Clodagh Finn: Let’s reframe how we think and talk about illness

The stigma that sometimes goes with mental and physical illness can be as harmful as the symptoms themselves, writes Clodagh Finn
Clodagh Finn: Let’s reframe how we think and talk about illness

Brazil’s president Jair Bolsonaro, who is infected with Covid-19, wears a protective face mask as he waves to supporters during a Brazilian flag retreat ceremony outside his official residence Alvorada Palace, in Brasilia, Brazil. The virus has no respect for high office.

During the earliest days of the pandemic, French President Emmanuel Macron gave a televised address to tell the French nation that it was at war against an invisible enemy. He used the phrase several times to rally the nation into action.

Or inaction, as it turned out because his speech marked the beginning of lockdown.

Since then, we’ve heard almost daily about the frontline medical staff battling a virus while the worst-hit fight for their lives. Military metaphors are now so ingrained in the way we speak about medicine that we hardly notice them.

No wonder. The ‘war’ on illness has a long history. In the 19th- century, Louis Pasteur spoke of germs as the invading armies that laid siege to the battlefield of the body.

The language of battle offers hope to some. How reassuring to think a team of medics is poised to wage war on the disease that has attacked your body. But what happens when – which is often – a patient doesn’t feel up to doing battle or, worse, feels that they are losing the war?

Just last year, researchers found that war metaphors used to describe the treatment of cancer patients put a burden on them and may even do more harm than good.

At the time, Jacinta Elliott, a cancer patient from York, made an observation that could also apply to how we talk about coronavirus now.

She said: “Battling metaphors hold an implicit suggestion that patients who succumb quickly have in some way failed to fight hard enough or have somehow “given in”, and that patients like myself who survive beyond their expected prognosis are in some way “tougher”.

The people who are finding recovery from Covid long and slow might be heartened by those words. They are not feeling ill because they didn’t ‘fight’ hard enough, but because it is not yet understood how the virus affects the body and why so-called mild cases can last several months.

It’s important to repeat that because that is how misunderstanding and stigma take hold.

Though, for all the challenges posed by coronavirus, it does not appear to be stigmatised. That may not be universally true.

And it’s not the case in many countries in Africa where negative attitudes have further increased the isolation of thousands of sufferers.

But in Ireland, Europe too it seems, the insidious and corrosive effect of stigma seems to have been contained.

Covid has not been spoken about in the same way as TB, for instance, a diagnosis that filled many Irish families with dread for much of the last century.

Tuberculosis not only affected the sufferer but also their families. The stigma was so virulent that it could damage job or marriage prospects.

It helped, perhaps, that this virus was no respecter of high office, bursting through British prime minister Boris Johnson’s door and later that of Brazilian president (and one-time coronavirus-denier) Jair Bolsonaro.

As early as March, a number of high-profile Irish people spoke openly about their Covid symptoms and that might have played a role in dispelling any notion that illness somehow taints the sufferer.

Whatever the reason, the stigma that clung so stubbornly to other pandemics such as AIDS and SARS, does not seem as present around coronavirus. This is a real positive and one with the potential to reframe how we think about all illnesses.

Let’s start with mental health because, as we have seen in a survey released this week, stigma and negatives attitudes to mental illness are still widespread even though most Irish people (96%) acknowledge that anybody can be affected.

Even so, two-thirds believe mental health difficulties are seen as a sign of personal failure, while one in five think it would be a sign of weakness if they looked for help for a mental health issue themselves.

The survey was conducted by St Patrick’s Mental Health Services to coincide with the launch of its No Stigma campaign, which aims to reframe attitudes to mental health stigma. 

It is ideally timed because the coronavirus has led to a surge in the numbers of people coping with mental health problems, many of them for the first time.

What better time, then, to confront the stigma and acknowledge the reality of the difficulties that are facing so many people around the country.

If there is no stigma attached to the people who contracted coronavirus, it makes no sense to stigmatise those who are suffering mentally because of it.

Research has continually shown that the stigma of mental – and physical – illness can be as harmful as the symptoms themselves.

Imagine what might happen if we changed how we spoke about mental illness and saw the person rather than the diagnosis. How might it be if we confined labels to jam jars, where they belong, and challenged our own perceptions and prejudices?

Attitudes can and do change. In 1971, another president declared war on a disease. On that occasion, it was Richard Nixon in the US who laid down a gauntlet to cancer.

In the same decade, American writer Susan Sontag, a cancer patient herself, highlighted the stigma that still surrounded the illness in her classic work Illness as Metaphor. Cancer, she said, was just a disease, not a curse, not a punishment and not an embarrassment.

Later, she challenged the stigma surrounding AIDS and unpicked the myths and punitive metaphors that accompanied it. Attitudes to both those illnesses have changed significantly since the publication of her book, showing that it is possible to erode stigma.

The best way we can tackle stigma now might be with a war on words. It isn’t very helpful to ‘battle’ illness, whether that is cancer, coronavirus or depression. We might call a truce and relieve the pressure on those on the frontline as well as the patients struggling behind it.

Likewise, it doesn’t serve anyone to consider it a ‘personal failure’ or a ‘weakness’ to look for help for their mental health.

Tell yourself you are doing the right thing, and repeat it, because words can dissolve the stigma that is so bad for health.

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