Myths and Stigmas Regarding Mental Illnesses: Influencing a Social and Behavioral Shift
Mental health plays an important role in our life just the way physical health does. It develops resilience i.e. increased ability to cope with daily life changes. In addition, it provides emotional stability in order to work productively in every field of life (Hussain, 2014). According to World Health Organization, “Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work fruitfully, and is able to contribute in the community”(WHO, 2014).
Despite its immense significance, mental health is highly neglected, especially in Pakistan. According to the express tribune article named Professionals stress on need to include mental healthcare at primary level, published in 2012 “The prevalence of psychiatric disorders in the country is 58 out of 1,000, but this is not accurate because many cases remain unreported” (Wasif, 2012).
There are several factors that hinder mental health development such as lack of awareness, low budget allocation for mental health, lack of accessibility for mental health, sociocultural issues, and strong religious beliefs. Moreover there are many stigmas and myths attached with mentally ill patients that cause a barrier in care for these patients. Stigma is labelling someone based on his characteristics and myth is a false belief regarding something (Bathla, Chandna, Bathla, &Kaloiya, 2015). It has been reported that 80% of all mentally ill patients still visit indigenous therapists in Pakistan (Bathla, Chandna, Bathla, &Kaloiya, 2015).
The reason behind the rise of myths and stigma is mainly lack of awareness. They play a very important role in negligence of mental health resulting in worst outcomes. I encountered a similar incident during my MHN Clinical at KPH, there was a 60yr old patient with MDD.
Patient verbalized “I believe that mental illnesses cannot be treated with medicines instead they should be healed through faith healers. My family says that my faith has weakened, thus God has punished me. I feel condemned when people stigmatize and say “yeh tou pagal hai” (He is crazy); some people keep themselves away from me because they think I will physically harm them. This is why I remain agitated and I like to live an isolated life”.
In our society, these types of issues are very common. According to the DAWN news article titled Mental illness in Pakistan: The toll of neglect, ‘Many people have misperceptions regarding mental illnesses and mentally ill patients. Whereas some people do not seek help because of the fear of being stigmatized by the society, therefore many cases remain unreported’ (Mahmood, 2014). The above patient also had the same perception, that is why she was being defensive.
It has been observed that general public defines mental health as “health of mad” (pagalon ki sehat) and its treatment means the person is mad and can never revert to the normal life (Ansari, Rehman, Siddiqui, Jabeen, Qureshi, & Sheikh, 2008). According to the scenario myths that can be identified are: firstly, mental illnesses results from doing something evil to someone or childhood bad experiences secondly due to the possession by Jinn and it is because of weak faith (Awan, Zahoor, Irfan, Naeem, Nazar, Farooq, & Jahangir, 2015). Furthermore, in Pakistan people believe that mental illness can only be treated by faith healers (Aamil) by recitation of Holy verses and by granting Holy water.
It is also noted that these faith healers badly torture the patients (Hussain, 2014). My patient also had a strong belief that led to mythological theory. In taking account the above scenario is basically the psychoanalytic theory given by Freud; he said that changes in behaviors are due to religious forces, beliefs or through childhood bad experiences (Martin et al. 2008).
Similarly, stigmas based on the scenario are that the mentally ill clients are aggressive, they do not understand, they cannot work (ADLs and Jobs) and they are dependent (Bathla, Chandna, Bathla, &Kaloiya, 2015). These stigmas lead to people’s bad behavior, and little sympathizing attitudes towards them. Theory regarding stigmatization is labelling theory in which self-identity, characteristics &behaviors label the individuals (Ansari, Rehman, Siddiqui, Jabeen, Qureshi, & Sheikh, 2008). Likewise in the above clinical scenario patient got the label of mad (pagal).
Similarly, a model related to stigmatization is FINIS model. In this model there are three levels, we will discuss these individually.
Micro level (right side): In this, characteristics of mentally ill patients predicts stigmatizing response. In above scenario, patient complained of decreased memory & concentration, so they are stigmatized that they cannot work properly in their professional lives thus remain dependent on their caregivers. Then, there are emotions of stigmatized individuals, like in above case, patient verbalized that people consider them as aggressive so people remain far (Martin et al. 2008).
Second is Macro level (left side): the first component is “Others” the way people accept, reject or modify dominant cultural beliefs. From the scenario it is evident as the patient said that community people call them mad and hospitals are considered as mad houses (Martin et al. 2008). Another component is media that shows that these patients are aggressive and violent. Next is national context, it comprises of environmental clues and cultural biases that say that mental illness can never be recovered. Like from the above scenario it has been noted that people made patient realize that she is dependent on others.
The third is Meso level: It’s a strategy for improvement that increasing social networks & providing positive reinforcement helps in dealing with stigmas further improving mental health (Martin et al. 2008). As my patient prefers isolated life so gradually increasing social interaction can be helpful.
Myths and stigmas badly affect an individual’s mental health in such a way that first they will not pursue mental health, exacerbating their mental illness (Afridi, M. I. 2008). Secondly the person will observe pessimism which will make them angry easily (Conlon, 2014) eventually person’s self-confidence & competency will be diminished (Ciftci, Jones, and Corrigan, 2013).
The recommendations that can deal with this situation should be done at three levels firstly at individual level, in which nurses can provide awareness to the patient about their illness and emphasizing its treatment through professional psychiatrist. We must logically solve their ambiguities by telling consequences of preferring indigenous mental health practices (Bathla, Chandna, Bathla, &Kaloiya, 2015). Secondly, at group level, the relevant nursing interventions are done by involving them in support groups and focus groups. This can help patients and families to discuss their concerns.
Group psychotherapy can also play an important role in this regard. Public awareness sessions should be conducted by nurses (Bathla, Chandna, Bathla, &Kaloiya, 2015). Providing awareness can play a pivotal role in removing public’s misperceptions and leads to health seeking behavior, so public awareness is a primary intervention which is effective and of low cost (Hussain, 2014).
Lastly, the third level is national level that considers the whole population. For this, good surveillance system should be developed to determine the actual population of mental patients. (Afridi, 2008). Policies must be made based on community needs and community participation (Hussain, 2014).
In conclusion, mental illnesses carry many false beliefs and labels (stigmas) that results in unreported cases. This negatively affects an individual’s as well as the society’s mental health. To overcome this situation, awareness to individual and society should be provided. Local political, religious and institutional participation can be influential and is an easy method to achieve the aim of awareness. Moreover, community participation is highly important in performing interventions and developing policies.
Afridi, M. I. (2008). Mental health: Priorities in Pakistan. Journal of Pakistan Medical Association, 58(5), 225-226.
Ansari, M. A., Rehman, R. U., Siddiqui, A. A., Jabeen, R., Qureshi, N. R., & Sheikh, A. A. (2008). Socio-Demographic Correlates of Stigma Attached to Mental Illness. Journal of Liaquat University of Medical and Health Sciences,7(3), 199-203.
Awan, N. R., Zahoor, N., Irfan, M., Naeem, F., Nazar, Z., Farooq, S., & Jahangir, F. (2015). Beliefs about illness of patients with schizophrenia. Journal of Postgraduate Medical Institute, 29(2), 67-71.
Bathla, M., Chandna, S., Bathla, J., &Kaloiya, G. S. (2015). Faith Healers in Modern Psychiatric Practice: Results of a 4 years Study. Delhi Psychiatry Journal, 18(1), 48-53.
Ciftci, A., Jones, N., & Corrigan, P. (2013). Mental Health Stigma in the Muslim Community. Journal of Muslim Mental Health, 7(1), 17-32. Retrieved from ISSN1556-4908
Conlon, M. M. (2014). Myths and mysteries of mental health: An interagency collaboration. Nurse Education in Practice, 14, 422-426.
Hussain, S. (2014). Mental Health in Pakistan: Myths and Facts. journal of pakistan medical student, 1-9. Retrieved fromhttp://blogs.jpmsonline.com/2014/06/17/mental-health-in-pakistan-myths-and-facts/
Martin et al. (2008). Rethinking Theoretical Approaches to Stigma: A Framework Integrating Normative Influences on Stigma (FINIS). Social science & medicine, 67(3), 431-440.
Mustafa, M., & Rana, M. H. (2009). Mental Illness and Violence: Myth and Reality. A journal of army medical corps, (4).
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