Living in the Shadows

by Phoebe Huo

41% of countries do not have a mental health policy.

25% of countries have no legislation on mental health.

28% have no separate budget for mental health.

37% of countries do not have mental health community care facilities.

These statistics present the current situation of global mental disease burden. However, behind the statistics, the reality shows more cruel pictures: discrimination and stigmatized images around people with mental disorders and shortage of mental health professionals lead the marginalized population to live in the shadow.

Like the person who has been locked in the wood house for ten years in the video we showed in the class, many people with mental disorders are victimized for their illness, and become the target of discrimination. Some stigma are from general population, as Dr. Maselko mentioned in her lecture, because the definition of mental illness is so vague and incomplete in developing countries, people may hesitate to search for help because they do not even have the knowledge of the symptoms. Therefore, due to inaccurate information of mental disorders, many people believe that the disease is untreatable, and the person with the disease needs to be excluded from population. On the other hand, abundant evidence from Western countries indicates that people with mental disorders are stigmatized and discriminated against by health professionals. Specifically in developing countries, treatment suggestions from health professionals to those with mental disorders include a wide range of proposals, some of them are punitive and discriminatory, and far from official guideline recommendations. These negative social attitudes towards people with mental disorders have an adverse effect on prevention and early treatment. And these attitudes are pervasive even though the United Nations has provided a basic standard for people with mental disorders:

All person with a mental illness, or who are being treated as such person, shall be treated with humanity and respect for the inherent dignity of the human person. All person with mental illness, or who are being treated as such person, have the right to protection from economic, sexual and other forms of exploitation, physical or other abuse and degrading treatment.

United Nations Principles for the Protection of Persons with Mental Illness

However, most countries of the world are far from complying with this principle.

As Dr. Maselko and Dr. Shirey mentioned in their lecture, there is a global disparity of receiving mental health care between high-income and low or middle-income counties. For over 30 years, international organizations such as World Health Organization have been encouraging developing countries to increase their mental health facilities, however, the progress in achieving well-equipped facilities for the care of mental disorders has been slow. Almost one-fourth of developing countries have no system for providing basic mental health treatment for citizens. Even among countries that have such a system, the health facilities lack trained professionals who can provide good mental health services. Most of the facilities contain few doctors and many non-professional health workers. The doctors are usually too busy for managing patients who need specialized care, and have no time to supervise other health workers. 

“ Where is the mental health hospital I can go for help? ” asked by the father in the video. He is still searching for a mental hospital that can provide accurate information and appropriate treatments for her daughter.  As well as the father, we still have a long way to go to bring people with mental disorders fully out of the shadows.  

Affects of the Negative Stigma Surrounding Cancer

By Elizabeth Monahan

One of the most interesting things that I learned from Dr. Zafar’s lecture was that around the world, cancer has a stigma.  This was something that I had never thought of before because everyone who I have ever known who has had cancer was incredibly supported economically, emotionally, and physically by the surrounding community.  Nobody was looked down upon or ostracized because they had been diagnosed with cancer.  Of all the reasons to fear being diagnosed with cancer, facing a negative stigma is something that I never would have considered.

After listening to Dr. Zafar’s lecture, I began to think of all the downstream effects of a communal negative stigma surrounding cancer.   We know that one of the best ways to increase somebody’s chance of survival is to diagnose their cancer early.  If there is a negative stigma regarding cancer, the chances that somebody is going to go to a clinic or the hospital to take part in early detection measures, or even go in when they start to suspect that something is wrong, is probably lower than in areas where there is not a negative communal stigma regarding cancer.  This results in cancer being caught in much later stages, and results in lower survival chances.  This means that a negative stigma is potentially contributing to higher rates of mortality due to cancer.  However, this stigma can also affect the lives of patients as they fight cancer and the lives of their families.

A negative stigma surrounding cancer is going to affect people economically.  I’ve seen communities rally around people who have been diagnosed with cancer to help support them economically by hosting fundraisers and making meals for the patient and their families to help with the economic burden of cancer treatments.  If a community finds having cancer shameful, they will not be inclined to help the individual with cancer or their family economically if the family needs economic support.  If a family or patient cannot afford cancer treatment, both the family and the patient suffer from both not receiving the necessary treatment and from knowing that there is nothing that they can do to get the treatment if they cannot afford it, which leads to another aspect of the fight against cancer that a negative stigma can affect.

A negative perception of cancer is also going to affect the person with cancer and their family emotionally.  A friend of mine said that the support that he received from friends and family when he was diagnosed with leukemia played a huge role in helping him get through his toughest days, and that he could not imagine having to go through his cancer treatments without the support of all the people around him.  As humans, we draw strength from each other; and positivity, kindness, and words of encouragement are infectious and desperately needed in all situations and especially valuable in our toughest moments.  While feeling supported will not cure cancer, positivity and support, even in a small amount, can never hurt.  A negative stigma surround cancer negates the chance of the person with cancer receiving the support that they need from the people around them, and unfortunately could leave them feeling incredibly alone.

Another aspect of the fight against cancer that a negative stigma can affect is research.  If people have a negative perception about cancer, they are not going to want to donate to cancer organizations or even listen to what these organizations are saying.  Organizations that support cancer research will not receive the support that they need to function, and cancer research will not be adequately funded. Furthermore, governments may feel less inclined to help fund cancer research if they fear losing the support of their people, or even a small portion of their supporters, over this issue.  Cancer research is extremely expensive and multifaceted because not all cancers can be treated the same way so many drugs and therapies are needed.  This means that strong funding is absolutely necessary to continue to make advances towards finding a cure for cancer.

Finding a cure for cancer has not and will not be easy, and neither will changing the negative stigma surrounding.  I’m sure that there are many areas of life that this negative stigma can affect for cancer patients and their families, but the above mentioned areas were what I immediately thought of during Dr. Zafar’s lecture.  After thinking about these areas, I believe that in order to truly find a cure for cancer, we also need to work to change this negative stigma surrounding cancer in order to give people fighting cancer the support that they need and deserve.

HIV - Not a Monster

by Shengjie Xu

Several months ago I received a phone call from a friend who expressed her panic about having had a dinner with a friend who MAY have a seropositive partner. She was considering stopping contacting her friend because of that. I was shocked.

30 years ago when HIV was first identified among homosexual men, because of ignorance people were scared. It was believed to be a punishment to gay people since it was mostly prevalent among the homosexual community. As we know now the method of transmission is through blood, blood-contaminated body fluids and mucosal contact as the virus can breach through the mucosal membranes. However even though we know about the science behind the nature of the virus, there’s still a big hurdle that prevents the society from accepting HIV seropositive people.

I spent hours try to comfort her, telling her that there’re many unknown factors that will lower the possibility of her being infected by dining with her friend. My arguing point is that physical contact and saliva are not the method where virus gets passed among people. I’m sure my friend knows about all the science, but when there’s a slight chance that she may get contact with “HIV” this word, she couldn’t pick up her mind to think rationally.

There are probably many people that still panic when hearing the word HIV even in a well-developed country. The social stigma and isolation of seropositive people remains a big problem of this battle. We have the resources to prevent and control viral spread, diagnose, and also treat patients for free. We know the science behind this sneaky virus. We know how to prevent and treat it. We even have research studies going on constantly to test for prophylaxis and vaccines. But why panic? The reason I used the title “not a monster” is because when we don’t know about a threatening creature, we call it “monster”. But when we start to know the nature of the unknown species, we start to face it calmly and start to call it “shark” or “lion” or “tiger”. HIV is like it: small amounts of people know the nature of HIV thoroughly and fight against it at the front line fearlessly. But the vast majority still sees HIV as a “monster” and even refuses to get contact with the warriors who risk their life helping the ones in need.

Educating the public should be an ongoing program of this campaign. The focus of the education part was on prevention. As the prevention part has done great jobs in reducing the incidence quite a lot in the past decades, maybe we should start bring our attentions to those underrepresented population who live with HIV in our society.

As Dr. Bartlett pointed out in his lecture about the antiretroviral study HPT 052, the use of antiretroviral therapy can reduce the sexual transmission of HIV-1 in serodiscordant couple by 96%. When the viral load of patient is minimally detectable, the risk of transmission is much reduced. This stunning number indicates that even as a HIV carrier, it is possible to live a normal life not passing the virus to their loved partner. There are also effective pre-exposure prophylaxis and post-exposure prophylaxis available for people who are at high risk of exposing to HIV. Science has also made it possible for HIV seropositive people to have healthy children. With the right treatment, living with HIV is not impossible. As we have good control and treatment methods, we may want to reconsider our unconscious discrimination against HIV+ population because of our ignorance.