Beyond depression or anxiety: When mental health stigma becomes a second illness

The coronavirus pandemic has meant, among other things, a paradigm shift for mental health conditions : in recent years, there has been more discussion and work on this fundamental aspect of society's well-being. Proof of this are the numerous studies detailing the state of Spaniards and the recently approved Mental Health Plan . But are all these conditions really treated equally? Are as many taboos about anxiety disorders as those about schizophrenia, for example, being broken?

Eduardo Cocho , a 60-year-old Madrid resident, knows a lot about the stigmas suffered by patients. Thirty years ago, he suddenly received a court order indicating that he had to be admitted to the psychiatric ward of the Gregorio Marañón General University Hospital . During his childhood and youth, he didn't have any symptoms that would indicate a disorder, but at 28, he suffered a family problem that he believes was the trigger. "At that time, I wasn't aware of it. Sometimes illness is caused by a serious situation, and I think my parents' separation was the trigger," he says.

What's more, he wasn't even aware that anything was wrong : "Looking back on it, I had a kind of altered perception of reality . I didn't go so far as to have hallucinations or delusions, but there was certainly some of that going on as well." Cocho doesn't remember any incidents during that time, but he believes that his profession may have contributed to him ending up in the Madrid hospital , as he is a lawyer and believes that the judge's order came about because of the documents he sent or the trials he attended, which ended up leading to his admission with the consequent diagnosis of schizophrenia .

"The truth is that the experience wasn't positive because I came out worse than when I went in . At that time, people's approach to mental health problems wasn't very positive; the treatment was very dismissive, a bit humiliating , and they did a number of things to me that I've since been told that if they had happened today I would have had to report them," she declares.

After 40 days in the hospital, the patient left the center to continue receiving outpatient care . Since the name of the disease entered his life, he has felt the stigma. "People ask you strange questions, they treat you as if you were different from everyone else , sometimes they would gather in groups, and I felt sick. I notice the prejudice that society lacks in its awareness that people are exactly the same as others, that they have the same dignity, the same equality, they just have a disability or a problem," he complains.

His situation improved dramatically when, after his mother's admission, she found the Spanish Association for Psychosis Support ( Amafe ). It offers a day center for patients, a space for young people under 30, and a job search department, among other services, to help the patient integrate and recover. He is currently secretary of the board of directors and, although he no longer practices law, he has a master's degree and is working on a doctorate. Another major change in his life has been the improvement in medicine regarding medication , which now causes no side effects. He currently only receives one injection every three months , along with follow-up care from his psychiatrist every four to six months.

Why aren't all disorders discussed in the same way?

After decades of living with her condition, Cocho has come to the conclusion that not all mental illnesses are discussed or treated equally due to a lack of awareness and the prevalence of some. "It seems more common; everyone has been depressed at some point. Saying I have schizophrenia, I'm bipolar , or I have OCD ... people have little understanding of these disorders; they are much more stigmatized, and they are seen as more serious or dangerous," she comments.

Carmen Moreno , head of the psychiatry section at the Gregorio Marañón General University Hospital, delves into society's perception of the dangerousness of these patients : "We know that most people with psychiatric disorders are more victims of violence than perpetrators." This position is also agreed upon by Bárbara Zorrilla , a health and forensic psychologist, who states that when someone comments that they have, for example, schizophrenia, people's response is fear, when this does not correspond with the figures available on the incidence of violence in the population with mental health in general, and she sums it up by saying that there are more victims than perpetrators.

Ultimately, stigma is a "reasonably complex" issue , according to Moreno, a member of the executive committee of the Spanish Society of Psychiatry and Mental Health ( SEPSM ). This expert points out that, for example, recent studies show that more than half of people with schizophrenia perceive the stigma "very intensely."

This fear of being treated differently even affects whether or not the condition is treated. The American Psychiatric Association reports that half of people with mental illness do not receive help for their disorders and often avoid or delay seeking treatment for fear of being treated differently or for fear of losing their jobs. "This is because stigma, prejudice, and discrimination against people with mental illness remains a serious problem ," these experts denounce. A study published in 2022 sought to understand the stigma surrounding schizophrenia, one of the "most stigmatized" psychiatric disorders, whose patients often perceive the burden of this stigmatization "as a second illness." Therefore, they urge the development of anti-stigma campaigns that contribute to creating "a welcoming and non-judgmental community."

Another key, according to Moreno, lies in the symptoms: "When we talk about the possibility of identifying with someone who has a mental health problem, it is not the same depending on the illness we are thinking about . There are certain symptoms that are easier to do so because who has not felt a little anxiety , sadness or overwhelm? This does not mean that all people who have had these symptoms have had an illness, but you can identify with someone who has them. It is less easy with other types of symptoms that involve perceiving things that others do not or having ideas that are incomprehensible to most people."

Zorrilla believes that the fact that issues like anxiety and depression are discussed more than other, and sometimes more serious, pathologies is also related to their prevalence . "I understand this is because most of the consultations made in primary care and referrals to mental health care relate to this," he says.

According to the Ministry of Health's report published in December 2020 on the prevalence of mental health problems and the use of psychotropic and related medications based on primary care clinical records, the most common mental health problem is anxiety disorder (6.7%), followed by sleep disorders (5.4%) and depressive disorders (4.1%). Regarding psychosis, which includes pathologies such as obsessive-compulsive disorders and schizophrenia, the prevalence is 1.2%.

In this whole issue, professionals have a lot to say. Zorrilla argues that they are often stigmatized by categorizing people . "It seems like you're no longer a patient, you're a label. When something happens to you, if you don't have a more biopsychosocial approach to health, these problems are treated exclusively with medication, which is useless," he maintains.

For her, there are two types of mental health professionals , both in psychiatry and psychology: those who see a symptom and treat it exclusively, and those who understand that the symptom is the tip of the iceberg of something that's gone wrong and address the cause. "Unfortunately, I think the former prevails in the Spanish healthcare system," she laments.