Reading a review of yesterday’s late-night talkshows, in particular an interview with award-winning Dutch author J.M.A. Biesheuvel, I can’t help but be appalled by the journalist’s choice of words: “When is something still an interview, and when is it ogling monkeys?”

He refers to the fact that J.M.A. Biesheuvel is “not only a winner of the P.C. Hooft prize but also a patient who has spent more than six months of the past year in a closed institution. “

He refers to the author as “ (…) a masterpiece. A risky masterpiece, (…)” and continues what is supposed to read as praise of the author recently released book ‘Verhalen uit het gekkenhuis’ (Tales from the loony bin’), by saying that the author’s on-air reading of his work contained “the echo of the brilliant writer that Biesheuvel was”.

The stigma isn’t between the lines, it is blatant, and that on World Mental Health Day (October 10). Biesheuvel suffers (amongst other things) from manic-depressive disorder, also known as bipolar disorder. This can include hallucinations and/or delusions, which is what gives rise to many of the stories in the book. About 60 million people worldwide suffer from bipolar disorder, another estimated 300 million are affected by depression, while 23 million suffer from schizophrenia [1]. Moreover we are potentially all at risk: determinants of mental disorders aren’t restricted to individual characteristics, but also include social, cultural, political and environmental factors.

“The stigma attached to mental illness is ubiquitous. There is no country, society or culture where people with mental illness have the same societal value as people without a mental illness” — Rössler, 2016

People with mental health disorders have been stigmatised for millennia. Even today “The stigma attached to mental illness is ubiquitous. There is no country, society or culture where people with mental illness have the same societal value as people without a mental illness” [2]. People’s prejudices evoke emotions such as fear or loathing, which in turn leads to discrimination of those afflicted. Furthermore, the more knowledge on psychiatric illnesses the public has, the more they stigmatise those affected [3].

“Thankfully Biesheuvel was on form.” Indeed, we didn’t witness any delusions, no need for us to feel embarrassed on his behalf. We don’t need to pity him. There was no monkey show, no entertainment by watching someone struggling in public, humiliating himself, and his wife who was seated beside him, in the process.

Now imagine that rather than suffering from bipolar disorder, Biesheuvel had been battling a malignant tumor and that is what his book is about. His performance would be praised, he would be considered strong and courageous rather than ‘risky’.

And what if he had been delusional on air? Why does it so frighten those not affected? Mass media, such as the newspaper that published the review, are key contributors to our fears: through dissemination of misconceptions and biased information, along with negative depictions of mental illnesses, they strengthen the negative views and supposed ‘knowledge’ of the public [2].

As a consequence we want to keep people with mental illnesses at a social distance, a gap that has only grown in the 21st century, and the more intimate the relationship the greater the distance [4]. This might be the underlying reason for the programme’s co-presenter to exclaim “Is it true love?”, when addressing Biesheuvel’s wife of 60 years. Yet an estimated 1 in 4 people will experience a mental disorder themselves at some point in their lifetime, meaning that those affected are much closer to us than we might like to think.

In short, the stigma surrounding mental disorders is extremely dysfunctional, to the point where it is harmful.

Culturally-determined stereotypes also affect those already suffering with a mental illness: by internalising the stigma (self-stigma) an individual’s self-esteem and self-efficacy decrease, decreasing their social networks and diminishing their chances of recovery. Then there’s courtesy stigma, where family members feel guilty and report poorer physical health and increased use of public services [2]. In short, the stigma surrounding mental disorders is extremely dysfunctional, to the point where it is harmful.

The best way to reduce stigma? Having those affected by mental illness talk about their disorders. Through our day-to-day conduct with these family members, friends and colleagues people can build a building a more realistic view of these disorders. It’s a slow process, not an overnight fix, that requires those suffering to overcome their fears and the stigma that holds them back so they can open up about their disorders.

In conclusion, Biesheuvel is a brilliant writer. And a strong and courageous person for publicly sharing his experience with a terrible disorder, particularly in light of the many people who fail to make fair judgements about him by their fear of the ‘monkey’ ogling them in the mirror.

REFERENCES

WHO (2018) Mental disorders. http://www.who.int/news-room/fact-sheets/detail/mental-disorders.

Rössler W (2016) The stigma of mental disorders: A millennia‐long history of social exclusion and prejudices. EMBO Reports, 17 (9), 1250–1253, DOI 10.15252/embr.201643041.

Schomerus G, Schwahn C, Holzinger A, Corri- gan P, Grabe H, Carta M, Angermeyer M (2012) Evolution of public attitudes about mental illness: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica, 125, 440–452, DOI 10.1111/j.1600–0447.2012.01826.x.

Loch AA, Hengartner MP, Guarniero FB, Lawson FL, Wang YP, Gattaz WF, Rössler W (2013) The more information, the more negative stigma towards schizophrenia: Brazilian general population and psychiatrists compared. Psychiatry Research, 205, 185–19. DOI 10.1016/j.psychres.2012.11.023.

The original review that this piece responds to can be found here:

https://www.nrc.nl/nieuws/2018/10/10/maarten-biesheuvel-zorgt-voor-onvergetelijke-televisie-tijdens-dwdd-a2417394