tag:theconversation.com,2011:/fr/topics/people-with-mental-illness-24572/articlesPeople with mental illness – The Conversation2016-09-30T20:39:35Ztag:theconversation.com,2011:article/661912016-09-30T20:39:35Z2016-09-30T20:39:35ZWhy Bruce Springsteen’s depression revelation matters<p>E Street lead guitarist Steve Van Zandt <a href="https://ultimateclassicrock.com/steven-van-zandt-exposes-bruce-springsteens-lack-of-drug-use/">once said Bruce Springsteen never took drugs</a> because he was afraid he might reprise his father’s depression. It turns out that Springsteen was suffering from mental illness all along.</p>
<p><a href="https://www.rollingstone.com/music/lists/bruce-springsteens-new-memoir-10-things-we-learned-w442001">Much of the buzz</a> surrounding Bruce Springsteen’s new memoir “Born to Run” has been about the rock star’s disclosure of his <a href="https://www.npr.org/2016/09/25/495391535/off-stage-and-inside-the-life-of-the-boss-battling-with-depression">long history of depression</a>, which, to many, was a surprise. </p>
<p>In the past, such disclosures have had consequences. It was only 1972 when Senator Thomas Eagleton <a href="http://www.npr.org/templates/story/story.php?storyId=7755888">resigned as George McGovern’s vice presidential</a> running mate after the revelation of his depression. Since then, the stigma of mental illness has diminished somewhat. And yes, the requirements for the job are less stringent for The Boss than for the president. </p>
<p>But Springsteen has long been committed to social justice; in writing about depression, he has perhaps undertaken a new cause, one that seeks to combat the stereotypes and stigmas about mental illness that still exist today. </p>
<p>Struggles with mental illness are common and familiar among rock and pop stars. They include <a href="http://www.femalefirst.co.uk/celebrity/Beyonce+Knowles-12915.html">Beyoncé</a>, <a href="http://www.eric-clapton.co.uk/interviewsandarticles/hisfatherseyes.htm">Eric Clapton</a>, <a href="http://www.telegraph.co.uk/men/thinking-man/11515605/Kurt-Cobain-was-not-a-tortured-genius-he-had-an-illness.html">Kurt Cobain</a>, <a href="https://www.questia.com/newspaper/1G1-108846444/exercise-not-prozac-beat-my-depression-two-years">Sheryl Crow</a>, <a href="http://www.washingtonpost.com/wp-srv/style/features/janetjack.htm">Janet Jackson</a>, <a href="http://www.dailymail.co.uk/home/event/article-3656403/Billy-Joel-stopped-writing-songs-took-toll-personal-life-went-hell-Billy-Joel-talks-three-divorces.html">Billy Joel</a>, <a href="http://www.starpulse.com/jon-bon-jovi-without-my-wife-and-kids-id-be-a-dead-man-1848007648.html">Jon Bon Jovi</a>, <a href="http://www.people.com/people/article/0,,20166204,00.html">Alicia Keys</a>, <a href="http://www.usmagazine.com/celebrity-news/news/lady-gaga-reveals-daily-struggle-with-depression-and-anxiety-20151610">Lady Gaga</a>, <a href="http://www.nytimes.com/2011/10/09/books/review/lennon-by-tim-riley-book-review.html?_r=0">John Lennon</a>, <a href="http://blog.sfgate.com/dailydish/2012/08/13/alanis-morissette-left-in-agony-by-depression-battle/">Alanis Morissette</a> and <a href="http://www.desertsun.com/story/life/entertainment/music/2014/08/27/beach-boys-brian-wilson/14716185/">Brian Wilson</a>. Were one also to include artists known to self-medicate with drugs and alcohol but are otherwise undiagnosed, the list would be far longer. The medical literature, though limited, <a href="https://www.sciandmed.com/mppa/journalviewer.aspx?issue=1148&article=1477">strongly indicates</a> that being a rock star is a high-stress lifestyle. </p>
<p>But Springsteen’s disclosure is arguably unique because his image runs counter to stereotypes of depression. <a href="https://rampages.us/univ200spring2015/wp-content/uploads/sites/4894/2015/02/Mass-Media-Images-A-Review-of-the-Literature.pdf">According to one study</a>, for years the media has reinforced negative stereotypes of people with mental illness, often depicting them as “inadequate, unlikable, dangerous” and absent a “social identity: single or of unknown marital status, frequently without identifiable employment … confused, aggressive and unpredictable.” </p>
<p>These media depictions, <a href="http://link.springer.com/article/10.2165/00023210-200620020-00002">according to public health scholar Heather Stuart</a>, “also model negative reactions to the mentally ill, including fear, rejection, derision and ridicule” and “impair self-esteem, help-seeking behaviors, medication adherence and overall recovery.” Stuart blames the media for fueling much of the stereotypes of the mentally ill that persist today.</p>
<p>Springsteen, however, is a living, breathing repudiation of these media-fueled stereotypes.</p>
<p>The Boss’s energetic devotion to myriad progressive causes, working class ethic, family values and ebullient liberal patriotism contrast sharply with the brooding manner and death-laden imagery of Jim Morrison, one of rock’s many <a href="https://books.google.com/books?hl=en&lr=&id=NWT9CAAAQBAJ&oi=fnd&pg=PA1&dq=27%27s+joplin+morrison+hendrix&ots=rJZB9WzTzr&sig=dAUnfKvHjbnekvx3t-ID_uYG9V8#v=onepage&q=27's%20joplin%20morrison%20hendrix&f=false">“27’s,”</a> the stars whose fast, furious lifestyles left them played out – and dead – at the age of 27.</p>
<p>Married since 1991 to bandmate Patti Scialfa, with whom he has three children (and who shares and empathizes with his depressive illness), <a href="http://www.newyorker.com/magazine/2012/07/30/we-are-alive">Springsteen enjoys a stable family life</a>. He works out with a trainer, which might help explain his legendary stamina. During tours that often include over 100 shows, he plays <a href="http://www.usatoday.com/story/life/music/2016/08/26/bruce-springsteen-breaks-his-us-concert-record-nearly-4-hour-show/89406912/">famously exhausting sets</a> that last nearly four hours.</p>
<p>The Boss’s treatment regimen has included both decades of therapy and antidepressants, the latter eschewed by many artists who <a href="https://www.theguardian.com/culture/2013/may/19/does-prozac-help-artists-be-creative">fear they will inhibit creativity</a>. But he has also said that <a href="http://www.newyorker.com/magazine/2012/07/30/we-are-alive">touring was the best therapy of all</a>: “You are free of yourself for those hours; all the voices in your head are gone. Just gone. There’s no room for them. There’s one voice, the voice you’re speaking in.”</p>
<p>Nonetheless, the stigma of mental illness remains deeply ingrained in society.</p>
<p>After reviewing a number of studies on stigma and mental illness, <a href="http://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-015-0706-4">a group of psychiatrists reported that most mental illness goes untreated</a>. And they found that stigma – what they defined as lack of knowledge of symptoms and treatment, prejudice, and fear of discrimination – is a major factor in not seeking treatment. </p>
<p>Public stigma leads to “self-stigma,” which can lead to diminished productivity (the latter apparently not, however, a problem for Springsteen). Many are still afraid to discuss their mental illness, which includes telling bosses. In some cases, there’s good reason to keep it a secret: <a href="https://www.scientificamerican.com/article/should-you-tell-your-boss-about-a-mental-illness/">A 2010 survey</a> of U.K. employers found that around 40 percent said they thought someone with a mental illness could be a “significant risk” to the company.</p>
<p>Springsteen’s wife, Scialfa, was initially apprehensive about his coming forward with his depression in a memoir that would be read by millions. But in the end she supported him, <a href="https://www.vanityfair.com/culture/2016/09/bruce-springsteen-cover-story">telling Vanity Fair</a> that the struggle was inextricably linked to his art:</p>
<blockquote>
<p>“That’s Bruce. He approached the book the way he would approach writing a song, and a lot of times, you solve something that you’re trying to figure out through the process of writing – you bring something home to yourself. So in that regard, I think it’s great for him to write about depression. A lot of his work comes from him trying to overcome that part of himself.”</p>
</blockquote>
<p>Springsteen has battled his demons out loud, in public and before his fans, contrary to the social isolation stereotypical of depression. </p>
<p>Yes, it’s still risky to open up about one’s vulnerabilities. In terms of choosing between “the closet” and coming out, the stigma of mental illness is most closely analogous to LGBT status, a cause Springsteen has courageously championed, <a href="http://brucespringsteen.net/news/2016/a-statement-from-bruce-springsteen-on-north-carolina">even canceling a recent concert in North Carolina</a> to protest its anti-transgender legislation. </p>
<p>The champion of numerous underdogs, Springsteen has now taken on depression, to the benefit of us all.</p><img src="https://counter.theconversation.com/content/66191/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alex Lubet does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With stigma about mental illness still pervasive, The Boss’ frank admission helps shatter some of the most common stereotypes about depression.Alex Lubet, Morse Alumni Distinguished Teaching Professor of Music, University of MinnesotaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/537942016-02-05T11:08:11Z2016-02-05T11:08:11ZLabeling people as ‘The mentally ill’ increases stigma<p>Consider this collection of headlines from national media outlets over the past few weeks: “<a href="http://www.politico.com/magazine/story/2015/10/oregon-umpqua-shooting-mentally-ill-background-checks-213221">Allowing the mentally ill guns is insane</a>,” or “<a href="http://www.nbcnews.com/news/us-news/ranks-isis-recruits-include-mentally-ill-n488891">Ranks of ISIS include mentally ill</a>,” or “<a href="http://usatoday30.usatoday.com/video/jail-last-refuge-for-the-mentally-ill/3681378933001">Jail last refuge for mentally ill</a>” or “<a href="http://newsok.com/article/5455929">Lawyer says driver in crash was mentally ill</a>.”</p>
<p>It seems the term “the mentally ill” is everywhere, and it is used interchangeably with “people with mental illness” in nearly every venue. Even within the helping professions, the term is commonplace and considered acceptable to publishers, educators and mental health clinicians. But do they really mean the same thing?</p>
<p>If you use the phrase “the mentally ill,” instead of “people with mental illness,” or describe a person as a schizophrenic instead of a person with schizophrenia, does that change how you perceive them? As a professor of counselor education, I wanted to find out for sure if these labels really make a difference in how people are treated. And, as it turns out, which term you use matters a lot. </p>
<h2>‘The mentally ill’ is a controversial term</h2>
<p>Use of term “the mentally ill” has been questioned as far back as the 1990s, when several major psychology and education publications proposed the development and <a href="http://www.apastyle.org/manual/related/nonhandicapping-language.aspx">use</a> of <a href="http://www.inclusionproject.org/nip_userfiles/file/People%20First%20Chart.pdf">person-first language</a>. This usage highlights the <a href="http://www.disabilityrightsca.org/pubs/CM0201.pdf">humanity of the individual</a>, rather than emphasizing their disease or disability.</p>
<p>But person-first language can feel bulky and awkward. It has <a href="http://www.healthyplace.com/blogs/breakingbipolar/2012/11/shackled-mental-health-political-correctness/">been criticized</a> as evidence of the excesses of <a href="http://www.conservapedia.com/Politically_correct">political correctness</a>.</p>
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<img alt="" src="https://images.theconversation.com/files/110209/original/image-20160203-5826-1n94l4s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/110209/original/image-20160203-5826-1n94l4s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=649&fit=crop&dpr=1 600w, https://images.theconversation.com/files/110209/original/image-20160203-5826-1n94l4s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=649&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/110209/original/image-20160203-5826-1n94l4s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=649&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/110209/original/image-20160203-5826-1n94l4s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=815&fit=crop&dpr=1 754w, https://images.theconversation.com/files/110209/original/image-20160203-5826-1n94l4s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=815&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/110209/original/image-20160203-5826-1n94l4s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=815&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Does using ‘the mentally ill’ affect counseling students?</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-49237249/stock-photo-young-pretty-female-college-student-sitting-in-a-classroom-full-of-students-during-class.html?src=YNA0ShVKsezG7f81mkdQJw-1-10">Students image via www.shutterstock.com.</a></span>
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<p>As a professor of mental health counseling, I would tell my students that they should never call a person by their diagnosis. Over the years, students rolled their eyes, told me that this wasn’t what happened “in the real world” and, in general, made it clear that they didn’t think it made much difference either way. At the very least, they argued, the choice of term didn’t affect those of us in the field of mental health. Our training, compassion and empathy, they believed, could override the mere use of words.</p>
<p>All of this got me thinking. Does it matter what terms we use? Is there a big difference between saying “There is a schizophrenic on my caseload,” and the person-first “I am working with a person with schizophrenia”? Without any evidence to support my insistence on using a person-first approach, I couldn’t justify continuing to correct my students.</p>
<p>I enlisted one of my doctoral students, and we decided to find out once and for all whether these words make a difference. We both agreed that we would abide by the results. No difference? No more correcting students. But, if there <em>was</em> a difference, we would redouble our efforts to change the language not just among our students, but in other parts of society as well.</p>
<h2>Language matters</h2>
<p>As it turned out, <a href="https://news.osu.edu/news/2016/01/26/person-first/">the series of studies we conducted</a> were the first of their kind. In spite of decades of discussion and debate, no one could say, from a research perspective, whether it mattered if we used the terms “the mentally ill” or “people with mental illnesses.” To determine the effects of language on tolerance, we devised an easy and straightforward <a href="http://dx.doi.org/10.1002/jcad.12059">series of studies</a>. </p>
<p>We decided to use an existing survey (the <a href="http://www.ncbi.nlm.nih.gov/pubmed/7280561">CAMI: Community Attitudes Toward the Mentally Ill</a> from 1981). In half of the surveys we used the original language (“the mentally ill”), and person-first language (“person with a mental illness”) in the other half. Nothing else changed. The same definition for mental illness was used for both versions of the survey, and everything else about the surveys was identical. </p>
<p>Then we gave the survey to people in three different groups: undergraduate college students in general education courses, adults recruited from a community center that promotes health and wellness, and professional counselors or counselors-in-training at a national counseling conference. In each group, half received the original survey, and half received the survey with person-first language.</p>
<h2>The term ‘the mentally ill’ changes attitudes</h2>
<p>In all three groups the people who received the survey using the term “the mentally ill” had significantly lower tolerance scores than those who received the survey using the term “people with mental illnesses.” </p>
<p>College students who received a survey with the term “the mentally ill” were significantly more likely to perceive that people who have a mental illness are an “inferior class requiring coercive handling” and that they are a “threat to society.” </p>
<p>This pattern was found in the sample of professional counselors and counselors-in-training. They had the highest overall levels of tolerance in the groups we studied, but they also responded with more authoritarian and more socially restrictive attitudes when they encountered the term “the mentally ill.”</p>
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<img alt="" src="https://images.theconversation.com/files/110213/original/image-20160203-3062-rxn0yj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/110213/original/image-20160203-3062-rxn0yj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/110213/original/image-20160203-3062-rxn0yj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/110213/original/image-20160203-3062-rxn0yj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/110213/original/image-20160203-3062-rxn0yj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/110213/original/image-20160203-3062-rxn0yj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/110213/original/image-20160203-3062-rxn0yj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Seeing the term ‘mentally ill’ can change attitudes about mental health care.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-184904372/stock-photo-man-talking-to-counsellor-who-takes-notes.html?src=zykLRlThQLIXMg9vFyipOw-1-25">Counseling image via www.shutterstock.com.</a></span>
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<p>Within the sample of adults in the community, a different pattern emerged. They also had lower tolerance scores when they received surveys that used the term “the mentally ill.” But unlike college students and professional counselors who became more restrictive and authoritarian when they saw the term “the mentally ill,” adults in our sample were less empathetic and compassionate when they encountered that term.</p>
<p>Adults who received a survey with the term “the mentally ill” were significantly less likely to perceive that they should be kind and should be willing to be personally involved with people who have a mental illness. They were also less likely to believe in the therapeutic value of community mental health care or believe that there should be funding to support mental health care in the community.</p>
<h2>What does this all mean?</h2>
<p>Within the three groups, the differences in tolerance between those who saw a survey with the words “the mentally ill” versus those who saw the words “person with a mental illness” was significant, with <a href="http://rpsychologist.com/d3/cohend/">medium to large effect sizes</a>. These differences were not just statistical findings of interest only to people in academia. The findings have practical, real-world implications. The difference in tolerance based on the words used is noticeable, meaningful and real.</p>
<p>After all, everyone deserves not just our tolerance but our understanding, compassion and respect – no matter their health condition. And now we know that simply using certain kinds of language can undermine that goal.</p>
<p>Using person-first language to describe people who have mental illnesses is not just an example of political correctness. These words matter. They influence people’s attitudes, and attitudes help determine behaviors. We make assumptions about people based on the words we use, and when we use the words “the mentally ill,” those assumptions lead to lower levels of tolerance and acceptance. </p>
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<img alt="" src="https://images.theconversation.com/files/110206/original/image-20160203-5853-xgq73w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/110206/original/image-20160203-5853-xgq73w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/110206/original/image-20160203-5853-xgq73w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/110206/original/image-20160203-5853-xgq73w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/110206/original/image-20160203-5853-xgq73w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/110206/original/image-20160203-5853-xgq73w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/110206/original/image-20160203-5853-xgq73w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Words can make us distance ourselves from people with a mental illness.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-364777085/stock-photo-beautiful-girl-in-the-christmas-market-back-view.html?src=ID6lKjR1JcHlPvTtT4HPLA-5-96">Woman image via www.shutterstock.com.</a></span>
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<p>When people in our study saw the term “the mentally ill,” they were more likely to believe the people described by the label are dangerous, violent and need coercive handling. They were also more likely to perceive them as inferior and to treat them like children, or to try to distance themselves and their communities from interactions with the people described, and less likely to want to spend tax dollars to help them. Those are some powerful reactions, and they deserve a powerful response.</p>
<p>This semester, when I corrected a student who said, “Well, as you know, it’s hard to work with a bipolar kid,” I knew it was worth stopping the discussion and correcting the words. And I knew I wasn’t the only one who had a negative reaction to those words. We all do. Whether we are consciously aware of it or not, all of us are affected by language that dehumanizes others and defines people only by their diagnosis. If we want to change the conversation, we have to change the words.</p><img src="https://counter.theconversation.com/content/53794/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Darcy Haag Granello does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We make assumptions about people based on the words we use, and when we use the words ‘the mentally ill,’ those assumptions lead to lower levels of tolerance and acceptance.Darcy Haag Granello, Professor of Counselor Education, The Ohio State UniversityLicensed as Creative Commons – attribution, no derivatives.