Quantifying stigma: pitting the mental against the physical

Content note: Mentions ableism, mental and physical health stigma, gaslighting, fat shaming, eating disorders, death.

Raising awareness to the prevalence and difficulties of mental illness – how commonly it touches people’s lives and the stigma people face, the hardship and stress that stigma causes – is undoubtedly a good thing. When it comes to raising awareness of anything, we find it easier to quantify it’s severity by having a mark of comparison, and with mental health stigma the comparative gauge is usually ‘how we treat physical health.’

You wouldn’t treat someone with a physical illness the same way you do mental illness

This is one of the most popular messages you see doing the rounds when it comes to trying to raise awareness of stigma that’s frequently associated with mental health. We still see metal health as something shamed, words such as ‘crazy’ and ‘mental’ are still thrown around lightly to describe people who have very serious and very real difficulties, and when you’re in the grips of ill mental health those words, those negative messages, they can hit you hard. They can compound negative messages already going around your head and to say that is unhelpful is the Mother of all understatements.

We can see the hardship that the stigma causes, we can express it and we can explain how and why it’s harmful. We can raise awareness of individual illnesses and teach people what the different terms they flippantly throw around actually mean. What many often cannot see is that the above gauge so quickly leapt to for a measure of severity gives away our ignorance of stigma in illness and disability, as well as the parallels between the mental and the physical.

To sit and read social media, blogs, and columnists for various newspapers, people decrying the things mentally ill people are forced to face by a society that doesn’t understand, while steamrolling over the very real experiences you have lived, can be extremely alienating. If you have a physical health problem, chances are you have experienced almost exactly those same messages that you are being told you would never be subjected to.

“You just need some more fresh air, get out a bit more! You’ll be better in no time”
“You need to eat better, the key to good health is making sure you have a good diet.”
“You just need to exercise more. That increases your happiness too, it’ll help you get stronger”
“You need to remove stress from your life, try and relax more.”
“Do you drink enough water? You should try and drink 3 litres a day, there’s a lot that can be fixed just by doing that!”
“You should cut gluten out of your diet. Most health problems are actually rooted in the gut.”
“You should remove caffiene from your diet, you’ll never get better poisoning yourself with that.
“You need to think positively about it. Mind over matter is really powerful. You’ll never be better if you keep being so negative”
“You should try homeopathy.”
“It’s all those drugs you’re taking, they’re making you sick.”
“You need to eat small breakfasts every day”

The list of things people tell you will cure you – if you just try hard enough, invest enough time, put enough energy in, be more positive about, spend money on, ingest this thing, cut this out – is endless and you hear it all the time. People may not necessarily mean anything by it, they just want to help you somehow and giving advice is not only the easiest way, but sometimes the only way they can do it. Realising you have a health problem is like giving up control of a huge part of your life and it can be hard for those around you to accept that things are just as they are.

Whatever the reason for giving their input, what it feels like you’re being given this sugar-coated pressure, this nagging shame, it’s put to you as though it’s in the form of Good Advice but the message behind it is always the same thing. It’s you. By doing or not doing something, not doing enough, not trying, you are the root of all your ills. The underlying message is effectively blaming them for being sick.

One way you can see that underlying message compounded or remove any doubt as to it’s presence is when you explain to someone who has given you this Good Advice that it just won’t help. You won’t get better. Fresh air is not magic. You appreciate what they’re trying to do but exercise is not a miracle. They will sometimes give other, similar advice, or they’ll begin to tell you they’re just trying to help, how do you know if you haven’t tried it? Sometimes they may get increasingly defensive as if you’ve personally insulted them. You can told you’ll never get better if you have such a bad attitude about it, and that you’re not getting better is evidence of this over time.

If you have accepted the fact that you are ill and just want to get on with your life, your illness can still be a big part of that, and there being no happy ending is something a lot of people simply cannot get their head around, and your acceptance is deemed giving up. For a lot of illnesses, the expected outcome is not necessarily a good one and false hope is crushing, but in the face of the worst odds you are expected to fight until the end. You’re not supposed to get on with your life. “Maybe you’ll be the lucky one, there must be something, just do this..”

Sugar coated blame is just one form of all this. Did you know you can sometimes have doctors telling you it’s in your head? That you’re making it up? You can be told that what’s happening to you just isn’t possible, that you’re “crazy”, that you’re imagining it, that nothing is wrong at all. You’re told you’re making up all the pain, drug seeking, even that you’re too young to be in that much pain, or ill at all, unable to walk well.

“You don’t look sick” is one of the most consistent things a lot of people with invisible illnesses get told. It’s as if your failure to fit the very mobility-focused disability chic view society has of illness, pictures of people in wheelchairs or sitting with blankets over their legs, being helped to walkers, nullifies your lived experience entirely. You can experience everything from an expectation to hear exactly how you’re sick in order to prove you are not lying to an outright denial that you’re sick, that you’re clearly faking it, you look too healthy as if that has some homogeneous visual quality.

Sometimes you’re told directly that it’s your fault, whether it’s true or not. Smokers with lung cancer or COPD are consistently reminded of the link between their health and behaviour, fat people are told every health problem under the sun is down to their weight, and you can see the parallels that arise when you see people with eating disorders told that their issue is vanity, people with depression told they’re just weak in character. Even people who are dying are routinely having it suggested that they’ve done it to themselves in some way. It can come up with bizarre and tenuous links through ignorance; told you’re being tested by god, it’s karma, blaming a use of medication in childhood for any variety of health problems, blaming a lack of breastfeeding, blaming poor diet when young, poor upbringing, bad schooling meaning you’re just not coping with what they see as “normal” health. ‘Broken’ families’, lack of a Father figure, too much TV, too much time in front of a computer, not socialising enough.

There is so much stigma around physical health and a lot of it is ignored, misunderstood, or simply tossed aside as flippant commentary you should ignore. It’s emotionally taxing and stressful, and it’s something a lot of people have to learn to manage on top of their health issues thanks to it’s prevalence in our society. You can’t ignore something that won’t ever seem to go away, not least because people so often wish to know “what you’ve done to yourself” at any hint you’re presumed to have a health problem. Over time it can drag you down and put you on edge, you start saying you’re fine a lot because then maybe, just maybe, it won’t come up. You can feel small and helpless the more you are told “you just need to..”, and over time as you’re ground down you start to doubt whether you’re really sick, whether you’re really just lazy, whether you’re really just mentally ill.

All of this is not to ignore that there are also some enormous crossovers with physical and mental health stigma. An expectation you’re depressed or otherwise mentally ill because “how on Earth can anyone go through that and not be?” The aforementioned being called ‘crazy’, imagining things, it all being in your head. If you are already diagnosed with a mental illness, it’s possible that a lot of other, unrelated, health issues get associated with it. Your lack of energy is your depression, investigation over, problem solved. Your pain is worse because you’re clearly not coping mentally, try and remove stress and just relax more. And equally mental health is ignored at times, “well of course you’re going to be stressed with all this going on” when really there is a deeper core problem that needs addressing. Let’s not forget, either, that many people who have physical health problems may also have mental illnesses. You have to navigate the stigma of not just each of them individually, but them both together as well.

Mental and physical health undoubtedly have their own individual issues attached to them, their own stigmas, and when you stand at the intersection of them both you see new ones arise. We can quantify the difficulties of mental health stigma people are subjected to without invalidating the incredibly harmful stigma that looms over physical health. We can explain the harm it can cause to individuals and to wider society, how it stops people from seeking help or ostracises them when they do. We can explain different terms and different illnesses, show that flippantly throwing around terms is belittling experiences people actually have, lift people out of their ignorance and show them that mental illness is not necessarily what they think. We can raise awareness without standing on top of those who are just trying to get through the same.

We can do better than this.

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