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Why Is Mental Illness Still So Stigmatized?

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After the shooting rampage in Tucson, the parents of the accused gunman released a statement that included this: "We don't understand why this happened."

At this point we can only speculate what happened. There were a lot of red flags in the shooter's behavior leading up to the incident that indicated he was mentally unstable. His Internet postings suggested someone really struggling, though people shade things on the Internet. And, of course, there is that photograph of him -- head shaven, the look of possession, lips slightly smirking.

Yet no one aggressively tried to get this young man committed.

There are a number of things that may have conspired to keep him on the streets. One possibility is what we know may happen when many people have information and assume that another will react. An example is the case of Kitty Genovese, who was stabbed to death near her apartment building in 1964. Her cries for help went unheeded by neighbors who heard them. Surely someone else will step in.

Another possibility is people might fear they will put themselves in jeopardy if they intervene. Will the dangerous mentally ill person come and get me?

Still another possibility is a person may be conflicted about intervening to put someone away: This would be a terrible thing to do to a person, and it should be done only if there's evidence of extreme dangerousness.

Or people don't recognize the signs of mental illness.

You will note that some of these possibilities turn on stigma -- that people who are mentally ill are dangerous, that holding a person in a mental hospital may somehow wrong the person, that failing to recognize the symptoms may be because people don't want to admit to something so stigmatizing to their family or friend - or even a stranger. Best to stay away.

In this case, the fallout of staying away was an act of extreme violence that unfortunately compounds the stigma of mental illness for all who suffer it.

Why is mental illness still so stigmatized?

People who wouldn't dream of saying a racial or ethnic slur glibly talk about nut cakes, lunatics and crazies. Perhaps they stigmatize the mentally ill because society always marginalizes people who are different. Or people may blame the person, not realizing that mental illness is a no-fault brain disease that you can't just will away. Then again they may feel unconsciously that they are to blame. Finally, people may have an unconscious fantasy that mental illness is actually contagious -- so one must stay away.

This is not just an academic exercise for me. I have struggled with schizophrenia for more than 30 years. My outcome has obviously been different than the accused gunman's, but I still suffered stigma. Possibly, like him, I was very resistant to the idea of being hospitalized when I was first ill. How could I bring such shame on my family and myself?

Friends sometimes looked confused or scared when I told them about my illness; and I lost some friends, which was very painful.

So, I understand first hand the effect stigma can have. Stigma is out there and it makes people feel damaged, lesser. It encourages people to be in the closet when being able to get help from friends, when one is suffering, is very important. Stigma's worst effect is that it deters people from accepting their illness and agreeing to treatment. If mentally ill people didn't have the added burden of stigma, maybe more of them would seek treatment. And then tragedies like the one in Tucson would be less likely to happen.

How can we combat stigma? More people coming forward to put a face on mental illness is important, though one must take care when doing this. A media that puts violence committed by people with mental illness in context -- most people with mental illness are not violent -- would be helpful. The media should also report more positive and hopeful stories.

This case will raise important legal issues, for example, whether severely mentally ill people should be ineligible for the death penalty, as some people with mental retardation and some young people are.

But in this moment, we should ponder how we think about and respond to people with severe mental illness. We need either to get them to seek treatment, or force treatment on them. And that will require all of us to resist stigmatizing what we don't understand.

Elyn Saks, professor at the USC Gould School of Law, is author of "The Center Cannot Hold: My Journey Through Madness." A 2009 recipient of a MacArthur Foundation fellowship, she is using funds from her "genius grant" to create the Saks Institute for Mental Health Law, Policy, and Ethics.

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