Stigma and Openness

Most of us exchange information about ourselves, our families, and our friends with others all the time. We make casual conversation with seatmates on an airplane, chat with colleagues at the workplace, send holiday letters with a summary of our family news, and have heart-to-heart conversation with our friends about the minutia of our lives. My question is how information about someone's mental illness should be treated in our routine exchanges with one another. On the one hand, it is widely regarded that mental illness should be regarded as any other illness: admitted openly and discussed without shame, on the model of how we treat diseases such as cancer or diabetes. If I would mention that my sister had breast cancer, why wouldn't I mention that she was struggling with bipolar disorder, when the conversation had turned to the topic of current family crises? If I would mention that my child was being treated for diabetes, why wouldn't I mention that he was being treated for depression? Mental illness is a genuine illness, with an identifiable physiological basis in aberrant brain chemistry. To avoid mentioning mental illness, when one would have openly mentioned some other form of illness, is to perpetuate a stigma surrounding mental illness that--one hopes--is woefully outdated. It certainly seems important to act collectively to reduce the stigma that wrongly surrounds mental illness, and one way to do this is to refuse to shroud mental illness in protective secrecy, as if it were indeed something one should hide. On the other hand, three distinctive features of mental illness need to be considered in deciding how best to proceed with open communication about it. The first feature is shared by other socially sensitive conditions such as homosexuality and AIDS, so we may gain insight by comparing how information about these other conditions should be shared as well. The other two, however, seem distinctive to mental illness. Reducing the Stigma of Mental Illness First, even if we believe that mental illness is unfairly stigmatized, the ongoing existence of stigma means that we need to weigh an individual's interest in avoiding the deleterious consequences of revealing his illness against the good to be achieved by taking one small step toward the goal of stigma reduction. Here we need to perform some weighing of clear and significant immediate harm to one individual versus diffuse and distant collective gains. This raises a host of philosophical difficulties. As with many collective action problems, such as those faced in reducing global warming, any one individual's contribution either to solving or worsening the problem is miniscule, if not completely without any actual practical significance, whereas the costs to the individual of engaging in or refraining from the relevant behavior may be great. We might want to distinguish here between the individual herself choosing to take the step of announcing her illness and someone else making that announcement about her. If we compare the case of mental illness to the case of homosexuality, we may have a different assessment about the individual outing herself versus being outed by others. Two plausible principles suggest giving considerable weight to this distinction. One is the principle that the person most directly affected by an act should have the greatest say over whether or not the act is performed. If she is the one who will be harmed by her outing, she is the one who should decide whether or not to make her sexual orientation public. Ditto with the revelation that one has been diagnosed with AIDS, or with the case that concerns us here, mental illness. The other is the related, but distinct, privacy-based principle that each individual is in some sense the owner of information about herself; it is hers to divulge or not to divulge as she chooses. Considering only the individual's own self-disclosure, both pragmatic and moral reasons encourage the open sharing of information about mental illness. …