"The Mark of Shame"

Stephen Hinshaw is Professor and Chair of the Department of Psychology at the University of California, Berkeley.

His work focuses on developmental psychopathology, with particular emphasis on (a) peer and family relationships in children with externalizing disorders, (b) neuropsychological risk factors for and correlates of psychopathology, (c) comparisons and combinations of pharmacologic and psychological interventions for children with ADHD, (d) assessment and evaluation, (e) conceptual and definitional issues in the field, and (f) stigma and mental disorder.

His books include Attention Deficits and Hyperactivity in Children, The Years of Silence are Past: My Father’s Life with Bipolar Disorder, and The Mark of Shame: Stigma and Mental Illness and an Agenda for Change.

Hinshaw put The Mark of Shame to the "page 69 test" and reported the following:

Despite great advances in knowledge about mental illness over the last 50 years, why are people with mental disorders still so devalued, discriminated against, and feared? The general public knows more about mental illness than ever before, it is far more acceptable to talk about being in therapy or taking medications like Prozac, and treatments for mental illness have effects, on average, that are as strong as those related to most treatments for heart disease or cancer. But if you admit to a history of mental illness, in most states you can’t vote, drive a car, serve on a jury, run for office, or have custody of your children. The average length of time to seek treatment is 10 years. Policies of deinstitutionalization, which closed mental hospitals but without adequate support in the community, have resulted in homelessness and jail terms for far too many with serious forms of mental illness.

I examine this depressing state of affairs from many perspectives — history, cultural anthropology, studies of ingroups versus outgroups, and even evolutionary theory (i.e., maybe we are “wired” to shun those who threaten our stability). At the same time, media portrayals of violence and incompetence, the lack of parity for mental health coverage, and internalized or self-stigma clearly compound the problem. I use disclosures and narratives — including my own family experiences of mental illness — to bring life to the issues I raise. At the close of the book, I spend several chapters on specific ideas for change, making parallels to the civil rights movement of the 1960s, in that both ‘top-down’ policy change and ‘bottom-up’ individual empathy and support are needed.

Page 69 is not an easy page, because it talks about the dual issues of being a child and having a behavioral or emotional disorder. Toward the bottom, I state that

From the periods termed the Dark and Middle ages … no recordings of children’s games or children’s literature have been found, suggesting strongly that children were viewed primarily as adults of small stature, with no special accommodations…. Even paintings of children from this period show them depicted essentially as small adults. Youth were commonly put to full-time work by the age of 6 years, and marriages were arranged before adolescence in order to ensure the economic well-being of families. It was not atypical for children to be sold into slavery, and beatings were routinely accepted as discipline…

Grim reading, indeed, setting the stage for discussing the almost impossible task of being a child with a mental disorder. But to overlook this legacy would be to deny the truth.

The book ends on a far more upbeat note. All societies need diversity to survive, and most people with mental disorders can and do cope and lead important (if sometimes troubled) lives. Most are neither villains, hopelessly and chronically impaired, or geniuses; and nearly all families are affected by mental illness. In the messages of The Mark of Shame, I hope to help all of us realize how much of our human potential we are wasting by continuing to treat mental illness as shameful and immoral.

Read a Q & A with Stephen Hinshaw.

Visit the complete list of books in the Page 69 Series.

--Marshal Zeringue