An individual suffering from a panic attack may react to the overpowering anxiety at home, in a car, or in a public place. Sometimes those around him do not even recognize what is happening. A recent posting on Facebook by Amber Smith brought international attention to the social stigma and presentation of a person suffering from panic attacks. The 22-year-old woman submitted photographs of her “normal” self and one taken immediately following an attack; the photos were accompanied by commentary on the way society reacts to her disorder (Appendix A). In an article by Today Healthy Living Newsletter, it was reported that the posting received over 20,000 viewings (Holohan, 2016). Articles discussing the posting also appeared in Self Magazine, The New York Daily News, Glamour Magazine, and ABC News online.
The bulk of the posting by Smith communicated her frustration and anger with the general public concerning her behavior. She berates people who tell her to medicate or that she will “get over it”. Smith also expresses frustration when she is told that she is too young to be anxious and that she doesn’t have enough to worry about. She concludes with an appeal for people to be nice to one another to protect those who may experience a panic attack from criticism and urged public education concerning anxiety disorders. A natural reaction is to wonder what the effects of social stigma are on patients with mental disorders and what interventions are possible to increase public awareness. A research question is “What is the effect of social stigma on patients with anxiety attacks?” The results of the findings will promote efforts to create a public educational campaign to recognize and accept the challenges patients face with panic disorders.
Panic Attacks
The average individual may experience a sense of panic a number of times in his life in a natural reaction to circumstances that generate overwhelming fear. However, if panic occurs unrelated to external influences and continues for more than a month, a diagnosis of panic disorder may apply (Torpy, 2011). Anxiety disorders are estimated to affect 18 percent of the adults in America. Recognition of panic disorder many be complication by symptoms resembling heart attacks, thyroid dysfunction, or other unrelated diagnoses. Treatment includes addressing negative feelings associated with mental illness reinforced by social stigma.
Public Stigma of Mental Illness
Public stigma concerning mental illness results in the individual’s self-perception as being less than those around him (Collins, Wong, Cerully, Schultz & Eberhart, 2012). A crucial response to identifying oneself as needing psychiatric assistance is to face the rejection of others; therefore, a patient experiencing panic attacks may avoid medical treatment, stop ongoing treatment, or fail in compliance. Ways in which mental health patients encounter stigma include the constructs of discrimination, prejudice and stereotypes (Corrigan, 2004, as cited in Collins et al., 2012). The behavior is influenced by stereotypes adopted by society which may include violent behavior or character defects or that treatment does not offer a solution (Pescosolido et al., 2010, as cited by Collins et al., 2012). Stereotypical beliefs are reinforced by prejudice and discrimination is the outward manifestation of the attitudes. As a result, a patient suffering from panic attacks may experience social isolation, confrontations with law enforcement, lack of employment opportunities, or even housing restrictions.
A survey conducted in 2006 demonstrated that almost one-third of American adults hold the belief that mentally ill patients have “bad character” and more than half credit biology as the cause (GSS, 2006). Most of the participants in the survey responded that they were opposed to having to work with or socialize with a mentally ill person and they would not want a family member to marry a person with mental problems; however, they would be willing to establish a friendship with such a person.
Stigma may be realized by a mentally ill individual in a number of ways (King et al. 2007). Discrimination may result in loss of employment or career advancement as co-workers are hesitant to work closely with people with erratic behavior. Family members and social contacts might behavior in a negative fashion by adopting critical or patronizing interactions. Crisp (2000) conducted a study to evaluation public opinion regarding mental illness to establish a preliminary baseline for an anti-stigmatization campaign. A survey was administered to adults in Britain (n=1737 interviewed, 65 percent response rate) with questions addressing seven categories of mental illness with perceptions placed into eight specifications. All disorders were described as having problems communicating with others and three types as being dangerous. Although the answers indicated reasonable knowledge about mental illness and more than half the respondents personally knew someone struggling with psychological problems, social impairment was given significant more weight in forming negative perceptions. The attitude promotes multiple negative effects for the patients, contributing to their illnesses.
The Stigma Measurement Scale
King et al. (2007) recognized that lack of instruments specifically for measuring public stigma against the mentally ill and the relationship to self-perception of the patients. Patients living in London with a variety of mental disorders were recruited from a number of different facilities and the 193 participants answered 42 questions on public stigma. Patients with anxiety disorders that may result in panic attacks were particularly sensitive to friends or family criticisms, even if they were not expressed. Reliability and validity scores of the survey were high with strong test-retest values and internal reliability was 0.87. This scale of others like it are scientific validation for a social phenomena that requires attention to assist acceptance of the mentally ill patient.
Effects of Social Stigma on Patients’ Quality of Life
The mentally ill patient has been ostracized in society since the times when they were felt to be possessed by demons. Today they are still seen as hopeless, uncontrollable, weak, and defective. Socially unacceptable behavior promotes fear and misconceptions encouraged by media overemphasizing the actions of a few patients. The patients themselves internalize negative public perceptions and adopt them as truth (Batinic, Lemonis & Opacic, 2013). As a result, patients with problems such as panic attacks experience a lowered sense of self-esteem, avoidance of medical assistance with accompanying longer periods of illness, pulling away from society, inadequate therapeutic outcomes, and a decreased quality of life. Batinic, Lemonis, and Opacic (2013) conducted a study with 40 psychiatric outpatients whose illness had lasted an average of over six years. The researchers used three different assessment tools to categorize degrees of mental illness. It was concluded that patients suffering from panic disorders incorporate public stigma into their self-perceptions, resulting in a decreased quality of life and lower feelings of self-worth. This process increases as depression becomes more pronounced and length of illness continues.
Another study by Parcesepe and Cabassa (2012) concerned the same topic. By conducting a literature review of 36 articles yielded information on demographics, personal contact, and other variables influencing beliefs resulting in stigma against mentally ill individuals. The negative connotations found in the Batinic, Lemonis, and Opacic (2013) were reinforced with this research including aspects of criminality and punishment. Support for treatment varies with sociodemographics and severity of perception.
Interventions against Stigmatism
Since patients suffering from mental instability may avoid treatment based on social stigmatism, prevention and early therapy may be encouraged if stigma is reduced (Collins, Wong, Cerully, Schultz & Eberhart, 2012). Public education programs have been initiated around the world in an effort to improve the quality of mentally ill patients. Papish et al. (2012) conducted research on public awareness campaigns in Canada and compared the impact on attitudes with those associated with type 2 diabetes. A trial design using randomized clusters was assessed using a scale with baseline surveys administered to 90 students. The results found that social stigma is greater for mental illness than diabetes, but a one-time exposure to education is not sufficient to create a significant impact. The implication is that a public awareness campaign must be ongoing as circumstances and exposure change for the general population.
Conclusion
The stigma present within the public against mentally ill patients continues to be prominent. Due to the impact on the patients concerning seeking assistance, feelings of self-worth, and acceptance into the community, improving the attitude of the general population toward individuals displaying socially unacceptable behaviors secondary to mental instability is important. People experiencing panic disorders have the ability to improve the quality of their lives and integrate more effectively into society when they are given less stigma-associated interactions. Additional research may provide recommendations, statistics, and tools for accomplishing the goal of reducing public stigma against mental illness in the future.
References
Batinic, B., Lemonis, E., & Opacic, G. (2013). 1004 – Effects of internalized stigma of mental
disorder on quality of life and self-esteem in schizophrenic patients. European Psychiatry, 28, 1. http://dx.doi.org/10.1016/s0924-9338(13)76135-2
Collins, R., Wong, E., Cerully, J., Schultz, D., & Eberhart, N. (2012). Interventions to Reduce
Mental Health Stigma and Discrimination. Santa Monica, California: Rand Corporation. Retrieved from http://calmhsa.org/wp-content/uploads/2011/12/Literature-Review_SDR_Final01-02-13.pdf
Crisp, A. (2000). Stigmatisation of people with mental illnesses. The British Journal Of
Psychiatry, 177(1), 4-7. http://dx.doi.org/10.1192/bjp.177.1.4
GSS. (2006). Public Response to Mental Illness. Gss.norc.org. Retrieved 15 April 2016, from
http://gss.norc.org/get-documentation/bibliography
Holohan, M. (2016). Woman's Facebook photos after panic attack go viral. TODAY.com.
Retrieved 15 April 2016, from http://www.today.com/health/woman-s-photos-after-panic-attack-aim-de-stigmatize-mental-t86041
King, M., Dinos, S., Shaw, J., Watson, R., Stevens, S., & Passetti, F. et al. (2007). The Stigma
Scale: development of a standardised measure of the stigma of mental illness. The British Journal of Psychiatry, 190(3), 248-254. http://dx.doi.org/10.1192/bjp.bp.106.024638
Papish, A., Kassam, A., Modgill, G., Vaz, G., Zanussi, L., & Patten, S. (2013). Reducing the
stigma of mental illness in undergraduate medical education: a randomized controlled
trial. BMC Medical Education, 13(1), 141. http://dx.doi.org/10.1186/1472-6920-13-141
Parcesepe, A., & Cabassa, L. (2012). Public Stigma of Mental Illness in the United States: A
Systematic Literature Review. Administration and Policy In Mental Health And Mental Health Services Research, 40(5), 384-399. http://dx.doi.org/10.1007/s10488-012-0430-z
Torpy, J. (2011). Panic Disorder. JAMA, 305(12), 1256.
http://dx.doi.org/10.1001/jama.305.12.1256
Appendix A.
Woman's photos after panic attack aim to de-stigmatize mental illness
Apr. 13, 2016 at 2:00 PM
Meghan Holohan
TODAY
Like many social media users, Amber Smith normally posts filtered images that find her wearing perfect makeup and cute clothes while flaunting her beautiful hair. But Smith recently decided to share another slice of her life —a photo she snapped of herself looking tearful and scared after experiencing a panic attack.
In a Facebook post shared almost 20,000 times, Smith says the distressed photo is just as real to her as those well-composed pictures. She also expresses frustration over how some people treat those with mental health issues.
"I'm so sick of the fact that it's 2016 and there is still so much stigma around mental health. It disgusts me that so many people are so uneducated and judgemental [sic] over the topic," wrote the 22-year-old from Rugby, England.
God knows why I'm doing this, but people need some home truths.
Top picture: What I showcase to the world via social media. Dressed up, make up done, filters galore. The 'normal' side to me.
Bottom picture: Taken tonight shortly after suffering from a panic attack because of my anxiety. Also the 'normal' side to me that most people don't see.
I'm so sick of the fact that it's 2016 and there is still so much stigma around mental health. It disgusts me that so many people are so uneducated and judgemental over the topic. They say that 1 in 3 people will suffer with a mental illness at some point in their life. 1 in 3! Do you know how many people that equates to worldwide?! And yet I've been battling with anxiety and depression for years and years and there's still people that make comments like 'you'll get over it', 'you don't need tablets, just be happier', 'you're too young to suffer with that'
FUCK YOU. Fuck all of you small minded people that think that because I physically look 'fine' that I'm not battling a monster inside my head every single day.
Someone actually said this to me one day 'aren't you too young to be suffering with anxiety and depression? What do you actually have to be depressed about at your age?' Wow, just wow.
I'm a strong person, I've been through my fair share of crap in life (the same as anyone else) and I will be okay. I have the best family and friends around me and I am thankful everyday that they have the patience to help and support me.
This is why I can't stress enough that it costs nothing to be nice to others. Don't bully others, don't put others down and the hardest one of them all (as we have all done it at some point) don't judge another person. We're all human regardless of age, race, religion, wealth, job. So build one another up instead of breaking each other down.
Peace & love guys ☮
EDIT: Please don't be afraid to share this, there needs to be more awareness. The more awareness there is, the less people who will suffer in silence.
Smith's frustration is understandable.
"[Stigma] is a general problem in mental health," says Dr. Ken Duckworth, medical director of National Alliance on Mental Illness.
"She should be saluted for having the courage to engage in the conversation. This is happening to her. This is the ordinary part of the human condition."
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What are panic attacks?
Most people experiencing panic attacks suffer from panic disorder, which falls under the umbrella of an anxiety disorder.
"Panic disorder is really the fear of recurrent panic attacks," says Scott Bea, a clinical psychologist in the Center of Behavioral Health at Cleveland Clinic. "A true panic attack is like a bolt of lightning out of a blue sky. It is really unexpected and accompanied by intense physical symptoms."
According to the National Institute of Mental Health, about 2.7 percent of the U.S. population experienced panic disorder within the past year and about 4.7 percent of the population will experience it in their lifetime, says Frank Ghinassi, vice president and director of the Department of Psychology at UPMC's Western Psychiatric Institute and Clinic.
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The cause of panic disorder remains unknown but there's a genetic link. Panic attacks last anywhere from a few minutes to a couple of hours.
"In the middle of the attackthere is an overwhelming sense of danger and it seems unrelated to something in the environment," Ghinassi says.
Many people experiencing panic attacks believe they're dying. Some symptoms mimic those of a heart attack — shortness of breath, numbness in fingers or toes, heart palpitations, tightness in the chest, and sweating.
And while Smith's post-panic attack face expresses fear, often there's no way others can tell someone's experiencing a panic attack just by looking at them.
"I don't think there is a specific look. They are extremely distressed. They think they are dying. They think they are going 'crazy,'" Duckworth says.
How to help
While panic attacks feel very intense and scary for those experiencing them, other people can help. Experts recommend:
Making eye contact: Looking you in the eye is a useful distraction that "keeps them from being self-aware," says Bae.
Empathizing with them: Duckworth suggests saying, "Let me sit with you, reassure you, support you." Ask what they need to feel better.
Refocusing their attention: Bea recommends asking them to describe their symptoms. Describing their experience will help them feel more grounded. Ghinassi recommends asking them to breath with you. This slows their breathing and allows them to feel as if they're regaining control.
In her Facebook post, Smith urges others to reach out if they need help.
"To anyone who is going through the same, please do not suffer in silence. There is so much support around — Don't be scared to ask for help."
And the experts agree. Talk therapy, cognitive behavioral therapy, and medications combined make panic disorders manageable.
"If they seek care, they will experience improvement," says Ghinassi. "They do not need to continue to suffer."
