Hickey: A Study in Stigma: How mental illness is like herpes

One in four. That’s how many American adults suffer from some form of mental illness every…One in four. That’s how many American adults suffer from some form of mental illness every year, and it’s also how many American adults are reported to live with the herpes simplex virus. And while mental illness isn’t viral or sexually transmitted, and herpes doesn’t affect brain function, there are a lot of similarities in how either diagnosis will affect your life.

Mental illness, like the herpes virus, tends to produce symptoms sporadically, rather than constantly. The outbreaks of painful sores most commonly associated with herpes are called “flare-ups,” while people with depression have “episodes.” People with bipolar disorder have episodes of both depression and mania, and people with anxiety disorders have “attacks” of anxiety.

Herpes — I refer mostly to genital herpes throughout this column, especially when talking about stigma — is treatable, but not curable. Antiviral medication can prevent outbreaks of herpes symptoms but the virus is never fully removed from the body.

The question of treatment versus cure for mental illness is more complicated. There is no such thing as a “depression virus” that remains in the body despite lack of symptoms, and so with mental illness the symptoms are the disease and a person who is not experiencing symptoms of depression might not be considered clinically depressed. However, people who receive treatment for a mental illness often relapse after being healthy and happy for years at a time. Psychotic disorders such as schizophrenia have an especially high relapse rate and most of them are considered lifelong conditions, but frequent relapse has also been observed with depression, anxiety disorders, bipolar disorder and eating disorders, to name just a few.

The swinging pendulum of recovery and relapse leads me to imagine mental illness, like herpes, as a virus that remains in the body even when symptoms aren’t being displayed. To speak for myself, I would like to wean myself off my antidepressants within the next three years. There is a strong chance that I will find myself choosing to go back on them later in life when the symptoms will likely reappear.

This is not to say that treatment is futile — on the contrary, regarding mental illness as a lifelong, sometimes-dormant condition is a great way to keep yourself vigilant against future outbreaks and allow yourself to fight relapses before they eat away at too much of your progress.

But the most glaring similarity between herpes and the wide variety of mental health conditions plaguing Americans is that despite their common and treatable nature, both come with an incredible stigma. I am able to speak publicly about my depression because it is being de-stigmatized faster than other mental illnesses, and because I’m not going into a career where a squeaky-clean bill of mental health is considered necessary. If, for example, I suffered from bipolar disorder and wanted to work with children, you would almost definitely not be reading this column.

A friend of mine, loosely diagnosed with psychotic depression, decided against an inpatient stay at Western Psychiatric Institute and Clinic when she felt it would have benefitted her because she was counseled that such a treatment could disqualify her from being licensed as a social worker when she completed her studies. It’s hard to imagine a med student being told that she can’t be a gynecologist because of her own ovarian cysts, but having your own mental health care needs is believed to make you less fit to address the mental health needs of others.

Likewise, herpes carries such a harsh stigma that people don’t even want to risk association with those who carry the virus. At the Scarleteen.com sex education site, columnist Leah Berkenwald talks about writing a paper on social attitudes toward herpes, and she worried that people would assume she was infected simply because she was writing about it. I briefly worried the same thing when I started this column. As of my last sexual health check-up, I do not have genital herpes — but if I did, would I have the guts to write about it? In all likelihood, no.

Like more serious mental illnesses, herpes is overwhelmingly discussed not as a condition that affects real people, but as a punch line. Think about it — when was the last time you heard someone refer to either herpes or schizophrenia in terms of the actual medical conditions, rather than as a joke or as shorthand for “slutty” or “crazy”? Such jokes use herpes as a catch-all symbol for dirty, irresponsible sex, while schizophrenia refers to any amount of perceived instability. More tellingly — imagine that you were in a group of people joking about illness this way. If you interrupted them in a serious tone and said, “Hey, I find that offensive because I have herpes” or “I have schizophrenia,” what would their first reaction be? They might think you were also joking.

The conclusion is obvious. Stigma against a disease invariably prevents sufferers from seeking and obtaining treatment — in the case of mental illness, this can lead to addiction or self-harm, and in the case of herpes it often prevents sufferers from disclosing their infected status to sexual partners. Whatever we think we gain from snidely moralizing against herpes or mental illness sufferers as dirty, promiscuous, weak or self-absorbed, it isn’t worth the public health toll involved.

Contact Tracey at tbh15@pitt.edu.