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Breaking the taboo

Individuals with mental health issues have to combat stigma, criticism and social isolation besides dealing with the actual disease. Gabriel Ellul says that our reaction to mental illness can increase or decrease the burden on affected persons.

Imagine surviving a car crash with multiple injuries. You awake in hospital unable to experience anything except excruciating pain. You would expect to find your family and friends beside you, ready to support you through the recovery period.

Now imagine what would happen if you start struggling with low mood or anxiety, and have no motivation or enthusiasm to navigate through the day. Very basic tasks become a huge chore. One would hope that our family and friends would provide the same support. Unfortunately, with regards to mental illness, this is often not the case. So over and above battling the symptoms of the illness, a person suffering from mental health issues has to combat stigma, criticism and social isolation.

All health conditions, be it medical or psychiatric, pose a significant burden on the individual and one’s supportive system. But a condition which is easily visible and causes impairment, such as a fracture, is more likely to elicit empathy and support. It may also lead to more favourable conditions in order to facilitate recovery: more help at home, better hours at work and being excused from certain duties.

Consequently, the social reaction to the disease mitigates the effect the disease has on the individual.

On the contrary, the stigma related to mental illness increases this burden. Stigma results from attitudes perceiving mental illness as “scary”, resulting in discrimination.

People may believe that individuals suffering from mental illness are dangerous

People may believe that individuals suffering from mental illness are dangerous, that their illness is self-inflicted and that they are difficult to approach.

These examples relate to “social stigma”, wherein the individual suffers as a result of society’s attitudes to one’s psychiatric illness. Some schools of thought criticise the attribution of a diagnosis, as this is believed to increase stigma by causing a subjective distinction between normality and illness.

Another type of stigma is ‘perceived stigma’, wherein the suffering individual shirks away from seeking help for fear that he will be stigmatised.

These perceptions will isolate the person, rendering one less likely to engage in treatment and to inform family and friends of one’s turmoil.

All this stress is exacerbated through numerous episodes in which mental health is depicted in a negative light. Some old practices shown in movies are no more, yet their effect remains, propagating our fear of mental illness. Every time Mount Carmel Hospital makes the headlines, it is due to a tragic incident. Unfortunately, all this adds fuel to the notion that individuals who are hospitalised are problematic.

These negative portrayals overshadow the tremendous work provided by dedicated service providers who work within a multidisciplinary team to help individuals overcome their illness and return to their usual lives. This ‘ethos’ incorporates the very scope of the local psychiatric services.

The Maltese are known for their outspoken habits.

We tend to blame one another, to find fault in others, instead of trying to understand ourselves better. This is even more so with regards to mental health.

Since we are a small society, with a population which is considerably interrelated and familiar, it may prove difficult to open up on one’s own condition. This factor is of considerable importance and explains why a patient may refuse to seek help. The taboo is real and the lives of our fellow peers may be at stake.

Discussions on stigma always elicit a negative response. Everyone publicly denounces it,claiming stigma has no place in the 21st century and that we should be more open-minded, more considerate of one another.

But stigma never exists publically. If so, it would be labelled as outright discrimination.

Stigma is fostered privately, in one’s mind, and then subsequently in one’s attitudes and behaviours. Stigma is mostly due to firmly-held beliefs which are so entrenched that one may not be aware of their very existence.

For example, a friend is diagnosed with depression and starts abusing alcohol. How would you react to this know edge?

What is the first thought that would come to your mind? Do you consider your own interests first before paying attention to his sensitive situation?

Are you willing to support your friend, so as to prevent the added burden? Or will you end up discussing his situation with others, criticising him for seeking professional help?

These questions are real.

They deserve a real response. Our reaction to mental illness will increase or decrease the burden on the affected individual. Let Malta’s answer be open-minded, empathic and spoken with care.

Let us address the issues at hand in a spirit of solidarity, bearing in mind that every small act of compassion counts.

Gabriel Ellul is the PRO of the Malta Association of Psychiatric Trainees (MAPT). This article was written as part of Serraħ il-Menti, a nationwide public awareness initiative organised by MAPT. For more information, send an e-mail to maptmail@gmail.com.

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