The stigmatisation of mental health and mental illness is nothing new and can be traced back through the centuries and across cultures.
Despite much improvement in the treatment of mental illness and an increasingly open dialogue about the effects of mental illness from sufferers and professionals, the evidence shows that paradoxically increasing numbers of the general public fear violence from those who are mentally ill.
What is mental illness?
Whilst the term mental illness is ubiquitous, it is a ‘catch all’ term which fails to differentiate between people struggling with their general mental health, people who struggle to regulate their emotions and the tiny minority who have an actual illness as defined in psychiatric terms.
In its most extreme form, mental illness is an inability to ‘hold’ onto reality and is a terrifying experience for the sufferer – this would be the definition of psychosis. However, as terrifying as this is, there is simply no correlation between violence and mental illness.
Where does this fear come from?
The fear of mental illness seems to be profoundly primal. Human beings pride themselves on the rationality and intellect and to be exposed to someone who has ‘lost their mind’ triggers fear – if it can happen to them, can it happen to me? Losing ones mind can feel like losing the connection with what makes us human.
Periodically these fears are brought back to the surface, often as a direct result of some unfathomable act such as the recent school shooting in Texas where 19 children and two adults were murdered by an 18 year old gunman. How can something like this happen? Who would do such a thing?
Human beings seek to ‘fit in’. We all to a greater or lesser extent abide by the rules and laws laid down by our culture and society. Where we abide by the rules and perform well, society tends to reward us. The rewards are multiple, but are generally related to social standing and financial payment which propels us to continue to do well: fitting into culture affords us self esteem.
Many people who suffer from mental health problems have experienced trauma during their lives – it can be argued all of them. We now know, in no small part thanks for the 1998 ACE study (Adverse Childhood Experiences) conducted by the CDC-Kaiser Permanente, that the more adverse childhood experiences a child is exposed to, the higher the likelihood that they will suffer from mental illness.
However, whilst striking, it was not only their mental health that was likely to be affected, the higher the number of ACE’s, the higher the risk of emotional and cognitive impairment, physical disease, poverty, criminality, social problems and substance abuse problems, all culminating in a higher likelihood of an early death. Trauma therefore impacts on a person in every facet of their future life. Trauma is not caused by poor mental health – poor mental health comes about through trauma, accompanied with the long list of symptoms above.
All human beings harbour thoughts and feelings that we consider to be in conflict to how we see ourselves and how we wish to be seen. Psychoanalysis was the first discipline to start to talk about how we all have sadistic drives, harbour murderous thoughts and take glee in the suffering of others. Psychotherapy seeks, amongst other things, to help people know themselves and to integrate these parts of their character.
However, where this integration has not happened people can ‘split’ these parts of themselves off – as if it simply is not a part of themselves – and ‘project’ them into others: I am ‘good’, you are ‘bad’, or in this case, I am ‘sane’ you are ‘mad’.
I would therefore suggest that much of what drives the stigma around mental illness and the association between the latter and violence is driven by fear leading to the psychological defence called projection. ‘Mental illness’ or ‘mental health’ is a convenient scapegoat for the parts of ourselves that we disavoy.
What can be done to challenge the misconceptions around mental health and violence?
In order to challenge the misconception that people with mental health problems are violent, we need to be able to have a mature and complex conversation about society, trauma and how we are all collectively responsible for ‘othering’: scapegoating and ostracising certain groups of people who are vulnerable. There is correlation between childhood trauma and violence, but violence is not caused by mental illness.
Alongside this we need to use factual statistic to show that simply having a psychiatric diagnosis or ‘suffering from depression’ makes a person no more likely to be violent or to commit a crime than anyone else. What does significantly increase the possibility is childhood trauma, contributing to feelings of low self esteem, a lack of belonging in society, poverty and feelings of disempowerment.
The effects of stigmatising those with mental health problems
Through engaging in an open and honest debate around mental health and mental illness, we can not only support those who are suffering to talk about their experiences and seek help, but also acknowledge to ourselves that we are all in no small part likely to be affected by a mental health issue at some point in our lives. This makes it ‘our’ problem rather than ‘theirs’.
Where people with mental health problems are stigmatised it further alienates them from mainstream society and the opportunity to ‘contribute’ to that society and feel a sense of belonging, purpose all leading to greater
Stigma and scapegoating leads to shame and shame makes it even harder for people to access help. People with mental health issues need support, compassion (not sympathy) and a pathway to belonging in society. It is no more helpful to pretend that they have no problems than it is to demonise them.
Mental illness is a social problem
As discussed earlier, trauma – particularly childhood developmental trauma – impacts on every aspect of a persons ability to lead a fulfilling, healthy life. And trauma begets trauma, meaning that it is passed from generation to generation. Therefore, rather that scapegoating those with mental health problems, perhaps we need to collectively pause, reflect and look in the mirror to see what sort society we are all contributing to.
Mark Vahrmeyer, UKCP Registered, BHP Co-founder is an integrative psychotherapist with a wide range of clinical experience from both the public and private sectors. He currently sees both individuals and couples, primarily for ongoing psychotherapy. Mark is available at the Lewes and Brighton & Hove Practices.
Further reading by Mark Vahrmeyer