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How the Stigma of Mental Health Is Spread by Mass Media

n the aftermath of an unconscionable act of random violence, many people are inclined to label the perpetrator “crazy.” Although the criminal may have a mental illness, automatically assigning the label “crazy” does a great disservice to people who live with mental illness every day.

In reality, somebody with mental illness is much more likely to be a victim—rather than a perpetrator—of violence.1 Calling a violent offender “crazy” spreads a dangerous stereotype and belies the complex relationship between criminality and mental illness.

The media teaches us about people with whom we do not routinely interact. This constant flow of data gives us incessant social cues about the nature of other groups of people—including which groups of people should be praised or scorned.

Media portrayals of those with mental illness often skew toward either stigmatization or trivialization. Consequently, all forms of media—including television, film, magazines, newspapers, and social media—have been criticized for disseminating negative stereotypes and inaccurate descriptions of those with mental illness.

What Is Stigmatization?

Stigma happens when some person is viewed as an “other.” A person who is considered an “other” is denied full social acceptance. Here is how one researcher, Brian Ahmedani, defined stigma in a 2011 paper entitled “Mental Health Stigma: Society, Individuals, and the Profession.”

“The most established definition regarding stigma is written by Erving Goffman (1963) in his seminal work: Stigma: Notes on the Management of Spoiled Identity. Goffman (1963) states that stigma is ‘an attribute that is deeply discrediting’ that reduces someone ‘from a whole and usual person to a tainted, discounted one’ (p. 3). The stigmatized, thus, are perceived as having a ‘spoiled identity’ (Goffman, 1963, p. 3).

In the social work literature, Dudley (2000), working from Goffman’s initial conceptualization, defined stigma as stereotypes or negative views attributed to a person or groups of people when their characteristics or behaviors are viewed as different from or inferior to societal norms.”2

Stigmatization of Mental Illness By the Media

Stigmatization of mental illness in media is abundant. For example, certain mental health conditions such as schizophrenia are seen as being so disruptive that people with those conditions must be isolated from society.

The stigmatization of mental illness is so entwined with the media that researchers have used newspaper articles as a proxy metric for stigma in society.

Media accounts tend to focus on the individual with mental illness rather than framing mental illness as a societal issue. Consequently, media consumers are more likely to blame an individual for the illness.

People with mental illness can also suffer from overgeneralization in media portrayals. Every person with a specific mental health condition is expected to display the same characteristics or symptoms.

For instance, common depictions are that all people with depression are suicidal, and all people with schizophrenia hallucinate. In reality, only between 60% and 80% of people with schizophrenia experience auditory hallucinations. An even smaller number of people experience visual.

It’s also not uncommon for media portrayals to discount the fact that many people with mental illness don’t need to disclose their condition to everyone around

Instead, mental illness often goes unrecognized (whether by intention or not). The portrayals in the media tend to present situations where everyone in a character’s life knows about their mental illness.

Perhaps most concerning of all, the media often portrays mental illness as being untreatable or unrecoverable.

Trivialization of Mental Illness By the Media

The media can also trivialize mental illness, either by promoting mental illness as not being severe or being less severe than it really is.

For instance, many people with eating disorders such as anorexia nervosa feel that their condition is made out to be less severe than it really is. This is in part because people with the condition portrayed in the media often minimize its seriousness and hide the severe consequences of the disease.

The truth is, the death rate for people with anorexia is high. In one oft-cited meta-analysis published in JAMA Psychiatry in 2011, researchers analyzed 36 studies representing 17,272 individual patients with eating disorders and found that 755 of them died.3

Mental illness can also be oversimplified by the media. For instance, a person with obsessive-compulsive disorder (OCD) is often depicted as being overly concerned with cleanliness and perfectionism. However, the obsessive thoughts that drive their compulsions are overlooked or absent.

The symptoms of mental illness are sometimes portrayed as being beneficial. For example, in the popular television series Monk, the protagonist is a detective who has OCD. The fact that he pays close attention to detail helps him solve crimes and advance his career.

People who do not have disabilities can use media channels to mock people who do have disabilities, such as by appropriating mental-illness terminology. For instance, the hashtag OCD (#OCD) is commonly used on Twitter to describe one’s attention to cleanliness or organization.

Depictions of Schizophrenia in Film

Probably the most disparaging stigmatizations of mental illness in media lie in the film portrayals of antagonists with mental illness. In particular, when characters with schizophrenia are presented as “homicidal maniacs” in “slasher” or “psycho killer” movies.

These portrayals disseminate misinformation about the symptoms, causes, and treatment of schizophrenia as well as other forms of severe mental illness. What’s more, research has shown that popular movies have been shown to exert potent influences on attitude formation.

In a 2012 paper, “Portrayals of Schizophrenia by Entertainment Media: A Content Analysis of Contemporary Movies,” researchers analyzed 41 movies that had been released between 1990 and 2010 for depictions of schizophrenia.1

Based on the findings of the analysis, researchers drew several conclusions.

  • Most of the characters displayed “positive” symptoms of schizophrenia, with delusions being featured most frequently, followed by auditory and visual hallucinations.
  • The majority of characters displayed violent behavior toward themselves or others.
  • Nearly one-third of violent characters engaged in homicidal behavior.
  • About one-fourth of the characters committed suicide.
  • The cause of schizophrenia was infrequently noted. However, in about one-fourth of the movies it was implied that a traumatic life event for the character had been a significant causative factor.
  • Of the movies that alluded to or showed mental illness treatment, the most commonly portrayed were psychotropic medications.

These portrayals are not only incorrect but damaging—and for several reasons. The portrayals of schizophrenia often focus on symptoms such as visual hallucinations, bizarre delusions, and disorganized speech, and presented them as commonplace.

In reality, symptoms like decreased motivation, poverty of speech, and flat affect are more common.

Several movies have spread the false stereotype that people with schizophrenia are prone to violence and unpredictable behavior. Some films even presented people with schizophrenia as being “possessed.”

These violent stereotypes influence viewers and engender harsh negative attitudes toward people with mental illness.

24% of the characters with schizophrenia committed suicide. In fact, between 10% and 16% of people with schizophrenia commit suicide in the course of a lifetime.

Demographics is another aspect of mental illness that is often misrepresented by media portrayals of mental illness.

For example, characters with schizophrenia are frequently depicted as being white males, but schizophrenia disproportionately affects African Americans. It also affects men and women almost equally.

In a few movies, schizophrenia was depicted as being secondary to traumatic life events or curable by love—both of which are misrepresentations of the condition’s causes and treatment.

Positive Representation

Not all the information presented about schizophrenia was found to be incorrect, misleading, or stigmatizing.1 For example, in more than half of the movies that researchers analyzed, the use of psychiatric medications was depicted or alluded to.

Nearly half the characters with schizophrenia were depicted as being poor, which aligns with epidemiological data suggesting that schizophrenia is diagnosed less frequently in people of higher socioeconomic standing.

Even when some movies get it right, the negative media portrayals—especially those that are violent—of people with schizophrenia and other severe forms of mental illness still contribute to stigmatization, stereotyping, discrimination, and social rejection.

What Can Be Done?

We need a better understanding of how these messages are disseminated by the media before we can rectify them. There is limited research looking at how media promotes mental-illness stereotypes, stigmatization, and trivialization.

Nevertheless, certain suggestions have been made on how to improve the depiction of people with mental illness in the media, such as:

  • Analyzing mass-media production procedures to better understand the current practices, needs, values, and economic realities of screenwriters, producers, and journalists (for instance, understanding the balance between being newsworthy or emotionally arousing and verifiable).
  • Implementing a mental health short course when training journalists.
  • Including expert input from psychiatrists during a film’s production.
  • Preferring non-individualized descriptions of mental illness and instead focusing on the societal aspects.
  • Presenting mental illness only when relevant to the story.
  • Using mental-health terminology with precision, fairness, and expertise.

As individuals who consume copious amounts of mass media and engage with social media, the best thing that we can do is to stop using words like “crazy” and “deranged” in a derogatory or flippant fashion. We also need to remember that it’s best to avoid making a psychiatric diagnosis outside of a clinical setting.

Only a specialist can make a diagnosis of OCDdepressionbipolar disorder, schizophrenia, and other mental health conditions. When we give someone the label of being mentally ill without clinical evidence, we hurt people who live with mental illness on a daily basis.

By Naveed Saleh, MD, MS

Naveed Saleh, MD

Youth Unity

Researchers Reveal Kids Who Get More Hugs Have More Developed Brains

There’s nothing like the warmth and security of a loved one being enveloping you in their arms.  The simple act of giving and receiving genuine hugs can completely change your mood.  You feel loved, cared about, safe, and unique.  I’m not sure there is a single action that can replicate the feeling of giving and getting a hug.

It’s a good thing that giving is the same as receiving when it comes to hugs, right?  Now, science says you can be smarter for it. If you were about two feet long and weighed roughly 10 pounds, your brain would develop better.  Researchers reveal kids who get more hugs have more developed brains.

BABIES AND THEIR BRAIN DEVELOPMENT THROUGH TOUCH

When we think about learning, we consider reading, studying, using our hands, calculations, and other processes.  We started, as babies, we began exploring by touching things.  Of our five senses, touch is the first to develop.  From this, a newborn baby must navigate their new world.

According to an article from Stanford’s Medicine, Dr. Susan Crowe, an obstetrician, and director at Lucile Packard Children’s Hospital, outlines the nine instinctual stages right after birth.

Birth cry, relaxation, awakening, activity, resting, ‘crawling’ (a shifting movement toward the breast), familiarization, suckling, and sleep.”

As soon as physically safe for both mother and baby, it’s time for skin-to-skin contact and guiding the baby toward breastfeeding.

Just the holding of the baby within the first hour, regardless of breastfeeding, can help in normalizing the baby’s body temperature, heartbeat, and pattern of breathing.  For many babies, it also decreases the amount of crying.  Simultaneously, the mother releases more relaxation hormones.  This also becomes the bonding time for mother and baby. Should the partner of the mother also hold the baby, it begins the bonding time for them as well.

BENEFITS OF INFANT MASSAGE

Infant massages could be integrated into this bonding experience, as well.  The same article in Stanford’s Medicine notes a wide array of benefits. According to Maureen McCaffrey, a certified infant massage instructor at Packard’s Children Hospital, these benefits consist of:

  • Better sleep patterns for the baby
  • Baby appears more aware of being loved, secure, and accepted.
  • Improved digestion and bowel movements
  • Babies demonstrate more comfort by less fussy behavior
  • Weight gain improves
  • Mother and baby appear more relaxed
  • Neurological function in babies is improved

Another study done at the University of Washington aimed to locate the area of the brain in which a baby registers both “felt” touch and “observed touch.” This study proves babies can discern between an actual physical touch vs. an image of a hand touching another person.  The study found that by seven months old, a baby can not only understand the concept of their “self,” but also knows their body is separate from another person.

THE POWER OF TOUCH FOR BABIES

That knowledge is what established the foundation for mimicking others’ behavior as well as developing empathy.  The researchers discovered through specialized imaging that touch registers in the somatosensory cortex.  Depending upon if it was an actual touch, what part of the body the contact occurred in, or if it was an image, the location, and strength of the signal within the somatosensory cortex in which it was registered changed.

What was also fascinating was recognizing that the baby, before it can speak or know the words for body parts, already understands that their hand or foot moves similarly to another person’s.  Through imitating how the other person moves, the baby is also able to move.  It is this process which makes both imitations, and later, empathy, possible.

In a study of the opposing focus, researchers learned of detriment to children who don’t receive touch.  A report in Pediatrics Child Health, published in PMC, outlines the results of various studies, one of which was the result of providing touch to children who were previously deprived.  The study focused primarily on limb movement as a form of sensory stimulation.  They discovered that with 10 minutes a day of handling, over ten weeks, babies “spit up” less.Overthinkers, pay attention to this one!https://imasdk.googleapis.com/js/core/bridge3.437.0_en.html#goog_975658294Volume 90% 

The babies with 20 minutes of daily tactile stimulation, over ten weeks, increased in their developmental scores.  In the case of premature babies, stroking their limbs, and mild limb movement demonstrated weight gain, longer alertness, more mobility, better adaptation to repeated stimuli, and awareness of their bodies. After a year, they scored high on weight and growth and motor skills and had reduced mild neurological dysfunctional symptoms.

OXYTOCIN AND HUGS

Oxytocin is a hormone and neurotransmitter produced in our hypothalamus and released from our pituitary gland.  Its levels increase during breastfeeding, orgasm, and hugs.

In regards to the effect on babies and their development, oxytocin encourages bonding between a mother and her baby.  This might explain why breastfeeding increases a woman’s hormone levels. It tends to foster feelings of trust, closeness in relationships, and maternal instinct or care.  Ironically, this hormone was discovered by scientists at the Weizman Institute to be the construction crew for its own future paths of blood vessels while in an embryonic brain.  Therefore, it facilitates the baby’s ability to produce oxytocin after the brain, his or her brain, fully develops.

While oxytocin has been nicknamed the “love hormone” or the “hug hormone,” it is more complicated than what was initially perceived.  It originally was recognized as the hormone that, when released in our blood, aids in uterine contractions during childbirth and induces labor.  Over time, it was discovered that it has a different reaction when it is released into the brain.  It then has variable effects on our cognitive, emotional, and social behavior.

MORE EVIDENCE

In the journal Nature, an article was published with outlined various studies which have been performed attempting to single out the role of oxytocin on our behavior.

The study focused on the response of female mice, who had never birthed, toward crying babies.  Initially, the female mice had little to no reaction toward the babies.  They then injected the mice with oxytocin, and they began responding as a mother would.  Interestingly enough, before the injection, their brain neurons were a bit scattered and unfocused.

After the injection, the neurons came together in focus as a maternal mindset would. Additionally, researchers noted that oxytocin appeared to decrease specific neurons. While hearing the cries, the oxytocin enhanced the cries and made them more important.  The scientists theorize this may be related to why some mothers claim they can distinguish their baby’s cry from another.

Another study posted in the American Psychological Association tested women at various stages of their pregnancy – the first trimester, the third trimester, and the first month after birth.  What they discovered was that more women with high levels of oxytocin in the first trimester bonded better with their child.  The women who maintained high levels of oxytocin throughout the pregnancy and the month after developed a closer relationship with their children.  They tended toward singing special songs, using more personal, specific ways to feed or bathe their baby, etc.

UNDERSTANDING OXYTOCIN AND BRAIN DEVELOPMENT

The general understanding of how oxytocin affects our emotional and social behavior is a bit complex.  Essentially, if you are with an individual or group of individuals, and experience an interaction that triggers higher levels of oxytocin as a positive experience, then you will view those individuals as safe, trustworthy, and develop affection toward them.  Conversely, your brain will then see others who are different than those individuals as less credible, not safe, and you will be more guarded.  This is one method in which you establish your “tribe” of friends and establish who your family is.

Additionally, it may play a role in your social memory.  Through the release of oxytocin, your memory views a specific event more favorably than one where it didn’t release oxytocin.

What does this have to do with hugging your child and brain development?  Researchers continue to study oxytocin due to its very complex nature. However, it’s important we understand that how we perceive friends, family, and strangers and interact emotionally with each other is definitely a factor in our memory and behavior.  This holds true for a baby who is newly forming their understanding of the world based on how they interpret the actions of those around them.

FINAL THOUGHTS ON HUGS AND CHILDREN

Science may still be struggling to find the formula for why touch is so important and how our brain assimilates it in regard to our development, but most parents seem to understand it regardless.  The results from hugging a baby, a child, your teenager, or your spouse are ones most of us can recognize.

Source: www.powerofpositivity.com

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Coronavirus doctor’s diary: We’re getting self-harming 10-year-olds in A&E

Source: BBC

The pandemic has had a deep impact on children, who are arriving in A&E in greater numbers and at younger ages after self-harming or taking overdoses, writes Dr John Wright of Bradford Royal Infirmary.

Children are a lost tribe in the pandemic. While they remain (for the most part) perplexingly immune to the health consequences of Covid-19, their lives and daily routines have been turned upside down.

From surveys and interviews carried out for the Born in Bradford study, we know that they are anxious, isolated and bored, and we see the tip of this iceberg of mental ill health in the hospital.

Children in mental health crisis used to be brought to A&E about twice a week. Since the summer it’s been more like once or twice a day. Some as young as 10 have cut themselves, taken overdoses, or tried to asphyxiate themselves.

There was even one child aged eight.

Lockdown “massively exacerbates any pre-existing mental health issues – fears, anxieties, feelings of disconnection and isolation,” says A&E consultant Dave Greenhorn.

While Bradford has been in lockdown longer than some other parts of the country, there is no reason to believe this is a local problem. Dave says fellow A&E consultants he’s spoken to in Scotland, Portsmouth and Northern Ireland all report a significant increase in mental health attendances – among all age groups, children as well as adults.

Self-harming “used to be the mind-set of older teenagers but we are seeing much younger children doing this now” says Ruth Tolley, a matron on the paediatric ward where children are taken if it is not safe for them to return home.

It may then take the combined efforts of several nurses to prevent further self-harm on the ward.

Eating disorders are also on the rise, says paediatrician Helen Jepp. So are overdoses – where children take their parents’ medication, or their own – and cases where children rush out of the house and behave recklessly or dangerously on the street.

A child psychiatrist who works with Bradford’s Child and Adolescent Mental Health Services (Camhs) says the caseload fell at the start of the pandemic then returned to normal levels. For him what’s new is not the quantity but the severity of the work. “We have been seeing more intense distress,” he says. “Young people are in a worse state than usual.”

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Consultant Dave Greenhorn describes a recent evening in A&E. It’s a busy one – there are 94 people in the department, including a pale-looking teenage boy, lying quietly in a cubicle.

Dave asks if he’s OK, but there is no answer and no eye contact.

The notes show that the boy has attended the Emergency Department every other day for two weeks. Before now he has taken small overdoses and told staff he wants to die. He has a child and adolescent psychiatrist and support worker but there is no firm diagnosis of mental illness.

One of the problems is that lockdown has prevented everyone from accessing their own safety valves. The boy has previously mentioned that he misses going out with his friends. Now he’s stuck at home, and so are other members of his family. Unable to get away for a few hours peace, the mum says she’s at the end of her tether and can’t deal with her son at home on this particular night.

Dave’s attempts to coax the boy to talk to him are unsuccessful, so he makes sure the youngster has some juice and a sandwich and asks the nurses to keep trying to get him to engage when they have a minute – though they rarely do.

On previous admissions to the paediatric ward the boy has been hard to look after, so it’s been agreed he shouldn’t be sent there, but he doesn’t want to go to an adult ward. In the end he spends the night in A&E.

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The pandemic has underlined for all to see just how important school is for children. Education is only part of it. There is also the social life, and children benefit from routine, boundaries and adult authority figures outside the home.

Teachers are also experts at spotting problems such as anxiety and self-harm that has taken place at home. A lot of referrals would normally arise in this way.

For older children, school is the framework that will enable them to reach university or employment, and some struggle when it appears to give way.

Seema [not her real name] attempted suicide and started self-harming when exams were cancelled last summer.

“We tried very hard for our exams – you’re taught that your entire future revolves around these exams, but that crumbles right in front of you and it’s really shocking. It has a huge impact,” she says.

“I felt like stabbing myself… I was in a constant state of anxiety.”

Now 17, she is doing a lot better, though she still misses contact with teachers and friends, and would like schools to organise online groups for students to socialise, not just meet for lessons.

Her family hasn’t been able to understand her problem, but she has now been getting help.

One crucial beneficial change that has come out of this epidemic of mental ill-health is that professionals from all the different agencies in Bradford have come together to support the children in their time of crisis.

Gone are the delays in referrals between different teams – the health service and social services are acting as one.

“Covid has brought services closer together,” says paediatric ward matron Ruth Tolley. “We needed an urgent meeting with the safeguarding team and various other agencies and we were able to pull that meeting together in two hours – getting people together and getting a plan, that is really positive.”

Paediatrician Helen Jepps agrees. She got a call about a teenager one morning, logged on and saw that a number of teams were already discussing the case – social workers, Camhs and voluntary organisations. “It feels a real privilege at the moment to have that close contact,” she says.

But this is little consolation for the damage that is being done to children’s lives.

The past 10 months of lockdown and school closures may have seemed unending for parents, but for a 10-year-old it will have felt like a lifetime. Their youth is being stolen from them.

John Wright

Prof John Wright, a doctor and epidemiologist, is head of the Bradford Institute for Health Research, and a veteran of cholera, HIV and Ebola epidemics in sub-Saharan Africa. He is writing this diary for BBC News and recording from the hospital wards for BBC Radio.