STIGMA-THE INVISIBLE PLAGUE
A Barrier to Treatment of Mental Illnesses

There is a sinister force abroad among us which, like the plagues of the Middle Ages in Europe, and like air, food and water pollution in modern times, though unseen, affects everyone's health and welfare in one way or another, and may cause fatalities. We are not referring to AIDS, SARS, or even Mad Cow Disease, which have caused alarm worldwide and resulted in international interventions, but something more insidious and much more pervasive.

This plague is called STIGMA, as it applies to "mental" (psychiatric) illnesses such as depression, anxiety disorders and psychoses, to those who experience them, their families and friends, and even professionals who treat them.

Stigma applied to a person is a mark of disgrace or inferiority, like the brand once placed on slaves to label them as beings of a lower order than normal people. Stigma is an attitude that, because it is embedded in our minds, acts like a computer virus in our individual and societal control centers. When based on misinformation it is a serious problem indeed, because it affects how we think behave, and make decisions.

Stigma is everywhere, though unnoticed by most, and not always intentionally vicious. It is in our everyday language, as in "crazy," "nut-case," "psycho" and "shrink." It is in our movies and popular television shows; and it screams from newspaper headlines which make the front page if a "mental patient" is involved in a crime, whereas other "routine" violence gets much less attention.

So what is the real harm? Stigma breeds fear, revulsion, derision and contempt, separating us from our fellow human beings, though "there but for fortune, go you or I." It prevents us from taking seriously psychiatric illnesses which affect more than one in five Americans, including children, in any given year, keeping them from being healthy, happy and successful, and in many cases, costing them their lives. Contrast this with the public attitude toward cancer and heart disease, which few would ignore, fail to treat, or joke about.

What are the facts?

1. Serious psychiatric illnesses are based in dysregulation of brain chemicals and circuits, not simply in character or upbringing (though stress and other environmental factors may contribute to their causes). Because the brain is the "command post" for and interconnected with the rest of the body, these illnesses have "bodily" as well as "mental" symptoms, and need to be evaluated, diagnosed and treated by a physician.

2. These are "equal opportunity" illnesses, afflicting many of the brightest, ablest and most talented leaders, scientists, writers, entertainers, artists and musicians, such as Abraham Lincoln, Winston Churchill, Janis Joplin, Beethoven, Vincent van Gogh, Emily Dickinson, Edgar Allan Poe, Leo Tolstoy, Isaac Newton, Judy Garland, Mike Wallace, and the list goes on….

3. Psychiatric illnesses are among the most successfully treatable of all chronic conditions, by psychiatrists and a range of other physicians and professionals, through medication combined with psychotherapy and other means.

4. These illnesses make people miserable and may disable or even kill them (by aggravating conditions such as coronary artery disease, ulcers and hypertension or by suicide). In the United States, untreated depression among workers costs employers more than any other illness in lost productivity and disability payments. Full insurance coverage pays for itself!

5. Yet, because of STIGMA, only a minority of those needing treatment seek and receive it. They are ashamed, or afraid-of ridicule and discrimination. Instead, they often suffer silently, along with their families. It prevents them from understanding that they have psychiatric conditions, which are medical illnesses, and from seeking and accepting help. As children and young adults they tend to do poorly in school and fail to obtain good jobs. Untreated adults, though infrequently violent, are found disproportionately among the homeless or in jails for petty crimes. In the United States, our correctional systems house between 5 and 10 times more mentally ill persons (mostly untreated) than do psychiatric hospitals.

6. American society chooses to pay for disability, welfare and prisons rather than invest adequately in research, training professionals, community-based treatment, supported housing, job training, public education and insurance coverage for psychiatric illnesses. Discrimination is exemplified by lower Medicare payments (50% instead of 80% of costs), by aggressive moves selectively cutting funding for mental health, and exemption of self-funded health plans from the insurance "parity" provisions of New Jersey state law.

The New Jersey Psychiatric Association joins with NAMI-NJ, the Mental Health Association in NJ, and many other concerned groups and individuals to OPPOSE STIGMA through education and advocacy. Join the struggle! Have a heart! Stop the stigma of mental illness! You can help by being mindfully aware of the problem of stigma, choosing to not engage in it, encouraging others not to, and objecting to sensationalistic and insensitive media portrayals. You can support helpful legislative efforts. The public is invited to call our NJPA office and continue to monitor our website for more information about our organization's efforts in fighting stigma, for public speakers, and for information about New Jersey psychiatrists.