Author: James Anderson

Speaking out on the stigma of mental health

When I started working on autism in South Korea in the early 2000s, nobody would talk about mental illnesses. Today we’re seeing change in South Korea led in part by cinematic and television depictions. It showed autism in a way that it had never been depicted before. Yet it was in his own profession that he felt the stigma of mental health most deeply, which led to the delay in seeking help. He was “ridiculed” by fellow medical students and ostracised by his closest companions. When he sought helpfrom the person in charge of student support, a person who had the power to have him removed from his course, he was “psychologically tortured”.

“Mental health stigma” or “mental illness stigma” refers to the stigma attached to mental health conditions and the discrimination that can happen to people who are living with them. It’s a stigma, in fact, that affects millions of people around the world who live with mental health conditions. It affects everything from their social relationships and professional opportunities to the way they view themselves. However, there are steps that a person facing mental health stigma can take, such as finding an advocate who can support them with work issues and financial matters. They can also educate others by sharing their stories to promote a wider understanding of mental health conditions. The most consistent sociodemographic association was noted with age.

They can explore any self-stigma and if so practice self-compassion and empowerment. And they can help others by volunteering or advocating on behalf of those with mental health conditions. Stigma forces people to not only struggle with their disorder but to cope with prejudice and rejection. This can lead people to develop feelings of self-blame and low self-esteem, and prevent them from seeking treatment or social and professional opportunities. A systematic review demonstrates these repercussions, finding that mental health stigma negatively affects employment, income, and public views about resource allocation and healthcare costs.

Professional

Another reason that a stigma surrounding mental health persists is the corresponding health problems that often accompany certain conditions. People don’t want to have mental health issues, Dr. McLaughlin says, making it more likely they avoid it or slip into denial. “The life expectancy of a patient with a serious, chronic mental health issue can be 10 to 20 years shorter,” he points out.

However, the stigma around mental illness and seeking help remains. We live in an era where we talk openly about mental health issues more than ever before. We talk about the need to take mental health seriously and the best ways to treat it, be it medication, therapy or self-care. Which is not to say that people aren’t suffering or discriminated against due to societal beliefs.

People living with mental health conditions are more likely to experience low self-esteem and lower self-confidence if they’re stigmatized. According to the results of the study, mental health conditions were more likely to be stigmatized and trivialized than physical health conditions. And the results varied by condition — with schizophrenia being the most stigmatized, and obsessive-compulsive disorder (OCD) being the most trivialized. Another key to fighting the stigma of mental health is learning the full circle of how mental health issues can affect a person and understanding that those issues are manageable.

It can come in the words people use to describe a mental health condition or people living with mental illness. This can involve hurtful, offensive, or dismissive language, which can be upsetting for people to hear. This can cause them to feel alone and that no-one understands what they are going through.

According to the literature, people who experience discrimination (even anticipated discrimination), social stigma, and self-stigma may be more likely to experience suicidal ideation. Public stigma refers to the negative attitudes society has toward people with mental illness. Self-stigma or internalized stigma is when an individual with mental illness internalizes these negative attitudes. Institutional stigma is systemic and includes laws or policies from the government or other organizations that, intentionally or not, discriminate against those with mental illness.

Anthropologist Roy Richard Grinker explores the roots of stigma in his new book.

One vignette per respondent was read aloud by the interviewer and printed on a card given to the respondent who was then asked a series of questions. The solid line provides the estimated trend across age groups (A), over time (B), and across cohorts (C). The shaded areas around the lines represent CIs, from light (95%) to dark (75%). Estimated cohort trends, which represent cohort-specific deviations from age and period trends, were obtained by averaging over all of the age-by-period combinations for a given cohort.

1. Alcohol dependence, however, was increasingly stigmatized, marked by significant change in respondents simultaneously citing bad character (18.2%) and ups and downs of life (11.3%) (eTable 2 in the Supplement).
2. In all cases, higher values indicate a preference for greater social distance; lower values indicate the reverse.
3. The disability rights movement, which includes the rights of people to have new identities, is also expanding the view that we all exist on a spectrum and that we can change over time.

Unfortunately, negative attitudes and beliefs toward people who have a mental health condition are common. According to the Mental Health Foundation, nearly 9 out of 10 people with a mental illness feel stigma and discrimination negatively impact their lives. He welcomes WHO’s Quality Rights Initiative, which takes an approach to mental health  grounded on a human rights framework that empowers, dignifies and humanizes people with mental health conditions. Not only is there ignorance, but there is also arrogance from health providers, some of whom look down on people with mental health conditions and psychosocial disabilities, he said.

Trends in Public Stigma of Mental Illness in the US, 1996-2018

It’s this openness and fluidity that I see as the tide that’s raising all boats. However, studies assessing changes in public perceptions of mental illness have been limited. Mental health stigma plays a significant role in the lives of people with mental health conditions — from the way that they’re treated to the way they feel about themselves. Generally, the lack of understanding about mental health — as well as the harmful assumptions about people living with mental health conditions — is at the heart of a bias or stigma. This can result in avoidance, rejection, infantilization, and other discriminations against people who are neurodivergent or have a mental health condition.

Stigma Changes

Another earlier study from 2018 took a slightly different approach in analyzing the social perception of mental and physical health conditions. In this study, researchers used automated software to track over a million tweets related to mental health and physical health over a 50-day period. What people stigmatize varies from culture to culture; culture informs how people perceive and explain differences. America tends to value individualism and independence, which some argue perpetuates stigma by placing responsibility or “blame” solely on the individual.

None of these characterizations are valid, and all of them are misinformed, cause pain, and prevent people from getting the help they need. A stigma is a negative and often unfair social attitude attached to a person or group, often placing shame on them for a perceived deficiency or difference to their existence. So many things have changed the way we view human suffering and disability in general.

You can take a particular case, like autism, and see how much our changing views of autism have come about because of our changing economies. The people who used to be denigrated for being “computer nerds” are now our heroes. Evolutionary biologists would say that it’s natural for us to be afraid of some people. Intersectionality refers to how someone’s intersecting identities — such as race, gender, sexuality, or class — contribute to their own unique experience with discrimination and oppression. Anxiety and panic can disrupt our lives but when we begin to understand them and how they manifest, we gain control over their devastating impact.

People with mental disorders have been blamed, vilified, and ostracized throughout human history. While attitudes about mental illness, and treatment for those conditions, have improved dramatically over the last century, stigma has not disappeared. Yet individuals, organizations, and societies are continuing to address mental health stigma and its consequences. The pressure of mental health stigma can come from family, friends, coworkers, and society on a broader level.