Finding Hope in Decreasing the Stigma of Mental Illness

This journal, like many others, frequently receives manuscripts about the stigma imposed by society on people with mental illness, a stigma that also afflicts their families and their professional caregivers. Sadly, the stigma is often internalized as well. IMHN receives manuscripts about the stigma of mental illness from many parts of the world. For example, we have recently published papers from Ghana (Bonsu & Yendork, 2019), Sweden (Sjostrom et al., 2021), Iran (Keshavarzpir et al., 2021), and Canada (Waddell et al., 2020). Last year, we also published a systematic review of studies of stigma that were conducted in North America, Australia, and the United Kingdom (Tyerman et al., 2021). The extant literature vividly depicts the cruel reality of the suffering inflicted by stigma upon a person who is already deeply suffering from their mental illness.

Today I find hope in a fresh look at the topic of stigma, provided by cultural anthropologist Roy Richard Grinker (2021). This is a book by an American scholar, from a family with four generations of involvement in Western psychiatry, but also drawing upon research in African and Asian cultures. Grinker contends that stigma is decreasing in the 21^st century, providing convincing reasons for his optimism. In this editorial I offer just a glimpse of his fascinating treatise, which I recommend to you for thorough reading and thoughtful reflection. I ordered Grinker’s book simply because the title was so appealing: “Nobody’s Normal: How Culture Created the Stigma of Mental Illness.” I liked his reminders that we’re all a bit neurotic, and that the flawed idea of “normality” was largely based on research done with white male undergraduates at Harvard! (see Hooton, 1945).

Grinker’s book carefully traces the history of the stigma of mental illness as it has been influenced by the industrial revolution, capitalism, war, racism, and medicalization of mental illness. With regard to the latter, the number of diagnostic categories in the Diagnostic and Statistical Manual of Mental Disorders steadily increased from 193 categories in DSM-II in 1968 to 541 diagnoses in DSM-5 in 2013 (Blashfield et al., cited in Grinker, 2021). Categories were rigid, with defining criteria that were well familiar to the readers of this journal who were required to supply insurance companies with the appropriate labels for their clients (e.g., paranoid schizophrenia, 295.3). But now the heterogeneity of mental illnesses is recognized, and the major diagnoses have been reconceptualized as spectrum disorders (schizophrenia spectrum, bipolar spectrum). Some of the old labels have gone away completely (hysteria, homosexuality, neurasthenia). There is greater acceptance of neurodiversity.

Fear of mental illness-related stigma still deters ill persons from revealing their conditions and causes them to delay in seeking psychiatric care (Knaak et al., 2017). However, as Grinker (2021) notes, athletes such as Michael Phelps and entertainers such as Lady Gaga and Bruce Springsteen have openly shared their emotional struggles. As anxiety, depression, and suicidality have been disclosed by other celebrities such as Elton John and Simone Biles, less stigma and greater compassion are becoming evident among the general public. Reduction in the societal stigma of autism is illustrated by the author’s experience over the years with his own daughter Isabel. Within the family, Isabel’s extraordinary talents and memory were appreciated. For example, Grinker (2021, p. 229) shares a vignette when his wife asked Isabel if she had ever heard a Stevie Wonder song before. Isabel replied that she had heard it on the radio, in a taxi “on Saturday, October 15, 2015, when we went to dinner on our vacation.” He also described other skills displayed by his daughter, such as identification of all notes in any chord played on piano or guitar. However, Isabel was aware that society did not expect her to ever graduate from high school. As graduation approached, her high school principal was not sure that it was a good idea for her to deliver a speech. When she did deliver the speech at her graduation, disclosing her autism to the audience, she received a standing ovation.

Grinker’s book describes the increasingly favorable stance of educators and employers toward individuals with autism. The “supported employment” movement recognizes the unique aptitude of some individuals with autism to perform repetitive tasks and provides workplace accommodations and support for them. For example, an autistic woman who counts blood cells in a hematology lab is allowed to take short breaks to spin in a room by herself to reduce stress (Grinker, 2021). This hopeful book includes inspiring stories of individuals with other conditions who are employed and living fulfilling lives.

Of course, it is impossible to end stigma completely—every society can find something to demean and marginalize. But we can still resist, name, mute, and shape it. Stigma is not a thing but a process, and we can change its course. (Grinker, 2021, p. 320)