Mental illness stigmatises those who have it. The stigma then has a variety of consequences, nowadays all negative in most countries. In previous times and still today in some settings, symptoms of mental illness, for example hallucinations, were perceived as a privilege, a sign of being in touch with deities. This is, however, today rare. In most countries of the world the stigma of mental illness represents a terrible burden that the person with a mental illness has to carry, in addition to all other difficulties that a severe illness might create.
But the stigmatisation of mental illness – marking the persons as being dangerous, lazy, useless for society – also has centrifugal tendencies. Members of the family of the person who has a mental illness are also marked as being affected by it in some way. Psychiatrists are considered as probably being mentally abnormal, because they are in frequent contact with their patients. Institutions in which people with mental illness receive care have a bad reputation regardless of the quality of care or the excellence of the staff working in them. The methods of treatment that psychiatry offers are seen as dangerous and harmful regardless of the evidence to the contrary. Medications prescribed for mental disorders are seen as being more dangerous than others. Any side-effect receives incomparably more attention than the same side-effect of a medication that serves for the treatment of other diseases: the agranulocytosis that might arise in the treatment with clozapine has been given incomparably more attention than agranulocytosis occurring in the course of treatment with chloramphenicol.
Stigma of mental illness contains the notion that the person who has it is not of much value: as a consequence there is almost no treatment method in psychiatry that is not considered too expensive. The cost of the most expensive medications used in psychiatric treatment is much lower than the cost of many other medications. The cost of drugs used to cope with nausea arising in the course of radiological treatment of cancer in a single day is higher than the cost per month of most medications used in the management of a psychotic: yet it is the treatment of mental illness that is criticized as being too expensive (and is therefore not likely to be reimbursed unless a variety of conditions are met). Psychiatric societies as well as patients and their families have to fight for parity of payment for the treatment of mental illness with that of other illnesses in most countries where treatment expenses are reimbursed. It is often extremely difficult to ensure that a minimal number of psychotropic drugs is available at different levels of care: arguments against providing them by government officials are clearly related to the stigma that marks psychiatric treatment methods and the low value that patients have in their eyes. Higher priority given to other diseases – often less dreadful than mental disorders – is not based on rational grounds nor can it be easily challenged by evidence and rational arguments.
The consequences of this situation for all involved should be clear: yet they do not seem to happen. The investment into producing better treatments should be matched by an equal if not larger investment in fighting stigma that is attached to mental illness and all that touches it. Seeking more knowledge about the nature of mental illness should be matched by similar efforts to learn about ways of reducing negative attitudes to psychiatry, to people with mental illness (and their treatment), and to their families. The budget for employing staff helping people with mental illness to overcome difficulties in finding jobs, housing, and respect should be similar to the budget that is reserved for action that is necessary to change laws, procedures, and regulations that contribute to difficulties that people with mental illness face.
Perhaps, some time in the future science will produce knowledge that will enable us to prevent mental illness or cure it fast and completely: until that happens, however, it is necessary to give as much attention to ensuring that what we have is used well as we give to the creation of ever better means to help