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The Other Within: the Stigma of Mental Illness Raises the Bar on Empathy

By Lou Agosta on June 7, 2012 • ( 1 )

In thinking about the stigma of mental illness I saw in a flash that the stigma is due to discovering the Other within coming at me in the form of another person from without. On a bad day it can be a confrontation with the wholly Other; on a good (if condescending) day it can be a “there but for the grace of God go I” moment; but on any day it is an opportunity for and challenge to empathy. Hence, this post.

“Active Minds” is the name of a student organization (community group) at Northwestern University (see http://www.ActiveMinds.org for the umbrella group). The commitment of this group (as I understand it) is to engage and take ground in overcoming the stigma sometimes associated with mental illness. Of course, this involves inquiring into and debunking a set of distinctions including “mental illness” and what is possible for a human being.

I was honored to speak to the group, share my thoughts, and engage in a discussion.

My initial thought? Speaking personally, there would be no stigma if I did not want to cut loose, appear totally uninhibited, stop complying, stop conforming, and run wild and naked through the streets – an extreme image of Dionysian intoxication – to violate boundaries. There would be no stigma if I did not want to do anything insane and be totally OTHER than I am, THEN no stigma would exist or be needed. The stigma is a reaction to a possibility within myself that then gets attributed (by way of projection) to the unconventional, nonstandard behavior or speech or affect of the other person.

The great Fear to which the attaching of a stigma is a reaction is the loss of humanness. Inhuman forces get inside and force the individual to renounce love, affection, affinity, humanity. Think of possession by demons or devils or other worldly forces in the conception of mental illness of the Middle Ages or in Salem, Massachusetts during a period of darkness. There was no such thing as mental illnesses – but there were spirits and demons abroad in the land. Think of Kafka’s story The Metamorphoses, where the loss of humanity is represented as a transformation into a giant bug. Think of the chilling conclusion of Orwell’s 1984. Think of domination by an inhuman totalitarian bureaucracy – instead of community, one is controlled by an influencing machine, at actual mechanism. It has become a common place that the reason that the locked wards of inpatient psychiatry units in hospitals are on the top floor and in back is … SO WE DO NOT HAVE TO THINK ABOUT IT – SEE IT –where “it” = behavior that is unconventional, non standard, non compliant, and , therefore, disturbing. Maybe I could behave that way too – and tell off the boss or just take what I want or just let it all hang out (in a totally non conforming way and unambiguous way). Where ever and when ever there is Stigma, there is fear – fear of the unknown – fear of the uncanny – fear of oneself and what one might due in an unguarded moment. Where ever there is stigma, there is upset and a boundary violation of someone’s “comfort zone” or conventional way of conforming. Where ever there is a stigma, there is a breakdown in empathy.

The Other as a person becomes inaccessible. That is a definition of the breakdown of empathy. That is the definition of the loss of empathy. The other person becomes Absolutely Other and, therefore, inaccessible. The loss of access is the loss of community – the loss of access to the human community. The upset person – the one who is labelled as “mentally ill” and indeed may be a threat to himself or to others – is a person who is suffering or in breakdown or otherwise dis-comforted in a way that I do not (as yet) appreciate or grasp or comprehend. Yet I know in my heart of hearts that, in spite of all the upset and fuss and non conformity, the person is like me and that is upsetting and requires a stigma to manage it.

Overcoming the stigma is an exercise that raises the bar on empathy. Empathy gives access to the other as a selective, sampling, trace affect;as a temporary, transient identification; not as a merger or total identification, but in a vicarious way as a representation. Therefore, empathy [paradoxically] can defend against compassion fatigue, burnout, or vicarious trauma … it give a sample, not the full blow experience itself (the latter being potentially overwhelming). The ultimate lesson? Through the distinction of the DSM (Diagnostic and Statistical Manual); through the distinctions of serotonin, norepinephrine, or dopamine; through the distinctions of cognition and behavior; never forget, never forget that one is in the presence of another human being. That is the empathic moment. [Caution: as with a drowning person, use judgment – throw the person a rope or a life preserver do NOT jump in with them (unless you are certified to do so) lest you both drown.]

Here is the complete PowerPoint presented to the Active Minds group at Northwestern University on 2012-05-24 as a PDF – TheOtherWithin:EmpathyAndTheStigmaOfMentalIllness

All the usual disclaimers apply – this voice is not expressing the truth with a capital “T” – but rather a voice crying in the wilderness. Please give me the benefit of your feedback. Thanks!