Censoring Schizophrenia

The word “schizophrenia” carries lots of negative connotations and stigma – erasing those associations are one of the principal goals of Michelle’s company. In Canada, however, some companies are removing the word from their names in order to make it easier to raise funds and support for schizophrenia research and treatment. One example is the formerly Schizophrenia Society of Ontario, which changed its name in 2020 to “Institute for Advancements in Mental Health”, because some people with schizophrenia were afraid of calling in and receiving treatment, because they would receive mail with a return address of “Schizophrenia Society”. The Schizophrenia Society of Nova Scotia is changing its name for a different reason: corporate sponsors believe that schizophrenia is not “attractive enough” for an investment, and that the name should reflect more common, well-known disorders such as depression and anxiety. The article notes that removing “schizophrenia” from names reinforces the stigma surrounding the word and that openness and honesty are important for people to feel recognized and included.

Underlying these issues, however, is the stigmatization by the general public. The reason people are afraid to call in and have their name associated with an organization that contains the word “schizophrenia” is precisely because of the fear of society’s rejection. Corporations, ostensibly trying to be more inclusive, shy away from the “extreme” mental illnesses such as schizophrenia, most likely not just because of their own stigma, but also because of the prejudices of stockholders. It is easy to blame the censorship of the word “schizophrenia” on the complicity and laziness of the corporations, but it is important to remember that each of us, as ordinary citizens, has a personal responsibility and stake in this game. Despite the twenty-first century’s self-proclaimed modernity and progressivism, mental illnesses such as schizophrenia are extraordinarily stigmatized, only further perpetuating the stereotypes and pushing schizophrenia into the deepest, darkest recesses of the closet of socially unacceptable topics. Ultimately, our systems are fueled by the general population, and so mental health activism has to occur on the ground level. It’s as simple as sharing on social media platforms.


The Shortcomings of Health Care Part 2

The former director of the National Institute of Mental Health (NIMH), Thomas Insel, writes in his book, “Healing,” that although during his directorship countless medical breakthroughs led to reductions in death rates from heart problems and infections, the nation’s mental health crisis ballooned out of control. Today, suicide kills three times as many people as homicide, and this figure is only growing. The reason for this, Insel asserts, is that there is a “gap between what we know and what we do.” Specifically, the healthcare system is designed to help people only when they get sick; it does not prevent them from getting sick in the first place. In other words, the system ought to provide social services, rehabilitation, and job opportunities, and treat patients holistically: that is, treating them socially as well as biologically. In the current system, patients spend their time in one of three places – the homeless shelter, the emergency room, or prison. The first results in tragedies such as the death of Michelle Go, the second drains our resources, and the third perpetuates negative stereotypes and causes unnecessary and unjust suffering. Insel estimates that the current system costs us $1 Trillion a year (a lot!). Mental healthcare that does exist is often expensive or of low quality.

There is only one word to describe how the system is now: lazy. That’s one drawback of the rapid advancement of modern technologies and science – people often don’t understand how limited it really is, and assume that medicine can fix all our problems. I, myself, am guilty of this fallacy. It’s the same with climate change: it seems so far away until it happens right in front of you. While it’s true that neuroscience is a rapidly developing field, it is important to understand that the brain is an immensely complex and enigmatic organism, such that we’re probably not even close to understanding a tiny fraction of its inner workings. But we do, more or less, know how to help people with mental illnesses, and at that task we are failing horrendously. In Insel’s words, “We know what works, we’re just not doing it.” Well, it’s time for policymakers to start doing it.


Mental Illness and Racism

What we know about Times Square subway shove victim Michelle Go

In a recent Schizophrenia and the City episode, Michelle Hammer examines the death of 40-year-old Michelle Go, who was killed by a train in Times Square after being pushed into the tracks by a homeless schizophrenic man named Martial Simon. This incident was largely a product of the inadequacy of New York City’s mental illness support systems, but as a CNN article reports, many are viewing it as a manifestation of anti-Asian hate. “You can tell me all you want this is not related to me being Asian but when I look at pictures of Michelle Go and read the story I see myself in it,” asserts Sung Yeon Choimorrow, executive director of the National Asian Pacific American Women’s Forum. As an Asian-American myself, the issue of anti-Asian hate that has spiked during the COVID-19 pandemic is personal. Even so, I believe that it is misleading to label this incident as a hate crime. I cannot say whether or not Michelle Go’s death was even remotely racially motivated, but I do know that focusing in on the race aspect serves only to obscure the fact that Martial Simon had schizophrenia and that the larger issue is likelier a lack of awareness and action concerning mental illness. The less privileged mentally ill bounce back and forth between prisons and under equipped mental institutions, and when they’re not in either they are homeless. The CNN article does not mention that Simon had schizophrenia; it only mentioned that he was homeless. We should be viewing this incident through the lens of intersectionality – that is, by understanding that multiple factors are at work behind the scenes. Asian hate is not the only thing that should change – stigma towards mental health should too.


Stigma and the Media

Stigma doesn’t just disappear – it only gradually fades, or, God forbid, gets worse. A recent U.S. News article presents research that suggests that both are happening in the U.S. right now. The study examines various representative samples of over 1,000 U.S. adults and their perceptions of depression, alcohol dependence, and schizophrenia in 1996, 2006, and 2018. Over the years, it appears that Americans’ “mental health literacy,” or understanding that mental illnesses are medical conditions, has improved. In addition, Americans in 2018 were less likely to avoid people with depression, which is a good sign. On the other hand, though, attitudes towards alcohol dependence and schizophrenia are worsening, with around 60% of the 2018 sample viewing the former as a character flaw and around another 60% viewing the latter as an indication of being “dangerous.” These changes could be attributed to the increase in high-profile figures and celebrities openly talking about their struggles with depression, or the prevalence of antidepressant ads, both of which could help “normalize” depression. Conversely, however, the media portrayal of alcohol dependence and schizophrenia helped perpetrate negative stereotypes. For example, the recent spike in gun violence has prompted people to erroneously fabricate a relationship between mental illness and violence.

This article demonstrates just how much of an impact media can have on people’s stigma. Media is also a double-edged sword – while it has the power to reduce people’s stigma, it is equally disposed to increase it. It all comes down to how we use it. Given media’s important role in public opinion, it is the responsibility of the distributors to be mindful of potential impacts. I’m definitely not arguing for restricting free speech in the media; that would obviously be unconstitutional. What I’m saying is that media producers should watch out for the effects of their media outside of the intended effect. For example, media coverage of gun violence is not intended to stigmatize mental illness (though if it is, that is a different issue). Thus, news organizations should make sure that the way they portray violence accounts for the potential stigmatizing effects. That said, doing so is much easier said than done. A more immediate solution would probably be to counter the negative effects of the media with mental health advocacy – something that is already being done, by people like Michelle. As history has shown us, though, advocacy by itself only gets us so far and it is necessary for our institutions and the government to expend effort towards the goal of reducing stigma.


Forced Treatment and the Law

Anosognosia (uh-noh-suh-noh-zha), or a person’s inability to recognize that they have a mental illness, affects an estimated 30% of people with schizophrenia and 20% of people with bipolar disorder. It is not denial; rather, it is hypothesized to be a condition caused by disorder in or damage to the frontal lobes. People with traumatic brain injuries, for example, sometimes have anosognosia. Anosognosia is very problematic, as it emotionally harms loved ones who want the person with anosognosia to get treatment, and it also harms the person with mental illness, who feels frustrated and alienated by the people around them trying to convince them that they are sick. The typical solution for this problem is forced treatment. A recent Seattle Times article dives into the policy of mental health care and anosognosia. Washington State has had a very tenuous relationship with mental health care, at one point forcing patients into overcrowded hospitals. Thus, to avoid another such fiasco, policy has reversed and Washington is now one of the hardest places to get forced treatment, and the only way to get someone with anosognosia treatment is to prove that they are a danger to themself or others. The article argues that the system’s libertarian focus is blind to the needs of people who literally are incapable of making informed decisions about their mental health, and change is necessary. 

This article confronts (and also explicitly acknowledges) a very salient topic in the world of mental health. What are the rights of people with mental illnesses? Michelle, for example, has had very unpleasant experiences with forced treatment, having been strapped down and forcibly injected with sedative at a psych ward. On the other hand, it is true that for some people the only way to get them treated is forcibly. Where do we draw the line? Washington state drew that line towards the free choice end of the spectrum, though the article is arguing for a relaxation of laws restricting forced treatment. I believe, however, that the answer lies in neither. The solution is greater individual attention towards people with mental illnesses. Nobody tried to explain anything to Michelle when she was in the psych ward, which greatly frustrated her. I can’t speak for Michelle, but I think it would have been less unpleasant if someone had sat down with her and asked her what she thought. From there, they could have decided whether she needed further treatment or not. 

The key word here is equity – it is an inherent flaw of policy that every person is different, and so has different needs. This is no less true for mental health care, and yet this topic has not received the attention and funding that it warrants. People with mental illnesses need treatment that is just right for them, which for some people is forced treatment, and for others is not. We need to stop thinking of mental illness as a monolith, and start viewing it as no different from the other topics that dominate policy. Ideally, every person with a mental illness should be able to talk with an expert and have a say in their treatment (or no say, if their anosognosia is too complete). Of course, nothing in this world is ideal, as policies are fundamentally limited by reality and are merely approximations of the ideologies behind them. Still, simply talking more about mental health is a step in the right direction. If we can put ourselves on the right path and keep walking forward, that is enough.


The Name Game

Will changing the name of a mental illness help de-stigmatize it? A recently published New York Times article describes a survey designed to build momentum for the name change. 

The name “schizophrenia,” meaning “split mind” and coined in 1908 by Dr. Eugen Bleuler, was not intended to have negative connotations. However, it has taken on a stereotype of “dangerous” or “amoral.” Schizophrenia has been misunderstood and appropriated as an insult. Doctors are reluctant to diagnose people with schizophrenia because it is such a loaded word, and people who do have it are reluctant to seek treatment because of the stigma. Now there is an organization trying to reduce these associations by changing the name of the disorder. 

There is undoubtedly harmful and unreasonable stigma surrounding the term. However, I don’t think that changing the term will achieve anything. It is comparable to changing a filter: it is shiny, new, and relatively problem-free soon after it is installed, but it does not withstand the test of time. The original term “schizophrenia” was coined on a scientific basis, and yet it has still been muddied by the public consciousness. Why wouldn’t the same happen for a new term for schizophrenia, especially since public stigma is just as bad, or even worse than it was soon after it was coined? The negative perception of schizophrenia attaches itself not just to the name of the disorder, but also to the people living with it. Even discounting the logistical difficulties of changing the name of a disorder, the change is not worth it. It only treats the symptoms of the problem, not the cause. The best route to destigmatizing mental illnesses is to create content, just as Michelle is doing, to demonstrate that schizophrenics are just as human as a “normal” person. Through first-hand experience (albeit through a screen), the true nature of schizophrenia overrides the stigmatized perception drawn from popular culture and the tabloids.