A mark of disgrace associated with a particular circumstance, quality, or person.
HOLD ON! Before you continue, please take a minute or two to fill out this survey on what you know about this topic!
What is the stigma of mental illness?
Stigma can be split into two main types: public stigma and self-stigma. Public stigma most commonly comes to mind when discussing the topic of stigma. It “refers to the negative attitudes held by members of the public about people with devalued characteristics” (Corrigan and Rao 464). Words like “crazy” and “weird”, which hold negative connotations, have become normal when talking about mental illnesses. These negative stereotypes often involve the assumption that all people with mental illnesses are dangerous. Movies and TV shows continually portray violent villains as “mentally ill” and fail to provide context or explain the broad spectrum of mental illness. As a result, people with mental illnesses are seen as dangerous and are pushed away by others, increasing fear and social distance. When we look back at the beginning of the institutionalization of people with mental illnesses, it’s clear to see that the cultural belief system played a huge role in influencing the shift to asylums. David Rothman, the author of The Discovery of the Asylum, tied this shift during the 19th century to cultural beliefs about the significance of rapid urbanization and mass immigration. Thus, according to these beliefs, asylums were created to remove people with mental illnesses from the hustle and bustle of urban life in order to provide them with an organized and structured routine that could be maintained easier, bringing balance to their unbalanced minds. When looking at the interpersonal and cultural context of mental illnesses during this time, it’s clear to see that cultural conception of mental health substantially influenced stereotyping, available treatments structures and peoples willingness to seek help.
Out of the 450 million people around the world who suffer from mental illness, 60% don’t receive care, yet, mental illness is the biggest economic hardship in the world, costing around $2.5 trillion in 2010 and an estimated $6 trillion by 2030. In the UK, 70% of people who have a mental illness reported experiencing some form of discrimination. And in developing countries, discrimination towards mental illness prevents proper mental health care almost entirely. Nora Mweemba, who works for the World Health Organization (WHO), explained that in Zambia many of those who have suffered from mental illness rarely come forward as “communities still regard mental health as a misfortune in the family or some sort of punishment [from God]” (Chambers). The stigma around mental illness is continuing to restrict a sense of social pressure on individual and governmental action.
Self-stigma happens when people with mental illnesses internalize “public attitudes and suffer numerous negative consequences as a result” (Corrigan and Rao 464). People recognize and internalize the public stigma towards then, which oftentimes results in decreased self-efficacy (an individual’s belief in their natural ability to achieve goals), self-esteem, and a “why try” attitude towards life. Acting as a wall, self-stigma can lead to a sense of worthlessness which can diminish one’s independence. For example, a person with a mental illness is aware of the public stigma about their condition, agrees with the public that the negative stereotypes are true, then applies those stereotypes to themselves. When someone with a mental illness experiences symptoms of their mental health, like anxiety or depression, stigma causes them to avoid and suppress their emotions and feelings, which can lead to a decrease in well-being and overall value of life.
Negative attitudes towards mental illness commonly present themselves as social distancing, especially when one feels that a person with a mental illness is dangerous. Increases social distance can result in social isolation, and feelings of rejection and loneliness. Self-stigma is commonly compared to perceived stigma, for example, “a person’s recognition that the public holds prejudice and will discriminate against them because of their mental illness label” (Corrigan and Rao 465). This can also lead to lowered self-esteem, self-efficacy, and perceived devaluation. Many people with self-stigma tend to hide in shame and avoid sharing their mental history with others, as talking about it can lead to further discrimination by peers.
“We are facing a global human rights emergency in mental health. All over the world people with mental disabilities experience a wide range of human rights violations” (WHO).
How does this impact people?
Stigma can make one’s life personally, interpersonally, and socially very challenging. In a study on stigma in the British Journal of Psychiatry, 46 people with mental illnesses were interviewed; researchers found that “the stigma very often took different forms, depending on the context. However, two distinct sub-categories that emerged were subjective feelings of stigma, even in the absence of any discrimination, and stigma in the context of overt discrimination” (Dinos 177).
41 of the 46 interviewees talked about their anxiety when dealing with the topic of mental illness and when deciding whether or not to tell friends, family and/or potential employers about their mental illness. One woman, 41, with schizophrenia said, “Well I’m too worried about telling people I’m on medication. There are very, very few people that I talk about the ECT [Electroconvulsive therapy] to […] I don’t really want to talk about it because I hate it and it’s horrible and also I feel there is a big stigma attached and if they hear about that they’d think I was really mad” (Dinos 178). Other participants also talked about different ways the stigma around mental illness had impacted their lives in negative ways: 29 interviewees said they had been verbally and/or physically harassed/abused, and 16 interviewees suspected people stopped talking to them due to their mental illness. Social isolation and rejection like this can have potentially harmful effects on an individual’s mental and physical health, and in some cases, can also lead to an early death.
However, not all aspects of mental illness are necessarily negative; in that same study, 11 interviewees felt relieved to be able to put a name to their mental illness after being diagnosed, 16 interviewees were able to accept their diagnosis and thus became more well adjusted, 7 interviewees expressed a positive attitude towards their treatment, and 21 interviewees said they didn’t feel a sense of stigma.
Looking back at how the public viewed mental illness in the ’70s, we can see that the stigma of mental illness has definitely decreased, but, sadly still exists today. People continue to pair mental illness with increased violence which only reaffirms the stigma, increasing social distance. Especially now, it’s important to practice empathy and understand that this stigma not only influences one’s life on a personal level but also influences care and resources available to all people with mental illnesses. A report by the Centers for Disease Control (CDC) explained that stigma can lead to decreased prioritization of public resources and overall lower quality of care provided. And a research review of 22 different studies by BMC Psychiatry found that stigma and embarrassment were the top reasons people with mental illnesses didn’t take medications as prescribed by their doctors.
“The effects of stigma work both ways – mental health conditions are not typically screened in most health care settings, losing an important opportunity for care” (Friedman).
What can be done to fight the stigma?
Overall, raising awareness is one of the most important ways to decrease stigma and stereotypes that surround mental illness. After all, how can we expect to see change if people aren’t informed about the issue at hand? Organizations like the World Health Organization (WHO), the National Alliance for the Mentally Ill, the Rosalynn Carter Foundation, United Self Help, and more have fought to reduce the stigma of mental illness, as well as raise awareness and advocate for change. It’s important to make sure people with mental illness know this stigmatization is not their fault; stigma is a social injustice and societal problem. Fixing this societal issue is something a community must work on together, only then can we work towards eradicating both public and self-stigma. Instead of simply recognizing that stigma is unjust and wrong, more people, like you and me, need to make an effort to inform others and do something about it.
Professionals who work with people with mental illnesses need to be trained to manage their biases so it doesn’t interfere with clinical care. By training more people in the medical field about mental health and mental illness, we can work towards integrating mental health screenings in a primary care setting. After a review of 14 different studies, the U.S. Preventive Services Task Force came to the conclusion that screening for depression in a primary care setting would help improve results as well as decrease stigma.
Educating Political Leaders
Educating political leaders on the stigma of mental illness and its impact on people can help make mental health care more accessible. In The Affordable Care Act of 2013, the Mental Health Parity and Addiction Equity Act of 2008 was expanded on and provided a greater possibility for potential mental health conditions to be covered at the same level as physical health conditions. Treatments such as psychotherapy, medication and lifestyle behavioral programs have been shown to be both effective and cost efficient, but the stigma around mental illness prevents people from gaining access to these.
Understanding all of these issues and practicing empathy is also vital. Neilani Siatini-Valencia, a Clinical Social Worker and Therapist in my community, said in an interview I conducted with her, “People see mental illness as ‘crazies, homeless, dangerous, violent, or drug addicts.’ Granted those are issues impacting people with mental illness, but that’s not WHO they are. […] They are people with a life story that is worth hearing. It’s a statistic that 1 out of 4 people experiences mental health symptoms. With a statistic like that, it must hit home more than people think (or are willing to see). Just think about 4 of your friends or 4 of your family members”.
A key part of practicing empathy is understanding what it is and how it differs from sympathy. A lot of people tend to use “empathy” and “sympathy” interchangeably, but they are actually quite different. Empathy involves understanding and experiencing what others are feeling, going beyond sympathy, which involves understanding and caring for others. Watch this video to learn more about the difference between the two:
Starting a conversation in my community!
Last week, I invited my friends to have a conversation about the stigma of mental illness and mental health as a whole, during one of our shared breaks at school. I asked some questions to get the conversation going (similar to the ones in the survey at the top of this page) and before I knew it our hour-long break was over! Talking about an important, worldwide issue like this really helped me gain a better understanding of the different perspectives people have on this topic.
I encourage you to have a conversation with friends, family members, co-workers, teachers, etc. about this topic in order to spread awareness. Think about different ways you can help inform your community and new methods of fighting the stigma.
Chambers, Andrew. “Mental Illness and the Developing World | Andrew Chambers.” The Guardian, Guardian News and Media, 10 May 2010, www.theguardian.com/commentisfree/2010/may/10/mental-illness-developing-world.
Corrigan, Patrick W., and Deepa Rao. “On the Self-Stigma of Mental Illness: Stages, Disclosure, and Strategies for Change.” The Canadian Journal of Psychiatry, vol. 57, no. 8, Aug. 2012, pp. 464–469, doi:10.1177/070674371205700804.
Dinos, Sokratis, et al. “Stigma: the Feelings and Experiences of 46 People with Mental Illness: Qualitative Study.” British Journal of Psychiatry, vol. 184, no. 2, 2004, pp. 176–181., doi:10.1192/bjp.184.2.176.
Friedman, Michael. “The Stigma of Mental Illness Is Making Us Sicker.” Psychology Today, Sussex Publishers, www.psychologytoday.com/us/blog/brick-brick/201405/the-stigma-mental-illness-is-making-us-sicker.
Link, B G et al. “Public conceptions of mental illness: labels, causes, dangerousness, and social distance.” American journal of public health vol. 89,9 (1999): 1328-33.
“Mental Health, Human Rights & Legislation.” World Health Organization, World Health Organization, 28 Aug. 2018, www.who.int/mental_health/policy/legislation/en/.
Gore, Joanne. “Group of People Forming a Finger.” Graphic Arts, https://graphicartsmag.com/articles/2017/07/changing-stigma-print-drive-new-business/.
Lohr, Susannah. “Green Half Head with Brain. .” KBIA, www.kbia.org/post/urban-league-panel-encourages-attendees-keep-talking-about-mental-illness#stream/0.
Lohr, Susannah. “Blue Half Head with Brain. .” St. Louis Public Radio, https://news.stlpublicradio.org/post/missouri-looks-improve-access-mental-health-care#stream/0.