Stigma, Shame And Discrimination

By: Dr Gurdeep Singh Grewal Consultant Psychiatrist

Ms J is a 27-year-old marketing manager at a local media company. Having recently been diagnosed with diabetes, facing immense stress at work and a failed relationship, she became severely depressed and anxious. Her close friend eventually brought her to see a psychiatrist, and she was started on medications and given 10 days of sick leave. A few weeks after her return to work, she noticed that her colleagues were treating her differently. Some were avoiding her altogether. Three months later, at her annual appraisal meeting with her superior, she was told that her promotion was denied on account of her “poor mental health and inability to deal with work pressure”. She resigned soon after and sought employment elsewhere.

The scenario highlighted above is more common than you think. In my practice, I have had patients who opt to use their annual leave to come for their appointments, as they do not wish to have “Consultant Psychiatrist” stamped on their medical certificate. I know of patients who were “let go” or not had contracts renewed because of this. The stigma and discrimination are real.

Some countries have made great strides in minimising the stigma associated with psychiatric illnesses through public education, legislation and the emergence of large advocacy groups. However, such stigma is still a universal problem. There is just way too much misinformation about mental illnesses; the media and popular culture continue to portray mental illnesses in a negative light. Sadly, even within the medical profession, the stigma persists.

This could be due to the dark, shameful history of psychiatry as a medical specialty. Prior to the accidental discovery of psychiatric medications in the 1950’s, there really weren’t any evidence-based therapies. As such, illnesses were poorly understood, leading to the emergence of asylums (or mental institutions) where the physical conditions were usually deplorable and basic human dignity and rights were abandoned. People with psychiatric illness were often regarded as dangerous or disgusting, and were (and still are) shunned.

Advances in the field of psychiatry over the past 50 years have been at an exponential pace. Yet, the misperceptions continue to haunt this area of medicine much to the detriment of the patients. It’s time to clear the air once and for all.

The brain is an organ and, like any organ in the body, can fall ill. Having a psychiatric illness is not a sign of personal failure or poor resilience. You don’t need a reason to have a psychiatric illness. It can just happen. Why can’t we offer the same empathy and support for a diseased brain that we do for other illnesses? Also, not all psychiatric illnesses are permanent. Save for a few very serious and debilitating illnesses (for example, schizophrenia), by and large, most psychiatric illnesses are easily fixed if treated early and patients can expect a full functional recovery. Why then does the negative stigmatising label linger for years after?

Let me now highlight some further examples of stigma in our society. If you have a pre-existing psychiatric illness, you will be denied medical insurance coverage. This highly discriminatory practice is such a huge injustice to the patients as it effectively denies them access to private healthcare in all medical specialties. Even if you already have insurance cover, you might notice that it does not cover access to mental healthcare. Contrast this with most of my expatriate patients: they do have coverage for mental health. So why the double standards? Most of us are probably not aware of this, but developed countries do provide insurance cover for mental illness. In fact, our neighbour Singapore has also gone in this direction last year.

Further discrimination against those with mental illness can be found in the workplace. While most corporations provide medical coverage for their staff, only a small handful view mental health as an important component of overall health and provide cover for their employees. Many patients feel that because the organisation has no clear policy on mental health issues, they feel trapped or fear that disclosure would cost them career progression or loss of employment. In a way, we cannot fault the organisations as the law itself is not clear on this issue. The Occupational Health and Safety Act 1994 does not have specific provisions for psychological wellbeing as a component of health and safety in the context of employment. It is past time that this act is updated and revised.

The stigma continues even among the close circle of people that surround a mental illness sufferer. Family and friends persuade patients to seek alternative forms of therapy instead of seeing a mental health professional. Countless times I have had to deal with family members who are reluctant to seek help out of shame or fear of how the community would negatively label them. In fact, stigma and misperceptions surrounding mental health are some of the primary reasons that patients delay or actively avoid seeking treatment. Invariably, it’s the patient who suffers the most.

Moving forward, efforts to destigmatise mental illness need to happen at all levels of society. At the governmental level, new legislation is required to protect the rights of patients with mental illness and grant them equal treatment in areas of employment and basic civil liberties. Corporations have a crucial role to play by having in-house policies to help workers deal with mental health problems in a confidential, fair, supportive and non-discriminatory manner. Ongoing public awareness should begin in schools and extend to the workplace and community at large. Together we can fight it, because the stigma has to STOP.

“Sometimes, there are no reasons are being afflicted with a psychiatric illness. It can just happen.”

“The same large insurance companies that offer mental health coverage in developed countries do not provide the same for Malaysians. Why the double standards?”


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