On the History of the Stigma Against Mental Illness, Depression, and Suicide
Leora Skolkin-Smith: On the History of the Stigma Against Mental Illness, Depression, and Suicide
Having now written two novels in which the main character is “mentally ill” and has spent time in a psychiatric hospital for suicidal depression, it feels right to ask questions about why, how, and when, precisely, this mental illness – specifically depression and suicide – was stigmatized. Mental illness and subsequent psychiatric hospitalization are still, at the time I’m writing this essay, what I call “impossible secrets.”
I was recently at a family affair and our host was telling us a detailed account of his physical illness where he had almost died. His account took up two hours of the dinner table talk. He spoke without shame, of course, and no one cringed at the inappropriateness of his account or was made uncomfortable by the details of his hospitalization. It seemed important to him to share this serious experience with friends and family. Support for him around the table was abundant. I couldn’t help wondering if this would have been true if he had confessed he was in a psychiatric hospital and that he had experienced a threatening, potentially fatal illness called depression. I even said to a friend who had listened to the host’s story, “What if this was a psychiatric illness? Would he have spoken so openly?” My friend answered: “Mental illness? Depression? People can’t go there. They are not willing to hear that. No, he would have had to keep a story like that to himself so as not to make people squeamish.” As much as I’d like to think the stigma of mental illness has been alleviated in our era and that the decades of the biological revolution in psychiatry have created a new societal openness to mental illness, I know the social stigma still haunts the survivors. The writing we have had these years about mental illness has been, primarily, from very bright people who survived their depressions with flying colors and were able to return to recognizable “normal” lives. Their accounts have been lucid and coherent, not the jagged raw expressions that ensue from mental breakdowns. In the fifties, “depressed” mentally ill suicide attempters had a romantic color to their experiences. I am thinking of Sylvia Path and Anne Sexton, as well as other poets and famous artists. The fifties and early sixties were a time when it was thought that brilliant, artistic people, geniuses and near geniuses, had breakdowns. This was also true at the time of Goethe and the book The Sorrows of Young Werther and, perhaps, Anna Karenina when suicide was a romantic condition, experienced by the extremely sensitive, victims of society’s rigid morality. The gritty, tragic, day-to-day, ugly struggle inside psychiatric hospitals wasn’t portrayed in these novels, nor is it portrayed with all the confusing imagery and sensibility recent books like Prozac Nation or Girl, Interrupted express. The people in these books were portrayed as completely getting over their own despair and situation, and the depth and complexity with which their depressions were explored seemed questionable. The endings gave relief to their readers, everything was sewn up, creating the effect that the main characters were over their crises permanently. When I wrote Hystera about a young woman’s breakdown, a reader wrote me and gave it a one-star review. Her reason was that my novel, in which my main character overcomes her suicidal despair but by no means is free from its recurrences, was not a fair representation of how mental illness results for those stuck for life. Not everyone overcomes the odds, she argued, not everyone goes back to a normal life, and there is no happy resolution for most people. I thought she had a very vital point; I had neglected to insert the hopelessness experienced of a future for my protagonist who was, in the end, just another bright college girl who had a breakdown but who would, because of her advantages, be able to reassimilate into society. I did feel good, however that I portrayed her breakdown with raw, sexual, and beguiling paradoxes, that I had shown, at least, the chaos and not a neat tie-up at the end. In my second novel, I wanted to go further into the aftermath of an institutionalized woman who could not, for thirteen years, find her way back to the world. The reader finds her practically living on the streets under Reagan’s cuts in the 1980s, the brutal stigmatization that does not allow her to reconnect with the world. In both cases, stigma was a prominent theme. In the first novel, the often-disturbing sexual imagery, and in my second novel, not yet published, the long ostracization by her peers and the society she once belonged to hopefully establish a depth and not facile resolutions.
The Oxford Dictionary defines stigma as “a mark of disgrace associated with a particular circumstance, quality, or person. ‘The stigma of mental disorder.’”
I have become interested in why those with psychiatric illness are still and forever stigmatized. And to give historical breadth and depth to the question, it was fascinating and horrifying to turn to history.
In his seminal book on suicide, The Savage God, A. Alvarez introduces us to the stigma and penalty toward those who try suicide by giving us an example from 1860, from a man named Nicholas writing to his mistress, Mary Sutherland.
A man was hanged who had cut his throat, but who had been brought back to life. They hanged him for the suicide. The doctor had warned them that it was impossible to hang him as his throat would burst open and he would breathe through the aperture. They did not listen to his advice and hanged their man. The wound in his neck immediately opened and the man came back to life, although he was hanged. It took time to convoke the aldermen to decide the question of what was to be done. At length the alderman assembled and bound up the neck below the wound until he died. Oh my Mary, what a crazy society and what a stupid civilization.
In this series, I hope to wander back through history, from Plato up to the present, in an attempt to determine whether our attitudes towards suicide and depression have really changed, or if the stigma is still there, manifesting itself differently through the ages. What can be learned by recognizing the continuum of social ostracization in regard to mental illness, specifically to suicide and depression? What does the future hold as a remedy for the stigma against mental illness, depression, and suicide?