Ep 293: Breaking the Stigma of Mental Illness

Andy Earle: You're listening to Talking to Teens, where we speak with leading experts from a variety of disciplines about the art and science of parenting teenagers. I'm your host, Andy Earle.

We're here today with Roy Richard Grinker talking about the stigma of mental illness.

If we want to understand how we can create an environment in our families and in our homes where our teenagers feel comfortable talking about their mental health, asking questions, and expressing to us when they might be struggling, we have to understand the history of the stigma behind mental illness in our country.

Why did it become so stigmatized to be struggling with your mental health? Why is mental illness something that we want to hide or don't want to acknowledge in ourselves and in our loved ones?

Roy Richard Grinker is a professor of anthropology and international affairs at George Washington University. He's the author of several books, including Unstrange Minds and the new book, Nobody's Normal, How Culture Created the Stigma of Mental Illness.

Richard, thank you so much for coming on the show today.

Richard Grinker: Thanks for having me.

Andy Earle: Really excited to speak with you. I've been reading through your book, Nobody's Normal, How Culture Created the Stigma of Mental Illness.

Really interesting. You go through a lot of history in here, diving into where these ideas around mental illness came from. Schizophrenia, Freud, and all kinds of fascinating stuff. Can you talk a little bit about where the book came from or what the impetus was?

Richard Grinker: I wasn't originally going to write a book about the stigma of mental illness in general, but I started to see so many of my freshmen and sophomore students talking about their own struggles or the struggles of their parents or their siblings or their friends. And I realized that, there was no 1 day when it changed, but it was 1 day when I really recognized that there'd been a change of openness and understanding that emotional distress is part of the human condition and it doesn't mean you're a bad person or doesn't mean you're of weak character.

And I remember 1 day when I was asking some freshman what the best day was of their freshman year. People said all sorts of things, but it got to one woman in the class and she was probably 18 And she said the best day for me was when I was diagnosed with ADHD. I said, really?

Why would that be such a great day? Because it sounds like maybe, a diagnosis of a sickness or something. And she said I had always struggled, in high school and in middle school. And I always told my parents, I think maybe I have something like a learning disability, or maybe I have ADHD.

And it was only when she got to college and she was independent that she could go and see a therapist who not only diagnosed her with ADHD but gave her a small amount of medication that helped.

And she said, that was the first time that I didn't see myself as my parents saw me. And it's the first time somebody said to me, you just need some support. And you're fine. You're not lazy. You're not dumb. You're not working less hard than anybody else. And it was that kind of acknowledgement of her worth.

And I thought, I want to write a book about how things are getting better for people, not about how things are getting worse.

Andy Earle: I think that's so interesting and also it's a double edged sword because you talk also in the book about how in some ways this diagnosis and biological model of looking at what their disorder is also in some way puts the impetus onto the person.

Instead of really factoring in the situation, the culture, the society, all the other kind of factors that might be also playing into that as well.

Richard Grinker: That's exactly right. We have had the decade of the brain and we've had major achievements in neurobiology.

When we say that something's wrong with your brain, how does that change you? And the reality is that there's never something that is just wrong with some part of you. It is your society that also interacts with you.

There's something called the social model of disability.

Which says that you're disabled only when your environment makes it. somebody in a wheelchair is not disabled if there are ramps and elevators.

And so it's society that really has an effect on our experiences. when we say something's wrong with the brain that doesn't really tell you very much about what's going on in that person's life and their experiences. Emotional distress doesn't come out of nowhere. It comes out of living, interacting, experiencing.

Andy Earle: So it's interesting, because that was a big message I got from the book, that it's interesting hearing you talk about this student who, getting this diagnosis of ADHD, was like a great day! Because now I, oh, it all makes so much sense now, or it's not just me being lazy, or me, not doing enough.

Richard Grinker: Yeah I'm not trying to trash her parents, but this was a case where getting mental health care really was positive. It wasn't like mental health care means a negative thing. The problem in the United States and other parts of the world isn't that people are getting too much mental health care.

It's that they're not getting enough. And one of the main reasons they're not getting enough is they're scared of it, or there's stigma, judgment about it, or people just don't understand the sources of emotional distress.

Andy Earle: Yeah, it's interesting also thinking about, because I can see as a teenager's parents, they're not getting that good of grades.

Maybe you're hearing about their teacher saying they're not really paying attention in class or not applying themselves. And you're like hey, you need to try harder. You got to focus. You got to get in there. And interesting thinking about it from her perspective of almost maybe feeling not seen or like invalidated or no, but I'm having this experience. Something's not right. Why is it so hard for me? And not feeling heard or listened to.

Richard Grinker: She was very fortunate that, she had the energy, the initiative.

To go and seek her own care. Some people don't, and then they struggle along and they feel badly about themselves. But that's part of emotional distress itself. Depression, for example, it's very hard to have that initiative and energy when you're depressed. Eating disorders, it's very hard to get care if you are experiencing symptoms that you in fact desire. You're losing too much weight, but you want to lose weight. Sometimes some of these things require that it's not on the burden of just the individual to go seek care, but their friends and family around them to actually help them get to care.

She could do this on her own, but for many people, they can't do it on their own. They really need help and support. the more people are afraid of mental health care, the less they're going to seek it.

Andy Earle: And there's an aspect of which probably we don't want to think that our kid has something wrong with them, or we don't want to think that there's a problem, and, you point out a number of really interesting things in the book at one point, you're talking about different, politicians getting questioned about whether they've had, therapy in the past. Oh no. I've never done that. Because that would be admitting that there's something wrong with you or something like that. And it's interesting just to think about where those kind of deep stigmas come from.

Richard Grinker: We have, long stigmatized people that we thought didn't have self control or impulse control or that were not fully independent. And knowing that somebody like a political leader might depend on others for care is something that brings about shame and discomfort and judgment.

This is the problem with mental illnesses that they come to us in society as a double illness. 1st, the suffering of the emotional distress itself and 2nd society's judgment that we also have to deal with. And in the cases you're talking about where somebody's running for office and something comes up about them having had, struggles with depression or anxiety or whatever it might have been, there's all this tendency to deny that they ever had a problem, instead of acknowledging that they might have had pain and are doing better, which actually could be very much a model for us.

Andy Earle: You're perpetuating the stigma.

Richard Grinker: It's no surprise that when you look at presidents of the United States who have received care and counsel from someone, it's almost always a religious figure because that doesn't have, the stigma of sickness with it. So that's why they'll seek that kind of care.

Andy Earle: That's admirable. You're spiritual.

Richard Grinker: Exactly. But, in the case where people have seen somebody. Even walked into their office, it's become something like a death sentence to the election.

Gerald Ford. Was the president of the United States briefly, after Richard Nixon resigned and he had been in the office of a New York psychiatrist. And the congressman grilled him about that. Why were you in the office of a psychiatrist? What does that mean?

And, Ford's response was, I am disgustingly sane, odd choice of words, but it tells you a little bit about what people are thinking, about how much discomfort there was. But you made the point, just a moment ago that parents don't want to have a kid who has a problem. We often put our value judgments and our own, feelings in the way of helping others.

Andy Earle: Some really interesting pieces of history in the book, including, this little gem that I found here: few people sitting at a table eating their Kellogg's cornflakes or granola, want to know that their breakfast was invented and marketed to prevent masturbation. What's going on?

Richard Grinker: This is a true story. The Kellogg brothers who were behind the production eventually of Kellogg cereals, were, very strong believers that, sexual activity, particularly solitary sexual activity was at the root of all kinds of evil and sickness. They were not unique in this.

People have thought about this for centuries. In the 17th century, there was a wax museum of masturbation where you could go to see wax figures that were in various states of decay ostensibly because they had masturbated. They thought that sexual impulses could be diminished by eating bland foods.

And they produced a concoction of dried oats and other dried grains. They didn't put sugar in it and, so it was very bland. And they tried to market it.

So they renamed it granola. And that's where we get granola from. Simultaneously Sylvester Graham was creating the Graham cracker for the same purpose. And if you look at the history of psychiatry, it's just fascinating how sexual activity and gender really play a role in how society has wanted to enforce certain norms and create a division between what's considered normal and abnormal. It's still there today in the way that people are discriminated against for who they love, whether it's in the military or it's in the workplace or it's within their families.

Andy Earle: A lot of the history of many labels, related to mental health seem to go back to economic causes or, access to help or access to resources. You talk also about slavery. And how getting a label of being insane, was really different, in different parts of the country during slavery in the early 1800s.

Why was that?

Richard Grinker: Things were very different between the North and the South. In the north, there were many more opportunities for all kinds of care, whether it was for the elderly or physically disabled or for people with developmental disabilities or serious mental illnesses. And that was particularly different for people who were Black. Because if you were black in the south, any care you got had to be paid for by the slave owner.

And in the north, there were state sponsored, government, opportunities for people to get some kind of care. At the same time that you get this difference between care in the North and care in the South, you get politicians who will look at the statistics and they say, Blacks in the North are getting more care than Blacks in the South.

If we look at hospital records and things like that, that must mean, they argued that if slaves are free, they get mental illnesses. Because otherwise, why would there be more people getting care in the north? They thought that slavery actually protected against insanity. There was even a mental illness term that was developed in 1851 called drapetomania.

It was a disorder that was defined by the urge to violate the laws of nature and the Bible by running away from one's masters wanting to be free. So if you wanted to be free, that was a mental illness. Now, if you think this was just slaves, no, it wasn't just slaves. It was also something that affected the way that people in the 19th century looked at women.

That women who didn't want to marry or have children were also insane. Scientists widely believed that marriage was, like slavery, a kind of protective factor. And that, within a marriage, a woman would be protected, but on her own, she would develop all kinds of serious mental illness issues.

It was also about another subordinated group, which tells us that in the early days of psychology and psychiatry knowledge was often produced in order to maintain a status quo and to suppress and oppress certain groups.

Andy Earle: And yeah, it's so interesting how as the pressures change or as the culture changes or society changes, then all of a sudden there's more or less people with certain labels.

And it makes me wonder ways in which that's probably happening today. And we're not aware of it.

Richard Grinker: We don't know. In 20 years, we may not use the term autism anymore. We may have other types of therapies. We know that language of mental illness changes. We now talk about spectrums of mental illnesses, which we didn't do that 20 years ago. We had these categories, you had autism or depression or schizophrenia. Now it's the autism spectrum, the depression spectrum. And so we talk about these things differently. And then some terms will come into fashion and out of fashion.

The, expression of emotional distress through physical, ailments used to be called hysterical, in the turn of the century. Then it became called psychosomatic. Then it became called conversion disorder. And now it's called neurologic functional impairment.

We find new terms that have slightly different definitions and that get traction in society at a certain time in history that wouldn't have had traction at another time. I can't imagine reintroducing the term hysteria today, for example.

Andy Earle: But it wasn't that long ago.

Richard Grinker: Asperger's was a term that was used very frequently between 1994 when it first entered into the diagnostic manual of the American psychiatric association and 2013 when it was removed from that diagnostic manual. And so we have to ask ourselves, was there a thing called Asperger's and now it's gone?

Andy Earle: It went away.

Richard Grinker: I'm an anthropologist, I'm not a clinician, and I have to emphasize that for your listeners. What I do is I study how culture and history influence the way we think.

About the mind, and about emotional distress, how we narrate, how we experience it. And if you just take Asperger's there's no scientific reason to get rid of it, necessarily. You could argue that it's very difficult for neuropsychiatric testers to distinguish between subtypes of autism, but they knew that in 1994 when they put Asperger's in.

So why did it happen? For cultural reasons. And that is why terms change. It is for cultural reasons, not because there was some new scientific discovery.

People who were verbal, people who were educable, not the stereotype of the autistic person who's non speaking, maybe intellectually disabled, self injurious, and needs 24 7 care. We introduced this term Asperger's, it gets used, and over time, things changed in our society, and today autism is not as stigmatized as it was.

So now we're free to get rid of Asperger's because we don't need it anymore.

Andy Earle: And now we have the autism spectrum. So we can just be anywhere on that spectrum and we don't necessarily need to have different names for a mild version or something like that.

Richard Grinker: But there is a myth that somehow when we make changes to psychiatric diagnoses that it's because there's some scientific discovery.

The changes come from what happens in society. And what our needs are and what's happening at a particular moment in our history

Andy Earle: On the topic of spectrum, you talk in the book about, how sometimes you'll hear your students referring to different things like, oh, that test gave me PTSD or, things like referring to different psychiatric disorders in a joking way. Or I have total OCD, I need my apartment to be spotless.

Do you think this is something that we should point out? Hey, that's not funny. Don't joke about something like that when our kids are using these kind of things? Or are they maybe talking about a very slight case on the spectrum? Or where does that fall in?

Richard Grinker: Yeah, I think that's a really good question and there's no single answer that you can give. You can take different positions on it. And I'll just give you 2 positions. 1 position is, as you might have suggested in your question that, by using terms like post-traumatic stress disorder, or OCD in a kind of non clinical, light, jocular way, almost flippant way, that you're really ignoring the fact that those are really serious conditions. That PTSD can lead to suicide. That OCD can totally upend and disrupt one's lives and family relationships.

On the other hand, if we start using these terms in a way that's not poking fun at anybody, I think we could potentially disarm the power of those words to stigmatize. The more we use these terms, the less we see them as scary. They're two sides to this and I think you could make a case for either or both together.

Andy Earle: Yeah, it's is that taking away from people who really need that label or really have that by saying, Oh, I have a little bit of that too.

Or is that actually removing the stigma and making it okay for us all to talk about?

Richard Grinker: This is something that has come up in recent years with the word autism. Increasingly, there are people out there who self identify as having autism who are superstars, right?

Like Elon Musk, Jerry Seinfeld, other people who will say that they have autism. Now, imagine that you were a parent of a child who has a serious intellectual disability and has autism and has never been toilet trained, is self injurious, who's really suffering, has seizures.

How do you hear that? You might hear that and you'd say maybe that's how you want to use the term and somehow find some benefit from it. But there are people like my child who are really suffering. And so we have to be empathic and understand how the use of certain terms can be understood and heard by others.

Now we have, at our disposal, this, manual, the DSM. And it doesn't just have autism spectrum disorder, but it has levels of support. You can say autism spectrum disorder with level 3 supports, level 2 supports. But that's not exactly something that, you know, on the street at a dinner table is everyday conversation, right?

You just use the word autism and you don't use this technical clinical language. And so there's now, developing some pushback from some families to try to develop a new term that will actually denote something that might be a profound or severe form of autism. To distinguish it.

Andy Earle: Yeah, we got rid of Asperger's. Now we need something maybe on the other end. It's really strong.

Richard Grinker: We do this all the time with ancient hominids. Do we call this a new species? Is it? We got Australopithecus africanus. Do we need Australopithecus afarensis?

How do we know? What's an entirely new category or species. And so you have conflict between the so called lumpers and the so called splitters. You see the same in medicine, right?

Andy Earle: I can see that being a really heated debate at a conference.

Richard, thank you so much for coming on the show today. It's been an honor and a pleasure speaking with you. I encourage people to pick up a copy of the book.

It's Nobody's Normal, How Culture Created the Stigma of Mental Illness. Where can we send people to find out more about your work, to follow updates from you?

Richard Grinker: I used to have a website that was operative, but I don't anymore. They can Google me and find out more about me. And I have books on Amazon.

Andy Earle: We're here with Roy Richard Grinker talking about the stigma behind mental illness, and we're not done yet. Here's a look at what's coming up in the second half of the show.

Richard Grinker: A 16 year old girl whose most traumatic episode in her life that caused her great hardship emotionally was not when a bomb killed her grandfather. It was when she had a small cyst removed from her breast. For the first time in World War II, we really see psychiatry moving out of the asylum and into the general population so that psychiatry is not just for the insane person.

And so the term normal might seem innocuous. But in fact, it can be used to lift up a particular group as the ideal. The ideas that we have about what is the ideal human being, how we measure people, how we value ourselves and think about emotional distress and emotional health. These things are not grounded in nature.

They are things that society makes.

Andy Earle: Want to hear the full interview? Sign up for a subscription today. It's completely affordable, and your membership supports the work we do here at Talking to Teens. You can now sign up directly through Apple Podcasts. Thanks for listening, and we'll see you next time.

Creators and Guests

Andy Earle
Andy Earle
Host of the Talking to Teens Podcast and founder of Write It Great
Roy Grinker
Roy Grinker
Author, Nobody's Normal @wwnorton Jan 2021. Anthropologist @GWU. Editor, Anthro Quarterly #autism #stigma #nobodysnormal #mentalhealth
Ep 293: Breaking the Stigma of Mental Illness
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