Mental Health Stigma: The Week Washington Erupted

By Mary Giliberti, J.D. | Aug. 03, 2017

 

When former White House communications director Anthony Scaramucci’s remarks called President Trump’s now-departed chief of staff Reince Priebus a “paranoid schizophrenic,” prefaced by profanity, he was widely condemned for his malicious vulgarity—and properly so. 

Much attention focused on the crudeness of his remarks, but less so the implications of the “paranoid schizophrenic” part of his outburst. Use of a medical diagnosis for political mud-slinging exploits the prejudice and stigma that traditionally has surrounded mental illness. Unfortunately, it is a reflection of a much deeper problem.

Almost 20 years ago, the landmark U.S. Surgeon Mental Health Report identified a key public health problem; stigma discourages many people from seeking help when they need it. It also deters our investment as a society in the mental health care system.

Less than 48 hours after Mr. Scaramucci’s quote became news, a syndicated Washington Post columnist fed the flames by asking satirically, “What do we do if the President is really crazy?” The column was peppered with slang such as  “nutter,” “barking mad,” “mad as a March hare,” “off his rocker” and “a few fries short of a Happy Meal.” It recounted advice from mental health organizations on how to address mental illness as a way to mock the President. We expect more from leading journalists and their editors in setting tones that influence public perceptions and attitudes.  

Stigma is non-partisan. Democrats and Republicans alike perpetuate it. During the 2016 Democratic primaries Senator Bernie Sanders joked: “When you watch these Republican debates, you know why we need to invest a lot in mental health.” It was the type of joke that both used stigma for a laugh and trivialized serious illnesses like schizophrenia or bipolar disorder.

Such remarks denigrate the achievements of many individuals who have struggled with such illnesses. Those with schizophrenia have included Nobel Prize-winning economist John Nash and law professor Elyn Saks, winner of a MacArthur Foundation “genius grant.” They also are insensitive to the many families who have, or have had, loved ones with the illness—including Nobel Prize winner Dr. James Watson, who co-discovered the double-helix structure of DNA and actor Alan Alda.

Perhaps most perniciously, they discourage young people from getting help at a time when science is telling us that early intervention in schizophrenia is critical to achieving better outcomes.

Mental illness does not discriminate. It affects Republican and Democrat families. Ironically, the week’s stigma eruptions happened during the week of the Senate’s vote on a health care bill that would have cut billions of dollars from Medicaid—the program that is the lifeline for millions of people with mental illness.

More than 2 million adults have schizophrenia. The average age of onset tends to be in the late teens to early 20s for men and the late 20s to early 30s for women. It does not mean that a person has a "split" or multiple personalities. Instead of slang, wisecracks, and jokes, we need leaders willing to educate national, state and local communities about effective public policy solutions.

Investment in mental health services and supports is needed. Early intervention programs for young people experiencing psychosis need to be expanded. Support for scientific research through the National Institute of Mental Health is essential.  Housing, jail diversion and employment programs are also needed.

Go to any jail or homeless shelter in America and you will quickly realize that these are serious illnesses that deserve serious responses. To address the stigma that erupted in Washington, D.C. last week, Scaramucci should directly apologize for his harmful and stigmatizing comments.

Perhaps Scaramucci’s successor, politicians from both parties and members of the press could visit community mental health clinics, early intervention programs, a recovery clubhouse, and research centers to get a better understanding of these issues. This would go a long way in educating the American people and helping to eliminate stigma. It is time to get out of the partisan gutter and elevate the public dialogue on mental illness.

Comments
Joanne Beckman
Reducing mental health stigma is a noble goal but politically extremely complicated. Labeling the President as incompetent due to "behavioral problems" is potentially using mental health as a stigma for partisan political ends,.if I understand Jay Yudof's points, especially #2. Stigma is rampant in political discourse,malign often as fear-mongering to frighten the public; wasn't the current President's child stigmatized with a "diagnostic label"? These days everyone seems to all to readily label anyone who disagrees politically with their point of view as "crazy". Perhaps a start would be for the better informed members of the public to evaluate candidates based on their negativity toward mental illness as well as how well they could address health reform and other issues. Lastly, let's not oversimplify answers to mental health reform, such as "more funding" and "better treatment". Mental illness simply is not well understood and maybe a disease model is not the best approach to reducing its spread. We need to look broadly at causes and compassion, not just cures. The whole health care system is broken, and it has been government-subsidized for decades. The real problems may be from deep cultural problems that lead to alienation and lack of community, which more medicine and money via government programs will never address.
9/10/2017 11:32:16 PM

Ruth Campbell
This article refers only to "schizophrenia" with no effort to distinguish between that and "schizoaffective disorder." The vast majority of people who are mentally disturbed have symptoms of schizoaffective disorder, not schizophrenia, which is far more serious and can be dangerous. If you want to know the difference, read the DSMIV or V, or whatever is out now.
9/2/2017 1:50:01 AM

Renee
I have a 30 y/o son who diagnosed as schzoid-affective. I was not educated
about his illnessl his first onset of his illness; he was diagnosed at 18 y/o. He has been hospitalized 3 times. He relapsed after Dr. changed his med due to the slight deterioration of his kidneys. He quickly went into a downward spiral. He refused to go to the hospital;take his meds. Dr. Untimely due to his unintentional incident with the law. He is now in the jail system. Silverlining; due to the changes in the jails. He is being adm. meds. getting therapy, working with competency team. I don't know what his future holds.
9/1/2017 4:59:21 PM

Paula Kelleher
I think the NAMI family 12 week course should be required for everyone. I have been a nurse for many years and thought of myself as empathetic. It was during this course that I learned real empathy. The stupid statement would not have any power if he said, he is a !!! Diabetic. People are fearful of talking about mental health.
8/31/2017 11:58:43 AM

Lily Arapeles
We have a long way to go to educate people that mental illness is like other medical illness . If we do succeed in any length , then we can reduce the stigma around mental illness . Education and advocacy is the key to all this problems.
8/31/2017 11:50:17 AM

T. Dolan
It is ashamed how people with mental health issues are neglected and mistreated. I suffer terribly. I have lost fifty pounds in the last month. I have been battling this for 8 years. I worked most of my life. My life savings is gone due to trying to find help for whatever I got. Eight years and nothing. I was 48 when this started. Doctors seem to just want to prescribe medicine. I know many people who have gone to mental hospitals and it is a nightmare. They are not treated like human beings most of the time. They are locked in their rooms, giving medicines with terrible side effects. If one does not work; the add another until you end up with a ridiculous *****tail of medicines. They raise money on TV for other types of illnesses . Why not one for mental illness. You never know when it may strike. I do not even know the cause of mine. For all I know it may be physical. Doctors just rush you in an out. Prescribing medications is so much easier than getting to the root cause. Thanks for your support. This needs to be aware to more people by television and other means. So many people end up taking their lives due to lack of treatment. Thanks again
8/30/2017 11:52:00 PM

Susan H Morris
I have a son with schzoid-affective disease. He was diagnosed at 19 yrs. and is now 41. The Mental Health System is broken! I have spent 22yrs. trying to get my son the best Drs; they rotate out so fast that there is a no continuous following! Trying to find therapist, trying to MAKE him take his medicine,etc.I think it has caused my health decline! Because as many have said no one has "your Back"! The governments inability to care about mental health is disgracful!!! And I AM SO SICK OF MEDIA OR POLICE ANNOUNCEMENTS THAT A CERTAIN PERSON MUST BE SCHZOPHRENIC! Everone with no knowledge of mental health labels a person schophrenic! I certainly causes discrimination and hurts people with that disease! IT makes me sick! There are many in the White House that should watch what they say about mental H ealth issues!
8/30/2017 7:55:49 PM

D.S. Arrowsmith
We should not over-react to Scaramucci. He has shown himself to be detestable in every way, so of course he talks like this. It would be different if someone respectable were flinging that language around.
8/30/2017 4:08:25 PM

Jay Yudof
With all due respect to the many commenters, and noting that I am, in fact, a lifelong liberal, I think a major theme is being missed.
1. The president exhibits behavior patterns which may likely meet some diagnostic criteria, and perhaps involve more severe emotional impairment than any of his predecessors displayed (of course, 18th-20th century presidents did not have the ability to Tweet).
2. As advocates for people dealing with ongoing mental health issues, we need to be in a position to be proud of this man for having gotten this far.
3. Public debate has shifted to questions of Mr. Trump’s fitness for office.
4. I am not aware of any specific fitness for office tests in the constitution or other US law.
5. I also do not believe that behaviors which could impair a common citizen’s ability to keep a high clearance serve as barriers for access to classified information by the president, cabinet officers, or senior members of congress.
6. While it is difficult to advocate for “reasonable accommodations” in the absence of a request for same, hopefully Mr. Trump, if he requests, could get OPM to assist him in obtaining reasonable accommodations.
7. As people with lived experience of mental health issues and lay and professional caregivers, perhaps we should start thinking about what those reasonable accommodations might look like.
8/30/2017 3:26:44 PM

Sabrina Green
This man is gone now. He is just plain ignorant. Maybe he will have time to read a book now?
8/30/2017 3:03:03 PM

Sue L
In the wake of so many horrible killings in our country, as much or more attention should be paid to the mental health of the perpetrators instead of increased law enforcement. If these people had been able to get help, any such incidents may have been prevented. Ms. Giliberti is right that government officials and members of the press should " visit community mental health clinics, early intervention programs, a recovery clubhouse, and research centers to get a better understanding of these issues." Specifically, I believe the people who actually have the most power to make the needed changes with drafting of legislation and their Votes - our congressional representatives - need this exposure. But how to accomplish this?
8/30/2017 2:28:09 PM

Saul Goode
There are 2 fundamental issues that people seem to gloss over when they talk about lifting the stigma surrounding mental health problems: 1) the myth of confidentiality and 2) distrust in professional performance by people with problems.

On Issue #1: healthcare providers of the world would like you to believe that your treatment records are "confidential." But such records are often subject to scrutiny. For a doctor who wants to be licensed: the licensing board asks probing mental health questions and often will demand complete records of applicants. Or ANYONE who ever brings a personal injury lawsuit, can have their mental health history probed in discovery, including their "confidential" health records, and such info routinely becomes part of the public record of their case file.

On issue #2, it's easy to applaud actors, like Carrie Fisher, who was open about her health problems. But let's be honest, the work performed by actors (or artists of any kind) doesn't directly affect a customer's life. But would you comfortable being operated on by a surgeon with schizophrenia? Or being represented in court by a lawyer with bi-polar disorder? Or a sky-diving instructor with severe depression? I believe most people would not be comfortable.

Until these two very real problems associated with the diagnosis and treatment of mental health are addressed (if they even can be), I can't imagine the stigma associated with mental health problems ever truly being lifted.
8/18/2017 5:29:13 AM

Linda
People like me who have bi-polar illness need more help fighting the stigma that goes along with a mental illness.
8/14/2017 7:37:04 PM

Donna Comiskey
We have come so far. However, we still have a long journey ahead. Together we must continue to support and educate the masses! Lead from where you are!
8/7/2017 10:14:24 AM

Carline Content
Mental health is in SEVERE crisis. For almost 20 years, I've been treated for ADHD, depression and anxiety. My health has steadily declined over the past 5-6 years. As a single mother, I knew I needed to get it under control. I arranged a neuropsych eval on my own. Apparently, I have NO signs of ADHD, but I have a lot of emotional issues- major depression, severe anxiety, possibly some PTSD... Why didn't anyone ever get me a proper diagnosis 10 years ago!!!! Right now, I'm out of work because the work force has no room for these types of issues. If you can walk, talk and write, you can also run around like a maniac all day and take A LOT of abuse. And I STILL get harassed by the manager! The kicker is, I've worked in healthcare for all these years. I always take care of the "gross, crazy, stupid jerks" Personally, I dont have issues with these types of patients. In fact, they love me just for the mere fact that I'm compassionate. So, now I'm outta work on medical leave. I see a counselor, an APRN for meds and my primary doc. The counselor signed off to take me out of work, but now no one wants to do forms for me to get disability benefits at work. I've already exhausted FMLA. I've dealt with these stupid forms at work and don't blame anyone for not wanting to take them on. But, now what do I do????? Go to drugs? Suicide? Crime? Homelessness? The only savior is my faith in God.
I don't know why it's so difficult to understand where a lot of the drug issues and homelessness stems from. NO ONE has your back. I've even lost my family cause they think I'm a miserable person. Well, I am. Thanks for the support.
8/6/2017 9:18:20 AM

HOC LY
HAI :D
8/4/2017 11:40:26 PM

JoAnne G
As a nation we are not caring for this very diverse population. We lack progressive insight on how to best treat / care for our loved ones in a humane long term plan of care. The gap of services in our communities is shameful.
8/4/2017 3:11:32 PM

Joan Rapp
I am grateful to Mary Gilberti for cataloging some of the very discriminatory and damaging remarks that have been flying the political scene over the recent months. This kind of rhetoric continues to create pain and frustration for individuals and families trying to escape the kind of stigma that keeps people from seeking help and continues to marginalize those with mental health challenges.
8/4/2017 2:23:00 PM

Brad Benson
As a parent and caregiver of a son with schizophrenia (diagnosed at 19 now 26) this hit me in gut & heart. 1 in 5 people on this planet have a defined mental illness, after joining NAMI and learning more about my son's illness I learned that my combat related PTSD is an mental illness. Investment in mental health services and supports is needed. Early intervention programs for young people experiencing psychosis need to be expanded. Support for scientific research through the National Institute of Mental Health is essential. Housing, jail diversion and employment programs are also needed. Sadly nothing has changed, my goal in life is work toward everyone understanding that when they see that manic person they understand that the person is simply having a heart attack in their brain. We all know how to react to a heart attack.......
8/4/2017 1:16:23 PM

J Norman
My grandson needs more help
8/4/2017 10:59:29 AM

John
It is really hard to get close ones to fully understand what my life has been like since I entered the world of serious mental illness called severe depression.
8/4/2017 12:17:35 AM

Jane Napper
Family and other caring individuals have Far Too Much Faith in our mental health systems as a whole!
8/3/2017 10:45:50 PM

Diana Lozano
Using Mental Illness in a crude method is unacceptable. People do not make fun of Cancer victims ...there is no difference !!
8/3/2017 6:34:40 PM

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