Bust the Stigma
“I HAVE got a new job. Should I tell my prospective employer that I have had Schizophrenia earlier?” asked the young man who had been on treatment.
This is a common question for which we, psychiatrists, don’t have a clear answer. There have been mixed results when we had suggested that they disclose their history of illness to their new employer. Some companies accepted them without any hassle but some revoked their appointments on medical grounds.
There is no database of companies that discriminate on the basis of one’s past history of mental illness. Such a database can be developed by sending two sets of fictitious CVs with the same credentials — one claiming to have past history of mental illness. The resulting database could help in deciding whether one should disclose or withhold information about past illness. In the absence of such a database, the advice is to disclose information if it is specifically asked for in the medical examination. If not asked, they need not volunteer information.
With early treatment, most persons with Schizophrenia recover and go back to whatever profession or occupation they were doing prior to their illness. And work well at that. His or her career potential depends on aptitude, talent, ability, motivation and willingness to work hard. The same determinants are applicable to others also. Prolonged illness with untreated Schizophrenia does bring down motivation levels and interferes with one’s occupational functioning.
It is presumed that knowledge about an illness leads to improvement in one’s attitude towards it and that, in turn, would lead to favourable behaviour towards those afflicted with the illness. Knowledge about mental illness is very low. In addition, there are many misconceptions about them. These lead to negative attitude and stigma.
One common misconception is that a person with Schizophrenia has a split personality, like the classic Jekyll and Hyde. This is not true. The prefix Schizo means “split”. Schizophrenia is a misnomer but, for historical reasons, the name has remained. Schizophrenia is an illness characterised by specific symptoms like delusions, hallucinations and other thought disorders. The personality change due to the illness is consistent at all times. There is no split personality.
Descriptions like Schizophrenic art, Schizophrenic city and Schizophrenic coalition in newspapers and magazines use the word “Schizophrenia” in an ignorant and stigmatising way.
Another misconception is that persons with mental illnesses are dangerous and unpredictable. The media too contributes to this myth. In a news report about a crime, if the perpetrator had a history of mental illness, this is focussed on to the extent that people associate mental illness with a particular criminal behaviour. Movies and television serials too contribute to this stereotype.
Those with mental illness are no more or no less violent or unpredictable than the so-called normal people. When there is violence, it is associated with alcohol or substance abuse or when their safety is threatened. The same reasons hold well for violence in general population too.
Stigma also prevents people from acknowledging their illness, seeking medical help and remaining in treatment, in spite of adequate medical facilities available. “What if somebody sees me in a psychiatrist’s waiting hall?” This avoidance is declining these days, as people are more open and also tend to discuss their illness with others. This is evident by the fact that old patients refer a substantial percentage of new patients to psychiatrists.
Improving awareness about mental illness can reduce stigma. School and college students are very amenable to information about mental illness and their attitude and behaviour becomes favourable.
What about those who portray mental illness in a stigmatising manner? The National Alliance for Mentally Ill (NAMI), a self-help group in the U.S., has a section called “Stigma busters”. If there is a stigmatising scene or depiction in a movie, TV programme or advertisement, the group writes to the concerned people to set it right. They also request others to send e-mails. On most occasions, the producers have obliged. India needs its own version of stigma busters.
This article was first published in The Hindu on 10 Oct 2004 to coincide with World Mental Health day.