Thursday, April 23, 2009

Sally Satel on Stigma

Sally Satel is a psychiatrist who has strong, and sometimes controversial, opinions. She has a terrific article in Monday's New York Times: To Fight Stigmas, Start With Treatment.

She talks about a reality TV show I've never seen (one of the many) called How Mad Are You? The premise: ten people, 5 with psychiatric disorders and 5 without are put together for a week and pushed to the brink. Psychiatrists reviewed the tapes and couldn't tell who had psychiatric disorders and who didn't. This is a surprise? Some people are obviously psychiatrically ill-- they behave in disruptive ways, don't attend to their hygiene, respond to stimuli that aren't there (meaning they're obviously hallucinating and responding to those hallucination), but, as Dr. Satel points out, often they are untreated. Or sometimes their treatment has side effects that are visible, such as tremors, or with the older medications, Parkinsonism. This isn't the majority of people with psychiatric illnesses. Go into any gathering of normal-looking people and take a poll: I assure you that some (if not many) of them will have had some type of treatment with either a psychotropic medication or psychotherapy at some point in their lives. People with psychiatric disorders just don't look different from others. And people with a past history of psychiatric disorders are not necessarily fragile human beings--- this is something I tell my patients: when you're better, you're better, you don't need to live a sheltered life and people don't have to protect you from every little stress. Yes, there are some people who are fragile, and some people who need sheltering-- but not everyone.

So Dr. Satel tells us that public service campaigns to destigmatize mental illness don't work. What does work? She writes:

If “How Mad Are You?” improved viewer attitudes, the credit should go to treatment, the most effective destigmatizing force there is.

Imagine poor psychotic souls cowering in doorways, shuffling along in stinking rags or arguing loudly with themselves in the park. No public service announcement will make the public less fearful of them or reassure prospective neighbors when a group home for the mentally ill wants to settle on their block.

Altering public attitudes toward the mentally ill depends largely on whether they receive treatment that works. This, in turn, sets in motion a self-reinforcing momentum: the more that treatment is observed to work, the more it is encouraged.

Thanks to Kelley who sent the link to this article