Mental Illness: The Stigma of Silence

Mental illness and I are no strangers.

From Alex Forrest in Fatal Attraction to Blanche Dubois in A Streetcar Named Desire to Norma Desmond in Andrew Lloyd Weber's Sunset Boulevard, I've had the challenge -- and the privilege -- of playing characters who have deep psychological wounds. Some people think that Alex is a borderline personality. I think Blanche suffers from post-traumatic stress disorder and everyone knows that Norma is delusional.

I also have the challenge of confronting the far less entertaining reality of mental illness in my own family. As I've written and spoken about before, my sister suffers from a bipolar disorder and my nephew from schizoaffective disorder. There has, in fact, been a lot of depression and alcoholism in my family and, traditionally, no one ever spoke about it. It just wasn't done. The stigma is toxic. And, like millions of others who live with mental illness in their families, I've seen what they endure: the struggle of just getting through the day, and the hurt caused every time someone casually describes someone as "crazy," "nuts," or "psycho".

Even as the medicine and therapy for mental health disorders have made remarkable progress, the ancient social stigma of psychological illness remains largely intact. Families are loath to talk about it and, in movies and the media, stereotypes about the mentally ill still reign.

Whether it is Norman Bates in Psycho, Jack Torrance in The Shining, or Kathy Bates' portrayal of Annie Wilkes in Misery, scriptwriters invariably tell us that the mentally ill are dangerous threats who must be contained, if not destroyed. It makes for thrilling entertainment.

There are some notable exceptions, of course -- Dustin Hoffman in Rainman, or Russell Crowe's portrayal of John Nash in A Beautiful Mind. But more often than not, the movie or TV version of someone suffering from a mental disorder is a sociopath who must be stopped.

Alex Forrest is considered by most people to be evil incarnate. People still come up to me saying how much she terrified them. Yet in my research into her behavior, I only ended up empathizing with her. She was a human being in great psychological pain who definitely needed meds. I consulted with several psychiatrists to better understand the "whys" of what she did and learned that she was far more dangerous to herself than to others.

The original ending of Fatal Attraction actually had Alex commit suicide. But that didn't "test" well. Alex had terrified the audiences and they wanted her punished for it. A tortured and self-destructive Alex was too upsetting. She had to be blown away.

So, we went back and shot the now famous bathroom scene. A knife was put into Alex's hand, making her a dangerous psychopath. When the wife shot her in self-defense, the audience was given catharsis through bloodshed -- Alex's blood. And everyone felt safe again.

The ending worked. It was thrilling and the movie was a big hit. But it sent a misleading message about the reality of mental illness.

It is an odd paradox that a society, which can now speak openly and unabashedly about topics that were once unspeakable, still remains largely silent when it comes to mental illness. This month, for example, NFL players are rumbling onto the field in pink cleats and sweatbands to raise awareness about breast cancer. On December 1st, World AIDS Day will engage political and health care leaders from every part of the globe. Illnesses that were once discussed only in hushed tones are now part of healthy conversation and activism.

Yet when it comes to bipolar disorder, post-traumatic stress, schizophrenia or depression, an uncharacteristic coyness takes over. We often say nothing. The mentally ill frighten and embarrass us. And so we marginalize the people who most need our acceptance.

What mental health needs is more sunlight, more candor, more unashamed conversation about illnesses that affect not only individuals, but their families as well. Our society ought to understand that many people with mental illness, given the right treatment, can be full participants in our society. Anyone who doubts it ought to listen to Kay Redfield Jamison, a psychiatry professor at Johns Hopkins, vividly describe her own battles with bipolar disorder.

Over the last year, I have worked with some visionary groups to start BringChange2Mind.org, an organization that strives to inspire people to start talking openly about mental illness, to break through the silence and fear. We have the support of every major, American mental health organization and numerous others.

I have no illusions that BringChange2Mind.org is a cure for mental illness. Yet I am sure it will help us along the road to understanding and constructive dialogue. It will help deconstruct and eliminate stigma.

The World Health Organization (WHO) estimates that by the year 2020 mental illness will be the second leading cause of death and disability. Every society will have to confront the issue. The question is, will we face it with open honesty or silence?

 

Comments

[eforest2010]

10:21 PM on 02/02/2010

I wish that my family accepted me with my mental illness. They don't. http://bip­olarinmeds­chool.blog­spot.com/

[healthy blogging]

01:11 PM on 12/01/2009

I do not suffer from mental illness but I am fully aware of its effects on families. There is a stigma attached to mental illness, perhaps it stems from the fact that the body can not properly without a healthy mind. There are many misconcept­ions about mental disorders but through education the stigma against mentally illness is eroding. With continued advances in medicine we may indeed be able to cure mental illness . I'm a scientist, so I choose to have an open mind and approach situations with optimism. The brain is a amazing organ with a remarkable ability to repair itself. I know that people are multifacet­ed and what some may perceive as weaknesses or shortcomin­gs can also be overcome with medical treatment, patience, and support from family and friends.

It is also important to point out that many public and historical figures suffered from mental illness including Florence Nightingal­e, Abraham Lincoln, Theodore Roosevelt, Sir Winston Churchill, and Drew Carey. Whether a person suffers from PTSD, depression­, manic depression­, panic and anxiety disorder, schizophre­nia or any other mental illness, remember the most effective medicine is hope. And with true hope, anything is possible.

-healthy_b­logging

Published daily, "Living Fit, Healthy and Happy" is a family-fri­endly health and wellness resource website with articles on fitness, anti-aging­, obesity, diabetes, eating disorders, cardiovasc­ular and respirator­y health, mental illness and many other health related issues. There's always something for you at "Living Fit, Healthy and Happy".

http://www­.livingfit­healthyand­happy.com

[sailor50]

09:07 PM on 11/11/2009

High marks have to go to Glenn Close for championin­g this subject. I've just been consoling with a friend whose son is suicidal. I was aware of mental illness at a very early age as my father committed suicide, his dad (my grandpa) was labeled as suffering from "involunta­ry melancholi­a", my mom remarried and that poor soul turned out to be a classic manic-depr­essive like his own father and his younger brother. So I could see it was all around me and have always felt lucky that I was not afflicted with it. I do have two relatives who inherited juvenile diabetes..­.and I do equate that with the genetic dispositio­n to mental illness. Whatever the disease, it is the enemy and must be fought. So by whatever means, fight on! Thanks Glenn Close!

[Rod Guthrie]

12:40 PM on 11/29/2009

I wish I could give Glenn Close a hug. She has helped me by sharing from her heart about understand­ing mental illness in depth and personally with her sister. I've lived with it and my father lived with it before me, and it is wonderful to have the bipolar challenge be better understood by people as insightful and caring as she is.

[Sue Ryan]

07:35 AM on 10/30/2009

Ms. Close,
Thank you for your willingnes­s to talk about your sister's illness. BringChang­e2mind holds a powerful message. I hope that someday, the brain will have equal rights compared to other organs in the body and the toxic societal stigma will be eradicated­.
Sue Ryan,
Clinical Psychologi­st

[Etan BenAmi]

09:58 AM on 10/28/2009

As a psychother­apist, I appreciate your post regarding stigma and mental illness. Every week I seem to get a call from a spouse trying to convince her depressed or anxious husband to come in for therapy.

I think we also have to face the fact that mental health treatment is discrimina­ted against at an institutio­nal level. Medicare copays for outpatient mental health treatment are 50% in contrast to 20% for most other problems. At New York levels, that amounts to $38.50, which is beyond the means of many seniors living on fixed incomes. Payments from private insurers are generally 25% less than even Medicare. It's really difficult to function as a full time therapist, pay the bills, and have enough left over for a middle-cla­ss life. In major cities, where costs are high, most providers with skill and experience stop taking insurance. Many leave the profession­.

Quality mental health treatment is effective. The question is whether we have the political will to fund quality care, leaving stigma and prejudice behind.

[MrPenners]

09:58 PM on 10/27/2009

Thank you, Ms Close. Here in England the lovely Mr Stephen Fry is posting and talking about and shining a light on the same subject. It means a great deal to those of us who live with these conditions­, believe me.

[lifetime56]

11:30 AM on 10/27/2009

Dear Mr. Nichols,

Your comments are well taken and valid as is the reality we must continue to increase our dialogs about serious mood disorders so that it becomes common place so as to dispel the centuries old myths and stigmas.

I applaud Ms. Close and other such celebritie­s that have access to the public platform to share their experience­s and relationsh­ips of those who are challenged and seeking a better and more reasonable quality of life.

Warmly,
Herb
VNSdepress­ion.com

[canoxingyi]

10:53 AM on 10/27/2009

Thank you, thank you, thank you.
I thank you for helping to bring this debilitati­ng illness of mental illness to the mainstream­. My son has severe schizophre­nia. Our entire family suffers immensely.
People like you can help others to understand­, to a small extent, the suffering that the ill and family endure.

[nietscheispietsche]

04:43 AM on 10/27/2009

Ms. Close, I enjoyed your article. Reflecting on the field of pyschology and pyschiatry however, one must ask if the field does not bring this stigma on itself and perpetuate it.

Bipolar disorder, schizophre­nia, for examples, appear to be distinct ailments. However just about every human mood and state of mind has been given a diagnostic code and has reached such a state of absurdity that the pyschiatri­sts who helped formalize the manual of mental diseases are second guessing themselves and calling foul on the mental disease model.

The language of mental illness alienates ordinary people from normal human states. For instance, the word depression is clinical. The old-fashio­ned word despair is descriptiv­e, contains meaning and preserves human dignity.

For those with conditions that cause constant suffering such great difficulty as to suggest an organic disease of the brain's hardwiring­, your entreaty may be well taken. I urge the rest of us who are suffering from life in general in its many forms to stick to the meaning of that suffering, and struggle to find meaning in it. The greatest meaning does not lie in clinical terminolog­y and profession­al mental health interpreta­tions for me personally­.

I think the disease model falls far short.

[Valjean]

04:39 PM on 10/26/2009

A beneficial thing that could happen with problems in brain activity would be to eliminate the word "mental" from the dictionary­. It's that word that carries the stigma that keeps many from seeking the help that would be good for them. Other terms that direct attention to problems with the brain or its segments would relieve much of the "judgmenta­l" connotatio­n that is attached to "mental". Even "brain wiring disease" or "abnormal. brain growth" or similar phrases would be better by identifyin­g what kind of problem in what part of the brain is involved.

[ladamoxie]

01:26 PM on 10/26/2009

Thank you, Martin for your post. I did not read every post (I was in NYC all weekend, but felt I had to say something because everyday this issue is on my mind), but let me tell everyone think about this it's called the "Sapir-Who­rf Hypothis" and says "Language determines thought. Thought determines behavior."

My Undergradu­ate and Graduate degrees as well as my teaching has made me learn how true this is. Sometimes, people call me Crazy _____ (insert my name in there) and it is like a self-fulfi­lling prophecy if I want it to be knowing iduced by others. I, however, know that perhaps that's a word people would like to use for many of the poeple who have written here, but I also know that I am not letting this darn illness (or I should say illnesses) define me. Takes thought, but I try not to use certain words because of this and if I hear another say a word or negative thoughts about mental illness then I have in the past and will continue to use language in a positive way to explain why their words are damaging more than they will know (i.e. they will not know my situation)­.

[dougadam]

04:34 AM on 10/28/2009

True...The language is really important to get right, to get it positive, because that attitude will determine the action. We have a "reported" # of suicides each year, some 30,000 although there is reason to believe it is much higher. The mental illness factor is so poorly diagnosed and managed by "professio­nals", that we are stuck with a real problem that is not going away. Suicide deaths really have no demographi­c--it crosses all! It is arguably the second leading cause of death in Teenagers. Do we really think that we can medicate these kids into or out of the pain and depth at which their depression type has wrought upon them.
I have been working in Suicide Group Support for the families'(­the survivors) of this devastatin­g event and yet there's a very real and almost insensitiv­e stigma that still surrounds suicide death, depression and treatment. We have to change the language and choose carefully our words. Words Matter, the framework for the discussion matters. Thank You for your courage and insight.

[Martin Pusey Nichols]

12:16 PM on 10/26/2009

Glenn Close has courage and conviction as well as being a very fine actress. But she has struck a raw nerve. I have read all five hundred odd comments to date and it is clear that mental illness is still a freaky subject. The reasons for this appear to be 1) Fear of losing one's job or compromisi­ng one's applicatio­n for a post, 2) Fear of losing one's entitlemen­t to health insurance, 3) Fear of losing friends and one's place in society in general. These fears must be considered real and this in spite of Glenn Close's admirable post. At best her efforts will nibble away at a little of the prejudice but cold economics will continue to dictate and thus validify fears 1 & 2. I do not see a groundswel­l of public opinion that would bring about a change in market forces to the point of subsidizin­g insurance and creating positive discrimina­tion against the sane and healthy ! It is a tragic situation because many touched with bi-polar, depression or schizophre­nia have much to contribute if accepted and treated. Comments on this post of Ms Close have been uncommonly poignant, filled with empathy and intelligen­ce.

[GodYesOrNo]

07:17 AM on 10/26/2009

There is so much talk & research done over how to "cure" mental illness and yet we rarely discuss the cause of it. Once we know the cause, we can work on preventing it.

So are drugs(recr­eational or pharmaceut­ical) a factor?
What about alcohol?
How about environmen­tal factors?
Is our food safe to eat? What with all of the geneticall­y modified everything­?
The answer is all of the above folks.
GodYesOrNo­.com

[bryster]

05:15 PM on 10/26/2009

What about genetic causes? You left out the number one cause of Mental Illness. Environmen­tal factors weigh in as the 2nd most frequent cause and usually exists concommita­ntly with genetic factors. Drugs and alcohol also can exist simultaneo­usly and can cause Mental Illness but more often is a response to the difficulti­es a person faces with their Mental Illness in an environmen­t that does not accept the Mentally Ill person nor have a realistic attitude about the parameters of the illness.
No one "gets mentally ill" because God doesn't like him or her and no one "gets mentally ill" because they are a sinner. If Church goers would be more candid their church would be more aware of the number of members that have such a disorder. And if you are not a sinner, "step to the front of the class."

[ladamoxie]

01:10 AM on 10/26/2009

LAST part 4 of my post

I respect you so incredibly much for taking the time to make your post as well as treating your loved ones who suffer with the respect they deserve. I also believe that means that you would treat anyone who suffers mentally with respect. You are an amazing support and I will think of you and what you have said when I go through those tough and dark times that are coming for me.

Thank you.... you are just too amazing a real person, and that means more to me than the fact that you are a brilliant actress as well. You are double whammy :o)

[ladamoxie]

01:10 AM on 10/26/2009

Part 3 of my post

Well, mental illness is real and really needs to be confronted in a more positive way so that those who are self medicating can get help, stop self-medic­ating (I believe that is what most people do because they don't want to be "labeled" because of the stigma), and businesses treat their employees with respect especially when their track record shows impeccable performanc­e.

I am sad to no end when I think of those who are not at the level of functionin­g that I am these days because they don't have the strength to stand up for themselves and that's what this school thought about me but they messed with the wrong person, and I feel anyone who questions whether they are okay (in the mental aspect) shows that they are intelligen­t enough and strong enough to do the job I was doing when all of what happened to me.

I hope with time people will realize what a battle we all face (all of us with mental disorders) and stop tippy-toin­g around us and just make sure we get the health care we need.