By Roy Richard Grinker
W.W. Norton & Company, 2021
By Curtis Abraham
Months of COVID-19 lockdown inactivity and physical disconnection from each other has forced us to take a closer look at ourselves, each other and the wider world. Death, physical disability due to the disease’s lasting effects (‘Long COVID’), lockdowns, economic hardship, and general uncertainty about the future has taken a toll on our mental psyche (according to US Surgeon General Dr. Vivek H. Murthy “Covid-19 has actually increased rates of depression and anxiety”).
In NOBODY’S NORMAL: How Culture Created the Stigma of Mental Illness, Professor Roy Richard Grinker III, an anthropologist at the George Washington University in the US, examines another aspect of mental health that has been largely ignored, stigma (even during the current Covid-19 pandemic stigma has found a way to reared its ugly head in the form of stigmatizing and victimizing the Asian-American community because of the disease’s origins in China and former President Donald Trump’s unhelpful rhetoric). One would think that it would have been discussed more in academic forums during the height of the HIV/AIDS epidemic, which sadly continues today. Still there are countless medical disorders where stigma plays a vital role.
According to the US Department of Health and Human Services (DHHS), stigma remains “the most formidable obstacle to future progress in the area of mental illness and health.” While Steven Hyman, former Director of the National Institute of Mental Health (NIMH) has called stigma an international “public health crisis.”
For Grinker, mental health is a deeply personal issue, far from being just an academic exercise. The profession of psychiatry in particular is literally in his blood, entwined in every strand of his DNA. His daughter Isabel is autistic. His wife Joyce Chung, a psychiatrist, was the source of inspiration for this present book, his great grandfather Julius was a late nineteenth century neurologist and psychoanalyst “who believed people with mental illnesses were biologically inferior”, his namesake grandfather was a patient of psychoanalysis founder Sigmund Freud in Vienna, Austria, who also “spent much of his career trying to eradicate stigma” not believing in his father’s beliefs in the inferiority of the mentally ill (actor Vincent Price once portrayed him in a radio drama about psychiatric care of soldiers during World War II). Grinker’s own father, Roy Richard (Dick) Grinker II who passed away in early 2022, was also a prominent Chicago psychoanalyst and psychiatrist whose 1977 study of children from affluent families earned him international fame (“The poor rich: the children of the super-rich”: The American Journal of Psychiatry, 135(8), 913–916).
In NOBODY’S NORMAL Grinker delves deep into the largely unknown historical and cultural forces that have shaped stigma over time (“Stigma isn’t in our biology, it’s in our culture”) in order to not only examine how and why such attitudes evolve over time and in various geographical locations, but to help reverse its detrimental effects (the persistence of stigma prevents people who need help from seeking the assistance they need).
“But only if we know the history of stigma can we target the social forces that created it in the first place,” writes Grinker.
The book gives us several examples of societies and communities where stigma is virtually non-existent in spite of the presence of mental malaise or physical disability. For example, small-scale hunter/gatherer societies such as the Jun/oansi San of the Kalahari in southern Africa don’t stigmatize their schizophrenic or autistic members of their community.
On Martha’s Vineyard, years prior to it becoming a playground for the rich and famous, descendants of the first British settlers of the early 1600, developed heredity deafness due to inbreeding. In time, the deaf, partially deaf and those with hearing developed their own sign language so that they could communicate. It was a stroke of human ingenuity- the development of a cultural adaptation in response to a physical condition.
However, by the end of the nineteenth century the stigma against this form of communication was loud and clear, schoolteachers banned children from using the sign language.
“They believed that sign language was primitive, almost savage, form of communication that would inhibit children’s intellectual and social growth and prevent them from becoming productive members of society,” writes Grinker.
European and North Americans, on the other hand, invented mental illness categories during the onset of the Industrial Revolution.
Grinker traces the history of how people with mental illnesses have been judged as abnormal, marginalized, discriminated against and even experimented on. Mental illnesses are modern phenomena stigmatized from outset of their invention, says Grinker.
But the times they are a changing and changing rapidly. Today, many mental illnesses and diverse ways of being are less stigmatizing than at any point in our history. In addition, there has been a global trend towards shedding the stigma of mental illness, especially so with the current millennial generation. Everyone from Lady Gaga to Naomi Osaka to Bruce Springsteen to Tyson Fury has fought their mental daemons in public and has spoken about it (perhaps actor Will Smith shall be added to this illustrious list one day). Secondly, what we humans can learn, we can also unlearn and plot a new course forward.
Even one of psychology’s anointed crown princes, the German-American developmental psychologists and psychoanalyst Erik H. Erikson, wasn’t immune to the pressures of stigma. In 1944, Erikson “whisked his son, Neil, born with Down syndrome, to an institution, telling his friends and his other children that the baby had been stillborn. He was afraid that having a child with Down syndrome would hurt his reputation”.
(Imagine this behavior from someone who not only believed in the importance of events in childhood but who also wrote the influential book CHILDHOOD AND SOCIETY!).
According to Grinker, an estimated 60 percent of people with mental illness in the US receive no mental health treatment whatsoever. Yet another frightening statistic the book reveals is that in any given year some 20 percent of American adults, more than 60 million people, meet the criteria for mental illness. Suicide, for example, is the third leading cause of death among American teenagers (“and most who die never received any mental health care”).
It’s been fashionable to translate such sad and shocking statistics as the reasons behind the spate of mass shootings that has horrified and terrified Americans in recent years. However, America’s uniquely tragic culture of mass shootings does not, Grinker argues, stem from mental health issues as is commonly reported in the mass media.
“The overwhelming evidence is that people with serious mental illnesses are far more likely to be victims of crime than perpetrators,” Grinker tells me. “And when the media do make the simplistic suggestion that perpetrators of serious crimes committed those acts because of a mental illness they increase the stigma of mental illnesses, making it more likely that people will fear someone rather than care for someone with a mental illness.”
Grinker grew up in a household that believed the specter of mental illness hung over the head of everyone, but less severe than other ailments.
And it’s no exaggeration saying stigma is an international health crisis, but it need not remain that way. Grinker rightly points out that fear and concealment of HIV/AIDS, for example, began to decrease as we learned more about the virus and its transmission and developed treatments to transform it from a fatal to a chronic illness. Another example is cancer, given the success of chemotherapy and immunotherapy in oncology.
The persistence of stigma, however, remains as such mainly because the actual cause of most mental illnesses remain a mystery to medical science.
Cultural anthropology arose as a reaction against the early evolutionary efforts in Europe to define humankind in biological terms…Anthropology challenges the mechanisms of exclusion- race, class, sex, and the institutionalization of the “insane”, for example”.
As further evidence of stigma’s mutability, Grinker points to several historical factors or patterns that have shaped the dynamics of the stigma of mental illnesses. For example, psychological impairment acquired new meaning in capitalism.
“The most stigmatized people tend to be those who do not conform to the ideal modern worker, the autonomous, self-reliant individual. In a country like the United States, with minimal hereditary distinctions, we place a high value on independence, social and economic mobility and self-sufficiency.”
But if capitalism can create mental health stigma, then changes to economic systems like Capitalism should, in theory, have the ability to affect stigma, says Grinker.Such changes are already underway.
“Today’s workers can be self-employed, work from home, work part-time, combine paid work with family care or volunteerism, interact virtually rather than in person, and even live with his or her parents.”
Such economic shifts have translated into new accommodations and greater access to previously marginalized (due to stigma) from education and employment opportunities.
Another historical pattern is war. World War I, World War II, The Korean War and the war in Vietnam, were to give rise to the disciplines of psychiatry and psychology.
“In wartime, psychiatric disturbances became an acceptable response to stress, whether inside or outside of combat. And because soldiers were, in effect, employed by the military, many of those who might have been unemployed and stigmatized in the civilian sector were integrated into a new community, their personality differences often muted by conformity to military structure.”
During the Second World War, for example, the commonality of mental illnesses in American society was exposed. There was also the recognition that more doctors needed to be trained as psychiatrists and the realization that mental illnesses were treatable outside of asylums and hospitals. It was this that prompted President Harry S. Truman to set up the National Institutes of mental Health (NIMH) while ordering the military to write a manual for the diagnosis of mental disorders Diagnostic and Statistical Manual of Mental Disorders.
As devastating and as costly in terms of lives lost and billions of US dollars spent, the armed conflicts in Afghanistan and Iraq were, they did help refocus on stigma of mental illness in the US and “efforts to eliminate barriers to mental health care have continued unabated”.
An increase in the medicalization of mental illness is yet another historical factor that has defined stigma. Such technical or scientific solutions hide or ignore the social origins of disease and stigma, says Grinker. Such separation assumes a separation of mind from body, and mind from the surroundings in which we inhabit.
“Who knows how many people who suffer from physical ailments could benefit from mental health care and yet do not seek treatment because they are convinced that bodily symptoms are unrelated to mind, and also because physical illnesses are more socially acceptable while mental illnesses are stigmatized,” writes Grinker.