This book chronicles the many cultural and historical threads that have brought us to the present, a time when societies throughout the world are challenging the stigma that has, for centuries, shadowed mental illnesses. We haven’t put it into words, but most of the people I encounter, even in low-income countries with inadequate health care, sense that something positive is happening. Although 60 percent of people with a mental illness in the United States still receive no mental health treatment, mental illness is fast becoming a more accepted and visible part of the human condition. We are acknowledging that mental illnesses are more common than we used to think, and that they affect us all—either individually or because of our relationships to others. Indeed, it is impossible to imagine that there is anyone unconnected to mental illness. In the twenty-first century, many of the people we most admire—celebrities like Lady Gaga and swimmer Michael Phelps, for example—speak publicly about their own emotional struggles. Also, in comparison to their parents, millennials are more willing to disclose a diagnosis and seek treatment. Many people, like my daughter Isabel, who is autistic, even celebrate forms of differences that just a few decades ago were a mark of shame.
These developments show us that we need not surrender to stigma, as if it were natural to marginalize otherness and difference. Stigma isn’t in our biology; it’s in our culture. It is a process we learn from within our communities, and we can change what we teach. But only if we know the history of stigma can we target the social forces that created it in the first place, strengthen those that reduce stigma, and say “enough” to the many barriers that keep so many people from getting care.
My grandfather, also named Roy Grinker, did not share his father’s objectionable views, and he spent much of his career trying to eradicate stigma. I was fortunate to grow up across the street from him. Occasionally, he would reminisce about the time he spent in Vienna as one of Freud’s patients, and I remember how often he talked about Freud’s wishes. One was that doctors could help lead people out of misery, not into a perfect life but into ordinary unhappiness. Another was to prove that emotional distress was universal. Perhaps, Freud told him, if people understood that we are all neurotic, they might eventually feel no shame seeking psychological care for their problems. Perhaps some psychiatric conditions could even become like the common cold, something everyone gets from time to time. And maybe students would be more eager to choose a career in psychiatry.
I was raised in a family that believed everyone had a little mental illness, that emotional pain was a normal part of life, and that mental illnesses existed within a hierarchy of all diseases. Anxiety, for example, was more serious than the common cold and less serious than cancers, but still in the range of what typical human beings confronted throughout their lives. I wasn’t ignorant of the stigma of mental illnesses since, outside my home, most people talked about them in a whisper. But people also whispered about cancer, dementia, and sexually transmitted diseases. It just took me a while to figure out the difference between the stigma of mental versus physical illness.
That realization came after I finished the tenth grade, when my grandfather helped arrange a summer job for me in a psychiatric hospital, cleaning and filing. One day I bumped into an emaciated girl who was my classmate. She was a patient, and simply seeing her caused an uproar. I was so harshly admonished by so many people—our school principal, her parents, my parents, my grandfather, her doctors, my supervisor at work—to keep her hospitalization confidential that I felt as if I had committed a crime. I can only imagine how uncomfortable she felt as she struggled with both her illness and the commotion around her.
I recognized then the extent to which our society had made psychiatric conditions frightening and shameful, a double illness: first, the ailment itself, and second, society’s negative judgment.