I first heard of the book Written Off: Mental Health Stigma and the Loss of Human Potential by Philip T. Yanos on a blog post by Don’t Stigmatize Me. It immediately went on my list of books to read, but it’s taken a while to get around to it, and I ended up getting a copy from my alma mater university library because the local public library didn’t have a copy.
That difference in availability gives some indication of the nature of the book. I didn’t find it overly textbookish, but at the same time it’s not a light and fast read. Parts of the book I read while my concentration was quite poor, and I found the layout was actually pretty conducive to reading section overviews closely and then skimming the subsections that went into a lot of detail. It’s pretty information-dense, so to read it without any skimming would require some commitment. However, there was a lot of valuable information, so I’ll try to cover the key points here.
The author explains that unusual behaviour may initially lead others to label the behaviour, but then this label comes to apply to the entire person. The label of mental illness is linked to certain assumptions, and when someone is labelled as mentally ill, those assumptions are applied to that individual. All future behaviours are viewed in the context of the label, and behaviours and then the person themself will be “written off”. It’s a huge leap in logic, yet one that happens so automatically.
According to the book, emphasizing diagnostic labels and the biological basis for illness can actually increase stigma, as it suggests that the perceived undesirable characteristics of mental illness are seen as inherent and immutable in the individual with mental illness. This is something I find so interesting, because logically you would tend to think that presenting mental illness as being no different from physical illness would generally be a good thing.
This idea of an inherent, fundamental flaw also shows up in the law. The book points out that in many locations parents who have a history of mental illness can be stripped of custody rights to their biological children, solely based on the assumption that having a mental illness means that a person is not qualified to be a parent. New York State is an example of this, which surprised me given that it’s a state I would have thought of as being fairly progressive.
The author explains that research has found that people who self-identify as conservative tend to have more stereotypes about people with mental illnesses, even when taking level of education and prior contact into account. This is something I would have suspected but not necessarily thought up it would turn up in research findings.
One chapter is devoted to the internalizing of stigmatized attitudes, leading to the development of self-stigma. This internalization tends to be more pronounced in people who have either a diagnostic label or symptoms that are highly associated with negative stereotypes. Research suggests that between 20 to 40% of people with severe mental illness have significant self-stigma. The book mentions the Internalized Stigma of Mental Illness Scale, which you can check out if you’re interested.
The author points out that when people remain silent in order to avoid stigma, this ends up actually maintaining stigma on a broader scale. The first-hand contact experiences that are most effective at decreasing stigma can’t happen without being open about having mental illness.
The book also describes a stigma by association that applies to family members and health professionals that treat people with mental illness. Culture has a significant impact on whether family members report experiencing shame and concerns about their own reputation. It really bothers me to think that people would be ashamed of a family member with mental illness. I can see that there could be an associated social burden, but shame seems very… selfish is the best word I can come up with.
The author writes that while in general mental health professionals have less stigma around mental illness than the general public, this is not always the case. Based on my own experience, I’m inclined to agree. Even among health professionals that may not at first glance seem to have stigmatized idea about those in the “patient” category, once colleagues start mixing into the “patient” category, all of a sudden it’s far less acceptable to have a mental illness.
There is a chapter on peer support, which mentions that while peer support interventions have shown good results for some people, the drop-out rates of formal peer support services are fairly high. I think the online mental health community is an invaluable way to access peer support, and for me it’s a much better option than being a client at a formal peer support program, which is not something I see myself ever doing.
The book’s final chapter includes the message that: “The true alternative to stigmatizing is not just tolerating, but accepting and embracing difference. If we can all accept and embrace the beauty of our own ‘freakness,’ and recognize it as such, we will be much more likely to accept and embrace the ‘freakness’ of others.” Amen to that, and bring on the freaky!
A related post you may be interested in is How can we fight stigma most effectively?
You can find my other book reviews here.
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