(Article published in Street Speech by the Columbus Coalition for the Homeless)
Robert was a homeless man who hung out across from the old Big Bear on High Street in Clintonville. Local residents, however, called him “the dancer.” He gyrated to his own beat, like someone listening with headphones to music no one else could hears, except Robert had no headphones. He usually seemed happy, why else would he dance? But there were other times when something, who knew what, spooked him and he became agitated- shouting and gesturing wildly. Pedestrians tended to give him a wide berth. He was well known to the police. Mostly they left him alone, but if they received enough complaints they would pick him up and take him to Netcare for a psychiatric evaluation. Usually he was back on the street dancing at his spot within 24-48 hours.
What are most people’s reactions to seeing someone like Robert? Are they afraid and try to avoid getting near him? Do they feel sympathy and want to help him? The answer, we said in Part I of this series, was not an easy one since the issues involved are complex. We began to try and understand the situation by taking a brief historical look at society’s treatment of mental illness right here in America. We saw that except for a brief period of time in the early 19th century when “the moral treatment” approach was in vogue, the attitude of most of society was one of “out of sight, out of mind.” Thus asylums, as they were called then, were generally located way out in the country away from populous city centers. The objective was to limit the disturbing behaviors, not restore the patient to a productive life in the community. Patients were routinely confined to these institutions, many times for life. They were buried in grave yards on the grounds with only a number instead of a name- the ultimate indignity.
How have things changed- or have they?
People tend to fear what they do not understand, and in the case of mental illness in particular, our superstitions and ignorance have led to many beliefs that influenced our perceptions of the mentally ill and in turn, our behavior toward them. Let’s look at just a few of those beliefs and see if any of them are still with us and contribute to the stigma many people still have toward the mentally ill.
Early History
Ancient civilizations in Babylonia, Assyria, Egypt, and the Mediterranean-Near East attributed mental illness to some supernatural force, generally a displeased deity or demonic possession. Demons or "foul spirits" were believed to attach themselves to individuals and make them "mad." The word mad became an early synonym for psychosis. The insane were treated through magical rituals, prayer and exorcism. In Greek and Roman cultures mental illness was thought to be the result of an imbalance in the 4 essential fluids in the body: blood, phlegm, bile, and black bile. Treatments consisted of emetics, laxatives, bloodletting with leeches and cupping to return balance. Even at present in some regions of the world, illnesses, both mental and physical, are thought to be caused by malevolent or misguided spirits, and healers base their practice on removing those entities from the patient. Almost every religion has its 'exorcists' who drive out the bad spirits.
Middle Ages
During this period mental illness was viewed with fear. Affected persons were thought to be influenced and controlled by the moon, thus the term lunatic emerged to describe them. Treatment was influenced by the belief that the mentally ill were evil, witches or heretics. They were therefore excluded from society and confined to institutions where harsh treatment was the norm. They were treated as criminals and punished for their behaviors.
18th and 19th Century
Physicians began to ascribe both moral and physical causes to mental illness. The hospital records for 1876 at the Athens Lunatic Asylum in Athens, Ohio list the leading physical causes of insanity among the male patients as masturbation, intemperance (excessive drinking) or drunkenness. The leading physical causes of insanity among female patients as "puerperal condition" (any condition that affects a mother from the period of the birth of her child until the uterus returns to normal), "change of life," and "menstrual derangements." Other physical causes listed in the record included epilepsy, bathing while overheated, fording a cold creek while menstruating, overwork and the strain of bearing too many children. Moral causes were thought to stem from bad character and included jealousy, religious excitement, disappointment in love, unmarried life, and financial troubles. Family members could have a loved one committed for something as simple as punishment for stealing or disruptive behavior. Even today many people still believe that some forms of mental illness, like depression and anxiety disorders, for example, are attributed to a weak character and can be overcome by sheer will power and determination.
Modern Views
In the first half of the twentieth century, psychiatry was advanced by the discovery of medications that helped to alleviate depression, mania, and psychosis. As often occurs in the history of medicine, physicians stumbled upon solutions before they understood the mechanisms that made the treatment work. Later studies began to reveal that certain patients responded to medications that increased certain neurotransmitters in the brain. Drugs that increased the levels of the neurotransmitters norepinephrine and serotonin seemed to help depressed patients. Similarly, medications that blocked the transmission of dopamine, another neurotransmitter, provided relief for patients suffering from hallucinations and paranoia. These insights have led to the present emphasis on the biochemistry of the human brain and its role in mental illness.
Today we also know that genetics play a big role in the development of psychiatric disorders. Research, for example, has revealed there is a specific gene associated with bipolar disorder (also known as manic-depressive disorder). Similarly, research done on identical twins has provided strong support for a genetic component in the development of schizophrenia.
Current attitudes
Opinions are shaped in large measure by what we read in newspapers, what we hear on the radio, and what we see on television and in the movies. Images of mental illness in the mass media are rarely accurate however. Movie characters like Norman Bates in Psycho or Dr. Hannibal Lecter in The Silence of the Lambs perpetuated myths about mental illness and people’s fears about those suffering from them.
News stories about psychotic-gunman-on-the-rampage also compound the negative stereotypes of the mentally ill and lead to the misconception that people with mental illnesses are violent and have limited potential for positive participation in society.
In actuality, studies have shown that only a minuscule percentage of the violence in American society can be attributed to people who have mental illnesses. In contrast, drug abuse is strongly linked to violence.
These kinds of depictions do not tell the whole story. Hollywood and the news media need to tone down their bias and not just focus on the negative. There is good news out there to report too. Patients do get better with medication and people with mental illness can go on to lead full, productive lives.
As more and more celebrities and public figures reveal their own experiences with psychiatric illness and drug abuse, perhaps the public’s attitude will change. Recent examples include Brooke Shields, journalist Mike Wallace, and Tipper Gore speaking out about their battles with depression and Patty Duke and Jane Pauley sharing their struggles with bipolar disorder.
Studies show that stigma is the greatest barrier to seeking treatment for mental and addictive disorders. No one wants to be the butt of a joke, called “wacko” or “psycho “ or have others avoid them or whisper about them behind their back. Stigma is something that both the homeless and the mentally ill in our community have in common.
Yet even as the medicine and therapy for mental health disorders have made remarkable progress, the ancient social stigma of psychological illness remains largely intact. Families are loath to talk about it and, in movies and the media, stereotypes about the mentally ill still reign.
This was made abundantly clear to a group of nursing students who recently ran an education group for psychiatric patients and their families on the topic of stigma. The patients talked openly about the fear, rejection and misunderstanding they encountered from both family members and employers regarding their mental illness.
Why do we have empathy for someone with a debilitating physical illness, but not a mental one? Despite our modern understanding of a biomedical view of the causes for mental illness, Americans are apparently no more tolerant of the mentally ill than they were a decade ago.
A study at the University of Pennsylvania (Social Science and Medicine, 2008) conducted by sociology professor Jason Schnitker) reveals that in the case of schizophrenia, genetic findings do nothing to assuage people’s fears of violence associated with this disorder. However, when applied to depression the condition seems more real and less blameworthy.
The study went on further to state that, “While the stigma surrounding mental illness has not diminished, the culture surrounding it has become more treatment focused with medications now a mainstay of popular media, but at the same time aren’t associated with increased tolerance levels.”
The study goes on to explore tolerance in terms of social distancing: unwillingness to live next door to a mentally ill person, have a group home for the mentally ill in the neighborhood, socialize or work closely with such a person or have a mentally ill person marry into the family. In all these areas Americans remain basically intolerant. It appears that the “out of sight, out of mind” attitude of generations ago still prevails.
One cannot help but wonder if our continued lack of tolerance accounts for our unwillingness to provide the community services needed to treat those suffering from mental illness. Is this why so many of them are homeless and left to live on the streets, like Robert?
