Does psychiatry worsen mental illness stigma?

4 minute read

Clinical Mental Health Psychiatry

By

Dr Christine B.L. Adams

Should mental and emotional illnesses be lumped together? asks Dr Christine Adams

 

When a person gets depressed over their divorce, they are said to have a mental illness.

When a person becomes psychotic from a manic episode due to their bipolar disorder, they are also said to have a mental illness. But are both of these illnesses mental illnesses? The definition of mental is that which relates to cerebral, brain, cognitive or intellectual processes.

Many disorders occur from problems in the anatomy or function of the brain: epilepsy, tumors, agenesis of a brain area, strokes, Parkinson’s disease, schizophrenia, bipolar disorder, autism, Alzheimer’s and Tourette’s disorder, to mention a few. These disorders can affect memory, thoughts, perceptions, emotions, and movements. Most of these problems or illnesses are called neurological disorders. But some are called psychiatric disorders.

There is also a third category, the non-brain-based emotional disorders such as depression, panic, anxiety, anger, substance abuse and obsessions. These are not caused by brain malfunction or anatomical anomalies. They are caused by our relationship problems with people we live with, associate with, and work with.

Don’t we all have emotional distresses and problems at times due to interpersonal strife? Don’t some of these become emotional illnesses? We all have relationship conflicts of varying degrees that cause us at times to feel depressed, anxious, angry, or sad. When these problems with our mates, children, co-workers, bosses, friends or relatives become severe, then we have emotional illnesses that require treatment.

But, under what circumstance will most people seek treatment? When they are told they have a mental, i.e., brain, illness? Or, when they are told they have an emotional illness that can be more common and which does not mean there is anything wrong with their brain but only that they have some problem in their relationships that requires better understanding and psychotherapy as their treatment?

Stigma is defined as “an association of disgrace or public disapproval with something, such as an action or condition.” We regard mental illnesses with stigma.  And, because we do many people do not seek treatment for fear of this stigma and discrimination.  Such discrimination does occur worldwide. Why do we do this?

My impression is that part of mental illness stigma exists due to psychiatry calling both emotional and mental problems mental illnesses. With mental illnesses, people know that something is wrong with their brain. Their concern is that their identity is uncertain since who they are is sick. This causes enormous distress. With emotional illnesses, something is wrong with how people manage relationships. Brain pathology problems are scary. Relationship pathology is not so terrifying.

Actual psychiatric mental illnesses of bipolar disorder and schizophrenia have a low incidence over centuries (about 1.1 percent for schizophrenia and 2.6 percent for bipolar disorder). They require medications, mood stabilizers, and antipsychotics, along with psychotherapy.  Yet 26.2 percent of American adults have a diagnosis of mental illness. It appears that the remaining 22.5 percent of these illnesses are emotional illnesses that are lumped in with the mental illness category.

If psychiatry would quit lumping the more frequent (22.5 percent) emotional illnesses in with the less frequently occurring  (3.7 percent) mental illnesses, many more people might seek treatment. They just might feel freer to seek out treatment and do it sooner for the common emotional illnesses they share with their neighbors’ friends, family, postman, and barber.  They might be glad to know they do not have a brain problem.

For most people when they break their leg they have no compunction in visiting an orthopedist to set their leg. Shouldn’t psychiatry urge the larger number of people with emotional illness to treat their relationship problems by a trip for psychotherapy?

Please let’s quit lumping mental and emotional illnesses together.  Psychiatry confuses people when it lumps the two. Perhaps by doing so, we can do away with some stigma. Wouldn’t it be great if psychiatry quit looking for emotional illnesses in the brain and helped people understand that relationship distresses can exist free of brain pathology? Our brains process everything in life that we experience, but that is not the same as having a brain problem. Emotional illness arises from the people we live with, associate with, and work with and how we manage our relationships with them.

Christine B. L. Adams is a child and adult psychiatrist.  She can be reached at her self-titled site, Christine Adams, M.D.

This blog was originally published on Kevin MD.

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Dr Lou Lewis
Dr Lou Lewis
8 years ago

Does psychiatry worsen mental illness stigma?
This is a topic that most general practitioners are confronted with on a weekly basis, usually by a patient who says that they are eligible for 12 free visits to a psychologist if they suffer from a variety of fairly benign mental illnesses rather than mental disorder. As this article quite correctly points out there is a huge difference between an illness, a disorder, a reaction to a certain situation such as death of a family member, a reaction to an impending divorce and so-on, and in my opinion the majority of these cases do not fit in with the diagnosis of a mental.
What I am referring to of course is the dreaded item 2715 which states, and I quote, “ The GP Mental Health Treatment items define services for which Medicare rebates are payable where GPs undertake early intervention, assessment and management of patients with mental disorders.”
When I point out to patients that they will be labelled as a patient with a mental disorder for life, over 90% of them do not go ahead and have these free 12 psychologist sessions, and for the 10% who want to I refer them to a corporate medical practice where doctors will do them without any compunction or how it will affect the patient’s future.
When I refer a patient to a psychiatrist the item number is standard item 23 and a print out of the patient’s medical history will show only a standard 23 but if they have seen a psychologist under the mental disorder scheme the item number 2715 will immediately be apparent and any prospective employer will know that this person has, or is alleged to have, a mental disorder.
A recent poll of employers showed that 44% were willing to employ somebody with a mental health disorder with reservations. One of their reservations was that their fellow workers would feel uncomfortable working with someone with a mental disorder and also the fact that some patients with mental disorders are violent and unpredictable.
Unfortunately the item 2715 does not discriminate against a person who has a mild depression or a person who is a raging bipolar schizophrenic or a psychotic. And let’s not forget that these 44% of employers were probably less than truthful in their replies by the fact that they offered reasons why they had reservations about employing mental health patients.

In order to protect my patients future employment opportunities such as working with children, working in security, working in the armed services et cetera, I explain to them that if I feel they truly need to get counselling I have a couple of cousins who will see them privately at a reasonable price as well as a psychiatrist will Bulkl Bill patient for psychotherapy, thus minimising the stigma of having a mental disorder. In truth, in order to save a few hundred dollars now will cost them thousands of dollars in insurance premiums in the future and could possibly even as adversely affect WorkCover claims, especially in cases where bullying or interpersonal relationships at work are causing anxiety.

Unfortunately too many people feel that every time they have an emotional crisis they need to see a psychiatrist or a psychologist, whereas in fact the problem is not psychiatrically based but emotionally based. Unfortunately everybody nowadays wants to have a specific diagnosis for a mental illness or disorder, yet I remember quite clearly when I had
a meeting between a psychiatrist and the daughter of a prominent specialist and the psychiatrist’s diagnosis was that the patient was simply plain mad! I was stunned at first but after a few minutes I realised that the psychiatrist was completely right and no other diagnosis really described this patient.

I urge my fellow GPs to listen to patients and their grievances and not give them a label but rather endeavour to explain to the patient that their reaction to, for example, the death of a loved one and grieving is not a mental illness but a reaction to a very sad occurrence and reassurance is basically what the person wants with the GP listening and giving simple coping remedies , and also taking into account the person’s cultural background as to how they react to their loss. The British use the stiff upper lip, Jews and Arabs and Greeks wail,as well as wear black for over a year in the case of a husband or child who passed away.
So in answer to the question “does psychiatry worsen mental illness stigma” my answer is probably yes.
Regards
Lou

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