Excerpt from Another Kind of Madness: A Journey through the Stigma and Hope of Mental Illness by Stephen P. Hinshaw, Ph.D.

Dr. Stephen P. Hinshaw on his Family's Journey with Mental Illness and Stigma

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Dr. Stephen P. Hinshaw's most recent book, "Another Kind of Madness: A Journey Through the Stigma and Hope of Mental Illness"

“Did I live in two different worlds, depending on Dad’s presence?

Was Dad two different people? Was I?

His particular form of bipolar disorder—with episodes beginning during his late teens, fast escalations into grandiose bouts of mania, miraculous recoveries after months of incomprehensible behavior, and remarkably normal functioning between episodes—was striking. Many people with this condition show lingering symptoms during periods between episodes. But until relatively late in his life, Dad showed the extreme, classic pattern.

Not surprisingly, when he took on a separate personality, my world turned upside down. When he vanished, I was frozen in time, not even daring to wonder where he might be. Following his return after weeks or months of shut-down, he was rational, calm, and responsive, my go-to person when confused or upset.

As strong as Mom was—holding the family together through sheer force of will—she didn’t want to see me sad or angry. It might remind her of another male in the house whose emotions could threaten destruction. I learned to keep things in.

Throughout, no one could let on that anything had changed. The doctors’ orders—that nothing could ever be mentioned or else my sister and I would be permanently damaged—were upheld without fail. We all engaged in serious play-acting, the costumes stiff and the scenes perplexing, without rehearsal. Over time, we ended up pretending that we weren’t pretending, enacting the ultimate in fantasy role-play. Each performance was live; we acted our roles as though our lives depended on their success. Whatever lay behind the silence must have been so devastating that it would have destroyed us if brought into the open.

For the past couple of decades, I’ve been engaged with the concept of stigma. This term is defined as the shame and degradation meted out to members of social groups believed to be unworthy, dirty, or untouchable. From its Greek origins, stigma signifies a literal mark or brand. Yet the vast majority of stigma today is psychological, referring to the subtler but still devastating mark of simply being part of an unfit group. Stigma pollutes any interactions between such individuals and members of mainstream society, containing the clear message that the outsiders are unworthy and despicable.

Throughout history and across cultures, many characteristics have been stigmatized. Some are overt and visible, such as race, physical disability, and many chronic diseases. “Lepers,” as they were called—noxiously equating the person with the disease—could be distinguished by their scaly, dark-toned, disfiguring skin lesions. Yet other stigmatized traits, like sexual orientation, being adopted, or having a history of mental disorder, are potentially concealable. These kinds of hidden stigmas are especially troublesome, because the individuals in question may constantly wonder whether their characteristics are “leaking,” adding layers of tension and uncertainty to every social encounter.

Think of the questions and decisions people like my father faced: Can anyone tell? If my secret of being insane, a madman, comes out, I’ll be shunned. Covering up completely is the only course. Stigma breeds shame; stigma breeds silence.

As cultures evolve, a number of formerly stigmatized traits or attributes can become far more acceptable. Left-handedness, formerly shunned, is hardly an issue today. Strikingly, rapid shifts in societal attitudes toward gay marriage have emerged over the past two decades, fueled largely by young people. Such positive trends are unmistakable. Yet mental illness and intellectual disability, a newer term for mental retardation, have been extremely stigmatized throughout history and across nearly all cultures.

During the silent 1950s, when I was young, mental illness was stigmatized to the extreme, linked in the public’s mind with utter incompetence as well as major potential for violence. The very term “mental illness” made one a complete outcast. Our family was caught in the crossfire.

As a boy I knew nothing of the term stigma, which became publicized after the 1963 publication of Erving Goffman’s classic monograph on the topic. What I did know was that something unimaginable lay just beneath the calm exterior of our family—and whatever it was could never be mentioned. What I did feel, in the rare times I allowed myself emotions, was that I might plunge so far down a steep chasm I’d never claw my way up to the surface. To invoke an overused phrase, the shame and silence were deafening. There were no awards handed out to our family for acting ability but we deserved, at the very least, nominations in all the major categories.”

Excerpted from Another Kind of Madness: A Journey through the Stigma and Hope of Mental Illness by Stephen P. Hinshaw, Ph.D.

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