Understanding Anxiety and Bipolar Disorders

Introduction

There are many different recognized mental conditions. Mental illnesses refer to a variety of conditions and illnesses that ultimately affect a person’s perception, behavior, mood or thinking. These mental illnesses result into various effects, most of which would impact the person’s relationship with other people in the society (American Psychiatric Association, 2015). One of the most common mental illnesses include anxiety disorders; which include generalized anxiety disorders, phobias in relation to things and events, post-traumatic events, panic disorders and obsessive compulsive disorders. Another recognizable mental illness is the bipolar affective disorder, which constitutes episodes of depression and elations. In certain occasions, patients with this kind of disorder may experience symptoms that are psychotic in nature (Salters- Pedneault, 2019). For those exploring this topic in depth, healthcare dissertation help can provide valuable insights. Other kinds of mental illnesses include the common instances of depression, dissociative disorders, eating disorders, psychosis and schizophrenia.

As shown in the study, there is a wide history of stigmatization of mental illnesses in societies. Mental illnesses have been thought as marks of the devil and even considered to be moral punishments. These conditions have had no scientific bases historically and as a result, treatment has often been inhumane and brutal. Treatment has from time in memorial evolved as the psychological and psychiatric fields have continuously and are continually growing (Caddell, 2019).

The Increasing stigmatization phenomenon

The concept of stigmatization of mental illnesses arises from the difficulty in distinguishing between psychiatric and non- psychiatric illnesses. In his article, Rossla (2016) describes stigma in relation to mental illnesses as ubiquitous. From a basic standing, there is no culture or society that exists where there is equal treatment and participation of societal values between people with and people without mental illnesses. Around half of persons with mental illnesses undergo discrimination in their personal relationships. This also applies to people those looking for close relationships. More than two thirds of these persons also anticipate discrimination and stigmatization in applications to different work places. Mental illness stigma may be universal in nature, but affected persons’ experiences remain to be greatly influenced by culture. Religious, magical or supernatural explanations would always play major roles in its prevalence (Rossla, 2016). Compared to other types of illnesses, mental illnesses have been subject to negative connotations and judgments over the years. Society has for millennia treated persons with mental illnesses as outcasts. It has in as much compared these people with criminals and slaves. Persons with schizophrenia, autism and other mental conditions were imprisoned, tortured and even murdered in the old ages (Lien et al, 2019). In the middle ages, treatment was no better. Societies justified inhumane punishments and actions towards people with mental illnesses by regarding the illnesses as punishments from God. They referred to these illnesses as possessions by the devil and as a result, punished people with mental illnesses by either burning them at the stakes or throwing them in mad houses and penitentiaries where they would be imprisoned on chained like animals.

It is not until the age of enlightenment where institutions and other organizations were established that finally freed the mentally ill from their chains. This did not however stop stigmatization. This discrimination and stigmatization against the mentally ill arrived at a point where hundreds of thousands of people were killed or sterilized in Germany; this was during the Nazi reign. The society continually finds this problem prevalent as the general population grows ignorant of the situations. Although the actions against these persons are relatively human, compared to extreme actions of the past, societal attitudes and standards remain to be unworthy of the welfare states required (Mascayano et al, 2015).

Reasons behind stigmatization

There are several themes associated with stigmatization and the misconceptions on mental illnesses. Abdeholden (2019) identifies three main themes: i) The mentally ill tend to be homicidal maniacs who should actually cause concerns to the public: ii) These persons have childlike views towards the world and therefore should be marveled: iii) Individuals with mental illnesses have weak characters, and as a result, they are responsible for their own illnesses. Rossla (2016) goes on to state that the most common reasons behind stigma towards mental illnesses point towards stereotypes surrounding the nature of the mental illnesses. The most common rebuttable presumptions include those presumptions of dangerousness, unreliability and unpredictability of the patients. Stigma arises just because of the fact that certain illnesses raise the aspect of danger and unpredictability. Many of these stereotypes have been associated with schizophrenia (Krezolek et al, 2019). Whereas the lack of differentiation between psychiatric and non-psychiatric illness compliment the aspect of stigma, mental illness in some societies primarily seem to be attached to more chronic forms of illnesses which do not respond to attempted treatments. A survey of around 2000 people in the UK as shown by Graham (2013) also portrays a number of reasons which society uses as the main instruments of stigmatization: The most recurrent belief among these people was that people suffering from mental illnesses are dangerous. This belief was mostly associated with mental illnesses such as alcoholism and drug dependence and schizophrenia: In some instances, people believed that some mental illnesses were self-inflicted, some of which included substance dependence and eating disorders: Respondents also had the belief that people or individuals with mental illnesses are generally difficult to understand or communicate with.

In regards to the differences in stigmatization depending on the kind of mental illness, the deinstitutionalization process might be a possible reason. This is because the process brings about debates on community psychiatry and the risks associated with the illnesses. Looking at the most common stereotypes, more than three thirds of the population has negative attitudes towards drug dependency, schizophrenia and alcohol dependency, whereas depression as a categorical illness receives better understanding and sympathy (Rusch et al, 2014).

The concept of stigmatization

Stigmatization may differ depending on the type of illness. From a general point of view, some people would look to avoid or keep greater distance from persons suffering from some types of disorders in relation to others. For instance, some people would avoid people suffering from schizophrenia more than they would people suffering from depression (Gaebel et al, 2016). In describing stigma, one can use three base levels: emotional, behavioral or cognitive. These three conceptual levels allow the separation of discrimination and prejudice from mere stereotypes. Prefabricated and presumed attitudes and opinions towards members of certain characteristics are what constitute stereotypes (Kosyluk et al, 2016). Stereotypes not necessarily have to be negative or wrong, this is because they can prove to be beneficial in certain circumstances as they help make quick judgments about people with particular characteristics. Stigma relating to mental illnesses can be categorized into two types: Social stigma and self-perceived stigma. Social stigma refers to presumed and prefabricated attitudes that society has towards mental illness. Self- perceived stigma involves stigma generated by the person or individual who suffers from a mental illness (Caddell, 2019). Social stigma remains increasing prevalent and pervasive in the modern society, Graham (2013) backs up this statement by depicting a survey of 1700 adults in the UK which raised a number of commonly held beliefs as the reasons behind this kind of stigma. Social stigma generally affects the attitudes of persons towards people with mental illnesses.

The concept of stigma becomes even more complicated in certain misconceptions that consent emotional and behavioral reactions towards certain stereotypes or the stereotyped person. Such changes in the contexts would characterize the illness as if the illness would amount to the whole person (Michaels et al, 2017). These stereotypes and prejudices eventually lead to discrimination and stigma of an individual or a whole group. The same would give rise to behavioral and stigmatized responses that would constitute avoidance and evasion from the mentally ill. Several studies show that even though the public has become more acquainted with the nature of different mental health conditions, public stigma still is insidious (Caddell, 2019). Many people still have negative views of people with these mental health conditions, even in as much as there is general acceptance of the genetic and medical nature of the conditions, and the consequent needs for treatment. In regards to perceived stigma, the mentally ill, from their own views, manifest internalized shame and low self-esteem which according to the long term effects, leads to poorer outcomes in treatments (Pescosolido, 2013). The lay concepts in regards to mental disabilities are easily associated with psychosocial and biological causes. The major public may believe that certain mental illnesses should be accountable for problems in relationships, traumatic events, financial constraints and work related stress. Majority in other instances would believe that biological causes are involved.

Effects of Stigma

Rossla (2016) basically states that stigmatization research necessitates a specialized social science discipline which widely overlaps and should be understood with research on the attitudes in social psychology. There are wide reaching effects which result from the stigma of mental illnesses, especially those that affect the seeking and participating in mental health care. Stigma ultimately plays one of the biggest roles in the limitation to access care and in the discouragement of people from pursuing treatment. According to Corrigan W, Druss B, and Pelick D, (2014), there are three major goals typical to people that are relevant to a relatively good quality of life: Health; People generally seek to maintain good physical and mental health. They also seek to achieve wellness and a sustainable psychological and physical sturdiness: Independence; It is a common notion that most adults have to start households that represent their lifestyles. This aspect would therefore also include decisions as to the type of house, relationships, décor, neighborhood and place. This aspect also includes the basics such as food, manifestations of style and clothing: Education and Employment; Goals related to independence are more likely to be achievable if a person has a good job and an excellent educational background. Notions of vocation and social affiliations also arise under this aspect.

The importance of these three major points arises from the fact that all these are affected by stigma in mental illness. This study has looked at the various effects of stigma and these basic foundations form the physical, social and psychological effects of stigma (Bharadwaj et al, 2017). From the general point of view, stereotypes in regards to mental illnesses have often associated persons with mental illnesses as dangerous, unreliable, and unpredictable and also those who are responsible for their own illnesses. The same have also referred to such individuals as those who are generally incompetent or incapable. These stereotypic comments or adjudications have devastating effects to the mental illness patients (Corrigan et al, 2014). These effects should best be looked at from a combined approach as they affect persons with mental illnesses right from etiology, diagnosis, treatment process, recovery and post treatment procedures. The aforementioned prefabricated and presumed judgments and opinions would often lead to active discrimination such as those associated with exclusion from work environments on the basis of their conditions (Hipes et al, 2016). These kinds of persons may be forced out of the window of opportunities in regards to certain tasks, work, social amenities and educational institutions.

In medical institutions and settings, these negative stereotypes can make the service providers less likely to concentrate on the patient as a person, and more on the disease or the condition. As a result of these stereotypes, the service provides are less likely to endorse the quick recovery of the patient. They would also, as a result, be unable to refer the sufferers to necessary and much needed consultations or appointments. Moreover, stigma in health care settings may also impede access to health care services through the intentional exclusion of health covers that would adequately provide for mental illnesses treatment. The negative displays of discrimination may also be internalized, therefrom leading to the development of self- perceived stigma. This situation refers to the growth in negative beliefs and thoughts by the persons with mental illnesses. As a result, these people would start believing in the negative misconceptions and opinions expressed by others and consequently, become more vulnerable to their own illnesses and many others (Stuart et al, 2014). They may, as a result, start to think themselves as unable or impossible to recover, a thought of which has major psychological effects on the creation of hurdles to the patient’s recovery process. The same also leads them to regard themselves as dangerous, the perception of which would even scare the patient himself/herself. This perception may also lead to self- denial and self- hate, which would be devastating to the patient (Link et al, 2015). Self- perceived stigma also leads the patients to think themselves as undeserving of care. This stereotype proves to be destructive on the patient’s self-esteem, which drastically reduces the self-esteem of the patient. Negative stereotypes also significantly destroy the self-development of the patient as it leads the patients to believing inability to perform or pursue their dreams and goals. In some instances, some people may even hide or refuse to seek medical care in a bid to avoid discrimination or social stigma. Worse cases of stigma would lead to relapses by the patients who would increase the long term run of susceptibility to negative conditions and illnesses. The worst case scenarios may even lead to death as the risks of committing suicide may also rise with the rise of self-perceived stigma (Kaltwasser, 2018).

The effects of stigma to mental illnesses may even go further to include physical violence, bullying and harassment. On the same social sphere, stigma may lead to lack of understanding by the patient’s friends, family, church members and even co- workers. Additional large scale barriers to health care are presented by structural stigma; which refers to stigma that relates to institutional and social practices and policies. Stigma undermines the opportunities for patients with mental illnesses to seek medical or professional help. From a structural stigma angle, there is continual lack of parity between other health care services and mental health services (Chen Kao et al, 2016). There is also the lack of financial support in mental health research. The continuous use of mental health histories in legal proceedings also present impediments to seeking of treatment by patients with such conditions. Stigma therefore hinders the effective and efficient the whole process in mental health care. Perceptively, self-stigma can be associated with poor outcomes in work places and increased isolation from societal activities. These factors also impede access to housing and other social amenities as they constitute concepts of discrimination.

Recommendations and Conclusion

Although stereotypes may help in the making of quick judgments about persons who possess same sets of characteristics, it is only fair if a person seeks more information. More information would always prove critical in the making of a rational, just and fair judgment on certain cases. For instance, in cases of stigma on mental illnesses, stereotypes may only prove to be dysfunctional due to the typical activation of generalized patterns of actions rather than customized response patterns. In such cases, the determination of whether a person is actually dangerous, unreliable and unpredictable is ultimately dependent on actual effort to know him/ her better (Corrigan et al, 2015). In his study, Rossla (2016) has also looked at how the terms or labelling of mental illness have contributed towards stigmatization. Some of the mental illness terms have in usual occasions denoted poor attributes. As a result, negative connotations have been associated with these terms. As a result of certain studies, the changing of how someone refers to certain mental illnesses goes a long way in reducing and controlling stigma, thereby greatly benefiting the mentally ill as the service users. An example is the use of certain terms such as ‘integration disorder’ instead of ‘mind- split disease’. The same can apply to different other mental illnesses. Judging from the mere fact that the relationship between access to mental health care and stigma is greatly influenced by cultural and social networks, many public health and initiatives implemented to promote care to the mentally ill should focus on instilling knowledge to people on mental health so as to be able to combat these harmful stereotypes (Moll et al, 2015). Towards the encouragement of treatment, societies should also address the barriers as to culture to include supportive and enhancing networks in treatment plans (Carter et al, 2014).

At a structural level, legislations should be introduced to specifically protect health care of people with mental illnesses. Examples of such legislations are the American Mental Health Parity Act of 1996, the Affordable Act of 2010 and the Addiction Equity Act of 2008 which have served to specifically protect the equality and treatment of persons with mental illnesses from practices that would be discriminatory and stigmatizing. Legislations and formulation of specific policies would significantly reduce structural stigma, therein improving the standards of equality in regards to the service users (Corrigan, 2016). In addition to the positive engagement and discouragement of stigma, integrative and extensive research connecting public health, education, primary care and mental health is necessary. Integrative efforts would notably help build stronger service and systematic networks which would encourage treatment and recovery without any fears of prejudice, stigma and discrimination (Corrigan et al, 2014). Principally, there are three general strategies that can be used in reducing stigma and discrimination: Promotion and creation of awareness on the nature, etiology and treatment procedures of mental illnesses: Protestation and advocating against unfair, unjust, unequal, unwarranted or unjustified descriptions and misconceptions on mental illnesses: Direct and clear communication or contact with the mentally ill which would enable better understanding (Stuart, 2016).

These three basic strategies, according to Rossla (2016), require three main channels so as to be effective in the reduction of stigma: opinion leaders, media masses and persons of trust.

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