Category Archives: Stigma

Stigma, The Brain And Brain Illnesses

By Dr David Laing Dawson

Every day the news contains at least one item describing our struggle to understand a difficult or troublesome or tragic human behaviour. As I write this there is an ongoing trial of a man accused of killing, dismembering, and then burning a Calgary man and woman and their grandson who happened to be on a sleep over with his grandparents. It is reported that the accused held a grudge against this grandfather because of a failed business arrangement years ago. The grudge “grew in his mind” until….

Then I read of a woman who committed suicide two months after the birth of a child. The grieving husband wants to shed light on post-partum depression but the emphasis in the article was about trying to alleviate the shame some women feel because they cannot breast feed.

This is the article that stuck in my mind because it emphasized the problem of stigma, the need for awareness, and the “let’s talk about it” approach to “mental health”. All well and good. But it continued the trend of trying to understand these tragic behaviours as the consequence of some kind of rational, all-be-it extreme, thought processes.

I understand this. When confronted by any odd human behaviour we try to “understand” it by applying two mechanisms: a logical sequence of cause and effect and empathy (how would I behave in similar circumstances?).

We live our lives believing in the supremacy of mind; we organize socially and act independently within an assumption of “mind”, of “free will”, of “choice” and consequences and personal responsibility. We are very reluctant to accept the fact that the brain can hijack this process, that the brain is the primary organ dictating human behaviour, that the brain, this biological computer system of cells and neurohomones and fragile connections, can go wrong. This reluctance has extreme advocates such as Bonnie Burstow who thinks…. or who’s brain leads her to think…

Actually I have no idea what she really thinks and why she thinks  it.

But phrases like “mental health issues”, euphemisms for mental illness, and much anti-stigma publicity continue to support the primacy of mind and downplay the role of brain. They continue to support the notion that all troubles, with a little support, acceptance and understanding, can get better, be overcome.

This does a tremendous disservice to those who suffer from true, serious mental illness.

From her culture, her family, and perhaps from all the current pop cultural emphasis on breast feeding, the new mother in question probably felt some degree of disappointment that she could not breast feed. But this was not an experience that propelled her, through a logical sequence of thought processes, to suicide.

No. Serious postpartum depression, and postpartum psychosis is as clearly as any serious mental illness, a brain problem. The brain has hijacked the thinking process. It is no longer rational. This is a brain illness.

Prevention of the tragic consequences of this illness requires knowing which women who have given birth are at risk, screening for and identifying this illness, recognizing it as a brain illness, and treating it vigorously as one would treat any serious and life-threatening illness.

Sure, let’s talk about it and de-stigmatize it, but we also need to recognize that it is an illness, a brain illness, and offer, make available, medical/psychiatric treatment, and occasionally protect by holding the sufferer in a safe environment while waiting for treatment to take effect.

And, contrary to what Bonnie Burstow and the anti-psychiatry people say, we now have effective treatment for depression and psychosis.

Naming

By Dr. David Laing Dawson

exorcism Part 1 of a few.

Disease, illness, affliction, problem, atypical neurological development, eccentricity, issue, alternate reality, way of life, gift? There is no shortage of words and phrases to name and describe the nature of our struggles to cope, to live and survive in our social world. But each word conveys implications of value, worth, status, promise, expectation, and responsibility. Often these implications themselves determine which word is chosen. About once a month I am told I am about to see (in consultation) a child who has been labeled “gifted”. Whereupon I must try to find a delicate way of asking if “gifted” means Carnegie Hall by the age of 13, or brilliant at quantum mechanics but can’t relate to people, or simply learning disordered, or, careful with these words now, mentally handicapped.

Unfortunately many of the words we use, benign and descriptive at first, over time accrue negative value like small crusty accretions. There wasn’t anything wrong with “retarded” (slowed, behind) until it became an epithet in the schoolyard.

To prevent misunderstanding, but inevitably to obscure, we often fall back on what an editor friend of mine calls “weasel words”, benign enough to not offend, but careless and unhelpful. “Issue” is one of those words, as in “addiction issues”, and “mental health issues.” I don’t know why anyone would say, “He has addiction issues.” rather than, “He is addicted to heroin.” But they do. The use of “mental health issue” is easier to understand, though equally unhelpful. The speaker or journalist is trying to avoid the word “illness”, as in “He suffers from a mental illness.”

A Monty Python skit comes to mind, in which the doctor hesitates while telling his patient that he has, or suffers from, Syphilis. He gets to the word and, instead of speaking it, bends and whispers it into the open drawer of his desk. The patient doesn’t hear the word and asks the doctor to say again. In Monty Python fashion this repeats over and over until….

Actually I don’t remember the ending and I cannot find it on Youtube. But I imagine Michael Palin finally screaming the word, and a few others, at John Cleese.

We avoid the word because of the stigma attached to it, thus increasing the stigma. It was not until we openly used the word “cancer”, that we didn’t run from it, euphemize it, hide it, that it began to lose its stigma. Once free of its stigma the doors opened, research money poured in; clinics, wards, whole hospitals were devoted to helping those who suffer from cancer. The illness cancer, the disease cancer. Not the “cancer issue”.

Terry Fox did not run across Canada with a leg amputated to raise money and awareness for Bone Health Issues.