Stigma often amounts to blaming the victim

Last week, we published a notice about the 2023 Mental Health Stigma Roundtable Discussion Series.

We ran the article because we believe it is important. The talks are free and open to the public. We hope to attend the roundtable on the role of the media in reducing stigma.

The title for the talks was chosen by the sponsors: the state’s Office of Mental Health and Behavioral Health News.

We were surprised to get a letter from a reader in Florida, Harold A. Maio, critical of our publishing word “stigma.”

Our usually short calls to confirm letters turned into an hour-long discussion with Maio. Formerly an editor for Boston University’s Psychiatric Rehabilitation Journal, Maio, who is now 86, sends out 10 to 15 letters a day to people he believes are prejudiced against people coping with mental illness.

“I’m empowered by Google,” Maio told us, noting he can respond to prejudice anywhere in the world as he can set his computer to alert him, for example, when the word “stigma” is used with mental illness.

“Before that, I had almost no power,” said Maio, stating that his letters have been published across the country and around the world.

Some editors are angered by his stance and block his emails, he said. We admire his tenacity and were interested to hear his viewpoint.

Maio believes that declaring a stigma makes it a problem. “It was not the stigma that killed six million Jews; it was those that believed it,” said Maio. He was, of course, referring to Hitler’s Germany; Maio believes that, because of World War II, no one today would say there is a Jewish stigma.

Maio writes in his letter to us, “Many years ago, we were told to stop declaring rape/stigma; we had done enough harm. We stopped. Without a murmur of complaint, we stopped.”

We told him just that morning we had read a story in The New York Times about Ukrainian women being raped by Russian soldiers and the reporter, Carlotta Gall, had not used their full names, writing of one of the rape survivors, “But the stigma and judgment of neighbors and acquaintances were also an abiding pain, she said. ‘They are gossiping about me, and I mostly stay at home,’ she said.”

Maio responded that he had communicated with an editor at The New York Times who told him that “stigma” is a neutral word.

We told Maio how, over our decades of reporting at a small, local newspaper, we have found rape survivors or survivors of other sexual abuse, very rarely want to tell their stories. If they do agree to have their stories told, they don’t want to be named.

Similarly, as we talk to family members, week in and week out, to write obituaries, often they are willing, even eager, to tell of physical illnesses suffered by those they loved, such as how they battled cancer. But rarely — almost never — do they want mental illness to be part of a published life story.

This is despite their telling us about how the person they loved heroically coped with bipolar disorder or anorexia or panic disorder or alcoholism, or how they succumbed to schizophrenia or to major depressive disorder.

We believe these stories need to be told just like stories of rape need to be told because both are more frequent than many people realize and, in our opinion, the prejudice is part of what keeps people silent about their suffering or the suffering of the people they love.

If we lifted that stigma, those who are suffering would not feel so alone. They would realize many others shared similar pain. They would not, as the raped Ukrainian woman does, “mostly stay at home,” believing others are gossiping about her.

In our long conversation with Maio, we agreed with him on some important things — that people with mental-health issues deserve and merit help, that words matter, and that prejudice is taught.

At one point, he quoted Rodger and Hammerstein’s song from “South Pacific”: You’ve got to be taught/ To hate and fear,/ You’ve got to be taught/ From year to year,/ It’s got to be drummed/ In your dear little ear/ You’ve got to be carefully taught.

Maio said his first degree was in art and his second degree was in literature and he learned from both fields of study the importance of “speaking in your own voice.” He believes that, while Hitler was in power, people who declared stigmas on others — on Jews, Catholics, people with disabilities, gay people — ruled. They formed a tight circle.

“When the war was over, the circle was bigger,” Maio said, and Hitler was then perceived as the deviant.

Maio likes watching “Law and Order” on television but says he bristles when a detective tells a rape victim, “It was not your fault.” What the detective should be saying, Maio contends, is, “It was his fault.”

We certainly agree that a survivor should not blame herself for a crime perpetrated upon her. But we believe that a stigma exists nevertheless — and may be part of what would cause a rape survivor to blame herself.

The best way for a society to rid itself of that stigma is to start by recognizing its existence. You can’t solve a problem unless you first recognize it.

“Stigma” seems to us like the painfully right word. It comes from the Latin for “brand or mark,” which in turn came from the Greek word “stizein,” meaning “to tattoo.” In English, “stigma” originally meant a scar left by a hot iron, a brand, which was close to its origins from ancient Greece where slaves were branded.

The people who were branded did not choose this for themselves; it was forced upon them — they were scarred by others. And that is precisely what we as a society do: We often brand others who are different from us. In the process, we scar them.

We published a letter last May that we admired from Stephen Giordano, Albany County’s mental health commissioner, and then we did a podcast with him to talk about it.

“Stigma leads us to overlook, forget, and deny the pain and suffering of our fellow community members,” Giordano wrote. “And most damagingly, it encourages us in our belief that mental health challenges happen to someone other than to us — it happens to ‘them.’

“The truth is that mental health challenges are insidious and they do not discriminate. Mental health challenges exist on a continuum for all of us. To think otherwise leads us to diminish the reality of those we know and those we love. It leads us to demonize individuals when they are at their most vulnerable.”

The numbers bear this out. The National Institute of Mental Health reports that, in any given year, nearly one in five adults in the United States experience mental illness and one in 25 experiences a serious mental illness. 

“‘Us/them’ thinking is at the core of many of the societal challenges we face today and it is most certainly at the core of the problem of mental health stigma,” Giordano wrote. 

This, to our mind, is not unlike the phenomenon Maio referred to in Nazi Germany where people in the ruling circle judged others as less than themselves.

Last year, the state’s Office of Mental Health awarded grants for what it called “stigma reduction projects,” which could be applied to education, employment, housing, parenting, health care — all intended to combat the discrimination that isolates people with mental illness and makes it hard for them to succeed.

On Monday, Xavier Becerra, secretary for Health and Human Services, was in Albany for a roundtable talk at the Mental Health Association of New York State to highlight how the Bipartisan Safer Communities Act is funding prevention, diagnosis, and treatment for mental and behavioral health.

At the state level, Governor Kathy Hochul announced on Tuesday, as part of the 2023 State of the State, overhauling New York’s mental-health care system, spending more than $1 billion, to better meet needs: expanding out-patient services and mental-health services in schools as well as increasing bed capacity for inpatient psychiatric treatment and creating 3,500 housing units for New Yorkers with mental illness.

Next week, Attorney General Letitia James is holding a second public hearing on the provision of mental-health care. The first hearing was held in June in New York City; this hearing will be in Buffalo but anyone in the state can submit online testimony through Jan. 18.

We urge our readers to join the conversation. Attending the free roundtable talks, online or in-person, with which we opened this editorial would be a good start.

While research has analyzed cultural ways to destigmatize — through constructions that remove blame or those that draw equivalences between the out-group and in-group — as matters of public policies, stigma can also be reduced on an individual level.

This means refuting stereotypes and diminishing feelings of difference. We’ve written on this page before about stereotypes — another painfully accurate word.

A stereotype is a printing plate; it is used to duplicate the original — again and again and again, always the same. The term was coined at the end of the 18th Century from two Greek words: “stereos” meaning firm and “typos” meaning impression.

It wasn’t until the 20th Century, though, that Walter Lippmann gave “stereotype” its modern meaning. In his book, “Public Opinion,” Lippmann wrote of the limitations people face in understanding their cultural and sociopolitical environments.

“The real environment is altogether too big, too complex, and too fleeting for direct acquaintance,” he wrote. People simplify by categorizing or stereotyping others; each person creates his or her own environment.

So, Lippmann wrote, people “live in the same world, but think and feel in different ones.” Hence, seeing through stereotypes subjects us to partial truths.

The Nigerian writer Chinua Achebe put it powerfully and well: “The whole idea of a stereotype is to simplify,” he said. “Instead of going through the problem of all this great diversity — that it’s this or maybe that — you have just one large statement; it is this.”

We love Achebe’s novel, “Things Fall Apart,” because of the way he described the lost Ibo culture; he made us see its complexities — its strengths and drawbacks — as the Christian missionaries were causing it to unravel.

It is only when we see the many layers that make up real people that we can know and love them. Such understanding is difficult to come by. It is far easier to stick with our own kind and to see others as stamped out, as if from a printing press.

Once we see them that way, as two-dimensional copies, rather than as flesh-and-blood originals, we are just a step away from treating them as less than human, less than ourselves.

Each of us can and must speak up if we hear a comment or see a gesture that diminishes another. We don’t have to laugh at a joke that, for example, uses mental illness as a punch line.

Rather, we should follow the advice of our mental-health commissioner: Strive each day to see yourself in “the other,” see the common struggles, see the continuum that we are all on. “Last I checked,” wrote Giordano, “this was the definition of empathy.”

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