It's Not Stigma -- It's Prejudice and Internalized Oppression

Stigma sticks to the persons stigmatized.  And sure enough, we are stuck.  Every time we repeat the word, we reinforce it.

Here is an idea.  It's not stigma.  It is prejudice and internalized oppression.

We gotta do something new, people.  We're dying out here.

Treatment For Mental Illness -- The Streets Or Jail

Ever since John Kennedy promised us more humane, community-based treatment for mental illness, we have been living on the streets.  Somebody with serious mental illness is four times more likely to be homeless than somebody without.

Or in jail.  On any given day, there are roughly 283,000 persons with severe mental illnesses incarcerated in federal and state jails and prisons.  In contrast, there are approximately 70,000 persons with severe mental illnesses in public psychiatric hospitals, and 30 percent of them are forensic patients.  Los Angeles and Cook County jails are the largest inpatient mental health facilities in the country.

No Respect=No Money=No Help

Does anybody out there live in a state where funding for mental health services is not being slashed?  Wasn't being slashed even before the last elections?

Now that we are talking money, how is this for a reality check on what we are worth -- from John McManamy's blog Knowledge Is Necessity:

In 2009, the NIH allocated $3.19 billion for HIV/AIDS research.  By contrast, research for depression (including bipolar) was a mere $402 million.

Million, not billion.  These are ratios that have held fairly steady over the years.  Approximately 1.5 million individuals in the US are affected by HIV or AIDS.  About 19 million in the US in any given year deal with depression or bipolar.  That translates to the NIH spending $2,013 per patient for HIV/AIDS research vs a paltry $21 per patient for depression and bipolar.  Putting it another way, for every dollar the NIH invests in an HIV/AIDS patient, depression and bipolar patients get one penny. [emphasis added]

Kinda puts things in perspective.

Funding By Death

But AIDS is fatal.  What about spending per death?

The number of deaths of persons with an AIDS diagnosis has stabilized in recent years at around 17-18,000 per year.  (Deaths of persons with an AIDS diagnosis may be due to any cause).  Since the beginning of the epidemic, an estimated 597,499 people with AIDS have died in the U.S.  Again, that does not mean they died of AIDS.  The figure includes heart attacks, cancer, accidents, suicide, etc.

In contrast, the Center for Disease Control reports that 34,598 people died by suicide in 2007.  We are pushing 900,000 deaths by suicide in the same period as the 600,000 people with AIDS who died for whatever reason.

But people with AIDS are now living longer.  Today, for every death of a person who has AIDS, two people die by suicide.  Far from stabilizing, the suicide rate has been rising since 1995.  [Side note: so much for that claim that increased antidepressant use caused the rate to go down.  There are more of us on them now than ever, and more of us dying anyhow.]

Depression is not the cause of suicide in all cases.  Research indicates that 90% of those who die by suicide have a mental illness.  That 70% have a mood disorder is a low ball estimate.  But that would yield 24,218 deaths by suicide among persons with mood disorders.

So the NIH spends $for 187,647/year for every death of a person with AIDS and $16,599/year for every death of a person with a mood disorder.

Oh, it's not so bad after all.  If we look at death rates, the disparity is down to $11 for somebody who has AIDS and dies by any cause to $1 for somebody who dies from depression.

Feelin' all warm and gooey inside now. 

No Political Price To Pay

Here is the politics at work.

The Ryan White Act was enacted in 1990 and named after a twelve-year-old who was kicked out of school because he had HIV/AIDS.  The act provides funding of last resort for poor people with HIV/AIDS and technical assistance to state and local organizations dealing with HIV/AIDS.  This is on top of the NIH research funding.

The money is not much, just over $2,000,000.  But it has held its own in the last decade, with modest increases every year until 2010.  Up for expiration in 2009, it was renewed by unanimous vote in the Senate and 408 aye/9 nay/15 abstaining in the House.

Now I am totally in favor of the Ryan White Act and the amount is stingy.  But I ask you to consider, do people with mental illness have anything like the Ryan White Act?  And can you imagine a legislator who thinks there will be any political price to pay for the cuts he/she is voting right now to services for people with mental illness, or for teaching laws enforcement how to handle mental health emergencies?

We could run the numbers for other diseases.  Breast cancer would reveal similar results.  Please, please understand me.  We are not on different sides here.  The AIDS example is especially valuable because we can draw lessons from what AIDS activists have accomplished. 

Stigma Busting Is A Bust

The problem is that people don't think of mental illness as real illness, right?  The solution is more education about the biological basis for mental illness, right?

No, not so much.  Researchers at Indiana University and Columbia University examined changes in understanding and attitudes in the US between 1996 and 2006.  Education has indeed increased understanding that mental illness is a biological condition.  54% of people knew that about depression in 1996, 67% in 2006.  Let's give the pharmaceutical companies some credit for their share, probably the lion's share of that change.

On the other hand, do they want to work with, socialize with, marry or live next door to us?  Nope.  Those numbers did not budge in the same time frame.  More telling for the task of designing stigma-busting strategies, there is no difference in attitudes between those who know that mental illness is biological, and those who do not.

In fact, those who understand the neurobiological basis for depression are more likely than those who do not to think that we pose a danger to them.

I'll kill 'em.  I swear, I'll kill 'em.  Just as soon as I can get out of bed.

What we are doing against stigma -- it's not working, folks.

How come?

Evidence-Based Stigma Busting

A study from the University of Kent in Cambridge, UK uncovered one flaw in typical stigma-busting efforts.  To bottom line it, how the listener responds depends on who the speaker is.

When allies (such as doctors or family members) make positive statements about people with mental illness, they are less credible than when people who have a mental illness speak for ourselves.  They is a word that doesn't cut it in stigma-busting, regardless of intention or attempt at sensitivity.  The authors cite previous research regarding other stigmatized groups showing that positive statements about them can be perceived as patronizing. 

This Is Good News

1. We were never worth much and now are worth less.

No, I mean it.  This is good news.  As my therapist used to say, The facts are friendly.  These are the facts, and they will be our ammunition.

2. We can do better.  In fact, the bar is set pretty low.

3. We have others, even among us, who have fought prior battles and can point the way.

Next week we take advocacy to the next level.


photo from La Brea Tar Pits by 3scandal0 and in the public domain
photo of homeless vet by Matthew Woitunski and used under the Creative Commons Attribution 3.0 Unported license
image of red ribbon in public domain
photo of coffins of members of the 101st. Airborne in the public domain
photo of chocolate molten cake by rore and used under the Creative CommonsAttribution-Share Alike 2.0 Generic license
photo of Ryan White taken by Wildhartlivie and used under the GNU Free Documentation License
flair by facebook
photo of Thomas Insel, director of NIMH in public domain


  1. Thanks Kind Citizen.
    I am a homeless baby boomer who has been blogging against the stigma of homelessness and the fact that most shelters are LEFTOVERS of the Drug War and Ill Equipped to handle the huge numbers of mentally disturbed baby boomers.

    Just about a year ago now a senile old black man shuffled around the financial district and was ignored for six months.
    He died when Winter came early and he was found in a box in the fetal position because he succumbed to the bitter cold when Winter came early November 29th 2010.I still do not know his name but he is not forgotten.

    This happened a block away from the Pyramid Building and Wayfare Tavern a hot spot for corporate SHILLS to close deals and short sales.
    The Short sales are booming when bankruptcy and foreclosure is looming.
    You would think they would care about these SENILE CITIZENS.
    To begin with the poor man was black and that was strike one.He was homeless that was strike two.He was mentally disturbed STRIKE THREE HE'S OUT.
    I am organizing a candlelight vigil at OCCUPY San Francisco.WE will gather and remember this UNKNOWN HOMELESS SENIOR WHO HAS DIED FROM SEVERE APATHY
    The Social Security act of 1935 has failed so many mentally disturbed citizens.
    Unacceptable in such a well educated and wealthy society.
    Are we the ARCHAIC ?
    THE US EMPIRE failed it's own citizens while continuing to OCCUPY Countries around the world and rebuild them.

  2. I must add that I am a Veteran and will have VASH housing soon.My nightmare will be a short one.

    I am doing fine compared to the senile boomers who aren't vets.
    They do not have light at the end of the tunnel.
    Imagine working for thirty years just to succumb to senility early.
    Then when you seek help.
    You find rancid toe jam smelling shelter aka Human Warehouse that has been used as a hammock by addicts for those thirty years while you were busy working and now we have the LEFTOVERS of a drug war.
    Then Photo Op Whore mayors like Gavin Newsom had the NERVE to call it Best Practices.
    ED LEE isn't much better

  3. do you have rights to these photos? can i borrow them?

  4. I only use photos in the public domain or from a source that grants permission for noncommercial use. All of the credits and sources are at the end of each blog. My most frequent source is Go there, find the photo, follow the instructions for proper attribution.

    Photographers are artists, and artists work for a living. They deserve their due. If they choose to share their work for free, they deserve to set the terms!

    OK, so I can't figure out the copyright issues on Flair from Facebook. I identify my source, and wait for somebody from Facebook to tell me I'm doing it wrong. In which case, I will make it right.

    PS - Thanks for your question.


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