Andy Whyman: Reality of mental illness, drug abuse painful to witness
June 18, 2014
Here are some words: Mick, spic, kike, nigger, wop, wetback, gringo. Here are some other words: looney tunes, wacko, schizo, psycho, meth head, pot head, drunk, derelict.
Nowadays, the first list is forbidden in polite society. The latter, however, is more or less acceptable. What both groupings have in common is the demonization of people who are different, different in ethnicity, skin color, or behavior.
It's a story as old as time. People who are like me are OK. People who are different are not. There is a burgeoning social science and psychiatric literature on this phenomenon called stigma research.
Each year, 60 million Americans experience some type of mental illness, from minor disruptions in emotional equilibrium to catastrophic disintegration. Each year, mental illness affects one in four adults.
Over 100 million Americans have used illegal substances. Each year, more than 22 million Americans 12 and older — nearly 9 percent of the population — use illegal drugs.
Most of them, aside from marijuana users, have associated mental health problems, particularly anxious and depressive problems, which drive their drug use.
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Yet, while mental and substance abuse problems create enormous human misery in the form of fractured lives, broken families, and abandoned dreams, we tend to make pronouncements and pass laws as if these afflictions are due to weakness of character or personal moral failing.
Thus, we end up with a primitive, underfunded mental health system while our jails and prisons overflow with nonviolent offenders, most of whom have mental and/or substance abuse problems associated with their "deviant" behavior.
How did we end up with a country that abandons the mentally ill and has the highest incarceration rate in the world?
Stigma provides a partial and powerful explanation.
Stigma is a mark of disgrace, shame, dishonor and /or humiliation.
Stigma occurs when a person with an attribute deeply discredited by society, i.e. mental illness, is then rejected by society as a result of that attribute.
Stigma produces negative attitudes and false beliefs about mental disorders.
We proclaim such unfortunates to be dangerous, violent, unhinged, unstable or worse, when in fact the overwhelming number of people with these problems are withdrawn, removed, isolated and lonely. They are far more likely to be preyed upon by criminals than to commit criminal acts against others.
The reality of mental illness and substance abuse is painful to endure and painful to witness. Hard to make that into a best-selling show — so instead, 2/3 of the time the mentally ill are portrayed on television as crazed killers or pathetic victims.
Stigma is a major barrier for individuals with mental and substance abuse problems as it interferes with community living due to the pejorative and negative stereotypes others have about you. Stigma interferes with obtaining community resources such as gainful employment.
Stigma further erodes your already damaged self-worth because added to your other problems you also feel stupid for having those problems. Stigma isolates and humiliates the families of those with mental and substance abuse issues.
Stigmatizing those with mental and substance abuse problems has other social consequences.
For example, stigmatizing this population justifies the application of social controls. Such controls can include involuntary psychiatric commitment, involuntary forced feeding of those so committed, or involuntary medication "treatment."
By stigmatizing illegal drug users we create and justify punitive enforcement-led approaches which criminalize their behavior under the umbrella of "criminal justice."
Stigmatizing certain behaviors ultimately debases both parties and erodes the social contract that binds us together. By exaggerating differences between "them" and "us," we increase our social distance from "them," dismiss their troubles as evidence of weak character, and inadvertently aggravate the very problems we seek to resolve.
How can we combat this all two human propensity to create we versus them dichotomies, to ally with and reward "our kind," while extruding and punishing "their kind?"
Really, it's simple in theory, but hard to implement in practice. Learn to empathize with the dignity and worth of those afflicted with mental and substance abuse problems. Put yourself in their skin for a moment. View the world through their eyes.
Try imaging what a day, a week, a lifetime with substance abuse and mental illness is like. How do you feel knowing that others view you as odd or different or crazy?
How do you manage carrying the stigma of being a convicted felon because you were caught using illegal drugs?
Ultimately, understand that but for the gift of your genes, your biochemistry, your good fortune in growing up in a secure and loving world, and yes, your perseverance and determination, you could be one of "them."
Incline Village resident Andrew Whyman, MD, is a clinical and forensic psychiatrist. He can be reached for comment at firstname.lastname@example.org.