From the Director

Winning the Battle Against Stigma

John F. Greden, MD
Executive Director of the U-M Depression Center

Stigma! The word itself evokes stress and facial grimacing. Stigma directed at illnesses is not new. Targeted illnesses change as society’s knowledge, sophistication and understandings change. Susan Sontag wrote only 20 years ago that “It seems that societies need to have one illness, which…attaches blame to its ‘victims’… Any disease that is treated as a mystery and acutely enough feared will (also) be felt to be morally, if not literally, contagious.” It seems incongruous now that she was talking about cancer. Yet, aging Americans recall that the ‘Big C’ was once intensely feared and stigmatized. Now it is time to make the same progress against depression and bipolar. This Newsletter suggests strategies for counteracting, reflects optimism, and appeals for help. We are winning this battle.

Why is this fight important? Too many struggling with depression still remain reluctant to seek treatment or fully disclose symptoms because they fear loss of job, relationships or insurance coverage. Thousands still resist accepting the clinical diagnosis. An estimated 20% don’t fill their first antidepressant prescription or start recommended psychotherapy programs. Some fail to adhere to longer-term maintenance recommendations even when told recurrences are the alternative. When providing clinical care, clinicians of all specialties may unwittingly help sustain stigma by “talking in code” and avoiding certain questions, using “safer” diagnostic labels such as “exhaustion,” or using language that subtly encourages poor adherence (“Let’s try this for a bit…”).

There are many ways that the Depression Center is seeking to battle the stigma monster. A few include: 1) recruiting celebrities, executives, athletes and performers as spokespersons to personalize the disorders; 2) using proper, matter-of-fact terminology and correcting colleagues and friends when they fail to do so; 3) educating teachers and school leaders that depression and bipolar are brain disorders linked with life events and have causes, treatments, and good outcomes when treated; 4) avoiding “safer” diagnostic labels; 5) recognizing that the best outcomes are achieved when supportive family members are involved; 6) developing self-management tools to aid monitoring progress; 7) educating family, friends and media, joining community volunteer groups, and advocating for greater research support; and 8) asking questions. In 2001, I suggested that the most powerful way to fight stigma is through “unarmed truth and unabashed openness.” I continue that belief.

Subsequent pieces in this Newsletter illustrate that clinicians are not exempt, that tailored strategies may be required for different groups, that families are vital partners in treatment, that we can learn from other disciplines such as cancer specialists, and that we might all benefit from well-designed “Toolkits.” The Depression Center, with generous support from its Community Volunteers, is now preparing such a Toolkit to help patients and families understand common diagnostic and treatment questions. This will be a future topic for this Newsletter.

How far we have come! Knowledge is expanding, screening is becoming more widespread, treatments are improving, genetic, sleep and other biomarkers are getting closer to clinical applicability, and thousands of powerful voices are joining the destigmatization chorus. Even our selection of the name “Depression Center” is part of this battle and others will be following suit nationally. It is being won. Thank you for joining the cause.