IntroductionMental health professionals in the Arab Middle East estimate that at least 60% of the population, age 14 and upwards, suffers mental health problems. Dr. Nasser Loza (2006), owner and director of the largest private mental health hospital in the region, Behman Hospital in Egypt, disagrees with this estimate. Loza (2006) insists that the figure is much higher. In Egypt, Kingdom of Saudi Arabia and Kuwait, for example, both medical and mental health practitioners have estimated the figure at around three-quarters of the above 14 age group and have identified depression as the most prevalent condition (Loza, 2006).Mental health problems, like the vast majority of physiological illnesses, are curable or, at least, controllable. Treatment or control of the problem, however, is primarily dependant upon the acknowledgement of its existence and the subsequent seeking of professional help. Within the Arab Middle East, as is the case with regions, countries and cultures across the world, there exists a persistent unwillingness to admit to the presence of a mental health problem or, at least, to acknowledge its existence to the point of seeking curative treatment. As Professor Loza (2006) explains, despite the fact that there are some very good mental health facilities and professionals in Saudi Arabia and Kuwait, it is incredibly rare for a Saudi or a Kuwaiti national to seek treatment within his home country. The stigma associated with mental health problems makes it virtually impossible for many to tolerate the notion of the social isolation/exclusion that would inevitably result from the acknowledgement of such a problem. Accordingly, when the mental health problem reaches the point where it is debilitating and difficult to conceal, the sufferer’s family only agree to treatment if that treatment is received from outside the home country and anonymously. Needless to say, many cannot afford this treatment option and, so, the vast majority are either left untreated which, as bad as that is, is infinitely preferable to the widely popular practice of self-medication and treatment (Loza, 2006).The stigmatisation of mental health is a formidable obstacle to treatment. Fearing stigmatisation, sufferers are reluctant to admit their condition and seek help. Family, friends, employees and society at large, plays an active role in helping to ensure that this reluctance is maintained and transformed into an outright refusal to admit to the problem and seek treatment. Needless to say, mental health professionals have repeatedly addressed this problem and have outlined strategies for the resolution of the stigma surrounding mental health complaints and conditions, believing that upon the elimination of stigmatisation, access to treatment will be facilitated. A World Health Organisation (2001) White Paper on the stigmatisation of mental health argues that the nursing profession, primarily mental health nurses, must play a more active role in the elimination of the stigma surrounding mental health problems. A critical analysis of the nursing intervention strategies outlined for the confrontation, and the removal of the stigma surrounding mental health illnesses indicates that several of the proposed intervention strategies can play a positive and constructive role in the reduction of the mentioned stigma but that its removal is a long-term process which requires much more than nursing intervention.This research shall argue that nursing intervention strategies can play an invaluable role in the reduction of the stigma surrounding mental health. Within the context of the Middle East, at least, the reduction of the stigma will help sufferers admit to their problem and actively seek treatment. However, upon tracing the background relationship between stigma and disease and the factors determining the stigmatisation of mental disease, it becomes evident that nursing intervention strategies must be expanded to embrace the addressing and education of societies and not just of professionals, sufferers and family members, as has been suggested (World Health Organisation, 2001).The Stigmatisation of Disease”Stigma is a pervasive influence on disease and responses of nations, communities, families and individuals to illness” (Keusch, Wilentz and Kleinman, 2006, p. 526). It has a pervasive influence on disease and the spread of disease because the stigma which surrounds a large array of physiological and psychological diseases actually prohibits victims from expressing their complaints, admitting to the presence of the disorder and/or its symptoms and seeking treatment. The stigmatisation of certain diseases further renders their admission in particular cultures useless. For example, in numerous villages and communities in China and India, HIV and cancer patients are completely ostracised. Their children are prohibited from attending schools; their relatives and family members are dismissed from their place of employment and in more cases than not, village administrators cut of water and power supply to the sufferer’s home, and those of all of his relatives, to drive them out of the area (Keusch, Wilentz and Kleinman, 2006). The stigmatisation of disease actively prevents admission of its presence and/or any of its symptoms. The consequence is not only death from possibly curable, or controllable, diseases, but the uncontrolled spread/transmission of disease. When looked at from that perspective, the cost of stigma to individuals, families, communities and nations is near-incalculable. Conceding to the magnitude of the problem, the Fogarty International Centre, in association with the World Health Organisation, the US National Institute of Health and the Canadian Institute of Health Research organised a landmark international conference entitled “Stigma and Global Health: Developing A Research Agenda” (Michels et al., 2006). The conference’s primary objectives were the development of a research agenda for the identification of the causes of disease stigmatisation and the articulation of effective intervention strategies designed to address and resolve the causes of stigma (Michels et al., 2006).The Conference identified several diseases whose treatment and control were virtually prohibited by their stigmatisation. While noting that the stigmatisation of physiological diseases such as HIV had potentially drastic effects on communities and nations, insofar as their stigmatisation facilitated their transmission, the Conference noted that no set of diseases suffered from stigmatisation as did mental health ones. It is, thus, that the Conference organisers emphasised the urgency of examining the reasons behind the stigmatisation of mental health problems, the consequences of their stigmatisation upon sufferers and communities and the articulation of corrective strategies designed to resolve the problem (Michels et al., 2006).The Stigmatisation of Mental Health DiseasesEvery society, culture and nation possesses ingrained prejudices against mental health sufferers. Jamison (2006) emphasises that research has effectively proven that the stigmatisation of mental health problems has its roots in ancient beliefs about, and attitudes towards, mental illnesses. As both Link et al. (1999) and Lauber et al (2004) explain, these beliefs and attitudes, passed down from one generation to another over the ages have, in numerous societies, determined the evolution of overt societal prejudices towards mental health sufferers with the predominant attitude being a complete refusal to tolerate mental illnesses and sufferers. Alternately feared and despised, mental health sufferers are generally regarded as either a danger to society or as weak and ineffective personalities who simply do not have what it takes to confront life and survive. Both of these attitudes have lent to deconstructive public opinions about mental health sufferers. The first opinion maintains that as dangers to society, mental health sufferers should simply be locked up. The second opinion quite explicitly states that since mental health sufferers do not have what it takes to live life and survive it, they, as would their families, be better of were they to die (Link et al., 1999; Lauber, 2004; Jamison, 2006). Given the negative public opinion towards mental illnesses, not to mention the unsympathetic attitudes towards sufferers, Link et al. (1999) argue that there is little opportunity or tolerance for open discussions on mental illnesses. In a surprising number of countries, the media is allowed to print and broadcast discriminatory opinions on mental health which would never be tolerated were they made in reference to any other group of people. The ability of the media to do so, whether in the supposedly enlightened West or the Middle East, is not simply an expression of the prevailing deconstructive and negative opinions on mental health but, more importantly, serves to justify intolerance and sustain discrimination.The stigmatisation of the mentally ill is largely a consequence of ignorance about mental health and the various illnesses which it embraces. A research on the stigmatisation of mental illnesses and the strategies which may be deployed to address the various stigmas surrounding the condition maintains that the first step towards destigmatisation is the articulation of the dominant prejudices regarding mental illnesses (World Health Organisation, 2001). Studies on the stigmatisation of mental illnesses reveal that prejudicial attitudes towards the mentally ill stem from a set of erroneous belies. The first is that the whole concept of mental illness is a myth and that psychological problems do not constitute serious illnesses which require treatment (World Health Organisation, 2001). The second is that mental illness is a blanket excuse for laziness and a fundamental unwillingness to work and be a constructive member of society. The third is that mental illness is nothing other than a symptom of character weakness which will only be compounded if `sufferers’ are coddled (Bolton, 2003). Mental illness, in other words, is not taken seriously and insofar as it is defined as an excuse for the unwillingness of some to work and take responsibility for themselves, is not tolerated. Within the context of societies which are intolerant towards mental illnesses, public health policies towards the expression of discrimination towards mental illnesses. Little public funds are allocated to mental illness, access to mental health care is problematic because available resources fall far short of the required, health insurance policies rarely cover mental illness, employees openly discriminate against mental health sufferers and mental illness research occupies the lowest of public priorities (Jamison, 2006). Stigmatisation of mental illness has, in other words, seeped through public policy and determined that sufferers suffer in silence and survive their condition as best as they can, often without access to the professional healthcare they require.The stigmatisation of mental illnesses and the pervasive unwillingness to help mental health sufferers is not confined to any single country or culture. Corrigan et al. (2004) explain that studies and surveys on public opinion towards mental illnesses has revealed that stigmatising attitudes, culminating in discriminatory health policies and employment practices, is a formidable problem throughout the United States and much of Western Europe. Brockington et al. (1993) supports this finding and maintains it to be an immediate outcome of social and communal intolerance towards mental health sufferers. Concurring, Weiner (1995) presents evidence which confirms that discrimination against mental illnesses and mental health sufferers operates on a global level. In fact, while mental health professionals in the United Kingdom may urge for greater societal understanding of mental illnesses and argue the urgency of greater public support, Western societies are infinitely more tolerant of mental health illnesses than are Eastern ones. In Eastern societies such as Asia and the Middle East, there is an overwhelming tendency to equate all forms of mental illness with insanity and to completely ostracise the mentally ill (Weiner, 1995). [To be continued...]
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