Psychiatrists can cause stigma too

R. Chaplin

The Royal College of Psychiatrists' campaign to reduce the stigma of mental illness needs to examine the role that we play in maintaining stigma as well as reducing it. The negative attitudes of members of the public (Crisp et al, 2000) towards people with mental illness were mirrored by some psychiatrists (Farrell & Lewis, 1990). The latter authors found that psychiatrists held significantly more negative attitudes towards patients with a prior history of alcohol dependence. This included the view that they would not like these patients in their clinics. Similar findings apply to other groups of patients. Lennox & Chaplin (1996) surveyed the attitudes of Australian consultant psychiatrists. They found that 39% agreed with the statement ‘personally I would prefer not to treat patients with learning disability and mental illness'.’.

The very nature of our job can be powerfully stigmatising in a way that cannot be underestimated. While engaging in debate with the public via the media and other means to inform and change attitudes, performing our clinical duties can have exactly the opposite effect. A Mental Health Act assessment at a patient's residence can be a cause of tremendous stigma to the patient and the family. This is especially so because of the highly visible involvement of the ambulance and police services whose help is often essential. It is against such almost routine community experiences that a broader national campaign has to compete.

Another very real source of stigma may be the side-effects of the medications that we prescribe. People with schizophrenia may not appear any different to the general public. However, side-effects such as drooling and tardive dyskinesia immediately point out an individual as being socially undesirable. Obesity, often a result of antipsychotic treatment, has been described as being seen as unattractive and unlikeable and has been linked with impaired employment and education opportunities (Crandall, 1994).

Psychiatrists have a clear duty to reduce stigma at the individual level. We must be prepared to identify and challenge our own prejudices and attempt to modify our clinical practice. Consideration also needs to be given to how we can carry out Mental Health Acts assessments, potentially the most stigmatising event that any family with a member with mental illness will suffer.