As long as psychiatry, psychology, psychiatric nursing, and other mental health-related professions use their status as a service to the established power, the mentally ill person will continue to be marginalized.
Joaquín Díaz Atienza
INTRODUCTION
As I did in the post about the stigmatization of the psychiatristThe opinions expressed here, which I share, are included in the documents published by the World Psychiatric Association and the European Psychiatric Association.
We first present the social stereotypes about psychiatry; then the stereotypes among health professionals and, subsequently, the opinion of patients and the media.
1. Psychiatry in the general population
The negative image that has been disseminated about psychiatry has its origins in its own history and is sustained by stereotypes and beliefs that belong to the past. Personally, when I study the history of medicine, I fail to understand how such magical and unscientific therapeutic procedures practiced in other specialties have not led to the marked stigmatization that psychiatry suffers.
I believe that social stereotypes have a lot to do with the effectiveness of treatments: if a patient with kidney, heart, or any other organ disease didn't respond to treatment, they were likely to die. However, the mentally ill were considered possessed or demon-possessed, a danger to society. This view has even been held by the Church throughout history. Society has internalized the idea that the mentally ill are, at the very least, potentially dangerous, someone we should isolate from society, with psychiatry as a profession dedicated to ensuring that this isolation is effective and lasting.
Asylums, asylums, and psychiatric hospitals were established, valued as institutions whose function was primarily custodial, with closed doors and located outside urban centers. In a survey conducted in Germany, 50% of respondents believed that the mentally ill should remain in the institution continuously, and 50% believed that the straitjacket was still commonly used as a means of restraint.
During the 70s, with the development of Community Mental Health, some positive changes were observed, although the community offered significant resistance to its implementation. This attitude of rejection is known as the NIMBY Syndrome (Yes, but not in my neighborhood).
Surveys conducted in the US have revealed that 80% of Americans reject the idea that the best way to help the mentally ill is to open the doors of psychiatric institutions, and 31% oppose the opening of a mental health center in their neighborhood. The most frequently cited concerns are that their homes will lose market value, and that children and neighbors in general will feel unsafe.
The aforementioned stereotypes are related to the supposed dangerousness of psychiatric patients and the ineffectiveness of treatments. Some consider these stereotypes positive, while others find them dangerous. In this regard, the general population overvalues psychotherapy, recommending it as the only option even for schizophrenia and other serious mental disorders, contrary to all scientific evidence.
There are five common stereotypes about drug treatments:
– It's addictive.
– It's silk, but it doesn't cure.
– It's an invasion of privacy.
– They are not useful for preventing relapses.
2. Stereotypes among professionals
Very few professionals understand the role of psychiatry, and even fewer in healthcare centers where there is no liaison psychiatry, or where they haven't received appropriate training or practical experience. It is also known that if psychiatrists' only interaction with other professionals is limited to emergencies, the image of psychiatry deteriorates even further.
A very negative view of psychiatry has also been found among some psychiatrists. These are usually professionals in the field of psychoanalysis.
3. Patients and families
Most patients with mental health problems fear being referred to a psychiatrist because of the stigma surrounding mental illness, not so much because they doubt the effectiveness of psychiatric treatments. In fact, patients' expectations are generally positive.
Many believe that medication is addictive, doesn't effectively treat the illness, alters personality, and suppresses the natural expression of feelings. Therefore, both patients and their families prefer psychotherapy, even though there is no scientific evidence of its effectiveness for the specific illness they are seeking treatment for. Most people place excessive, and sometimes even mythical, faith in psychological treatments due to misinformation and/or misconceptions.
4. The media
The image that is usually given in the media about psychiatry is quite negative: psychiatry is a discipline without a training program, it does not have a scientific basis, and its treatments are ineffective.
They persist in associating psychiatry with outdated psychiatric institutions, obscuring the progress made with new mental health centers. Along the same lines of clinging to the "old" to sensationally criticize the "present," they refer to treatments: supposedly, only electroshock, straitjackets, and forced isolation exist.
In the cinematic portrayal of psychiatry, there is what has been called "the Hollywood methodology," which consists of emphasizing the therapeutic "successes" produced by simple cathartic patient meetings and highlighting the "serious" side effects of psychotropic drugs, without mentioning other medications indicated for non-psychiatric illnesses. In this way, the idea is internalized that psychotropic drugs produce horrific personality changes, while those prescribed for other illnesses have no effect on the central nervous system or the psyche. For example, antiepileptics with serious side effects, such as the onset of psychosis, are accepted, but not an antidepressant.
Next post: RECOMMENDATIONS FOR IMPROVING THE IMAGE OF PSYCHIATRY.
