Unpacking mental health stigma

Have you ever wondered why mental health is so complex to understand and to work with? I can think of a ton of reasons, specifically language used and attitudes towards mental illness.

I went on a word search for this week’s column. I enlisted the help of friends from various parts of the world. The intention was to establish whether it is a Lesotho specific challenge or if Language used for mental health has a negative connotation in other countries.

Lehlanya in Sesotho, Lewany in Pashto, Khon-Bah in Thai, Batard’’ (Tu es con ou quio?) French, Maluco/Maluca in Portuguese, Louco in Spanish, Were in Yoruba, Kichaa in Swahili, etc.

The sense I got when talking to my friends is that if you go around addressing people with these terms, you are likely to get a beating based on the negative connotation that they carry. This poses a big question of whether individuals can willingly declare their mental illness without being at risk of the stigma it comes with.

I regard the stigma to be rooted in that which people do not understand, not the mental illness itself.

Mental illness is hard to describe, its symptomatology is not physical like it is the case with communicable diseases. Imagine going to a doctor and saying “There is something not right in my head.”

This can be interpreted in so many ways. There is no blood work that can be done, whereby the results indicate a high level of Schizophrenia that requires a change in diet or adopting a healthy lifestyle.

Mental illness is as complex as the neural network that communicates messages to and from the brain. We have excused ourselves from trying to understand factors at play by casting out those that live with mental disorders, a scapegoat that has worked for many years.

You ask yourself, not everyone that lives with a mental disorder faces stigma. Some are supported in their mental health journey. You would be absolutely correct in thinking this way.

Interestingly, stigma is multidimensional. It can also be self-imposed because the person living with the mental illness struggles to deal with the difference in personality, behaviour, physical appearance, illness, and overall functioning. Also, the stigma can come in the form of how other people react towards the person battling a mental illness.

They are faced with stereotypes and prejudice that result from misconceptions about mental illness. On one hand, they struggle with the symptoms and disabilities that result from the disorder. Mental health stigma can be a barrier to treatment. Mental health stigma operates in society.

It is internalised by individuals and is attributed by health professionals.

Here is a double edged sword of how stigma can look like. Thandi is married to Thomas (pseudonyms).

They have been together for ten years and are blessed with two children. Thomas gets a tat bit angry every now and then and as a result he “Lays his hands on Thandi” multiple times in one week. Thandi starts wearing excess make-up to hide the bruises and discoloured skin. This continues for approximately seven years until Thandi starts stonewalling, acting like being assaulted is a norm.

She does not cry anymore. She just sits there and takes her beatings in a true “Mosali o ngalla motseo” style. Thomas finds more aggressive ways to enforce the abuse, to get a reaction out of his wife. Unfortunately, a beating coupled with strangulation sends Thandi to the hospital after she stops breathing.

Thankfully, she survives and is discharged after four days. She goes back home to a sorrowful Thomas who promises to change his ways. However, this is short-lived which results in Thandi’s head getting banged against a wall, resulting in a stroke, impairment of speech, and low functioning.

This is an example of a woman who cannot seek help since it will portray her as a victim of abuse.

This is someone that struggles to seek mental healthcare because “ase lehlanya.” The word lehlanya is too narrow to showcase the unique presentations of how mental illness looks like from one person to the next.

Thandi’s experiences with violence can bring about TBI, PTSD, depression, GAD, etc. How would we determine this? Through creating a safe space for her to talk about the trauma she has experienced while using language that does not continue to victimise her.

It would also require a non-judgmental attitude, one that does not ask why she did not leave. It would require attitudes that are uplifting and empowering.

Ask yourself this, if you were to seek services for your mental health; what would you say when you arrive at a provider’s office? In other parts of the world, it is everyday language to be “on the Spectrum or have ADHD.”

As long as there is stigma attached to mental illnesses as well as negative attitudes towards those that are living with mental illnesses, ours is a journey without a destination.

Contrary to widely held beliefs, homeless people do not all have mental disorders. Not every homeless person has Schizophrenia. Not every homeless person is lehlanya as we tend to loosely use the word.

If we only focus on this group, we risk missing men in suits and ties, students faced with modern day challenges. We risk missing women in tight pencil skirts and six inched heels. We risk missing the grannies in the villages experiencing dementia and rapid decline in their cognitive abilities.

It is not always boloi as we tend to conclude.

Why does it look like mental health is characterised by hesitancy to openly talk about the things that stress us and affect functioning? The hesitancy is seemingly brought about by fear of being judged, treated poorly, as well as negative attitudes from others.

Language is important, it can produce desirable behavioural change if it is used resourcefully. One of my former Professors once said, “Understanding how to influence behaviour requires a better understanding of the social context.”

Until Next Time!

• The writer works as a psychotherapist. She holds a Master’s in Counseling Psychology. She has certifications in Global Health Delivery, Policy Development & Advocacy in Global Health, Leadership & Management in Health, as well as Fundamentals in Implementation Science.