The Birthplace of Stigma!?

Today, there’s a lot of talk and initiatives directed at reducing stigma associated with mental illness. But has anyone really investigated the root cause of ‘stigma’ that radiates from such a mysterious and misunderstood illness? I believe I may have ‘accidentally’ stumbled on its origin – or at least the gateway to a clearer perspective about stigma and its relation to mental illness.

So I’m reading Dale Carnegie’s How to Win Friends & Influence People again to refresh myself on some timeless principles of understanding people and their behavior. A good, productive step in my desire to help people in depression, I figured! Anyways, I stumbled upon this quote:

“There are more people suffering from mental diseases in the United States than from all other diseases combined.”

What struck me about this wasn’t so much the factoid itself, but rather, the time it was written: 1936 (first edition) or 82 years ago! Ironically, it was written at the tail end of the Great Depression although Carnegie did not connect these two dots when making his point.

Reading on: back in that time, Carnegie associated the term “insanity” to “mental disease”. I’m not certain if this term implied a different meaning back in the day, but he claimed that one-half of mental diseases were attributed to physical ailments that affected brain cells, while the other half were not – meaning, people went “insane” even though there was nothing wrong with their brain cells.

I was curious to compare meanings to some mental illness – related words from back then to today. For this purpose, I’ve consulted two versions of Merriam-Webster’s Dictionary: one published WAY back, in 1828 (60 years before Dale Carnegie’s time and the only historical Webster’s dictionary I could find online!), to the latest online version that we consult today.

So, the first term in Carnegie’s quote above is (mental) “disease”:

Webster’s Dictionary (1828)

Merriam-Webster Dictionary (2018)
The cause of pain or uneasiness; distemper; malady; sickness; disorder; any state of a living body… Disease

a condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms : sickness, malady


These definitions appear to be consistent. Terms common to both definitions include “malady” and “sickness”, the former elaborated on below. Also, note that the old definition associates “disorder” (defined below) with ” disease”.

Webster’s Dictionary (1828)

Merriam-Webster Dictionary (2018)
Disorder of the understanding or mind. Malady

a disease or disorder of the animal body


A common term shared between these two definitions is “disorder”:

Webster’s Dictionary (1828)

Merriam-Webster Dictionary (2018)
Discomposure of the mind; Irregularity in the functions of the brain; derangement of the intellect or reason. Disorder

to disturb the regular or normal functions of


The present definition corresponds, in part, with the old definition, particularly “Irregularity in the functions of…”. The old definition elaborates by the inclusion of the term “derangement”:

Webster’s Dictionary (1828)

Merriam-Webster Dictionary (2018)
Put out of order; disturbed; embarrassed; confused; disordered in mind; delirious; distracted. Deranged

mentally unsound


The old definition includes “disordered in mind” or alternatively, “mental disorder”. “Deranged” is about synonymous with the term “insanity” (which Carnegie uses in his writing):

Webster’s Dictionary (1828) Merriam-Webster Dictionary (2018)
Unsound in mind or intellect; mad; deranged in mind; delirious; distracted. Insane exhibiting a severely disordered state of mind : affected with mental illness


Note that the old definition of “insane” includes “unsound in mind” which corresponds with today’s definition of “deranged”.

Note also that the present definition of “insane” includes the term: “disordered state of mind” or alternatively, mind (mental) disorder. So, words like “deranged”, “insane”, and “mad” were/are associated to terms that we use today to describe ailments like depression, particularly “mental disorder” and “mental illness”. So, when we piece all of this together, here are the etymological associations:

Mental illness associates with major depression which associates with (mental) disorder which associates with derangement which associates with unsound in mind which associates with insanity.

At this point in the article, I’m so deep in the rabbit hole of etymology that I’m not sure I can get out! Regardless, the point of all of this is that stigma in mental illness is not terribly surprising given some generic associations. During my most challenging times in my disorder, I was afraid to talk about it or see a psychiatrist because in my mind, I didn’t want people to think I was crazy! But, stigma – I don’t think – is about ignorance. It’s about 190 years of etymological evolution – and the consequential conditioning of perceptions that spawn from it.

Alright, moving on! A side bar here: It is worth noting that this book was written around the time when scientists were just discovering the existence of “neurotransmitters”, or brain chemicals: specifically, monoamine chemicals (like dopamine and serotonin), which we now know directly affects emotions, mood and behavior. Further, anti-depressant medication is used to influence monoamine production in the brain to treat psychiatric disorders, like depression and anxiety.

“Why do these people go insane?” This was a question Carnegie put to a medical professional (at that time). The short answer was that, “Nobody knows for sure.” But explained that, “…many people who go insane find in insanity a feeling of importance that they were unable to achieve in the world of reality.” Hence, as Carnegie noted: people went “insane” even though there was nothing wrong with their brain cells.

Indeed, the underlying message of Carnegie’s writing in this particular chapter – “the secret of dealing with people’ – is that everyone has a hunger to feel important and appreciated. When they don’t, their mental state may be subject to erosion and prolonged mental illness may prevail. However, if people in fact strive to feel important in life, and we each make a conscious effort to make people feel appreciated and important, than by logic – from Carnegie’s message – this can have a profoundly positive effect on a person’s mental well-being.

More importantly, it may even remove a single brick supporting stigma in mental illness. This will be revisited at a later date, but for now, time to wrap this up!