Discussions in South Africa about stigma related to mental illness were abruptly started last year after numerous psychiatric patients in Gauteng died of negligence. Yet, the dialogue dissipated, and the events are seldom revisited. Are we just waiting for the next death for a new think piece?
Normal. Defined by the Oxford Dictionary as “Conforming to a standard; usual, typical, or expected.” Synonyms include conventional, mainstream, or accustomed.
The so-called ‘mentally-ill’ have for centuries been classified as definitively abnormal. As Peggy A. Thoits puts it in her 2011 Social Psychology Quarterly article, “‘The mentally ill’ are believed to be unpredictable, irrational, dangerous, bizarre, incompetent, and unkempt, and these stereotypes have persisted and even strengthened from the 1950s to the present, along with a steady desire to keep social distance from such people, despite educational campaigns.”
Today, a staggeringly high number of people are being diagnosed with some form of mental illness. According to the World Health Organisation, over 350 million people worldwide are currently diagnosed with depression, 60 million with bipolar affective disorder, and 21 million with schizophrenia and other psychoses. Whether these steep figures are a result of over-diagnosis, misdiagnosis, or are actually true is hard to say.
I was diagnosed with depression at the age of sixteen. After years of feeling utterly dysfunctional and hopeless, I felt a profound sense of relief at being able to place a name to my experience. Going to therapy and taking medication fundamentally altered my life for the better.
I no longer deal with depression on a daily basis as I used to. I am still on anti-depressants, but I don’t feel “depressed”. I don’t know whether to call myself depressed or not. I don’t know if it matters.
What does matter is the fact that people are still dying because of mental illness. Just recently, Chester Bennington took his own life. The high-profile case sparked some trending conversation around mental illness, but it was only trending, fading within a week or two.
Discussions about stigma in South Africa were abruptly started last year after numerous psychiatric patients in Gauteng died of negligence. Yet, the dialogue dissipated, and the events are seldom revisited. Are we just waiting for the next death for a new think piece?
Bennington’s death, and all of the deaths that have occurred as a result of mental illness, do not occur in a vacuum. What makes them tragic is the fact that they are highly preventable. But we continue with our lives as though there is little to be done, relegating the ‘mad’ and the ‘crazies’ to some dusty corner of the mind, willfully ignoring our long and fatal history with stigma.
In his comprehensive book History of Madness, Michel Foucault describes how historically those considered mad were imprisoned with criminals in the Bastille in France, how the madman was to be confined, punished, corrected. The “character of the marginal was produced by the gesture of segregation itself,” he argues. “For the day came when this man, banished in the same exile all over Europe in the mid-seventeenth century, suddenly became an outsider, expelled by a society to whose norms he could not be seen to conform; and for our own intellectual comfort, he then became a candidate for prisons, asylums and punishment.”
In 1846 in South Africa, the chronically ill, those suffering with leprosy, and lunatics were exiled to the newly opened General Infirmary on Robben Island. Areas of the infirmary were divided up along class and racial lines. According to Harriet Deacon in her 1996 article on Robben Island in History of Psychiatry, wealthier patients (who were all white) were given better rooms and were not made to work like lower-class patients. Black and coloured patients were treated differently for their disorders. White lunatics were “ordinary” lunatics, and it was theorised that their treatment would be more effective if they were separated from people of colour, and that being around them would in fact be detrimental to their health.
Each society gives birth to its own contours of madness, its own Other, its own terms of inclusion and exclusion. Once it was the leper, but when leprosy was eradicated, madness became its successor. As Foucault argues, “Only after a long latency period of almost two centuries did that new obsession take the place of the fear that leprosy had instilled in the masses, and elicit similar reactions of division, exclusion and purification, which are akin to madness itself.”
We continue this process of exclusion today, more insidiously than before. We may not be locking up vulnerable people in prisons, but we fail to recognise, acknowledge, and confront the fact that large numbers of us require help.
In a world that values images of strength, we have learnt to mask the supposed weaknesses in ourselves and others. That people can still be surprised to learn someone they know has a mental illness is surprising in itself, but it shows how opaque the façade of normality is. The performance of daily life hides the inner struggles mostly expressed in the confines of privacy. But it is the unwillingness to listen that prevents the transformation of this allegedly private issue into what it actually is — an everyday, widespread, societal occurrence that requires our sustained reaction.
Stigma does not exist on a personal level. It exists on a historical and institutional level. We have made advances in reducing stigma and raising awareness, but it’s not always enough. Sometimes, we need to question the very pretenses our society has built itself on. Sometimes, we need to question if the society we live in is normal. Otherwise, we will only be having this conversation again on the eve of another’s death — a conversation that will likely end as soon as it began. DM
Bladerunner (1980s version) is a visual feast due in large part to the Hollywood Actors Strike. This allowed the designers an extra three months to refine the sets and props.