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Addressing mental disorders in medicine and society

By Norman Sartorius

Stigma attached to mental disorders often makes the life of people who suffer from such illnesses harder than the illness itself. Once marked as having a mental illness, the persons who have them (as well as their families) encounter difficulties in finding jobs, marital partners, housing, or protection from violence. If they happen to have a physical illness as well, they get lesser quality treatment for it. The outcome of physical illness in people who develop a mental illness is also poorer because those affected often delay seeking help, afraid that they might be recognized as having a mental illness and therefore experience discrimination and rejection.

A good example of this is the co-morbidity (the simultaneous occurrence) of diabetes and depression. These two diseases tend to occur together and there is some evidence suggesting that they may even cause each other. When depression is present, the complications of diabetes are considerably more frequent and its treatment is hugely more expensive. Depression is often not recognized by the physicians who treat diabetes and patients — afraid of being labeled as having a mental illness — are less likely to volunteer information about their depression.

The problems arising when depression and diabetes occur at the same time, the organization of health services so that they can provide comprehensive care to people with co-morbid mental and physical illness, and the scientific endeavors to learn more about the pathogenesis of co-morbidity is currently being reviewed during an International Conference on Depression and Diabetes organized by the National Institute of Diabetes and Digestive and Kidney Disease, in collaboration with the Dialogue on Diabetes and Depression.

The excellence of the participants in the Washington conference and its comprehensive, well-composed programme will make it possible to advance our understanding of mental disorders regardless of whether they appear alone or in combination with physical illness. In turn, this understanding will make it possible to improve the way in which mental disorders are managed and thus contribute to the betterment of quality of life for people with those disorders and to the reduction of the stigma of mental illness, which is one of the chief problems that they and their families have to face.

Professor Norman Sartorius, MD, PhD, FRCPsych is a co-author of Paradigms Lost: Fighting Stigma and the Lessons Learned. He is President of Association for the improvement of mental health programmes (MH), a previous Director of the World Health Organization’s Mental Health Program, and past President of the World Psychiatric Association and the European Psychiatric Associations. Read his previous blog post “The stigma of mental illness.”

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