Book reviews, Stigma

Book review: Written Off

Book cover: Written Off by Philip Yanos

Written Off: Mental Health Stigma and the Loss of Human Potential by Philip T. Yanos wasn’t available from the local public library, so I got a copy from my alma mater university library. 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. 

I read parts of the book while my concentration was quite poor, and the layout was actually pretty conducive to reading the section overviews closely and then skimming the more detailed subsections.  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 the label is then applied to the entire person.  The label of mental illness is linked to certain assumptions, and those are applied when someone is labelled as mentally ill.  All future behaviours are viewed in the context of the label; as a result, behaviours and then the person themselves 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. The problem is, characteristics of mental illness are assumed to be inherent to the individual and immutable.  I find this so interesting, because intuitively likening mental illness to physical illness this way seems like 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 with a history of mental illness can be stripped of custody rights to their biological children. This is based solely on the assumption that having a mental illness makes someone unqualified to be a parent.  New York State is one example, which surprised me, given that it seems like a fairly progressive state.

The author explains that people who self-identify as conservative tend to have more stereotypes about people with mental illnesses. This holds true even when taking into account the level of education and prior contact.  This is something I would have suspected but not necessarily thought up it would turn up in research findings.

One chapter describes how internalizing stigmatized attitudes can lead 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, it actually maintains 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 stigma by association, which is applied to family members and mental health professionals.  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 overall, mental health professionals tend to have less stigma than the general public, but that’s not always the case.  Based on my own experience, I’m inclined to agree.  Even when health professionals don’t seem to have stigmatized idea, if colleagues start mixing into the “patient” category, all of a sudden it’s far less acceptable to have a mental illness.

The chapter devoted to peer support mentions that while peer support interventions have shown good results for some people, formal services have fairly high dropout rates.  For me, the informal support of the online mental health community is a much better option. I don’t see myself ever accessing formal peer support programs.

The final chapter states 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!

Written Off is available on Amazon.

You can find my other book reviews here. There’s more on stigma on the Stop Stigma page.

book cover: Making Sense of Psychiatric Diagnosis by Ashley L. Peterson

My book Making Sense of Psychiatric Diagnosis breaks down the different categories of DSM-5 diagnoses, explaining the diagnostic criteria and providing first-hand stories of the various illnesses.  It’s available on the MH@H Store, as well as Amazon and other online retailers.


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9 thoughts on “Book review: Written Off”

  1. LOL! Skimming gave you a geat insight to the book you’ve read.
    I believe in a broader discussion than hiding the fact that we have a mental illness. However, that being said… The only family member that I can discuss this with is my mother, other family members discarded me as if I was trash for having an illness.
    I embrace my “freakness” as a means of trying to help and educate people through my own experiences.
    Thank you for sharing this book review. 😊

  2. FREAKNESS!!

    It’s too bad this book was too dry and scholarly!! You probably read it better than I would’ve. I’d most likely have DNFed. It’s hard to read academic stuff!!

    I guess that’s possible about conservatives, but I’m a Republican, and I’m totally mentally ill. Huh! My dad watches a lot of FOX news. I’ve never heard them say mean things about mentally ill people, but they do believe that guns shouldn’t be sold to people with mental illnesses. I have to agree–I wouldn’t trust myself with a gun!!

  3. Sad to say, I think I score highly on the mental health self-stigma scale, and also if I replace ‘mental illness’ with ‘autism’. Maybe it will be easier to see my thinking errors now? It is hard to know who and how to share my story with, especially as autism makes judging social interactions difficult for me in general. That may be one reason I find it easier to have social contact through my blog, because then I know what people know and if they stick around, they usually won’t say anything unpleasant.

      1. Hmm, that’s a hard one. A lot of my low self-esteem is rooted in my childhood experiences, not so much how I was taught to see myself, but how I ended up seeing myself as a result of things like bullying and not fitting in at school. I think the self-stigma flows from that lack of self-esteem. I wasn’t brought up to think negatively about mental illness per se and my parents are really supportive of me both regarding mental health and autism.

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