Nobody's Normal: How Culture Created the Stigma of Mental Illness by Roy R. Grinker

Author:Roy R. Grinker [Grinker, Roy R.]
Language: eng
Format: azw3
Publisher: W. W. Norton & Company
Published: 2021-01-26T00:00:00+00:00

CHAPTER 13

AN ILLNESS LIKE ANY OTHER?

“Depression is a cold of the heart” (“Kokoro no kaze”).

PsychoDoctor, Japanese television drama (2002)

Beginning in the 1980s, pharmaceutical companies, mental health advocates, the US government’s National Institutes of Health, and researchers and clinicians throughout the world formed what the writer Robert Whitaker calls a four-part harmony, a “powerful quartet of voices” to convince the public of the biological nature of mental disorders.1 They all agreed that stigma could be reduced only if people understood that mental illnesses were diseases of the brain, not of character.

Yet biological models of mental illness have been central to the stigmatization of mental illnesses. Whereas the DSM-I and DSM-II conceptualized mental illnesses as emotional reactions to one’s environment—often quite appropriate reactions, like having anxiety in combat or grief after the death of a loved one—in 1980 the DSM-III redefined mental illnesses in more scientific terms. In the DSM-III, mental illnesses were distinct clinical conditions essential to a particular kind of person, disorders that doctors could measure, reliably diagnose, associate with certain demographic groups, and attempt to treat with medications. Someone with a psychosis was now “a schizophrenic”; someone with depression was “a depressive.” And that’s exactly what stigma is about: when a diagnosis comes to represent a person as a whole.2 To counter the risk of stigma, most of the clinicians I know thus tend to say that someone has schizophrenia or depression, not that they are a schizophrenic or a depressive. But the rest of society doesn’t necessarily heed this linguistic detail.

Many experts reasoned that if mental illnesses could be conceived of as medical conditions they would be less likely to define one’s personhood. This is why British doctors rejoiced when, in the 1960s, they discovered that the confusion and hallucinations of the mad king, King George III, had been caused not by a mental illness of unknown cause but by the metabolic disorder called porphyria. They declared: “Finally, by implication this diagnosis clears the House of Hanover of an hereditary taint of madness.”3 In 1984, in an attempt to reduce stigma, psychiatrist Nancy Andreasen called mental illness a “broken brain.” Someone with a broken arm or leg wouldn’t think of staying away from a doctor, but someone with a serious mental illness does. Andreasen argued that prejudice and discrimination of people with mental illnesses derived from ignorance, “from a failure to realize that mental illness is a physical illness, an illness caused by biological forces and not by moral turpitude.”4

Social scientists often call this desire to comprehend humanity in medical terms medicalization. Medicalization has its roots in the Enlightenment, in secularism, science, and the drive to make material those aspects of human experience—like the spirit, the mind, and the personality—that used to be immaterial. Medicalization is the process of turning previously nonmedical problems into medical ones, as when people think about childbirth as a sickness that requires admission to the maternity ward of a hospital or when they take medicines for menopause. Privileging the body over the mind,

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