When I served as president of the American Psychiatric Association, many will recall that the theme I chose was "Overcoming Stigma." That was in 1989--21 years ago. I actually began my anti-stigma career a few years earlier, in 1982, when I delivered a talk titled, "The Enigma of Stigma," at the American College of Psychiatrists meeting, and that presentation was a resounding success.
Stigma against mentally ill patients and their caretakers has existed for as long as I can remember. Our patients were ridiculed by attendings and nonpsychiatric residents when I went to medical school, and I was often ridiculed because of my interest in, and eventual choice of, psychiatry as a specialty.
Jokes about psychiatry have been rampant for decades, and it seems that virtually every issue of The New Yorker includes at least one cartoon with a couch. At one point during my early years, the stigma got so bad that I decided to become an internist. But that idea was quickly extinguished during the first rotation of my internship. I was on the medicine ward, which had 40 beds. One resident and I were tasked with caring for them. Thirty were dying, and there was nothing we could do. The experience was depressing and discouraging. With only a few drugs available and very little technology, we saw the specialty as hopeless. So I switched to psychiatry and am very thankful that I did not go into internal medicine. My father was very upset by my decision and took back the black bag he bought me when I graduated from medical school For him, my choice of psychiatry was a colossal disappointment.
Shared Perceptions in America
My own experiences correlate well with the British survey findings. We are plagued by continual stigmatization of our profession, treatments, methods, and, in particular, Freud. Delving into the mind has always frightened people; the idea of seeing someone who is "insane" is terrifying, because people always fear that they, too, might share the same fate.
Countless families in America are disrupted by mental illness or drug and alcohol addictions. Spouses and children are traumatized by the behavior of the disturbed patient, and word gets around that someone "crazy" is living in that house. Concerns about stigma are even more pronounced among members of ethnic and racial minority groups. African Americans, for example, are far more likely to discontinue treatment for depression than are their non-Latino white counterparts (Depress. Anxiety 2010;27:485-94).
All labels that imply mental or brain impairment cause a big reaction in people and in their families. It's a stigma, a mark of disgrace, something that can never be removed.
The media have contributed a great deal to the stigma against the mentally ill and their caretakers. "Psychiatry and the Cinema," by Glen O. Gabbard and Krin Gabbard (Washington: American Psychiatric Publishing Inc., 1999), reviews many of the films in which a main character is a psychiatrist. Very often, the psychiatrist is seen as ridiculous or crazy. Many of these psychiatrists are very memorable, ranging from those in "High Anxiety" to "Psycho."
There also is the implication by print and broadcast media that every bizarre crime must have been committed by a lunatic. The subtext of these stories is that no one in their right mind would do such a thing. And unfortunately, as it turns out, some crimes are committed by people suffering from mental illnesses--but in a relatively small number of cases.
However, we know now that in the Virginia Tech murders, the perpetrator was disturbed. Another crime that was committed by a person with mental illness was the 1981 attempted assassination of President Ronald Reagan. John W. Hinckley Jr., whose verdict was not guilty by reason of insanity, was diagnosed by the court with psychotic disorder not otherwise specified, in remission; major depression, in remission; and narcissistic personality disorder (John W. …