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On sharpening knives, stigma and mental health

Academia, Tiago Zortea

On sharpening knives, stigma and mental health

By Tiago C. Zortea:

Ten years ago, in the second year of my undergraduate course in Psychology, I came across a short book chapter that caused me to rethink many of the ways in which I understood mental health: The actress, the priest, and the psychoanalyst: The knife sharpeners, written by the Brazilian Professor of Social Psychology Luis Antonio Baptista [1]. Baptista uses the examples of an actress, a priest and a psychoanalyst to explore how ‘public opinion makers’ can indirectly contribute to intolerance and violence against those who they do not consider ‘standard’, ‘holy’ or ‘normal’ respectively. According to the author’s metaphor, they are not directly involved in these people’s death, but they ‘sharpen the knives of the crimes’.

Since then, I have asked myself many times whether I am a ‘knife sharpener’. Do the things I do and say, in some sense, contribute to excluding people from society? Am I categorising people into personality profiles or groups of symptoms that mean they identify themselves as being either ‘normal’ or ‘pathological’? What kind of approach do I take towards mental health and what are the consequences of this approach in people’s lives? The more I study, the more concerns I have about the implications of my words on people, especially on the general public. Diagnosis criteria can be easily misunderstood, particularly when the topic is mental health. It is critically important to be careful when talking about psychiatric diagnosis in a public forum (e.g., on television, at public engagement events). It is from misunderstandings and insensitive perspectives on mental health that popular and stigmatising notions of ‘normal’ and ‘pathological’ are born. In 2014, Professor Peter Kinderman, President-Elect of the British Psychological Society published a fantastic book entitled “A prescription for psychiatry: Why we need a whole new approach to mental health and wellbeing” [2]. Among several issues regarding mental health, Kinderman alerts us to how problematic certain labelling practices can be and suggests we should stop dealing with “people’s distress as merely the symptom of diagnosable illness and instead develop a more appropriate system for describing and defining people’s emotional problems” (p. 48).

Baptista [1] examines how stigma can be reinforced not only by specialists but also celebrities and certain conservative religious institutions. It is important to remember that until the 1970s, homosexuality was listed as a mental disorder in the DSM (Diagnostic and Statistical Manual of Mental Disorders) classification [3], and several religious institutes based their arguments on DSM to state how each gender should behave and to to justify their position that same sex relationships were abnormal and unnatural.

On the 17th of April 2015, BBC Panorama showed a documentary entitled “A Suicide in the Family” [4] and one of the interviewees, Matt – a young man who tried to end his own life – said: “I’ve always been a quite expressive person, if you like… I’ve been sort of, quite effeminate maybe? It did not really fit in with my group of friends, sort of things. I always felt like an outsider looking in. That was obviously difficult because when you’re growing up, nobody likes to be an outcast, do they?”. Notice which topic Matt chose to bring up to the conversation where the main theme was suicide. He could have mentioned numerous issues such as unemployment or family problems, but he chose to describe something that he had experienced since he was a child: feeling rejected for being an expressive person. ‘Effeminate’ was the label. Matt grew up learning that in order to be a man he was required to fulfil a list of behaviours and modes. For those who couldn’t respond to the requirements, something was wrong, strange, unnatural or abnormal. Fortunately, Matt asked for help and received support.

As a mental health professional, I understand that one of my most important tasks is to work hard to end stigma. One of the many possible ways to accomplish this is by praising human differences; Emphasising that there are innumerable ways to be a human and they can’t all be fit in boxes or separated by social labels. There are expressive people like Matt, and there is nothing wrong with that. We all have different backgrounds, different genders, different bodies, different abilities and disabilities, different beliefs, different moods, different ways of expressing ourselves, different tastes, and different trajectories. All we have is difference! We are rich in diversity, but as society we insist in creating social categories and excluding those who do not fit in. This indicates our difficulty of dealing and living with our differences. Perhaps we could encourage ourselves to make small changes to challenge this; we could push our boundaries, expand our acceptances and understand that social exclusion and stigma kill people. We could develop more empathy. We could save lives.


[1] Baptista, L. A. (1993). A atriz, o padre e a psicanalista: Os amoladores de faca. In L. A. Baptista. A fábrica de interiores. Rio de Janeiro: UFF.

[2] Kinderman, P. (2014). A Prescription for Psychiatry: Why We Need a Whole New Approach to Mental Health and Wellbeing. Palgrave Macmillan.

[3] Homosexuality and Psychology. (n.d.). In Wikipedia. Retrieved July 15, 2015, from https://en.wikipedia.org/wiki/Homosexuality_and_psychology#cite_ref-3

[4] Sculthorp, T. (Producer and Director), Thomas, C. (Editor), & Jack, S. (Reporter). (2015). A Suicide in the Family [Documentary]. United Kingdom: BBC One. From http://www.bbc.co.uk/iplayer/episode/b05rcrx0/panorama-a-suicide-in-the-family

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