Fair, Not Fear

The mistreatment of the mentally ill has been an issue since the Middle Ages. Its causes
unknown, the mentally ill were subject to horrifying avenues of treatment throughout the history.
Even now, we know little of the causes of mental illness, and thus stigmatize those who are
effected by them. The key to dispelling misconceptions is to treat mental illness like any other
physical disease--because that is what it is. This prejudice affects the mentally ill as individuals
and as a group. In a country where we pledge equality and liberty for all, we isolate those
plagued by conditions they cannot control. We deny them decent and respectful treatment that
any human being deserves. This needs to stop. Those whose views are not misconstrued must
step up as allies of the mentally ill, whose silent cries of suffering have not been efficient in
conveying their plight to the public. The rights of an individual are important, not just to the
person himself/herself, but to those they influence and effect as well.
The mentally ill have long since been regarded with suspicion and trepidation.
Throughout history, individuals who had mental conditions were shunned, isolated, and treated
inhumanely. In ancient times, mental illness was regarded with a somewhat positive light; a
direct correlation was drawn between mental illness and divine powers by the Greeks and
Romans. Hippocrates regarded mental illness as a physiological affliction, but this view became
lost as civilization became ignorant. In the Middle Ages, those plagued with psychotic mental
illnesses resembled what people perceived as demonic possession. In such cases, exorcisms
were performed in attempt to cure them. Other cases seemed like witchery to the uneducated
public, spawning witch trials and burnings. One of the more gruesome methods of treatment
was bloodletting, which killed patients more often than it cured them. In colonial America, chains
and shackles were used to restrain the mentally ill in poorly maintained facilities that contained
no heat, no light, and no bathrooms. They were often isolated with the disabled and
delinquents--others who were concerned abnormal to society. Such mistreatment continued
until in America until Dorothy Dix pushed for reformation of mental illness care and the
establishment of mental health hospitals. Even so, over time facilities become overcrowded and
unpleasant.
The first form of treatment for the mentally is Sigmund Frued's "talking cure," which
continues to be the only treatment until the 1930s, when more inhumane inhumane methods are
developed. The talking cure stemmed from psychoanalysis, founded by Sigmund Freud. It
divided the brain into conscious, preconscious, and unconscious thought. Freud explained his
model of the mind as an iceberg; only a small section (consciousness) could be seen, but a

large section remained underwater (preconsciousness + unconsciousness). Preconsciousness

remained not far below the surface of the water and could be easily obtained while
unconsciousness was more difficult to grasp. Freud also developed the idea of ego, superego,
and id as different modes of thought. Each mode is responsible for a particular manner of
thinking: the supergo deals with moral imperatives, the id with primary urges, and the ego acts
as moderator between the two to produce rational thoughts and decisions. From these ideas,
Freud concluded that mental illness was caused by a conflict within a person's
unconsciousness, and since unconscious thought lies below the surface of the water, the
conflict cannot be resolved and illness persists. According to him, the key to treatment of mental
illness is for patients to realize and come to terms with their unconscious thoughts, previously
obscured from them. Thus, psychoanalytic treatment is dubbed the "talking cure," when patients
simply talk until they feel better. As this was the first form a treatment that yielded moderate
success, it became widely used through many decades. The "talking cure" is the origin of the
mental illness trope in which a patient is pictured lying back on a couch, spilling all their troubles
to their doctor. This was indeed not so different from the first execution of the "talking cure;" the
doctor who carried it out wanted to make sure the patient was comfortable and relaxed,
unknowingly creating the stereotype of the mentally ill patient and the reclined sofa. These
stereotypes have contributed to mental illness stigmas. There is a lot of negative connotation
surrounding "shrinks" and people's needs to confide in paid professionals. Today psychoanalytic
treatment remains but is falling out of favor. In a modern age of science, drug therapy is a more
popular form of treatment and sometimes, more effective.
Drug, electroshock, and surgical therapy emerged and became widely used in the
1930s. The most popular form of drug therapy was insulin coma therapy, in which patients with
psychotic disorders where injected the hormone to induce calm and obedience. This often led to
overdose and comas from which patients could not be roused from. Another popular method of
treatment in the 30s was lobotomy, a surgical procedure in which part of the brain was surgically
removed by inserting a needle into the brain through the eye. The procedure had consequences
of severe brain damage and eventual death. These were the staple methods of treatment until
the development of antipsychotics in the 1950s. Since the emergence of antipsychotics in the,
drug therapy has become a more and more popular mode of treatment for mental illness.
Although our knowledge of drugs' effects on the biochemistry of the brain has improved greatly
since the development of the "talking cure," psychiatric medication is still far from perfect.
Different medication has been developed for different illnesses, but that is about as far as the

fine-tuning has gotten. They can come with a myriad of side effects, depending on the person,
and do not treat the root of the problem. The National Institute of Mental Health (NIMH) states
that "Medications treat the symptoms of mental disorders. They cannot cure the disorder, but
they make people feel better so they can function."
Antipsychotics were the of the first to become popularized in use. They are used to treat
schizophrenia and bipolar disorder. They are separated into drugs developed in the 1950s-typical antipsychotics, and those developed in the 1990s--atypical antipsychotics. An example of
a typical antipsychotic is lithium, used to treat bipolar disorder as a mood stabilizer. Many
patients have been found unable to handle this medication. Additionally, it has broken through
into pop culture as a medication that most psychos take. A particularly poignant example is
Patrick Bateman, the serial killer with malignant personality disorder in the film American
Psycho. An atypical antipsychotic is clozapine, used to treat hallucination and breaks with
reality--common symptoms of schizophrenia. Clozapine is an effective drug but has a
dangerous side effect: it kills white blood cells, an effect called agranulocytosis. This results in a
weakened immune system in the patient, and they must go get their white blood cell checked
often enough for it to be an inconvenience for most, in regards to both time and money.
Generally antipsychotics have many other possible side effects including drowsiness, dizziness,
blurred vision, and skin rashes (detailed on the NIMH website, the link of which can be found in
Resources). Typical and atypical antipsychotics also have their own side effects, some of which,
such as weight gain by atypical antipsychotics, can create future health concerns. Taking typical
antipsychotics cause symptoms of muscle rigidity, which could eventually lead to tardive
dyskinesia (TD), a chronic condition which the patient loses some muscle control. It can be mild
or severe, curable or incurable, and may or may not go away after the patient is taken off
medication.
Antidepressants are used to treat symptoms of depression and sometimes anxiety
disorder. Depression is often caused by an imbalance of neurotransmitters in the brain-specifically the chemicals serotonin, norepinephrine, and dopamine. Each neurotransmitter is
responsible for many of our daily function such as sleep, appetite, and mood (serotonin) and
ability to determine motivation and reward (norepinephrine and dopamine). Any kind of
imbalance of these chemicals, levels that are too high or too low, can lead to depression and/or
other mental illnesses. People with depression have been found to have low levels or serotonin
communication. The categories of drug used to treat this are called selective serotonin reuptake
inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). Although they

do not cause as many side effects older categories of antidepressants, they can still cause
nausea, drowsiness, headache, and agitation. Older category antidepressants are still
prescribed to some people because they treat their brand of symptoms more effectively, but
they also come with most of the side effects for SSRIs and SNRIs plus constipation, bladder
problems, and risks in eating certain foods that contain certain disagreeable chemicals.
Stimulants are usually used as medication for ADHD, attention deficit disorder. These
types of medication are most often prescribed to children and can create side effects such as
decreased appetite, sleeping problems, stomachache, and headache. There is also a possibility
of the child/patient developing erratic tics or experiencing a change in demeanor. Studies have
shown that stimulants increase risks factors for strokes, heart attacks and sudden death. More
rarely patients develop psychotic symptoms similar to those characterizing schizophrenia.
Because of these risks strict guidelines have been imposed on the prescription and
manufacturing of ADHD medication.
Psychiatric medication comes is a trade off. Because they treat the symptoms and not
the problem, individuals will likely have to take some dosage for a long period of time.
Additionally, they must deal with the side effects of such medication. Often patients can't handle
the side effects well, particularly those on antipsychotics, and some even feel it becomes as
much of a burden as their mental illness. The medication is relatively crude, as its aim is to
manipulate the intricacies of the human hormonal chemistry. Everyone's chemical system is
different, so it is very easy to give the wrong dosage or wrong type of medication to a
particularly person, causing them great difficulty. Such a factor becomes extremely dangerous
when an individual stops taking the medication because of its side effects--or even because
they believe they are better and do not need drugs. Actions like these can cause relapses and
significant pain--even danger--for the individual and those around them. They contribute to
stigma of mental illness as a consequence. Additionally, those who do experience effective drug
therapy often end up homeless due to poor follow-up care.
Other methods of treatment include behavior therapy, rational motive therapy, and group
therapy. Behavior therapy is a method of treatment developed based on the ideas of B.F.
Skinner, an American behavioralist who believed that the key to treating psychological behavior
was changing external behavior. Although this perception is skewed, his development of operant
conditioning, promoting the change of behavior through positive and negative consequences,
helps treat people with OCD, PTSD, phobia, and anxiety. Group therapy is similar to Freud's
psychoanalytic treatment in that it focuses on talking and venting, but instead of freely rambling

about anything that comes to mind to a psychiatrist, group therapy emphasizes emotional
support from people who have had like experiences. This often works for depression brought
upon by grief, eating disorders, and gambling. Rational-emotive therapy was developed by
Albert Ellis, who believed that mental illness is caused by irrational thinking, and that changing
to a more rational mindset will cure patients. He describes the onset of mental illness using the
ABC model: and activation event causes an irrational belief to manifest, bringing upon the
consequence of illness. Treatment would center upon dispelling that irrational belief so the
patient can be brought out of the mindset that their illness put them in. This type of therapy is
more effective with people who experience depression caused by a tragic life event. Modern
science is enabling us to learn more about mental illness and how they affect the brain, but we
still do no know enough to come up with treatment other than medication and coping.
Meanwhile stigma and prejudice against mental illness grows.
Stigma stems from two main sources: ignorance, and fear. The two factors foster
negativity in attitudes, or "the individual's organization of psychological processes, as inferred
from his behavior (Newcomb in Gould and Kolb 40-41). Such negative behaviors not only harm
stigmatized individuals, but serve to fortify prejudice. In court, lawyers easily play upon this
lurking fear and turns proceedings against mentally ill victims. A notable example of this is Kelly
Thomas, who was beaten to death on July 10, 2011. He was homeless, schizophrenic, and only
37 years old. There is video evidence of the police, who approached him because he was
looking into cars and pulling on door handles, literally holding him down while he begged for
mercy. Two cops charged for his murder were acquitted this past January 2014 despite video
evidence of their continual abuse of Thomas.
Prejudice is also caused by a fear of the unknown; "the tenacious refusal to know and to trust
the other...breeds prejudice" (Ackerman 27). When spread amongst of many, eventually forming
a like-minded, like-prejudiced group, stigma manifests. In law, public fear or violent actions by
mentally ill patients result in mandates that leave patients little choice in the type and level of
treatment they receive. Laura Wilcox was 19 when she was shot by a severely mentally ill man
while working in a mental institution in Nevada County, California in 2001. Her family,
devastated by her death, pushed for the implementation of Laura's Law, a bill that "order[s] a
small subset of people with serious mental illness who meet very narrowly defined criteria to
accept treatment as a condition of living in the community" (mentalhealthpolicy.org). The goal
that Laura's family had in mind was to prevent a tragedy like hers, or like Kelly Thomas', to
occur again. The law's outline states that it aims to provide treatment for those incapable of

choosing it for themselves and to prevent such individuals from falling into jails, prisons, or
shelters. Thus far, Laura's law has been passed in Nevada County, Orange County (where Kelly
Thomas was killed), and is being piloted in Los Angeles. These counties have seen positive
results (more can be found on the law's website, which is linked in Resources), but controversy
still affects the law's progress.
Prejudice in it and of itself is difficult to break, "...once prejudice serves a psychological
function for a person, he clings tenaciously to it and to its basic tenets
unquestioningly" (Crocettl, Spiro, Siassi 29). When the foundation the prejudice was founded on
is proved to an individual, it is difficult for them to let it go. A generic example in terms of mental
illness would be an individual who experiences a schizophrenic's psychotic episode in a
negative way, and thus becomes prejudiced against schizophrenics. Sharing their experiences
with others in the community can spread the prejudice, create stigma against the schizophrenic,
and isolate them.
Shame is also a large part in stigma. When people use stereotypes and prejudice to
perpetuate stigma against the mentally ill, they become ashamed of their illness because it
makes them different--and not in a good way, "Mental illness, despite centuries of learning and
the 'Decade of the Brain,' is still perceived as an indulgence, a sign of weakness" (Byrne).
Shame is a path to secrecy, and secrecy will obstruct individuals from accepting their illness and
getting treatment. What's more, often family members are also ashamed as well, and try to
prevent others, professionals included, from discovering the presence of mental illness in the
family. This is not what families should be doing for their mentally ill members; as people who
should be the most exposed to and most understanding of mental illness, they have a duty to
make an effort towards eliminating stigma and promoting respect for mental illness.
But how would they go about doing this? Byrne suggests the use of politically correct
terms. The presence of defined terms seems to have helped dispel prejudice from social
movements dealing with other factors such as race, sexuality, and gender. Drawing a parallel to
LGBTQ rights, Byrne proposes the promotion of the term "psychophobic" for those who
discriminate against and hold prejudice against the mentally ill. As Byrne also points out, mental
illness stigma has existed long before the development of psychiatry, which only began in the
mid-19th century, yet it still manages to manifest to an alarming degree in today's society. The
development of successful treatment had eased the prejudices, but the dissemination of
prejudice and stigma has somewhat stunted progress.

Logically, mental illness stigma should not be as pervasive as it is today. With all our
advancements in scientific knowledge and the sheer amount of mentally ill individuals, our
society should be far more accepting of illness. We have, after all, come very far since our
ancestors accused the mentally ill of witchcraft in order to rationalize their abnormal behavior.
And yet, stigma still exists, and not only that--it thrives. One of the main causes of stigma's
continued prevalence is Thomas Szasz's Myth of Mental Illness, published in 1961. In it, Szasz
denies the idea that mental illness is a type of physical sickness; he specifically addresses
psychotic illness such as schizophrenia, insisting that the "illness" really only boils down to
emotional problems in individuals. Since many were skeptical of psychiatry at the time it was
published, Szasz's book became a household item for anti-psychiatry advocates. The book
threatens the foundation of modern psychiatry as it declares that science and mental illness
have no connection at all. Szasz casted doubt upon psychiatry as a practice, doubt that
transferred to the general way society view mentally ill people, whose reasons for illness and
disability became unreasonable and unfounded.
One of the key issues that propagates mental illness stigma is the misperception that it
is not an illness--at least, not one in the sense that other physical diseases are. This idea was
largely promoted by Szasz and other like-minded writers, but in reality, mental illness is just that:
an illness. Although it's causes are more obscure and complicated, especially considering our
limited knowledge of the brain and the nervous system, it should be treated as such. The
Diagnostic and Statistical Manual of Mental Disorders (DSM) bases the classification of mental
illness on the idea that it will disrupt the patient's life in a negative or harmful way, the criteria for
any medical disease. Each mental disorder in the DSM, which is now in its fifth edition, has a list
symptoms that serves as common language for psychologists, just as knowledge about the
symptoms of sicknesses allows any standard physician to diagnose a patient. It is time for more
than just the professionals to become aware of the truthful nature of mental illness.
In The Invisible Plague, Torrey and Miller urgently stress the effects of ignorance on
widespread mental illness. They deem mental illness, or insanity, an epidemic,

"Living amid an ongoing epidemic that nobody notices is surreal. It is like viewing a
mighty river that has risen slowly over two centuries, imperceptibly claiming the
surrounding land, millimeter by millimeter. The people who once lived on the land have
either died or moved away, and few of their relatives are aware that the river was once

much smaller. Humans adapt remarkably well to a disaster as long as the disaster
occurs over a long period of time.
Since the middle of the twentieth century there has been virtually no discussion of
epidemic insanity. Like the mighty river, the high prevalence of insanity is accepted as a
given and assumed to be similar to the prevalence of insanity of one hundred, five
hundred, even one thousand years ago. The possibility of its having been otherwise is
not considered and, when raised for discussion, is met with incredulity. Haven't you seen
the river? How could you think that it was ever otherwise?" (Torrey and Miller 300-301).

The writers do not exaggerate. Mental illness has and will continue to rise, and instead of
helping those affected most determinately ignore existence or deny its effects. Most people are
not aware of the relevance of mental illness, but it affects individuals, communities, and
societies in important ways.
For my original research, I conducted and informal survey that contained two parts: a
series of three multiple choice questions aiming to show the relevance of mental illness and an
optional question for participants to provide a more detailed written response about their
experience with mental illness, particularly on illness within the family. The survey was open to
anyone with a link for 10 days. A total of 68 people participated. The results were then organized
and assembled into representational statistics.

On the most basic level, a

majority of participants at the
very least are acquainted
with someone who has a
mental illness. Although the
percentage of yeses
decrease as the relation
becomes more specific, the
number of participants who
are close to and/or are
related to a mentally ill
individual is still notable
In addition to the three
multiple choice questions,
participants had the option of
sharing their experiences
regarding mental illness. A
surprising number of 15
people responded with
varying lengths and detail.
This survey was anonymous
and all participants' identities
remain unknown.

Below are responses to the optional question on my survey, "If someone you are related to has
a mental illness and you are comfortable sharing your experiences, please do so below. Did you

have trouble accepting it? Were you unsure about how to treat the relative/family member? How
does the rest of the family deal with it

Some of these responses are examples of reasons why mental illness stigma continues
to thrive. The fact families themselves are ashamed of mental illness in a member and attempt
to hide of deny it is one of the main sources of fuel for stigma. Shame and secrecy prevent
enlightenment and predictably, encourage ignorance. The first step for a family to dispel stigma
and help their mentally ill family members is to accept the illness themselves.
At the same time, many of these responses show a certain kind of respect for the
mentally ill. Coping with any kind of illness is not easy, and individuals who accept it themselves
and try to live as normal as they can deserve and receive the same kind of respect paid to
cancer survivors. Many people who responded also express their urge to help but not knowing
how. Helping mentally ill family can be done in simple ways. First, initial acceptance, which
many of the survey participants have realized. An illness does not fundamentally alter a person
or who he or she is, even if it does effect their lives in unchangeable ways. After acceptance is
the dissemination of knowledge; a collective effort of this will dispel ignorance and consequently
eliminate stigma. One family can make a notable difference, as demonstrated by Laura Wilcox's
family; families united can very well make huge progress in bringing mentally ill individuals the
treatment they have been too long denied.