Against Stigma: Writing Responsibly About Mental Illness

Published on
April 2, 2014

One of the first blog posts I wrote after joining the Texas Observer staff was about the local sheriff’s call to decriminalize mental illness. At the Harris County Jail — Texas’s largest — about a quarter of the inmates take psychiatric medication and most of those inmates are booked for nonviolent offenses. They should be in treatment, the sheriff said, not in jail.

In writing that blog post, I discovered two things. One was the germ of “Barred Care,” the story I’d write two years later with support from the National Health Journalism Fellowship. The story investigated how Texas’s largest jail became its largest mental health facility — and, for many of Houston’s most vulnerable citizens, the only means for psychiatric treatment.

My other discovery was that I’d have to tell that story carefully. In my blog post, I used the phrase “the mentally ill” instead of saying “people with mental illness.” Right away, a reader emailed us, stressing that defining people by their illness contributed to stigma. You should always say “person” before any condition, she wrote, to avoid making that condition eclipse personhood. That had never occurred to me, but it seemed immediately, obviously appropriate. I changed the language in the blog post and never made that mistake again. But preventing stigma would be a major challenge, both in writing on this subject in general and specifically due to the nature of my story.

Mental illness often appears in the news when someone who has it commits a terrible crime, whether that’s a mass shooting or a mother drowning her children. But most people with mental health problems have no criminal history and, as mentioned above, most who do have such a history have committed nonviolent crimes.

The trouble was, my story centered on the collision of the criminal justice and public mental health systems in Texas. I had to find a way to I minimize the stigma my story could potentially reinforce.

My solution was twofold. First, I grounded the problem in its true source: an underfunded public mental health system. In Texas, a decade of cuts to funding for the public mental health system — the only access to medication for most people without health insurance — created a crisis-driven system. People who couldn’t get treated for their illnesses went into psychiatric crisis and were arrested largely for nonviolent crimes, such as trespassing or public urination. The jails, overwhelmed with people in need, had no choice but to create programs to treat those inmates. They would receive medication in jail, stabilize, and be released, but on the outside they would still not be able to get treatment because waiting lists for public services were about six months long. Untreated, they’d relapse and be picked up again.

Besides being unkind and ineffective, the crisis-driven system was extremely expensive. In Harris County, you can medicate someone for a year for less than the cost of the average jail stay. But the state pays for medications while counties pay for their own jail programs. By underfunding the public system, state legislators were literally passing the buck. I kept that at the center of the story.

My other means for minimizing stigma was to pick my profile subject carefully. For a 4,300-word feature, I interviewed eight people in the Mental Health Unit of the jail for about two hours each, but ultimately selected just one inmate to profile: Preston Murski. Murski was perfect because he was young but already had a long history with the criminal justice system. He talked bluntly about his bipolar disorder, impulsivity, and the fact that, for most of his life, when he lost access to medication, he has gone to jail. Murski — young, hopeful, and worried — was neither a good person nor a bad person. He was just a person with a problem: one that the jail could help with and the outside world could not. In journalism, writing about someone can easily dehumanize them, reducing them to a symbol or a single aspect of their lives, usually negative. Giving people room to tell stories, express humor, and otherwise be a full human ameliorates that.

Focusing in-depth on just one inmate also helped the story cohere. For the reader, really getting to know a single character can be much more engrossing and engaging than hearing just a few lines from several people, especially in a story as numbers-heavy as this one was. In retrospect, I wish I’d specified about half as many numbers. Though they’re all relevant and interesting on their own, one of my most trusted readers said (after publication, unfortunately) that the numbers quickly started to blur together and lose meaning. When I’ve spent a long time researching a story, I sometimes get excited about cramming in all the fascinating things I’ve learned. But while I hate leaving out good data, I hate even more knowing my story could have had greater impact.

But the best solution to avoiding stigma is to write about mental illness more regularly and outside of a criminal context. It’s a vast issue. More Americans will suffer from a mental disorder than from diabetes in a given year. The World Health Organization reports that four of the 10 main causes of disability in developed countries are psychiatric. Mental health has all the angles that other health topics do, from conferences and breakthroughs to alternative therapies, celebrity advocates, and everyday success stories. Plus, little gems abound if the topic is on your radar. I did a short piece in January about how in Texas, the application for a drivers license asks if you’ve been had a mental illness in the last two years. Before you answer, know that the most recent Diagnostic and Statistical Manual of Mental Disorders includes caffeine withdrawal as a diagnosis.

Mental health is a fascinating beat with relevance for millions of Americans. Normalizing and humanizing mental illness isn’t just a responsible act — it makes for compelling journalism.

Photo by ranchocanyon via Flickr.