History shows us that the arrival of stigma coincided with the departure of the view that our minds are affected by our bodies.
With 27 years of world mental health awareness days now behind us, you’d be tempted to optimistically answer, “yes, surely we are now living in a post-stigma world.” Those experiencing mental ill health, however, will tell you that this is not the case. In journeying back four hundred years to the stigma-free early modern period and examining the melancholic and fearful behaviour of our ancestors, we can see just how far we are today from living in a post-stigma world.
The concept of stigma is ancient. In the 1600s hot irons were used to brand evil-doers with a mark of infamy. Stigma was, and is, a sign of disgrace. Yet, what is truly a disgrace here is the disapproval and discrimination that society often attaches to mental health today through stigma. This comes from a lack of understanding and the ill-informed belief that those with mental health disorders are violent, weak, and to blame for their illnesses. This is hugely problematic as it discourages those suffering from speaking out and seeking help. This was, however, not always the case…
Physiology to psychiatry: from gut to brain and back again
People often assume that mental illnesses such as anxiety and depression are cultural conditions of modernity. It is easy to blame the sudden influx of these disorders on things such as the fast pace of modern life, technology, social media, long working hours or the cost of living. In Reasons to Stay Alive, Matt Haig writes “The world is increasingly designed to depress us. Happiness isn’t very good for the economy.” But what if people were always feeling anxious and depressed but didn’t have the understanding we do today to define it? Through symptoms reported in the early modern period, recorded by the scholar, Robert Burton, we can look back in time to see the emergence of what we now know as anxiety and depression, and explore how they were viewed, once upon a time, without stigma.
In 1621 Burton recorded patients having irrational fears such as “their heads fall[ing] off their shoulders” or “hav[ing] frogs in their bellies”. Such inappropriate worrying was not, however, attributed to the mental, but the physical: it was believed to be a symptom of humoural imbalance. According to Hippocratic physiology, there were four humours: phlegm, blood, black bile and choler (also known as yellow bile).
Traceable as far back as the 1300s, Greek physician, Galen, linked Hippocrates’ theory of the bodily humours to temperaments of the mind, suggesting imbalanced humours undesirably altered a person’s disposition. For example, the presence of melancholy, which holds similarities to modern day depression, was believed to be a result of excess black bile. In a similar manner, fear was considered to be a passion: an extreme emotion believed to alter the balance of humours and, in their close association with sin, even affect the soul. Although the theory of the humours persisted until the 1800s, we now know that black bile doesn’t even exist.
What is important in this now-obsolete theory is acknowledging how, up until the 1800s, emotions and mental afflictions were explained through the body. For the last two hundred years, however, with the rise of psychiatry, this notion has been lost. We are only now returning to it with ideas of the gut and inflammation.
But what does this have to do with stigma? Well, with the loss of the view that our minds are affected by the body came the rise of stigma. As soon as the mind was made distinct from the body, it fell upon ourselves as being responsible for what happens in our minds. Separating the mental from the physical generates blame. Mental ill health becomes a personal failure.
In the early modern period, when people believed that their fear or melancholy was a result of imbalanced humours, there was no stigma. People readily sought help from healers as there was no cause for judgement with the belief that the humours could not be self-regulated. But let me remind you, in many cases, neither can our minds.
Between 1850 to 1950, the belief that mental disorders were caused by bodily humours was ruthlessly (and rightfully) deconstructed. But, in its place, the mind-body, mental-physical dualism was installed. As Bullmore explores in his book The Inflamed Mind, this dualism goes so far as to inhibit diagnoses of mental illnesses such as depression “if the symptoms could be “attributable to the physiological effects … of another medical condition.”
With this in mind, we can see how the ideology that ‘the mind is distinct from the body’ may not only be directly responsible for the lingering culture of stigma, but is also damaging to people suffering from unrecognised mental illnesses due to their accompanying physical symptoms. Correspondingly, it is damaging to those with mental illnesses who have unrecognised physiological issues or diseases of the body.
What would a post-stigma world look like? How do we get there?
There are two things that need to happen for humanity to experience its right to live in a post-stigma world. Firstly, we need educating, young and old alike. We need a clear understanding of mental health that reframes current negative and antiquated attitudes. We need to be cognisant of the fact that not only are people not responsible for their illness, but that they are not their illness, full stop.
We need to foster an environment in which people no longer feel scared to speak out about mental health. Luckily, with publications like Bullmore’s The Inflamed Mind and Haig’s Reasons to Stay Alive, people are beginning to grasp that our mental health is not a choice and that we should therefore not be victims of shame or blame.
Haig was happily living abroad in Ibiza when one day, out of nowhere, his mind turned on him and he found himself in a deep spiral of anxiety and depression. His story highlights how mental ill health is not an active conjuring or a result of weakness, but a terrifying and often arbitrary oppressor.
The second thing that needs to happen is, as neurobiologist Sir Colin Blakemore puts it, a “reunion of the body and the mind”. For too long now we have been forcing the view that our minds and bodies work independently of one another. Perhaps returning to the ways of our early modern predecessors and restoring the knowledge that our minds and bodies work in harmony would facilitate this reunion and bring us one step closer to living in a post-stigma world.