Stepping Through Stigma

By Naomi Stapleton, Psychology, 2016

Over centuries, there has been progress in mental health both strikingly forwards and shockingly backwards. Depression (or as it was known in ancient times, melancholia) has a particularly turbulent history of treatment and perception.

Melancholia was initially attributed to demonic possession in many civilizations. Hippocrates, hailed as “The Father of Modern Medicine,” was the first to consider both mental and physical illness as medically treatable, but even he attributed melancholia to an imbalance of the “humors,” particularly an excess of black bile. Later, Roman and Greek doctors interpreted the disorder as both biological and psychological, but sought to cure it with such methods as donkey milk, gymnastics, massage and baths. Surprisingly, the Age of Enlightenment brought even more misunderstanding and mistreatment to depression; thinkers during the 18th century saw melancholia as a permanent and irreversible weakness, which yielded mass ostracization and imprisonment of the mentally ill. The depressed were left to devastating squalor at best.

The introduction of neurology in the late 18th century framed a dramatic reinterpretation of melancholia as an affective disorder. William Cullen attempted to find a neurological cause, describing melancholia as “partial insanity” caused by inactivity in the nervous system. Alternatively, Sigmund Freud cited psychological imbalances and unconscious conflicts as the underlying factors of depression, facilitating the still ongoing debate of the merits of psychodynamic versus cognitive and biological approaches to mental illness.

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Sigmund Freud had a lasting impact on the way depression is viewed[/caption]

This scientific debate about the nature of depression has fueled years of productive psychological and pharmaceutical research. In the last hundred years, great strides have been made in the treatment of depression. Patients now have access to effective and personalized combinations of medication, psychotherapy, transcranial magnetic stimulation, cognitive behavioral therapy, and electric shock treatment (ECT). Contrary to popular understanding, ECT is an effective and humane last-resort treatment. First introduced in 1937, the approach yields a rapid remission of symptoms in more than 80 percent of patients, though there is a minor risk of confusion and memory loss.

Specialized medicine along with targeted treatment plans are becoming widely accessible, with 80 percent of patients showing an improvement within four to six weeks. If the rate of recent research continues, treatment methods for depression will continue to become more and more refined for the approximately 14 million American adults who suffer from depression each year (6.7 percent of the US population). Depression is highly comorbid with other disorders and diseases, like cancer (25 percent of cancer patients have depression), strokes (10–27 percent), and HIV (33 percent). More than two-thirds of the 30,000 suicides committed in the U.S. each year are attributed to depression. Despite these distressing statistics, only a third of the 14 million sufferers in the U.S. seek treatment. This isn’t a depression-specific problem: a quarter of the world’s population have a mental illness, yet as many as 75 percent of those people do not receive treatment.

Many cite stigma around mental illness as the main reason for this major discrepancy. A recent cross-cultural study review from King’s College London explained, “When seeking help for mental disorders, people reported feeling not only stigmatized by society but branded by their own hand, with a deep sense of personal shame. Other barriers to treatment included a fear of public disclosure as well as that classic self-diagnosis: not crazy.”

According to Dr. Ramin Mojtabai’s 2007 study, the American public has relatively positive attitudes regarding seeking treatment for mental health issues. The study shows that between 1990 and 2003 there were improvements in willingness and comfort to seek help. However, our perception of the effectiveness of treatment hasn’t changed: “In [1990 and 2003], the public estimated that more than half of people with an emotional problem who see a professional are helped and that less than half of those who do not obtain professional help recover,” says Mojtabai. The situation is clearly the reverse: not enough people are being helped even though successful treatment is highly likely. We are lucky to be living in a time where we can more comfortably acknowledge and discuss these issues, but there is still work to be done in terms of awareness and education. The stigma around mental illness must catch up with science.