Imagine you break your leg, but no one believes you. Your boss tells you to just get over it. Your mother says it’ll be all right in a few days. Your spouse snaps in frustration, “Stop limping! You’re scaring the children!” Despite your pain, you don’t want to go to the doctor, because when another friend went to the doctor for a broken leg, people talked behind his back about how crazy he must be.
It’s preposterous to think of treating someone with a broken leg so poorly. But if you’re honest, have you ever caught yourself thinking something similar about someone with depression? This kind of treatment is reality for many living with depression, a common mental illness that affects at least one in ten Americans. But what would happen if everyone were convinced that depression was as much of a real medical problem as a broken leg?
In the 1990s, mental health patient advocacy groups and psychology professionals decided to try to answer that question. Growing evidence for neural and biological contributors to depression seemed to offer a way to simultaneously decrease stigma and increase popular support for mental health treatment. After all, Americans don’t tend to stigmatize people with medical illnesses, and generally support treatment for medical problems. Many were well-intentioned in their eagerness to ‘market’ depression as a “brain disease” as a way to change the public perception of depression.
It has been years since this strategy has been implemented – has it worked?
In 2006, eight out of ten Americans surveyed said that they would attribute depression to a “chemical imbalance” or neurobiological problem, and two-thirds thought that it was an inherited or genetic problem. Probably not coincidentally, support for a variety of mental health treatment options for depression had dramatically increased since the same survey was taken ten years prior, with 91% believing that depression should be treated by a physician. By these measures, describing depression as a medical illness appeared to have ‘worked.’
Souring this success, however, is the fact that stigma associated with depression did not appear to decrease in the same decade. Some of the same people surveyed who said that depression is a medical problem that should be treated by a doctor were also unwilling to hang out or work with someone with depression. A third of the people surveyed still believed that depression was due to the bad character of the person. Do we usually send people to doctors to treat bad character?
I have written previously about the problems with speaking of depression as a purely biological illness. Depression is not imaginary. It is not a moral failing of those who live with it. But depression cannot be fully accounted for by biology, and the attempt to cast it simply as a medical problem was somewhat misguided. That aside, the strategy to speak of depression as a biological illness was both a rousing success and a stunning failure – everyone now seems willing to think of depression as a medical illness, but many are unwilling to change negative beliefs about the people who have depression.
There are a few theories as to why stigma has not decreased. Perhaps talking about depression as a medical problem has only encouraged people think of those with depression as “broken,” with no hope of recovery. Whatever the reasons, the way forward is unclear.
There are some positive signs of change, including influential role models coming forward and speaking about their experiences with depression. Many celebrities, including Ashley Judd, Brooke Shields, Mike Wallace, Rosie O’Donnell, Sheryl Crow, and others have openly discussed their struggles. But the backlash that many of them faced is still indicative of public opinions about depression.
Admittedly, you might not care too much about what people say on TV about celebrities. But prevailing public attitudes are powerful, and can translate into how communities set public policy. Stigma can mean the difference between discrimination or early medical attention, between denying funds for research or treatment facilities and equality of service for all with debilitating conditions. In this way, stigma is a threat to an equal society. We need a new strategy to fight it. Because even if the public is now convinced that depression is just like a broken leg, then people with broken legs are still being treated like they’re lazy.
Pescosolido BA, Martin JK, Long JS, Medina TR, Phelan JC, & Link BG (2010). “A disease like any other”? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. The American journal of psychiatry, 167 (11), 1321-30 PMID: 20843872