In Virginia, 317,000 adults are estimated to have a mental illness that causes serious functional impairment. Mental illness affects so many lives, yet it is rarely discussed — today, professors and students at the University are making an effort to break the stigma.
Stigma is defined as a mark of shame or discredit. As a result of stigmatization, people’s experiences are disbelieved or hidden. Mental illnesses are subject to far more stigma than other kinds of illness — a phenomenon that Psychiatry and Neurobehavioral Sciences Prof. Jennifer Payne has seen firsthand both personally and professionally.
“There’s a lot of stigma that psychiatric illnesses aren’t real,” Payne said. “And then on the flip side of that, there’s a lot of stigma that if someone has a psychiatric illness, they’re not a normal person, or they’re something to not be talked about or hidden away.”
When Payne’s daughter was 15 years old, she became very ill with a schizoaffective disorder.
“It was very horrifying to watch my sweet daughter turn into this person that I almost didn't know,” Payne said.
Her daughter was hospitalized at Johns Hopkins, where Payne worked at the time. Payne recalled that her psychiatric colleagues told her she was “so brave” to hospitalize her daughter where she worked — in other words, to expose the fact that she has a daughter with a major psychiatric illness. The implication is that they would not have called her brave if they did not perceive mental illness as shameful in some way.
Around the same time, Payne’s family friend developed a brain tumor and was also hospitalized.
“I kept thinking, nobody's saying … that he's brave to have brought her and to expose that she has a brain tumor,” Payne said. “And serious psychiatric illness is very much the equivalent of having a brain tumor. [But] even psychiatric colleagues thought I was brave to hospitalize [my daughter] at work. I thought, boy, this stigma is seeping everywhere.”
The stigma of mental illness isolates those who are suffering, breaks relationships and makes it difficult for them to get jobs and access help.
Third-year College student Anna Brule is a philosophy major and history minor who plans to go to law school. She struggles with depression and has experienced the way that mental illness is often discredited during her time at the University.
“Especially when it comes to depression, the way [mental illness] is talked about is, just pick yourself up,” Brule said. “I've had to miss classes, both during COVID and this year because of depressive episodes … It feels like a huge personal shortcoming to miss classes because of something like depression, but if I woke up feeling really sick, I wouldn't feel like I'm being lazy.”
Brule has also experienced the perceived shame of mental illness in the way people avoid talking about it.
“[Mental illness] is an impediment to success, and nobody wants to show those parts of themselves, especially in a competitive environment like U.Va.,” Brule said. “If you're going to therapy, you don't say that you're going to therapy. You say, I have an appointment. [You say] I need to take my medication, [you don’t say] I need to take my antidepressants. If someone breaks their leg, that's not the way we talk about it at all.”
Payne is trying to fight this aspect of mental illness stigma in her research by supporting the experience of depression with biological evidence.
She has discovered a biomarker determined from blood samples — two genes whose expression changed in response to hormonal change — that can predict whether a pregnant woman will become depressed after giving birth.
Payne chose to focus on postpartum depression because it is relatively feasible to make conclusions about whether a person will get sick with the condition. Researchers can measure genetic markers before the onset of the illness — during pregnancy — to compare to the postpartum time period itself, which differentiates it from types of clinical depression that originate more spontaneously. In particular, about one-third to one-half of women with pre-existing mood disorders will be diagnosed.
Payne began collecting blood samples in 2007, first published her findings in 2013 and is currently working on grants to fund studies trying to prevent the onset of depression in women with the biomarkers. Her team is also working with a company to begin the process of making this test available to the public.
“I'm really excited about it because it offers, for the first time, a test for a psychiatric disorder,” Payne said. “People are going to take that seriously. If there's a test, then it's got to be real. And it really decreases stigma from that perspective.”
On the other hand, professionals disagree about whether testing is an appropriate strategy to address mental illness stigma. Asst. Sociology Prof. David Skubby, who teaches a class called Sociology of Mental Illness, was concerned that tests might exacerbate the other side of mental health stigma — the perceived shamefulness of not being a “normal” person.
“The finding is that once people know that your issue is genetically related, that tends to bring out more negative opinions of people,” Skubby said. “What they think is … your aberrant thoughts are critical to who you are, and therefore you should be avoided. The scientific findings of genetics has had, I think, the opposite effect of acceptance.”
Studies have shown that mental illness stigma is worsened when the illness is explained with a genetic framing, especially with illnesses like schizophrenia.
Brule, however, agreed that a test would be helpful to those suffering from depression.
“It would be validating to have something physical that you can point to,” Brule said.
All mental illnesses are not treated equally. Skubby emphasized that illnesses such as eating disorders, schizophrenia and bipolar disorder are especially stigmatized.
First-year College student Ploi Sripoom, from Thailand, is majoring in economics and minoring in Global Studies in Education. She said she feels more comfortable talking about depression and anxiety attacks at the University than she did at her high school in Thailand. However, she added that mental illnesses like schizophrenia, anorexia nervosa and bipolar disorder are “definitely not” as frequently discussed as depression or anxiety.
Skubby said that people tend to have more understanding for those with anxiety or depression, because everyone experiences the stresses and losses of life on some level. He said we must work hardest against the stigmatization of people whose illness cannot be explained by circumstances — such as those suffering from bipolar disorder and schizophrenia.
To address these stigmas, Payne recommends frequent conversations. In addition to bringing the topic up to her friends and colleagues, she openly talked with her daughter about her illness as she engaged in treatment and began to improve.
“We both agreed that we were not going to hide this,” Payne said. “This is not something to be swept off into a closet. … Let's talk about it and talk about it normally. Everybody that I work with knows I have a daughter with schizoaffective disorder, not because I'm announcing it but because it comes up in a reasonable conversation.”
Moving forward, Brule said we need to learn to talk about mental illness with all types of people.
“[Talking normally about mental illness] is almost an activist action,” Brule said. “Because that is where we should be headed. But doing it is not going to be received normally by a lot of people. I think when it's brought up, it's going to be rough socially.”
Skubby said that bringing serious mental illness into normal conversation would be a positive step forward if it emphasizes our common humanity.
“Put the human first rather than the disease first,” Skubby said. “We're talking about people, and they're in their lives, and they are whole, important individuals. No less important than anybody else, no less human than anybody else. We say that first.”
In the wake of the pandemic, far more people are developing mental illness or relapsing. Many healthcare workers have developed PTSD. Payne and many of her colleagues across the U.S. believe that there is a correlation between an increase in people developing serious psychiatric illness and having COVID-19.
“There's a real increase in mental health needs,” Payne said. “If we're not going to talk about it now, we're never going to talk about it.”