Book Review: Written Off

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 the nearby university library. That difference in availability gives some indication of the nature of the book. I didn’t think it was 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 to labelling of 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 that people assume that characteristics of mental illness are inherent in 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 consistent 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 remaining silent to avoid stigma actually maintains it 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 applies 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; however, that’s not always the case. Based on my own experience, I tend to agree. Even when health professionals don’t seem to have stigmatized ideas, 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 (affiliate link).

You can find my other reviews on the MH@H book review index or on Goodreads.