The psychiatric stigma and ‘diagnosing’ our society

”The problem we Israelis suffer from is a form of bipolar disorder – we are either extremely euphoric or experience so much anxiety we assume a fetal position waiting for it to pass, and that is not healthy for the soul.”

Those are the words that ex-director-general of the Health Ministry Moshe Bar-Siman-Tov used in a recent opinion piece — its topic further unrelated. Something that unfortunately appears to be common in our current day language: the use of diseases as a way of expression. Amongst these also psychiatric disorders: not only used to relate to the mental status of an individual, but also to society as a whole.

Frankly, most often the use of the psychiatric illness as an expression is not even correct when looking into the official clinical symptoms. Each psychiatric disorder that we — as medical professionals — are able to diagnose, is described in the Diagnostic and Statistical Manual of Mental Disorders: the so-called DSM. Often, the popular use does not refer to these official criteria as listed in the DSM. So also in the case of our current example:

Analyzing Bar-Siman-Tov’s broad statement about the Israelis suffering from bipolar disorder, does this correspond with the DSM diagnostic criteria? No, not really. According to Bar-Siman-Tov, bipolar disorder would mean to switch between two extremes: either absolute euphoria or paralyzing anxiety. However, according to the most recent DSM-5 criteria, bipolar disorder is a highly-debilitating disorder characterized by an altering mood from heightened grandiosity and increased irritability with risk-taking behaviour to depression and guilt. Symptoms that lead to many problems in the individual’s personal, work and academic life, and causes a high-burden for the society.

To understand the full meaning of the severity of the disorder, I would like to offer some more context. Bipolar disorder has from all psychiatric disorders the highest rate of suicide: approximately 20-30 times that of the general population (Source). Moreover, during my time working in an acute, closed mental health hospital in the Netherlands, we very frequently had to admit patients with a manic episode. Often these episodes were so severe that patients had be separated from other patients and medical staff in special areas, sometimes only allowing contact through a small hatch and in the presence of a force majeure of security due to the risk of aggression incidents. Even with adequate pharmaceutical treatment, such episodes may last for weeks or months. 

And these are not incidental episodes. Bipolar disorder is a chronic disease, requiring strict therapy adherence as well as always being on the watch for possible symptoms of either a manic or depressive episode. Think about what an impact that has on someone’s life, as well on the life of their loved ones. To state that all Israeli’s suffer from such a disorder, chas ve’shalom, is insulting and offensive. And simply not at all true. 

Now, regardless of this mistaken use of symptoms under the term bipolar, one may argue that it’s unfair to put these words from Bar-Siman-Tov under such a loop and out of the context from the rest of his article. However, we are talking here about a public opinion statement by a former director-general of our Health Ministry, who in 2015 became the first non-doctor to lead the Health Ministry. Something which then lead the Israel Medical Association to an official appeal at the High Court of Justice, contending his lack of medical expertise made him unfit for the job.

Someone with such a high public position within our health system, should be especially wary about the use of words and the influence these might have. Especially when completely unnecessary in the broader scope of the point one is trying to bring across.

Incorrect and ”popular-language” use of psychiatric disorders contributes to the lasting stigma. And unfortunately, mental illness is still highly stigmatized:

• through public stigma, causing discriminatory and negative attitudes towards individuals psychiatric disorders;
• through self-stigma, leading to internalized shame as well as significant delays in seeking for professional help;
• and through more systematic institutional stigma, in which intentionally or unintentionally opportunities for individuals with psychiatric disorders are limited.

And if popular-language use of psychiatric disorders doesn’t actively contribute to further stigmatization, then it at least does so through stereotyping and misunderstanding of mental illness for those outside the mental health work field. Especially people in public positions, such as being involved on a high level with the Ministry of Health, must be meticulous with their words and refrain from diagnosing a whole society with a mental disorder. Because yes, it may sound catchy as a phrase, but it does so much unnecessary harm. More than one often realizes. And that’s exactly the core of the problem.

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For further information on stigma and discrimination in psychiatry, please see the American Psychiatric Association. If this article triggered you, or you believe you may be experiencing mental health issues, please get in touch with a mental health professional or your family doctor.