There are likely a myriad of causes of the stigma against mental illness that so many people hold and it’s also likely that in any individual multiple ideas are at play in fuelling their prejudices. I think that one of those ideas that drive stigma lies in people’s explanations as to what causes mental illness and their perception of the agency of the sufferer in that causation.
(I’m going to write about depression as that’s what I know but I reckon these ideas can apply more or less as well to many other mental illnesses.)
Everyone who has known someone living with depression has ideas about what causes their illness. It’s possible to consider these theories of causation as existing on a spectrum based on the degree of agency attributed to the person suffering. At one extreme (say, zero on the scale) would be the neurobiological explanation: depression is solely caused by an imbalance of neurotransmitters in the brain independent of the events in the person’s life. This positions depression as something that merely happens to a person, something independent of their life and experience, something over which they have no control.
At the other extreme (say, ten on the scale) would be the wholly moral explanation: people are depressed because they choose to be, that they are malingering, that they are self-indulgent and sympathy-seeking. This positions depression not only as something entirely within the person’s control but as a state they are somehow encouraging.
Between these two extremes can be placed all other theories of depression causation such as (in rough order of least to most agency): depression is caused by stressful or traumatic events in a person’s life that result in an imbalance of neurotransmitters in the brain; depression is a pathological but understandable emotional response to stressful or traumatic events in a person’s life; depression results from poor coping skills to stressors/traumas; depression is a weakness of character; etc.
In any individual, differing theories of causation will be attributed to different people they know experiencing depression.
For the person encountering someone with depression, the degree of agency perceived to be involved in causing that depression is likely to be directly proportional to the amount of stigma they may hold to the person living with the illness. The higher on the agency scale the person’s causative theory of depression is in any instance, the more they will perceive the depressed person responsible for their own suffering, the more likely they are to view the person to be inherently morally flawed and the less likely they are to feel sympathy or offer help.
It’s human nature to reason about our lives and experience, particularly to determine the cause of problems in order to discover solutions. In depression it’s often impossible to definitively identify the cause of an episode. In the absence of any clearly identified external cause, sometimes people slide up the scale of agency: “Since I can’t see any reason for your depression, then it must be something wrong with you.”
Looking for causes is not only often futile but frequently pointless. Even in instances where contributing factors can be identified, they may not be able to be removed or modified. Where searching for causes encourages stigma, it’s not only unhelpful but positively harmful.
I think the focus on the cause of someone’s depression diverts attention and energy from the immediate issue: someone is suffering immense pain. If you can’t identify and remedy the cause of the person’s suffering, I’d suggest stop trying, accept what they’re experiencing without judgement, be there for them and give them the love and support they need.
(I’m aware of the irony in arguing for less focus on the cause of events in a blog entry exploring the cause of stigma.)
by auchel
I love the last paragraph of this article. It frustrates me when people try to “fix” my depression without actually taking the time to either understand it, or what has caused the depressive episode. They believe that focussing and taking action on the cause will ultimately remedy the entire depression; and they seem to be oblivious to the fact that I am in tremendous pain and just want someone to be there with me. Not even to help me “fix” the depression, but just as a friend to hang out with.
Same. The people who want to forensically examine why I’m feeling the way I do so we can get it all sorted (preferably by this afternoon so we can still catch a movie) can be pretty exhausting. I guess it’s well intentioned tho’ I sometimes sense it’s more about relieving their discomfort than my suffering. But I truly appreciate those friends that come around (with a DVD so I don’t have to leave the house to see the movie), make a cup of tea, let me be how I am with no judgement and just be with me. That acceptance is more therapuetic than others’ emotional autopsies.
I think it’s important to do both. The current model of ‘understanding’ is detrimental to emotional healing and hope, and is backed by little sound evidence. Thus, attempting to disperse these misunderstandings is very important to helping others heal and not get trapped in a fraudulent system. Psychological explanations often aim to rehumanize and localize treatment for mental illness.
All the while, depression should be dealt with in a subjective, sensitive manner when speaking of an individual basis. The overall picture of peoples’ depression as a whole isn’t as important as the factors in that person’s life that contributed to the depression, but when someone applies a detrimental and poorly supported macro-view to themselves, it is often detrimental to their OWN subjective experience.
So just close your eyes to the theories, and applications of civil policy and therapeutic interventions based on those theories, no matter how awful they are?
We who have been yanked into the debate of causation are talking back to broken brain dogmatists who, you may notice, are the reigning voice, insisting that our distress is meaningless, our life experience has no relevance, and our finite recovery hopeless. We are aliens in need of medication management to keep us from disturbing the sane. This dominant belief is worth investigating for all of us trying to eliminate stigma and discrimination in 2008.
[...] for those passionate about mental health.” My first comment (in moderation) is a response to this wrong-headed post, which maintains that explanations of mental illness contribute to social stigma, [...]
I was not intending to suggest that one should never look for causes of depression. In fact I believe that doing so is not only an essential part of the therapeutic process, it’s can enable people to discover why their distress is not meaningless, how their life experiences are relevant. My concern is where the search for causes aportions blame to the ill person and diverts attention from their suffering.
As to critically examining the social construction of depression, the dominant models of causation, I believe that’s vital. But I think that’s a broader debate than considering the theory of causation that any single person applies when encountering another depressed person. (Although within any individual,obviously, the received dominant models of causation are influential).
I stand by my original argument: in any individual engaging with someone with depression, their explanatory theory and perception of that depressed person’s role in their illness can drive stigma in that instance.
We too are engaged in eliminating stigma.
This stands out as particularly important:
“Looking for causes is not only often futile but frequently pointless. Even in instances where contributing factors can be identified, they may not be able to be removed or modified. Where searching for causes encourages stigma, it’s not only unhelpful but positively harmful.”
We agree. No need to identify cause. We definitely don’t want to go there.
There are actually studies that show that the more people think depression or other mental illness is caused by chemical imbalance or brain dysfunction or genetics and not by the person themselves or their circumstances, the more social distance they want to keep between themselves and that person. So actually when tested your theory doesn’t hold up even though intuitively it may make sense. It is not accidental I think that the decade of the brain campaign by NAMI coincided with an uptick in prejudice in the USA against people with mental illness.
When faced with an individual person who is depressed, it really isn’t anyone’s business why in my opinion unless that person has invited them to inquire, I agree with that premise. My own depression currently is actually most likely caused by my raised parathyroid hormone due to my kidney failure, a true organic cause. But it doesn’t make me feel one bit better to know that…
Of course you don’t want to identify causes iamthebrain, it might lead to “gasp” families! And family therapy would be very difficult to impose through force…
>hymes
It’s interesting that you point out that research indicates that stigma seems to be directly proportional to the degree that a person views depression to be biologic and not situational. If that’s true (and I’ve not reason to doubt it as, from your blog, you seem to be far more thoroughly researched than me), then you’re correct: it blows my idea out of the water. But it also raises a couple of questions.
Firstly, why is that so? Since my original idea seems so intuitive (although I’m obviously biased), what is it about an explanation of depression causation that removes any attribution of responsibility from the sufferer that results in the person to want to increase their social distance from the depressed person? Is this stigma or merely discomfort and impotence in dealing with and existential problem for which they have no solution/s?
Secondly, what does this mean for the way depression is framed in society? Is the shift of depression causation in the common rhetoric toward biologic explanations actually increasing stigma? Should we be agitating away from such explanations in order to reduce the discrimination exprerienced by the ill?
I have no interest in being right or wrong in what I’ve written. My only intention in writing my thoughts was to encourage self-reflection in readers and debate. So, from that perspective, thank you muchly for your comments.
The following post on a social anxiety forum goes into the mind of a clearly distressed individual who is finding how pointless life is and the uselessness of finding out the cause does. it’s rather long, but has stuff i was able to identify with
fallingodwnonmyface wrote
“This madness has entrenched me from foot on up. If these are my last words so be it. It is in human nature to be selfish, so I’d rather get the last words for myself then have someone else speak for me with all their bullshit theories.
Freewill has become a big joke at this point in my life. Have I ever had it? I was given the minutest trivial struggles that finally overflowed the den and collapsed on in. On top of that I was given a predisposition I despise. A predisposed combination of genes prone to depression, suffering, misery, complacency, and rapid mood swings. Life would have been so easy if my human nature lacked major depression. [i]And I would have had no complaints whatsoever. [/i] Whether this vulnerability was posed upon me by a Higher Being or through the indifferent process of evolutionary theory is not an issue to examine. Both of the cases seem entirely indifferent and selfish to me. For one I never asked for this so called ‘gift of life’. It was imposed upon me out of my will. And where is truth? There is no way to find it. Whether we try and use reason to prove God, or put “faith” in this unknown- both fail to impress me. Paradoxically both of these futile attempts require ‘leaps of faith’, with the latter threatening eternal damnation for a finite life if one had not lived his life in accordance to God’s word. Whatever word that may be.
This depression has manifested itself in the sickest forms of human inactivity. Some days my mind becomes so blank that I forget who I am. Procrastination takes over in every human affair, organized school work, and errand I attempt. Socializing begins to take great effort, where it otherwise wouldn’t. Learning from past mistakes becomes unheard of. Bad habits continue. Life seems to lack meaning. I feel boring when I’m bored. Hence, I bore others when I’m bored, and that means my family, friends, and self. I depress others when I’m depressed. And this in turn makes me more depressed. I forget what it’s like to be happy. Then I forget what it’s like to be normal. It’s a vicious self defeating cycle of flames. If there is a God, I feel that he is nonchalantly observing this with his omnipotence, which must prevent him from any feelings whatsoever. I observe people of faith and realize…..eh fck it, I’m blaming others again. I don’t blame anyone for this , myself included, because it’s all one big fucking paradox. If this fog lifted I could easily score a girl, maintain my friendships, enter a lucrative and joyful career, have genuine relationships with those I love, relax, hang out, be funny, not give a fuck, and take full control of my responsibilities. But as this things worsens I begin almost not caring, which at the same time causes shame. It’s confusing. The shame and guilt is probably due to giving up on a part of me that wants to stay, and to not flake out on those that be upset over a bad decision.
Should I take medication?Therapy?Meditate?Eat the right foods? There’s such an abundance of bland information and self help material out there that it ruins the seriousness factor out any legitimate solution. Maybe I should, just snap out of it. Anyways like I was saying….”
http://www.socialanxietysupport.com/forum/
posting.php?mode=edit&f=59&p=793032
I apologize for taking up space on the page, i should have just left the link.
But I must add to the discussion, some important pieces.
Once the person starts feeling depressed, his actions and behaviors change. The person begins to notice serious changes start taking place in their character causing symptoms of (insert mental disorder of choice).
The onset of the hardest period to go through. how will the person explain his erratic behavior, better yet how will he control it around his peers and family? These may sound superficial at glance, but it’s obvious how much we think what others think, and what are reputations are like. If the person tries to pull a facade and hide his positive symptoms of let’s say, paranoia, he may say something out of context or character. If the people he is around are not supportive, the person will fall into isolation.
so what about biology? Let’s say this same patient’s mental disorder was the result of his DNA. this patient checks himself in and finds a medication that has reduced his symptoms, and now the patient has learned something significant that others may not know. That he/she had a predisposition to a certain mood disorder. It may even run in the family, and it is not their fault it occurred. BUT now the patient has lost his social support group. they may or may not recall how they acted in the past, they may have (given diagnosed disorder) displayed for example mania, reclusiveness, anxiety, bizzare ideas, etc…..
one may now try to win back their old peers or make new peers but find it extremely difficult. remember, this person is now changed. in some peoples’ eyes who are truly supportive they will always be by their side, while others will have already shunned off the individual because he just completely “went insane” and became a “lost cause”. It’s these attitudes of people that cause the extreme shame in the people dealing with mental illness.
And the study mentioned about people not being attracted to those who preach chemical like theories of depression, makes sense. Everyone wants to play the game where we make choices, and the general population still has a hard time believing that mental illness can be just as expected as a causality in a world war.
I myself made the mistake of disclosing information about my mental health to some friends. Perhaps the effect if greater in men. In a fit of hopelessness I started acting out of character and couldn’t hold in my illness any more. I let some friends know about it. Obviously they were supportive, but I knew in that moment I was someone different in their eyes, or so my thoughts had me believe. Eventually extreme shame intruded me, and I always believed that people could only see the “insane/problemed” version of me, even when I was feeling okay, causing me to feel bad. That vicious cycle stuff. It felt like a great burden to get off my chest, but if I could go back I wouldn’t disclose the information to anyone , given societies attitudes today. For what is this necessity and feeling of having to be open to others and explain their inner demons. I say if you can hide it hide it, but then again look what happened to me. I just couldn’t hide it.
There is another study I read in graduate school many years ago and can’t find now that showed that people were more sympathetic after reading the story of someone who had a car accident that was slightly their own fault than reading the story of someone who had the same injuries but had no fault at all in the accident. So I think it is to do with how humans react to bad things happening to good people more than anything else. If it is not the person’s fault, it could happen to them or their kids too, it makes people uncomfortable. I think people are actually more sympathetic in some ways to people whose cancer they may have contributed to by smoking than they are to young folks who get it out of the blue. At least people seem to always want to know “the cause” behind someone’s serious medical illness in some sense to see it if could happen to them and if it is something that likely couldn’t happen to them, they are relieved if not more sympathetic.
I don’t know what we do with this. I don’t think we want to go around saying people with depression have weak characters etc. On the other hand, there is a strong body of research that shows that a vast majority of people with severe mental illness (not sure about depression on its own) have experienced abuse as children or adults, physical, emotional or sexual. I do think that is an important fact to get out there.
[...] Another related article with a ton of merit and kudos from me. Credit to: http://eliminatethestigma.wordpress.com/2007/12/29/are-explanations-for-depression-contributing-to-s... [...]
Yes. This shift to biological explanations in our own lifetimes did not just come out of the blue. It is driven by NAMI, and funded by the pharma industry. Questions for you:
Why does NAMI drive this theory, despite studies that show biological explantations increase stigma? Why does NAMI ignore those studies? Who, besides NAMI has set up the causation debate between that of bad character or biology? And what is missing from these two possibilities?
The average person believes lived experience (adversity, interpersonal abuse, childhood trauma) cause mental illness. There are “psychoeducation” campaigns intent on changing these beliefs, why? Who funds them? Who profits? Who loses? What is true? The majority of people in psych wards report trauma histories.
Just wanted to say thanks for the discussion. Guess this is why we PRACTICE medicine… people don’t really get to ‘practice’ accounting or economics or engineering.
…and I’m gonna get to decide just who I’d like to practice my medicine on, whether they like it or not.
[...] presents Are explanations for depression contributing to stigma? posted at Eliminate the Stigma of Mental [...]