Would You Want A Psychiatric Patient Living Next Door?

For many people, fear drives their prejudice against psychiatric patients.

by Gary Small, M.D.

I was having coffee with a friend, when he confided in me that he had been feeling depressed and was thinking about taking an antidepressant. I was both surprised and relieved – I had always enjoyed his dry, humorous and incisive perception of the world, and believed that his sarcastic brooding was just part of his personality, entertaining though a tad on the negative side. But the symptoms he now described – trouble sleeping through the night, loss of appetite, forgetfulness, and occasional thoughts that he might be better off dead – all sounded like a major depression that could have a good chance of responding to the right medication. Unfortunately, he was a guy who had always been reluctant to take medicines. He swallowed an occasional aspirin when a fever topped 101 degrees, but avoided antibiotics, antihistamines and most other common drugs. It was a huge step for him to consider taking an antidepressant medicine that could affect his mental state. And now, even though he was thinking about antidepressants, he still wasn’t sure. He had just read an article about a study showing that a daily jog or swim could cure the blues. Maybe all he needed was the exercise-induced endorphin rush to lift his mood.

I suspected that exercise might help but wasn’t likely going to be enough to cure the blues in my friend’s case. Some of his reluctance to get conventional psychiatric treatment probably stemmed from a lingering stigma of mental illness. A lot of people are concerned that they will get a psychiatric label, and a new study indicates that they have reason for such concerns. Despite decades of effort to educate the public about the biological basis of mental illness and its response to treatment, the stigma of mental illness has not changed.

Dr. Bernice Pescosolido of Indiana University and her collaborators analyzed surveys given to nearly 2,000 people in 1996 and 2006. The subjects were asked to respond to vignettes describing patients withschizophrenia, major depression, and alcohol dependence. They discovered that 67 percent of the respondents attributed major depression to biological causes, which was an increase from 54 percent a decade earlier. They also thought medical treatment was best for people with mental illness regardless of the diagnosis.

Despite this greater acceptance of mental illness as a medical condition requiring medical treatment, the stigma of the disease lingers. Six out of 10 respondents were not willing to work closely with someone with schizophrenia, and more than seven out of 10 felt the same about people with alcohol dependence. Even if a person believed that the mental disturbance was from a biological cause and they were in favor of treatment, the respondent was more likely to endorse community rejection of the person described in the vignette.

The stigma doesn’t just seem to apply to patients with psychiatric conditions, but also to those who treat them, and I’ve known several doctors over the years who have endorsed such anti-psychiatry views. I remember the anti-psychiatry sentiments when I was in medical school – I would overhear an occasional student or professor take a poke at psychiatry, insinuating that it was an ineffective specialty based more on speculation than science. Scottish psychiatrist R. D. Laing had questioned whether mental illness should be considered an illness at all, since it had no proven physical cause. He argued that the concept of madness stemmed from political and interpersonal influences.

In 1973, Stanford psychologist David Rosenhan published “On Being Sane in Insane Places,” which described how university students pretending to be psychotic gained entrance into psychiatric facilities. Once admitted, these pseudo-patients stopped feigning their madness, yet the hospital staff perceived their normal behavior as symptoms of psychosis. Interestingly, the actual inpatients knew better.

After WWII, psychoanalysis – a form of psychiatric theory and treatment – dominated many medical school psychiatry departments. In Freudian psychoanalysis, patients verbalize their free associations, fantasies anddreams to their analyst, who then interprets the unconscious conflicts that may be causing the patient’s symptoms or problems. When the patient gains insight from the analyst’s interpretations, the symptoms often improve, but it can take years of nearly daily treatment, which is expensive and obviously time consuming.

Psychoanalysis has helped many people with their neuroses and personal problems, but it’s difficult to prove scientifically that it works any better than just talking with a friend who is empathic and supportive, although systematic studies have demonstrated the effectiveness of a similar treatment approach, psychodynamic psychotherapy. Also, psychoanalysis is not for everyone, particularly patients with severe depression or psychosis. With the development of antidepressant and antipsychotic medicines that can improve mental symptoms more rapidly, the medical community seemed to warm up to psychiatry. And, many psychiatrists turned away from pure psychoanalytic approaches and took a more eclectic strategy combining both talk-therapy and medication. This medicalization of psychiatry gave the field more credibility and acceptance by other medical disciplines, although anti-psychiatry sentiments persist.

For many people, fear drives their prejudice against psychiatric patients and their treatment. Sometimes in denial about their own mental struggles, people avoid or attack psychiatry in an attempt to keep mental health practitioners from somehow recognizing their secret psychological issues – as if the psychiatrist had some magical powers to do so.
This latest study suggests that the public now has greater acceptance of the biological basis of psychiatric illness, but most people wouldn’t want to work with a depressed patient or one who suffers from schizophrenia, let alone have such a patient move in next door.

This latest study suggests that the public now has greater acceptance of the biological basis of psychiatric illness, but most people wouldn’t want to work with a depressed patient or one who suffers from schizophrenia, let alone have such a patient move in next door.

One reason for the prejudice and discrimination may be the perception that psychiatric symptoms are permanent. Although we have no cure for a biological predisposition to a mental disorder, many symptoms respond well to treatment. An estimated one in four adults – nearly 60 million people in the United States – suffer from a mental disorder. Psychiatric interventions have been shown to diminish and often eradicate the symptoms of psychosis, depression, and anxiety; yet many people do not have access to care, and often those who could improve with treatment, never seek out a specialist, in part because of fear and their perceived stigma.

Teaching about the biological basis of mental illness has brought about a greater understanding that mental illnesses in many ways are like medical illnesses. But that awareness has not reduced the fear and shame of mental illness. What do you think will alter the stigma and make us more accepting of the psychiatric patient next door?

Visit me at DrGarySmall.com

Published by

Will Savage

Quantum Units Continuing Education provides online CEU training's to licensed professional mental health therapists, counselors, social workers and nurses. Our blog provides updates in the field of news and research related to mental health and substance abuse treatment.