Mental illness hurts, but it is something acceptable, a decree from God that we can’t control, but that we can usually treat. Stigma also hurts, but it is not acceptable. The suffering that people experience from mental health problems is not limited to the symptoms of their particular disorder, but is multiplied and expanded by stigma. Our community can and must understand the stigma of mental illness and its effects, and mobilize to reduce it
Stigma and Its Effects
Stigma is when people believe that something about an individual makes them unacceptably different from others, which leads to prejudice and discrimination against them. Of all stigmas, the stigma related to mental illness is so powerful and ingrained in society that one expert, sociologist Gerhard Falk, referred to it as “the ultimate stigma.” These negative attitudes toward mental illness and the people stricken by it are ingrained in us from an early age. Young children disparagingly call each other “crazy” or “weird.” Children who act out or are more hyperactive are often labeled as “bad kids,” and those who have trouble learning are labeled “dumb.” Emotionally sensitive children are called “cry babies,” and those who can’t keep their finger on the place or finish their work on time are “lazy bums.” These kids are often rejected by their peers — an experience that has long-term negative consequences for any child — which only makes their problems worse. By adulthood, the majority of people hold negative stereotypes and attitudes towards people with mental illness.
The effects of stigma for people with mental illnesses are widespread and sometimes severe. For example, 70% of employers report being reluctant to hire someone with mental illness, even if it is under control. This means that people have to keep their illness a secret and sneak out to psychiatrist appointments for fear of losing their jobs. Even doctors demonstrate stigma toward mental illness. A study published just two months ago found that the same doctors who effectively help patients manage chronic physical illnesses like diabetes neglect to follow up with their patients when their diagnosis is depression.
The stigma of mental illness also prevents people from getting the help they need to treat their mental illness. Some people have internalized the message that “that’s not what we do.” Others are afraid that getting therapy or taking medication is a crutch or a sign of weakness. Some people are just so afraid for their children’s shidduchim that they believe that deciding whether or not to help their 6-year-old boy with severe distress means choosing between whether or not their 16-year-old daughter will ever be able to get married.
For people with mental illness, stigma makes their struggle a double challenge. They must contend not only with the symptoms and impairment of the disorder itself, but also with the prejudice, discrimination, secrecy and isolation that stigma creates. Stigma makes people with mental illness more aware of their disorder as something that makes them different. At the same time, it makes people afraid to tell others about their problem, even close family and friends, out of fear of rejection or a negative response. (And they’re usually right: most people who do speak up report being misunderstood, ignored, or ostracized by family, friends and colleagues.) These dual effects of heightening people’s awareness of their disorder while also preventing them from telling anyone about it can be very harmful, sometimes with devastating consequences. For some people, that experience of stigma and the stress it causes is what actually brings on the illness in the first place, turning formerly light symptoms into full psychiatric disorders. For others, particularly those who experience depression, the shame of disclosing their disorder is so intense that they suffer in lonely silence, without getting the support they so desperately need. Tragically, this, too, often ends with that person losing their battle with depression and taking their own life – only to have their suicide covered up, as well.
Reasons for Stigma
But why? What is it that makes people feel so negatively about individuals with mental illness? Some of that discomfort has to do with the media, who most often portray people with mental illness as dangerous. This happens in fictional depictions, such as Alfred Hitchcock’s acclaimed horror film, whose most famous scene involves a mentally ill woman stabbing someone with a butcher’s knife, tellingly entitled “Psycho.” This also happens on the news, often in the aftermath of mass shootings, when the news media paint the perpetrators as “mentally ill” without providing the context of the broad range of mental illnesses.
In our communities, stigma is also closely related to shidduchim. Families looking for a match for their child fear that an individual with mental illness will taint the family’s gene pool, leading to generations of mentally ill offspring, and even generally, be a poor spouse. Families in which any member has a diagnosis — whether it’s a child who is dating and has depression or a 6-year-old brother who has ADHD — are terrified that someone will find out.
Disorders are most likely to be stigmatizing when people generally believe that they are not “real” illnesses, or that they are within the person’s control. Thus, for example, when people, instead of educating themselves, hold the view or comment that ADHD is just: concocted by drug companies, an excuse for laziness, a way to score Adderall, a result of poor parenting, etc., they are actively contributing to the stigma that people suffering from ADHD must face. Such openly dismissive attitudes can also lead people to think of mental illness as some kind of moral flaw in the individuals themselves, which further increases the shame associated with the illness. It also makes people internalize the stigma of the outside world and to turn it on to themselves.
What Can You Do?
Once we truly appreciate the magnitude of the problem of stigma in our community, the next, essential thing we must do is to accept responsibility for and commit ourselves to addressing it. Over the years, numerous heroic people have come forward and shared their own stories of mental illness for the sake of the klal. Some notable examples include Rabbi Nathaniel Helfgot’s 2001 Jewish Action article about depression, Temimah Zucker’s writing on eating disorders, and Ruth Roth’s recent incredibly powerful essay for the Jewish Week on losing her son to suicide. However, it can’t keep being that the onus of ending our stigma is on its targets. It can’t keep being that we expect people with mental illness to be the big ones and expose themselves before a community that hasn’t made the efforts necessary to hear them without judgment.
No, stigma and its consequences are problems that belong to every one of us, both because we must each look out for every Jew and because we, as members of the community, all share responsibility for sustaining the stigma. Moreover, that responsibility is supported by numerous positive and negative mitzvos, including “Lo taamod al dam rei’echa,” — not to stand idly when your fellow Jew’s life is at risk. Perhaps even more appropriate to this situation is the mitzvah of “Vchai achicha imach,” literally meaning “and your brother shall live with you.” Regarding the stigma of mental illness, this mitzvah takes on two meanings: (a) to save a friend’s life (c.f., Sheiltos 147:37 and HeEmek Sheailah, loc. cit.) and (b) to end the rejection and isolation caused by stigma and literally allow our brothers to live with us.
With that sense of responsibility, one of the most effective ways to combat stigma is through education. This means educating yourself and others about mental illness and what it’s like to suffer from it. Go online, to sites such as: apa.org, nami.org, nimh.nih.gov, and time-to-change.org.uk. Read memoirs of people who suffered from mental illness, such as An Unquiet Mind by Kay Redfield Jamison, and Blue Genes by Christopher Lukas. Encourage others to become educated, too. Speak to your children about it, and encourage your Rav to address mental illness and suicide in shul. The more we know and the more we can speak about mental illness, the more it demystified it will become.
The other method that studies have found works for stigma reduction is contact. It’s simple: the more contact one has with people who suffer from mental illness, the more they will be comfortable with and accepting of those people. Mental illness sufferers are all around us — they’re just undercover. A 2014 government study found that during the previous 12 months over a quarter of all Americans had suffered from symptoms sufficient for diagnosing a mental disorder. Reach out to a friend who seems to be suffering. You don’t need to ask if they have a diagnosis, just a simple, “I was thinking of you” will do. But if you are sincere about being a safe person for people to open up to, they very well might. Even if someone is not your friend (or maybe especially if they are not), find the person or the family in shul that just doesn’t seem to fit in — the ones that might seem a bit awkward or unsure of themselves, the mother who never seems to brag about her child’s accomplishments with all the others — and invite them for a meal. Don’t make them your mitzvah; be genuine and friendly. You never know how much it might mean to them, and you never know how much it might end up meaning to you.
People in our community are suffering because of the stigma of mental illness. Each of us has the power to help chip away at that stigma, if we’re willing to use it. This issue has particular relevance and urgency now, as we stand in the period of sefiras ha’omer, when we are charged with building our middos — especially our love and respect for our fellow Jew. As it happens, May is also Mental Health Awareness Month, during which people and organizations across the country work together to fight stigma, educate the public, increase support and improve care for people who live with mental illness. Let’s seize the moment to move ourselves and our community forward, to be more accepting and understanding, and to ease the unnecessary pain of our brothers and sisters.
Bin Goldman, PsyD is a licensed psychologist conducting evaluations and therapy on the Upper West Side and in Teaneck, NJ. You can reach him at doctor@bingoldman.com, or via his website, bingoldman.com.