Professor Mark Harris
Social Problems 2023
To Fight Stigmas, Start with Treatment
Last fall, British television broadcast a reality program called “How Mad Are You?” The plot was simple: 10 volunteers lived together for a week in a house in the countryside and took part in a series of challenges. The amazing thing was that there were no prizes at the end of the challenges. There was a very interesting concept to the reality show. Five of the volunteers had a history of a serious mental illness, like obsessive compulsive disorder and bipolar disorder, and the other five volunteers did not have any mental illness. The challenges that were meant to elicit latent symptoms included mucking out a cowshed, performing stand-up comedy and taking psychological tests. At the end of the week there was a panel of experts that watched hours of video tape. The panel consisted of 3 people: a psychiatrist, a psychologist, and a psychiatric nurse. The real concept of the show was to see if the panel of professionals could distinguish between who had mental illness and who didn’t. After watching hours of videotape, the experts correctly identified only two of the five people with a history of mental illness. Also they misidentified two of the healthy people as having mental illness. The point that was made is that even trained professionals cannot reliably determine mental illness by appearances and actions alone. The true reason the experts were stumped is because the participants’ most dramatic symptoms immobilizing depression, agitated mania, and relentless hand washing and so on had been treated and were under control. Rob Liddell, the producer, wrote “Having a mental illness doesn’t have to become your defining characteristic and it shouldn’t set you apart in society.” The show “How Mad Are You” might be the first reality show of its kind, but it fits within a well-established category of social marketing aimed at removing stereotypes and combating negative attitudes about people with mental illness. According to Sally Satel, M.D., a psychiatrist, the leading mental health advocacy group in England and Wales, MIND, praised the program for encouraging viewers to re-examine their preconceptions of mental illness. (1) The World Psychiatric Association sponsors antistigma campaigns in 20 countries. In the United States, the federal Substance Abuse and Mental Health Services Administration has a resource center to promote acceptance, dignity and social inclusion associated with mental health. The National Alliance on Mental Illness has a program called Stigma Busters to break down the barriers of ignorance, prejudice or unfair discrimination by promoting education, understanding, and respect for all people who have mental health challenges. That’s just some of the organizations I found that have antistigma campaigns in place. My question is do such campaigns work. According to a 2006 article in Psychiatric services, a journal of the American Psychiatric Association, “education produces short term improvements in attitudes, but that the magnitude and duration of improvement in attitudes and behavior may be limited.” Even though antistigma campaigns are in good faith, they lack a crucial element. No matter how sympathetic the public may be, attitudes about people with mental illness will inevitably rest upon how much or how little their symptoms set them apart. Therefore altering public attitudes would largely depend on whether the mentally ill was receiving treatment that works to stop the symptoms. This would in turn set into motion a self reinforcing energy that the more that treatment is observed by all people, the more that it would be encouraged by all people. We see this in some of the more recent direction of treatment promotions. Psychiatric medications are now routinely advertised on television. The military...