Roy Richard Grinker - Nobodys Normal: How Culture Created the Stigma of Mental Illness

NOBODYS NORMAL

How Culture Created the Stigma of Mental Illness

ROY RICHARD GRINKER

To the Chicago Grinkers

Part way back from Bedlam

I came to my mothers house in Gloucester,

Massachusetts. And this is how I came

to catch at her; and this is how I lost her.

I cannot forgive your suicide, my mother said.

And she never could. She had my portrait

done instead.

Anne Sexton, The Double Image

CONTENTS

The concept of the normal is properly a variant of the concept of the good. It is that which society has approved.

Ruth Benedict (1934)

W hen I was six years old, my grandfather gave me a copy of his newest publication, a book about how to diagnose borderline personality disorder. He signed it: To my grandson, who will carry on. I didnt know how to read full sentences, so he told me what it meant: I would be a psychiatrist, just like himthe fourth generation of psychiatrists named Grinker.

I am not a psychiatrist.

My family was deeply disappointed, of course, but I eventually earned some redemption by marrying a psychiatrist and by becoming an anthropologist who studies mental health. And inasmuch as this book is about both psychiatry and my family, I do carry on their legacy. The lives and work of those generations infuse the pages belowfrom my great-grandfather, Julius, a late-nineteenth-century neurologist and psychoanalyst who believed people with mental illnesses were biologically inferior, to my own cross-cultural research on autism in sub-Saharan Africa and East Asia that rejects such antiquated views.

This book chronicles the many cultural and historical threads that have brought us to the present, a time when societies throughout the world are challenging the stigma that has, for centuries, shadowed mental illnesses. We havent put it into words, but most of the people I encounter, even in low-income countries with inadequate health care, sense that something positive is happening. Although 60 percent of people with a mental illness in the United States still receive no mental health treatment, mental illness is fast becoming a more accepted and visible part of the human condition. We are acknowledging that mental illnesses are more common than we used to think, and that they affect us alleither individually or because of our relationships to others. Indeed, it is impossible to imagine that there is anyone unconnected to mental illness. In the twenty-first century, many of the people we most admirecelebrities like Lady Gaga and swimmer Michael Phelps, for examplespeak publicly about their own emotional struggles. Also, in comparison to their parents, millennials are more willing to disclose a diagnosis and seek treatment. Many people, like my daughter Isabel, who is autistic, even celebrate forms of differences that just a few decades ago were a mark of shame.

These developments show us that we need not surrender to stigma, as if it were natural to marginalize otherness and difference. Stigma isnt in our biology; its in our culture. It is a process we learn from within our communities, and we can change what we teach. But only if we know the history of stigma can we target the social forces that created it in the first place, strengthen those that reduce stigma, and say enough to the many barriers that keep so many people from getting care.

My grandfather, also named Roy Grinker, did not share his fathers objectionable views, and he spent much of his career trying to eradicate stigma. I was fortunate to grow up across the street from him. Occasionally, he would reminisce about the time he spent in Vienna as one of Freuds patients, and I remember how often he talked about Freuds wishes. One was that doctors could help lead people out of misery, not into a perfect life but into ordinary unhappiness. Another was to prove that emotional distress was universal. Perhaps, Freud told him, if people understood that we are all neurotic, they might eventually feel no shame seeking psychological care for their problems. Perhaps some psychiatric conditions could even become like the common cold, something everyone gets from time to time. And maybe students would be more eager to choose a career in psychiatry.

I was raised in a family that believed everyone had a little mental illness, that emotional pain was a normal part of life, and that mental illnesses existed within a hierarchy of all diseases. Anxiety, for example, was more serious than the common cold and less serious than cancers, but still in the range of what typical human beings confronted throughout their lives. I wasnt ignorant of the stigma of mental illnesses since, outside my home, most people talked about them in a whisper. But people also whispered about cancer, dementia, and sexually transmitted diseases. It just took me a while to figure out the difference between the stigma of mental versus physical illness.

That realization came after I finished the tenth grade, when my grandfather helped arrange a summer job for me in a psychiatric hospital, cleaning and filing. One day I bumped into an emaciated girl who was my classmate. She was a patient, and simply seeing her caused an uproar. I was so harshly admonished by so many peopleour school principal, her parents, my parents, my grandfather, her doctors, my supervisor at workto keep her hospitalization confidential that I felt as if I had committed a crime. I can only imagine how uncomfortable she felt as she struggled with both her illness and the commotion around her.

I recognized then the extent to which our society had made psychiatric conditions frightening and shameful, a double illness: first, the ailment itself, and second, societys negative judgment.

In any given year, nearly 20 percent of American adultsmore than 60 million peoplemeet the criteria for a mental illness.

Why dont more people seek treatment? It is true that many barriers to care are inherent in the conditions themselves. People who are seriously depressed, for example, may simply not have the will to see a doctor, or they may believe they deserve to be depressed. Because the person with anorexia nervosa may welcome the extreme weight loss, they may not want to seek care. But, for the most part, the experts say that stigma is the biggest problem. According to the U.S. Department of Health and Human Services, stigma remains the most formidable obstacle to future progress in the area of mental illness and health. Steven Hyman, former director of the National Institute of Mental Health (NIMH), has called stigma an international public health crisis.

But what exactly is stigma? Even in the academic literature, stigma has become a default concept that condenses a multitude of different kinds of fears, prejudices, and shame into a single and often amorphous word. Scholars speak of stigma in conditions as different as AIDS, Alzheimers, and schizophrenia, in locations as different as rural Namibia and downtown Chicago, and among populations as different as hunter-gatherers and college students. But at a very general level they are all referring to the process through which people who think or behave in ways that diverge from a societys norms are alienated and abhorred. The word