Stripping Dignity: The Impact of Mental Health Stigma
Starting this World Mental Health Day (10 Oct) let’s leave stigma behind us and engage in acts that amplify dignity going forward.
Dignity—that delicate, intrinsic right that each of us have to personal value and worth. We may not think of dignity on a daily basis, but we certainly know when we feel it and, more importantly, when it is absent. Nowhere is this more evident than in the area of mental health.
In India, like most other places around the world, dignity is the first thing that is stripped from a person who is labeled with a mental illness. In an instant, their worth as an individual, their value to society, their trustworthiness and freedom to make choices is suddenly compromised. Each doubt felt, each choice removed from a “labeled” individual, is another layer of dignity stripped away.
Harvey Max Chochinov a seminal researcher in the field of human dignity says, “dignity is in the eye of the beholder.” Chochinov suggests two types of dignity: internal dignity, which we maintain ourselves, and social dignity, which is maintained by those around us and affects the former. In other words, our experience of dignity is affected not only by how we treat ourselves, but also by how others treat us.
I have witnessed Chochinov’s concept of dignity from within, and from without, in my work, from red light districts across India to my private practice in Mumbai. I have seen dignity not only exist, but thrive in the most desperate and abhorrent of circumstances. I have seen internal dignity outshine dark, unimaginable realities, only to be extinguished by a lack of communal support.
Take the story of Garima, who experienced anxiety and depression not long ago. Garima struggled desperately – daily –for the dignity of making her own choices. For from the moment she shared her symptoms with her family, she was told she was not well enough to make decisions for herself. This message compounded her own self-doubt. And so, she was inundated with different explanations for what was happening to her, ranging from the strange to the occult. Her family forced her to submit to a battery of physical tests, unwilling to accept the possibility of mental illness. When all the results showed she was in good physical shape, a physician suggested that it might be “all in her head.”
Garima felt shamed by the physician’s suggestion that she was making up these symptoms. While her family immediately dismissed the idea, they still refused to accept mental illness might be possible for their daughter, for their sister. To them, Garima’s feelings must be temporary fancies, which would pass if she would only keep busy or find a nice husband. But for Garima, her emotions were anything but temporary, and the dignity of being trusted to know one’s own innermost feelings was stripped. After months of struggle, while her anxiety and depression worsened, Garima mustered her damaged internal dignity and called the physician to get a referral for mental health treatment. Despite resistance from her family – and threats that no one would marry her if they found out – Garima continued with treatment in secret. Though she is denied the dignity of sharing this part of her life with her community, she has refused to let that keep her from recovery.
Garima is a compilation of many clients’ experiences and is a name chosen to represent the struggle of all clients. For all that, she is no less real. Her story brings to life the tension between internal and social dignity, and the enormous challenge of maintaining a strong internal core in the face of constant, ubiquitous external stigma. Despite her own feelings of shame, her fear of judgment, the stigma around mental health and the discouragement from her family, Garima was able to draw on her internal sense that she was worthy of support.
However, many others like Garima do not have such inner resources when they are most vulnerable and those closest to them stand in their way.
Stigma is one of the most notorious weapons against dignity. Social stigma marginalizes those with experiences considered unpleasant or unacceptable, so as to keep them from ‘tainting’ others. Although social stigma is weakening in some parts of the world, it is very much alive and well and continuing to play an incredibly destructive role here. Many of us deeply fear any association with mental illness, and stigma is the tool we use to distance ourselves from any doubts about our own mental state. While shaming others into segregation and silence allows us to keep from seeing ourselves in them, there is nothing dignified in depriving people of sharing their pain without judgment.
Maya Angelou, the iconic American poet, once said, “dignity really means that I deserve the best treatment I can receive and that I have the responsibility to give the best treatment I can to others.” Dignity is a right, and we deny people that right by acting on stigma. If we could start to think of mental health as something to encourage in our children and to fortify in ourselves, we would begin a movement away from a legacy of discrimination. This change of perspective and proactive approach would clear the way for those suffering to be treated with the respect that would empower them through the struggle.
Rather than being shamed, shunned, and blamed, others like Garima would have a chance to recover from trauma, depression, anxiety and other conditions and to lead healthy, productive lives. Like the national flower of India, the lotus that thrives from adversity—given the right context and support, those suffering from mental illness can emerge from the challenge to create vitality from turmoil.
The opposite of shame is not pride; it is resilience, and dignity is its root.