By: William Obilisundar, PharmD Candidate c/o 2023, Binghamton University School of Pharmacy and Pharmaceutical Sciences
One of the most interesting events hosted by the Binghamton University School of Pharmacy during the 2019-2020 academic year was a seminar entitled, “Mental Health Awareness: A Focus on Suicide & Stigma,” presented by Dr. Carolyn M. Tyler, Ph.D., neuroscientist and Medical Science Liaison from Otsuka Pharmaceuticals’ newly promoted PsychU. PsychU is an online platform whose mission is to improve mental health treatment for all individuals in the health care community, including patients, friends of patients, and providers. The main take away points from the seminar were that stigma contributes to the negative attitudes, beliefs, and behaviors of healthcare providers toward people with mental health disorders; mental illness is not the same as other diseases, such as diabetes and heart disease, and that stigma remains a barrier to recovery and social integration.1 Being introduced to PsychU, I found a pertinent online service that provides a well-rounded presentation of a variety of topics relating to mental health. Nevertheless, as with any such platform, there is always room for improvement in developing accurate statements for sensitive topics like mental health and the stigma that surrounds it.2
The data presented during the seminar resonated with me. Roughly 40 to 50 percent of patients with schizophrenia consider suicide and their life expectancy is reduced by approximately 25 years due to the risk of suicide.1,3 The numbers hit me in a very personal way, as I contemplated about a population with which I identify. I have schizophrenia; however, I do not have suicidal ideation. When it came time for Q&A, upon attempting to ask how to deal with emotional abuse targeted at those with mental illness, the data and personal dilemmas became an overwhelming weight on me, and I was hit with raw emotion, bawling with tears as I asked my questions. I had to cover my face with my palm. My thoughts on the university’s advocacy for mental health transitioned into my thinking solely about committing faux pas – now I would be labeled mentally ill and at risk for suicide at my school, an untrue label.
Following the event, I thought about voicing my opinions on the topic. Simultaneously, my tears caused the university administration to be notified and consequently email me campus resources for mental health. While the school may not be wrong in forwarding me available resources, there are a few questions to be had – does a display of raw emotion and feelings contribute to stigma? Does an identity dissipate upon being recognized as one with mental illness? Moreover, does data crunching sample statistics further the problem of stigma? What concerns me the most amid all the possible questions is the entirely paradoxical component to addressing mental health and stigma in that a full-blown effort can contradict itself and even exacerbate the issue. Inevitably, I became a sheer number assumed to death by suicide in the eyes of a few of my peers, whereas neither my question nor any other considerations took place.
While I would like to be open about having schizophrenia and possibly advocate for the illness, it is not an easy task. Dr. Tyler mentioned during her presentation that one of the largest problems in treating schizophrenia is that many of the first generation antipsychotics (FGAs) are derived from mid-19th century treatments, with a seeming purpose of keeping schizophrenics complacent in society, rather than improving quality of life outcomes.1 The issue of stigma for those with schizophrenia deviates into a sociocultural dilemma in which a society cannot interpret unaccustomed events; therefore, the conditions and outcomes of a disease state are reaffirmed by numbers which are written off by healthcare professionals.
To the point, rhetoric drives into the perception and interpretation of data. In an improved outreach over the topic this year, Otsuka developed an infographic to reframe ways to deal with stigma. One is not mentally ill, but instead has a mental illness.2 Phrasing alters the perceived insult.2 Although looking at data crunching, the effect of a number in statements seems unmalleable. PsychU’s webinar on the topic not only addresses Dr. Tyler’s overview, but also several contributors to institutionalized stigmatization of mental health.3 One of many reasons why negative rhetoric matters in the context of people living with mental illness is because the expectation of a negative prognosis contributes to stigma.3 The aforementioned data in Dr. Tyler’s seminar may as well have been translated as, ‘those with schizophrenia are a coin flip ticking time bomb.’ While the numbers are high, other contemporaneous conversations show different numbers, and some explain in other words that the shortened lifespan and standardized mortality ratio for those living with schizophrenia is two to four-fold the general population.4,5 At the same time, another psychiatric expert expresses that those with schizophrenia have life expectancies reduced by 10 to 20 years on account of functional issues, including other physical and metabolic illnesses related to inflammation.6 This phrase makes a world of difference in terms of perception and interpretation of the data. While statistics may seem immortal, their explanations are broader than their actual presentation.
The issue of stigma lapses further in rhetorical nuances at the hands of healthcare professionals. A single nuance can mislead an audience over matters at hand. For example, a PsychU webinar presented by Dr. René Kahn, M.D., Ph.D., and Dr. Christoph Correll, M.D., outlines many coherent cognitive facets of schizophrenia, yet amid the presentation is a diagram listing primary or negative cognitive symptoms in schizophrenia, among them being mental retardation and substance misuse.6 While a subset of people living with schizophrenia do experience cognitive impairments, I am not mentally retarded, and my pursuit of a career in pharmacy demonstrates the antithesis. The referenced article, dated 2014, fails to acknowledge diagnostic terminology pursued in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), dated 2013.7 In addition, there are other nuances in metapsychiatry that stigmatize schizophrenia to a greater degree. The referenced article is of the few studies that list substance misuse as a symptom. In the American Psychiatric Association’s 2004 edition of the, “Practice Guideline for the Treatment of Patients with Schizophrenia,” substance use is described as a plausible comorbidity, common contributor to system relapse, and a common comorbid condition.4 In the current 2019 draft of the same guideline, substance use is described as plausibly concomitant, co-occurring, or a common co-occurring condition.5 This shift in phrasing dangerously misleads individuals in the health care community and beyond into thinking substance use defines the epidemiology of schizophrenia; all the while, the shift presents a professional environment with slurs at best. There may be a percentage of people living with schizophrenia who present with substance abuse, but I can assure you it is not everyone and not me – substance use neither produced my disease state nor is it resultant from my disease. Thus, rhetoric or misappropriation of words in some cases proves a challenge to the cause of raising awareness for such mental illnesses and their stigmata by amplifying the stigmata rather than mitigating them.
Healthcare professionals have the tools to address mental health and the stigma associated with it. My only qualms are that some healthcare professionals fail to see potential flaws in their efforts. In the future, I hope to see the language used in discussing mental illness evolve for the better, not only for my sake, but for the sake of others who live with mental illnesses as well.
- Tyler CM. Mental Health Awareness: A Focus on Suicide & Stigma. Seminar presented at: Binghamton University School of Pharmacy and Pharmaceutical Sciences;11/06/2019; Johnson City, NY.
- Overcoming Stigma in Mental Health. PsychU website. https://www.psychu.org/patient-caregiver/overcoming-stigma-in-mental-health/. Published 02/2020. Updated 05/04/2020. Accessed 06/12/2020.
- Self R, Archuleta B. Mental Health Awareness: A Focus on Suicide & Stigma. PsychU website. https://www.psychu.org/mental-health-awareness-a-focus-on-suicide-stigma/. Published 05/27/2019. Accessed 06/12/2020.
- American Psychiatric Association. Practice Guideline for the Treatment of Patients with Schizophrenia. 2nd ed. Washington, DC: American Psychiatric Association; 2004. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/schizophrenia.pdf. Accessed 06/12/2020.
- American Psychiatric Association. The American Psychiatric Association Practice Guideline for the Treatment of Patients with Schizophrenia. Washington, DC: American Psychiatric Association; 2019. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Clinical%20Practice%20Guidelines/APA-Draft-Schizophrenia-Treatment-Guideline-Dec2019.pdf. Accessed 06/12/2020.
- Correll C, Kahn R. Cognitive Function & Neuroprotection In Schizophrenia. PsychU website. https://www.psychu.org/cognitive-function-neuroprotection-in-schizophrenia/. Published 06/26/2019. Accessed 06/12/2020.
- Intellectual Disability. American Psychiatric Association Website. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-5-Intellectual-Disability.pdf. Published 2013. Accessed 06/16/2020.