Who's+Crazy?+The+mentally+ill,+or+society+for+stigmatising+them?

Name: Tianna Camilleri Student number: n8319286 Tutor: Abbey Hamilton

CULTURAL ARTEFACT [|Who's Crazy - My psychopharmacologist and I.doc]

This artefact is lyrics to a song from a Broadway musical, ‘Next to Normal’. The song, ‘Who’s Crazy/My Psychopharmacologist and I’ is told primarily from the point of view of a mother of two, Diana. After losing her first child, Diana develops bi-polar disorder and the musical tells the tale of her life raising a teenage daughter, while still mourning the loss of her son. This song fits into the storyline when Diana begins to see a new psychologist and he is determining a new course of treatment for her. Other lyrics include her husband grappling with his wife’s diagnosis.

PUBLIC HEALTH ISSUE

Mental health is an omnipresent issue in contemporary society, accounting for 13% of the total burden of disease in 2003 (ABS, 2006). Stigma is an almost expected occurrence for those with mental illness, often to such a degree that it amplifies the problem at hand (Ben-Zeev, Young & Corrigan, 2010). Goffman (as cited in Horsfall, Cleary & Hunt, 2010) commented that “stigma involves a combination of personal attributes and social stereotypes related to a well known ‘unacceptable’ or ‘inferior’ human characteristics”. He is implying that society believes that if a person exhibits behaviours or traits stereotypically representative of a mental illness, they assume the person automatically has this diagnosis. Further to this, the severe stigma related to medicated mental illnesses is so extreme that it often results in non-adherence to such drugs (Sajatovic & Jenkins, 2007).

LITERATURE REVIEW

Mental illness can present in any variety and combinations of illnesses; often making diagnosis treatment quite difficult. Mental illness is described as “condition characterised by a clinically significant disturbance of thought, mood, perception or memory” (Australian Government, 2000). With one in five adults suffering from a mental illness in 2007 (ABS, 2008), it is vital that we address the societal bigotry these individuals are facing, and allow them to live their lives, stigma free.

Research has revealed that mental illness is caused by a chemical imbalance in the brain (Beyond Blue, 2010). While ‘chemical imbalance’ is often the layman’s term used for the aetiology of mental health conditions, correlations between neurotransmitter levels specifically, and certain conditions have been found (Carver, 2009). The primary neurotransmitters that cause mental illness are dopamine, serotonin and noradrenaline (Carver, 2009). The respective level of these is proven to correspond to conditions such as schizophrenia, depression, bipolar disorder, obsessive compulsive disorder and ADHD (Carver, 2009).

Specifically, if a person has high levels of dopamine in their brain, it may cause them to lose contact with reality, leading to paranoia and in severe levels, delusions (Carver, 2009). Serotonin has affinities to depression, obsessive compulsive disorder, anxiety and eating disorders (Carver, 2009). Incorrect serotonin levels is also problematic in times of stress, as stressful situations (particularly prolonged ones) cause the body to use serotonin faster than it can be replaced (Carver, 2009). This leads to ‘chaotic’ and disorganised behaviour, and over extended periods of time this can induce chronic fatigue (Carver, 2009). Decreased levels of noradrenaline promote loss of memory and increased depression. As it is linked to the ‘fight or flight’ mechanism, it also decreases reaction times and alertness (Carver, 2009).

While understanding what causes mental illness is invaluable for researchers in determining appropriate treatment options, it does little to stem the stigma received from society as a whole. Van Brakel’s (2006) research report examined the health related stigma in society and it included a section on mental illness. His research showed that there were many surveys and questionnaires posed to both the patient and wider society that examined their perceptions of mental illness and its impacts on their lives (Van Brakel, 2006). These questionnaires aimed to provide insight into the three primary types of stigma; public stigma, self-stigma and label avoidance (Ben-Zeev, Young & Corrigan, 2010). Public stigma is the stereotypes and behaviours of social groups towards those they are stigmatising, in this case people with mental illnesses (Ben-Zeev, Young & Corrigan, 2010). Self stigma relates to the loss of self esteem and self-efficacy when they take the public stigma and internalise it and begin to believe it themselves (Ben-Zeev, Young & Corrigan, 2010). Finally, label avoidance consists of the patient avoiding seeking assistance and treatment, in order to avoid being ‘found out’ by their peers and thus deflecting any stigma towards them specifically.

Generally, society believes that because a person has a mental illness, that is an intrinsic part of their self, as Horsfall, Cleary and Hunt state, ‘one fact taints the whole person’ (2010). This stigma, whether public or self-stigma, affects individuals with mental illnesses and causes them to become less secure with themselves (Ben-Zeev, Young & Corrigan, 2010). It leads to patients being less likely to confide in their peers and seek help, as they feel they will be judged for their illness if they do (Ben-Zeev, Young & Corrigan, 2010). By removing stigma from society, it will allow people with mental illnesses to live their lives without the fear of being judged or prejudiced for their condition, as everyone has the right to live; the presence of a mental illness should not be an excuse to treat someone as less of a person.

Corrigan and Wassel (2008) suggested three areas they believed could change the attitude of society towards those with mental illnesses. Firstly, they believed protest was important to allow the community to understand that the stigma will no longer be tolerated in their society. This would lead to their second area of interest, education. By educating society on mental illness, what causes it and the factual evidence on the implications for the characteristics of the individuals, they could create an understanding with members of society about mental illness and its manifestations. Finally, they proposed that contact with those with mental illnesses would lead to less stigma as they could observe first-hand that they are not ‘crazy’ or ‘psycho’, but in fact upstanding citizens in society (Corrigan & Wassel, 2008).

In order to allow people with mental illnesses to continue to live ‘normal’ lives, removing the stigma is just the beginning. For a person to live their life as if they did not have a mental illness, not only does there need to be an absence of stigma in their daily lives, but they also require access to talk therapies and medication. Medication works by correcting the chemical imbalances that are found in the brain in the case of mental illnesses, as outlined above. By re-balancing these levels, the neurotransmitter levels are back to a healthy level and thus the patient is in a healthy state of mind (Wyeth Australia, 2009, Sane Australia, 2010).

The presence and use of medication for mental illnesses allows that person’s life to go back to its state before the onset of the illness. This, in turn, can reduce the presence of stigma directed at them; if their symptoms, specifically feeling and behaviours are under control, society would have less reason to regard them as lesser members of society. Unfortunately, non-adherence to medication is increasingly common for a variety of reasons. The two key reasons for non-compliance with medication are the side effects and the stigma related to medication (Sajatovic & Jenkins, 2007). The side effects for anti-depressants and anti-psychotics are quite harsh, with nausea, headaches, sweating, weight gain and dizziness only naming a few (Beyond Blue, 2010). Too often patients find these effects too severe to handle and discontinue medication.

Studies have shown that nearly one in ten patients are reluctant to take their medication due to embarrassment of their illness and resultant treatment (Sajatovic & Jenkins, 2007). If mental illness and medication did not have associated stigma, compliance rates would be significantly higher (Piat, Sabetti & Bloom, 2009). Society may discriminate against those with mental illnesses, but this attitude is further cause for these members of society to avoid treatment for their illnesses and thus magnifying the problem in an impossible paradox.

CULTURAL AND SOCIAL ANALYSIS

There are two social theorists that can be applied to the all-too-common practice of stigmatising the mentally ill in society, the first of which is Durkheim. Durkheim’s theory around suicide can be related to mental illness, as suicide is often a result of mental illness. His theory states that social causes precede personal causes, and therefore people’s behaviour is determined by the family, religious or national group they belong to, rather than personal predisposition (Morrison, 2009, p. 199). He believed that people took their lives (or in this instance, people have mental illnesses) not because they are a result of internal occurrences, but because of societal influences. He believed that certain religious groups, family situations and military status predetermined their mental illness. This correlates with the ‘risk groups’ for mental illness. The most at risk groups for mental illness are females, separated or divorced people, socioeconomically disadvantaged or those with lowered health statuses.

While this is a valid theory to explain the high prevalence of mental illness in society, it does not give cause to the stigma associated. The utilitarian theory could be one explanation as to why this occurs in society. While predominately a moral and ethical theory, it does hold relevance to the stigma issue. The utilitarian theory states that any action is morally right or just if it provides the greatest good and happiness for the greatest number of people (Moreland, 2008). A point also made by Baumann (2007), is that the public may stigmatise those with a mental illness as a genetically in-built ‘survival of the fittest’ response. In centuries past, only the strongest and fittest people were able to maintain society, and those who did not meet this standard we placed in work elsewhere. While humans have evolved significantly from these ideologies, the fundamental basis may still hold true. Prejudice against those with mental illnesses may not be an entirely conscious thought; it may purely be a result of needs to maintain society with the fittest and healthiest people at its forefront.

Albeit instinctual, it is unfair to treat those with mental illness conditions as sub-standard citizens in society, as it is both derogatory and disallowing them to progress in their development. It is vital that the issue of stigma is demonstrated to society in a way that allows the public to understand how their actions can have such substantial effects on those with mental illnesses. As suggested by Corrigan and Wassel (2008), society needs to be presented with protest, education and contact with those with mental illnesses in order for them to create an understanding of their illnesses and how they manifest, rather than allowing such severe prejudice and discrimination to continue.

ANALYSIS OF ARTEFACT AND LEARNING REFLECTIONS

The article I chose to represent the stigma related to mental illness, as well as the use of medication in relation to this is the song ‘Who’s Crazy/My Psychopharmacologist and I’. The lyrics in this song sung by Diana’s husband are ones that I believe relate to the stigma around mental illness; //Who’s crazy –// //The one who can’t cope,// //Or maybe the one who’ll still hope?// //The one who sees doctors// //Or the one who just waits in the car//

This, I believe is her husband wondering what a constitutes a mental illness; by asking who is crazy, his wife with the diagnosed mental illness or him for trying to live his life with the shadow of her illness over their heads. The use of the word ‘crazy’ indicates that he and his wife face large amounts of stigma, to the point where they use the derogatory terms themselves.

These lyrics also discuss the various medications prescribed for mental illnesses and tell of the gruelling task of determining which medication is most appropriate for each specific patient. The final words of this song are those which I find most powerful; //I don’t feel like myself. I mean, I don’t feel anything...// //Hmm. Patient stable.// These lyrics depict the feeling often reported by patients with mental illnesses; after receiving their treatments, they don’t feel like themselves and worse still, they don’t feel any emotion at all. While this means that the negative feelings have been corrected, it can lead to non-adherence of medication as patients would rather suffer with their mental illness than with the consequences of their medication. Furthermore, the words of the doctor, stating that Diana is stable only after eliminating all emotions, implies that people who are medicated for their mental illnesses hold no emotions or feelings, and therefore are open for stigmatisation. Examining the stigma of mental illness, particularly in relation to these song lyrics has really resonated with me that this is a significant issue within contemporary society, potentially more serious than the presence of mental illness itself.

REFERENCES

Australian Bureau of Statistics. (2006). //Mental health in Australia: A Snapshot 2004-2005.// Retrieved from []

Australian Bureau of Statsics. (2008). //National Survey of Mental Health and Wellbeing: Summary of results, 2007’.// Retrieved from []

Australian Government. (2000). //Mental Health Act 2000.// Retrieved from []

Baumann, A.E. (2007). Stigmatization, Social Disturbance and Exclusion because of Mental Illness: The Individual with Mental Illness as a ‘stranger’. //International Review of Psychiatry, 19//, 131-135. doi: 10.1080/09540260701278739

Ben-Zeev, D., Young, M. & Corrigan, P. (2010). DSM-V and the stigma of Mental Illness. //Journal of Mental Health, 19//, 318-327. doi: 10.3109/09638237.2010.492484

Beyond Blue. (2010). //Antidepressant Medication: Advice for adults// [Brochure]. N.p.

Carver, K. (2009). The ‘Chemical Imbalance’ in Mental Health Problems. Retrieved from []

Corrigan, P.W. & Wassel, A. (2008). Understanding and Influencing the Stigma of Mental Illness. //Journal of Psychosocial Nursing, 56,// 42-48. Retrieved from []

Horsfall, J., Cleary, M. & Hunt, G. (2010). Stigma in Mental Health Clients and Professionals. //Issues in Mental Health Nursing, 31//, 450-455. doi: 10.3109/01612840903537167

Moreland, J.P. (2008). Ethics Theories: Utilitarianism vs. Deontological Ethics. Retrieved from []

Morrison, K. (2009). //Marx, Durkheim, Weber: Formations of Modern Social Thought// (2nd ed.). London: SAGE Publications Ltd.

Piat, M., Sabetti, J. & Bloom, D. (2009). The Importance of Medication in Consumer Definitions of Recovery from Serious Mental Illness: A Qualitative Study. //Issues in Mental Health Nursing, 30//, 482-490. doi: 10.1080/01612840802509452

Sajatovic, M. & Jenkins, J. (2007). Is Antipsychotic Medication Stigmatizing for people with mental Illness. //International review of Psychiatry//, //19,// 107-112. doi: 10.1080/09540260701278911

Sane Australia. (2010). Antidepressant Medication. Retrieved from []

Van Brakel, W.H. (2006). Measuring Health-related stigma – a literature review. //Psychology, Health and Medicine, 11//, 307-334. doi: 10.1080/13548500600595160

Wyeth Australia. (2009). Treatment for Depression and Anxiety. Retrieved from []