I'm sure that I join many of you in being disappointed, but not surprised, by the findings of a recent Indiana University-Columbia University study, published in the online American Journal of Psychiatry last month, that found no change in prejudice toward people with serious mental illness or substance abuse problems, despite years of research that have uncovered and helped explain the neurobiological basis of these illnesses. The stigma was measured by, among other things, questions about respondents' willingness to “work closely” with individuals with schizophrenia, major depression, or alcohol dependence.
These findings hit home for me when I remembered the outstanding plenary session offered by pharmacologist Carlton Erickson, PhD, one of the nation's most respected addiction science researchers, at September's National Conference on Addiction Disorders (NCAD). Erickson started his session by recounting the words of a prominent acquaintance who, in reference to Erickson's body of work, said: “I don't believe addiction is a disease. Every once in a while something like this comes along to kill off the weak people.” When asked to consider the likelihood that an addiction would impact a member of his own family, the acquaintance replied, “The hell it will.”
The gasp in the audience was audible.
Dr. Erickson went on to explain that, with regard to addiction, many people are skeptical over the status of addiction as a “disease” because they experience those who call themselves addicts when their issue is actually one of misuse or abuse, due perhaps but not exclusively to bad personal judgment. Such a person, he explained, certainly has a problem but “doesn't have what it takes”-genetic and other as yet unrecognized factors-that cause the brain disease that is real addiction. Regardless, this confusion makes the common bias easier to maintain. So, despite a measurably better understanding of the brain disorder involved, 74 percent said that they would be unwilling to work with an alcohol-dependent person.
The bias against the mentally ill is more subtle. Everyone, it seems, is sensitive to their plight, but there's a real NIMBY (not in my backyard) reaction when the mentally ill move a little closer to home, as I observed in my July/August 2010 editorial, “What kind of people will be living here?”
The study shows there's plenty of bias in the workplace as well. Consider the range of behavioral tools and consulting services sold to businesses today-including personality tests, evaluations, coaching, and the like. In dedicated and caring hands, tools such as these can promote good working relationships, inspired leadership, honest dealing, and personal growth. But in the hands of the pressured or impatient, these tools can become a means for labeling, then winnowing out, those whose differences can be uncomfortable or inconvenient-the anxious, the insecure, the impulsive, the moody, the awkward, the quirky but brilliant.
Which brings me back to the study results: The researchers suggest that stigma reduction efforts shift away from emphasis on the involuntary mechanisms and symptoms of addiction or disease and instead recognize the strengths, abilities, talents, and diversity of individuals affected by mental illness or addictions.
Sure makes sense to me. It is these personal qualities-along with courage, fortitude, and access to treatment-that make recovery, employment, and a “normal” place in our diverse society possible.
Dennis G. Grantham, Senior Editor Behavioral Healthcare 2010 October;30(9):6