via New Scientist
As celebrities become more open about their mental health problems, stigma still ensures most people conceal such illnesses, say two researchers in the field
In recent weeks Ruby Wax and Stephen Fry have once again reminded us that the lives of the famous are not always as perfect as we might think. Not for the first time, these two stars of British TV have publicly discussed their mental health: Wax her depression and Fry his bipolar disorder. Their continued openness furthers a helpful trend among celebrities. But for the vast majority with such conditions, discussion is not the norm.
Stigma and discrimination have long been major barriers to people with mental illness. The same is not true for other conditions: it is inconceivable that a person with asthma or hypertension, for example, would have faeces posted through their letter box to scare them away from the neighbourhood. Yet people with mental health problems report such abuses. Even so, the true scale of these problems has become apparent only relatively recently.
In a global study published last year, we showed that 79 per cent of people with depression had experienced discrimination in the previous year (The Lancet, DOI: 10.1016/s0140-6736(12)61379-8). More than 1000 people were interviewed across 35 countries, and a remarkably consistent picture emerged: such experiences are common and may severely limit how far people with mental illness can lead normal lives. Almost a quarter, for example, said they had been unfairly rejected when applying for jobs. Intriguingly, these figures are very similar to the findings of a previous international study that we had conducted, focusing on people with schizophrenia.
Cycle of exclusion
Perhaps unsurprisingly, people with mental illnesses adjust their expectations to society’s views. The Lancet study discovered that more than a third of participants had not started a new relationship because they expected it to fail as a result of discrimination. For the same reason, 71 per cent said that they wished to conceal their diagnosis of depression from others. The cycle of social exclusion and self-exclusion is therefore complete.
Although concealment is an understandable reaction to being shunned, it creates two problems of its own. First, if employers are not aware that an employee has a mental illness, they cannot adapt the job role or the workplace accordingly. Second, concealment means that fewer friends, family and colleagues know that the person has a health problem, and so their prejudices may remain unchallenged. Most research on discrimination shows that direct social contact between people in good health and people with a mental illness is an important way to reduce stigma.
Concealment therefore reduces social contact and perpetuates stigma. On the other hand, disclosure also brings real risks of discrimination. Those with mental illness are constantly confronted with this dilemma of keeping quiet or opening up.
The consequences of stigma and discrimination can be severe or even life-threatening. The average life expectancy of people with mental illness is at least 15 years shorter than that of the general population in Europe. This is, at least in part, due to less effective treatment by family doctors and hospital staff of the physical health problems of people who also have mental illness: staff sometimes misattribute physical complaints as being “all in the mind”, rather than investigating problems thoroughly.
A further challenge is that, in every country where this has been studied, the great majority of people with mental illness do not get any treatment at all for these conditions. In poor countries this is largely because treatment is not available, but it is now clear that another important reason is that people do not seek help because stigma makes them fear loss of reputation.