute reducing them from whole or usual to tainted or less than whole. This appalling description translates into seeing the stigmatized person as “less than fully human” potentially due to physical deformities or blemishes of individual character like mental illness or race, gender, religion.

So stigma represents discrimination caused by prejudice leading to opinions and behaviours that negatively affect the individual or group.

A frequently held (but often denied) stereotype is that people with a mental illness are responsible for their condition. Two types of this have been described. Onset responsibility occurs when by a voluntary action the person contracts a disorder, or that they were exposed to mental illness and absorbed it as a result. Offset responsibility describes a failure to resolve health conditions by not fully engaging in treatment. These two descriptions most accurately describe my own experience and interestingly my own opinions when I am unwell.

Also damning is the fallacy that people with a mental illness are dangerous and unpredictable. Resulting terror encourages extremely prejudiced discriminatory behaviors: avoidance and withdrawal. “Anyone mind if this person with schizophrenia moves in next door?” Despite the statistics I’m sure many of you would have a negative reaction, especially if you compared changing the word schizophrenia for cancer.

It is interesting that when the neurobiological theories for the aetiology of many psychiatric illnesses emerged that the onset responsibility opinions did not really change. Maybe time has improved things somewhat but the cognitive effort versus biology and genetics cause of mental illness imbalance still exists. True, mental health illness is complex and multifaceted but one study showed that paradoxically a genetic basis for mental health disorders can actually increase stigma due to disease permanence and heritability.

So what to do. Well most research suggests a 3 pronged approach. Public, Self (patients) & Language avoidance

For the public, similar to other described health research successes, we need education programmes, public awareness campaigns (even going as far as protests if necessary) and time. The good news so far is that we as an international population are more sophisticated, more open with better disclosure, recognition and responses. But it’s not all sunshine and roses. Despite the advances, studies show social acceptance remains poor with rejection of individuals from a myriad of societal groups and exclusions from ‘normal’ population activities. Interestingly research has shown that similar mental health conditions are viewed much more sympathetically and accepted in child and adolescent compared with adult populations.

Helping ‘Self’. This area is undergoing change, maybe assisted by technological advances in communication, social media and the internet. This has allowed sharing of stories and experiences, peer support and self help groups. Advances in mobile phone applications has helped developed self management programs which encourage self analysis, a deeper understanding of how ‘self’ is and subsequent wellness action plans.

Finally we may also be able to change the stigmatising language that we use. This is often embedded with prejudices and assumptions that predicate practice and can interfere with potential diagnoses and treatments. Anyone ever heard “the treatment you’ve been taking, it’s failed”. Changing language to “Unfortunately on this occasion it has been unsuccessful” can be a game changer to those in the middle of mental health turmoil but with greater appreciation of changing the stigma of self-blame that still exists.