Correspondence

Authors


Dear Editor,

Stigma blocks recovery from mental illness. Advocates have known this for more than a century and been eloquently arguing to audiences that would listen for much of that time. Psychiatrists have come later to the fray, most prominently in the past fifteen years which brought the authority of medicine and science to battles against the injustice. Unfortunately, research often showed psychiatrists of yore, among most mental health service providers, frequently added to the stigma of mental illness by endorsing notions of unrelentingly poor prognosis and need of institutionalization. In this light, a WPA task force recently posed stigma experienced by psychiatrists as another area of prejudice and discrimination 1. The report noted the “nefarious consequences” of psychiatrist stigma that undermine training needs of students and residents, lessen professional prestige, impact good salaries, and restrict possible resources. We feel that prioritizing psychiatrist stigma undermines psychiatry's moral authority in an argument where it had been noticeably missing. At best, posing psychiatrist stigma distracts from the core of the injustice, its harm on people with serious mental illnesses. At worst, it muddies psychiatry's role in promoting recovery.

In their saltatory definition, Link and Phelan 2 described power and status loss as primary to stigma. People labeled as mentally ill are shamed and have far fewer opportunities due to fellow citizens in their society. Many are unable to work, live independently, develop relationships, or enjoy health to their full potential. Perhaps psychiatrists suffer status loss too, especially in the light of superior acting medical colleagues. But the loss is miniscule compared to those about whom the stigma movement is built.

Consider two historical examples. For thousands of years people with leprosy were chased out of their homes into colonies of shame and deprivation. Good people often stepped up to care for those with leprosy, typically suffering the same kind of social opprobrium as those with the disease. Alternatively, the first 250 years of Europe's history in the New World were a time when Africans were brutalized as slaves. Caucasians of conscience spoke out about this moral plague, some working in the underground railroad, offering refuge and nourishment to slaves who were fleeing north. The freedom riders risked arrest, jail, and the murderous rage of neighbors. It is hard to focus on the unjust discrimination of carers in leper colonies or freedom fighters on the underground railroad, viewing both as a preposterous distraction. Perhaps our comparison is overstated. But then using the stigma of mental illness to describe the woes of psychiatry may be exaggerated. Psychiatrist stigma might gain legitimacy if it had the support of grass roots advocates with serious mental illnesses, those leading the charge against mental illness stigma. This is an interesting empirical question to be sure, one perhaps in need of a study. We hypothesize most from this group may not concur with the psychiatrist stigma agenda.

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