How can we fight stigma most effectively?

Mental Health @ Home - How can we best fight mental health stigma? - graphic of loudspeakers blaring the word change

I was inspired to write this post after reading the book The Stigma Effect: Unintended Consequences of Mental Health Campaigns.  It’s written by psychologist Patrick Corrigan, whose research on stigma I first encountered when I was working on my Master’s thesis, and in it he challenges a lot of commonly held ideas about how we should fight stigma.

The stigma effect that the book is based on refers to unintended negative consequences of anti-stigma efforts.  While public campaigns to fight stigma are well-intentioned, it turns out that in some cases they may actually end up having the opposite effect.  That’s why I think it’s really important that we pay attention to what Corrigan has to say in order to make sure that we’re being as effective as possible in the fight against stigma.

What is stigma?

Corrigan starts the book with a primer on what stigma is.  Stigma is not actually inherent in mental illness itself.  Instead, things like psychiatric symptoms, social skills deficits, poor hygiene, and illness labels act as cues for people to apply stereotyped beliefs and discriminatory behaviours.  Stereotyped beliefs are framed as facts, but in reality are based on inaccurate assumptions.

We’ve all been exposed to the stigmatized belief that people with mental illness are dangerous and unpredictable.  Corrigan explains that in a 2006 study, around 40% of Americans thought people with mental illness were dangerous.  This was about the same as the figure in 1996, and double that from 1956.  Yet it would seem that there is much more education now about the reality of mental illness and public exposure to anti-stigma campaigns, so something isn’t adding up here.

How do we fight stigma?

The book outlines three broad types of anti-stigma approaches: protest, education, and contact.  These may be informed by different agendas depending on who’s leading the campaign.  Professional groups tend to promote the idea that decreasing stigma will lead to more people accessing mental health services.  Families and other supporters may have a similar agenda, whereas people with mental illness may be more focused on promoting dignity and self-worth.

Slacktivism

Corrigan uses the term “slacktivism” in which people are able to easily endorse or support something, e.g. on social media.  This takes little effort and generally doesn’t translate into any sort of meaningful action.  There are multiple large campaigns that allow for slacktivist engagement, like Time To Change‘s Time To Talk Day or Bell Let’s Talk Day.  There is a ton of promotion and these efforts capitalize on the easy buy-ins across a broad swath of the population, but from what Corrigan has to say these may not be very effective.

Language usage

Chances are many of us have seen (or been) people arguing about language change, such as using “completed suicide” rather than “committed suicide”, or “person with schizophrenia” rather than “schizophrenia”.  Except you know what?  It can actually have a negative effect, according to Corrigan.  There are a couple of elements to this.  If you tell someone not to think about a white bear, what are they guaranteed to think about?  A white bear.  Also, we haven’t necessarily come that far from our inner 6-year-old; telling people what not to do naturally triggers psychological resistance to change.  Corrigan also points out that language is the result of stigma, not the cause of it, so targeting language ends up trying to address the issue backwards.

I found it interesting that Corrigan uses the term patient to refer to a role that people play.  I choose the same term in the same context, although I recognize some may see it as archaic.  Apparently surveys of people with lived experience show no particularly label that’s preferred; however, consumer has been found to be the least preferred.  That rather surprised me.  Personally I can’t stand the term consumer, but thought I was somewhat alone in this; apparently not.  The term consumer is fairly popular, though, which makes me wonder if its use is because organizations are trying to be politically correct.

Education as a strategy to fight stigma

When it comes to attempts to educate the public about mental illness, Corrigan doesn’t mince words: “Education, at least for adults, is an overrated, mostly feckless approach to erasing stigma.”  He gives the example of myths versus facts as a common type of educational approach.  This seems rather unfortunate; I certainly love me a good myths vs facts!  The messages are likely to go right over the head of the average person who is already prejudiced; plus, they can trigger a psychological resistance effect that can actually increase stigma.  Corrigan gave the example that something similar been observed with campaigns to educate parents about vaccines, which have actually increased resistance to vaccination.

Another surprise?  Apparently public service messages that mental illness is biologically based are actually unhelpful, because people seeing these messages tend to conclude that recovery is unlikely.  Even cheerful antidepressant ads about suddenly un-depressed people singing and dancing and enjoying life can also lean people towards conclusions that recovery is unlikely.  One of the messages that I tend to be quite attached to is that mental illness is just like any other else, but guess what?  Such messages can actually increase perceptions of dangerousness and unpredictability.

Contact as an anti-stigma strategy

Ok, so what does work?  For “normal” people to have contact with people living with mental illness.  It’s most effective when the contact is with average people rather than seeing celebrities open up about their experiences with mental illness.  Contact works best with people who are believable as having a mental illness, but don’t conform closely with stereotypes.  Contact with someone who is acutely unwell and acting like a “crazy person” is more likely to reinforce stereotypes.  Contact also works better when it’s with people from similar sociocultural groups.

Corrigan explains that contact is effective because not only does it decrease negative beliefs, it helps to replace them with positive ones.  It’s 2-3x more effective than education at changing stigmatized attitudes.

What advice does he have for us to share our stories effectively?  We should share stories of our illness experiences, but also about our recovery journeys.  We should talk about how we have been affected by stigma in spite of what we’ve managed to overcome, and conclude with a call to action to address this injustice.

The thing with contact, though, is that it requires us within the mental illness community to speak up.  To have the greatest effect, we need to not openly speak up anonymously online, but also “come out” as mentally ill in our regular environments.  We need to make it personal.  We need to demonstrate that there are many faces of mental illness, not just the stereotyped homeless person on the street.  That’s not to say that coming out is easy, but to really make a dent in stigma a critical mass of us needs to do so. We truly can be the change we wish to see in the world.

Were you surprised by anything this book had to say about what does and doesn’t work? Do you have any ideas about the best way for us to fight stigma?

 

You can find The Stigma Effect on Amazon.

I received a reviewer copy of The Stigma Effect from the publisher via www.netgalley.com.

This post contains affiliate links.

 

Visit the Mental Health @ Home Store to find my books Making Sense of Psychiatric Diagnosis and Psych Meds Made Simple, a mini-ebook collection focused on therapy, and plenty of free downloadable resources.

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27 thoughts on “How can we fight stigma most effectively?

  1. Invisibly Me says:

    Slacktivism, I think that happens a lot. While not causing any lasting impact on those who do it, I don’t think it’s necessarily a bad thing; it could still have a subconscious impact and boost any awareness campaign when they share things (going for the ‘every little helps’ approach). Language can have subtle implications yet very powerful ones, as long as we don’t get too caught up in it to the point of absurdity. I do think people need to stand up and be heard, but it’s easier said than done for many as you say, but the tide is slowly turning. I definitely think more needs to address the multi-faceted nature of mental health and illness, just as with physical illness, and how much it varies from one person to the next, how it’s not ‘one size fits all’, how it doesn’t ‘look’ the same each time. Interesting post..!
    Caz xx

  2. Marie Abanga says:

    Ashley, I must appreciate you for the ‘professional’ effort you put into your reviews and all such analysis.

    Now, this book seriously has several standpoints I share and champion out here. I hate that word consumer too, I mean consumers do so ‘willingly’ right? User or peer are better options for me. In the end however I really don’t care about language, sometimes I rub it in people’s faces hahaha
    Education and what I call “World Day campaigns” hmmmmmmmmm that’s for another comment, but I just smirk sometimes and roll waiting to see actions…
    Contact, that I do and encourage.
    I think this is a great book going by your analysis. Thanks for doing them and sharing with us. Will note to buy on the Amazon next time via the affiliate links here

  3. Meg says:

    Huh. Great, thorough review of a book about an important topic!!

    I agree with him that we should “come out” in our personal lives. So I tell just about everyone I know (beyond an acquaintance) that I’m schizophrenic. It’s not really like a self-pity thing, but more of an “I’m schizophrenic, and I make it cool, because it is cool,” thing. (I don’t feel strongly about the whole “I have schizophrenia” versus “I am schizophrenic” issue, although of course we should support the individual’s preference, if someone has one.)

    I’ve gotten some odd reactions to it:

    * “So you think you have a major mental illness? No, you seem too ‘normal’ to me.” I tend to take that one as a compliment, and I start describing the five medicines I take each day.

    * “You probably don’t need those drugs, but I understand you think you need them. If you were to do more meditations or calming visualizations, you could probably go off them slowly.” My reaction to this one involves my eyebrow shooting up, followed by an admonition that the person should run fast and far if I’m ever stupid enough to go off the meds.

    * You know I love my brother’s girlfriend, Teri, but a year ago at Christmastime (2017), I gave her tween daughter a unicorn bank for Christmas. It came from Books-a-Million unpackaged, so I concealed it in an empty cardboard box of Mr. Kitty’s cat food fillets. From what I understand (I wasn’t there), the little girl unwrapped it, and the whole family decided I’d given her cat food for Christmas. Yeah, and they didn’t even have a pet cat… so. While I laughed it off (it was a few weeks before the girl finally opened it and found her unicorn bank), I couldn’t help but figure that they thought I’d given her an oddball cat-food gift due to my being schizophrenic. Definitely stigmatizing, albeit unintentionally.

    Sorry I don’t have any great conclusions to add!!

  4. DV says:

    One thing that hasn’t been mentioned – not sure if it is in the book or not – is how mental illness is represented in tv/movies. It’s nearly always negative – violent crazy people. I’m sure that contributes vastly to stigma and also to people with mental illness feeling even more isolated, because they can’t identify with what they are seeing. I’ve certainly found that attittudes to all sorts of “other” have changed for the better in the last twenty years just from seeing them as part of normal life on screen instead of something weird or different; things like racial and cultural diversity, disability, sexuality, gender. Mental illness deserves the same inclusiveness and normalisation.

    • ashleyleia says:

      Absolutely. The book touched on that briefly, and also mentioned the negative effect of politicians blaming gun crime on mental illness. More inclusiveness and normalization would definitely be a good thing.

  5. Autistickish says:

    I’ve always assumed that the idea of a mental health stigma had to do with things like incompetence or danger, and although I think that’s also true, it’s only been in the last couple of years that I’ve started to see the importance of the notion of malingering, or faking/exaggerating a disability in order to shirk various kinds of responsibilities.

    I think part of the issue relates to the fact that no matter how bad one has it, there’s usually lots who have it much worse, and as long as an observer can compare me (for example) to those who have it worse, that person will be more or less likely to stigmatize me as some sort of malingerer.

    It’s probably impossible to keep that from happening, but what is possible is that I can choose to join those who might judge me thus in focusing on those who have it worse than I do. If I commit to doing that, perhaps I can eliminate or reduce at least that aspect of stigma. They might still misjudge me as incompetent or dangerous, but at least they won’t see me as a malingerer.

    A serious obstacle to that strategy, of course, is the fact that one’s own problems will always be much more salient (problematic?) than the problems of others. Even if both of your legs are broken, it’s my sprained ankle that makes it hard for me to walk.

  6. suninthespring says:

    Well this is interesting and good to know!!! I’ve heard that contact with people of different races, especially being friends with people of different races, decreases racism, so it makes sense that it would be the same with other stereotypes.

  7. seaofwordsx says:

    Beautiful post 💕👌 I agree with what you have written. Unfortunately, there’s still a stigma of mental health illnesses but it’s getting better. People are speaking up. It’s just so important that we all speak up about it not only celebrities. It feels like only when a celebrity suffers from a mental illness the whole world is in shock. We all have to care about each other. Each person matters 💕 We are all in this together 🙏

  8. ezi2015 says:

    I get the whole “slackvism” thing, but we should talk about mental health stigma the way we talk about everything else. Think about things our grandparents wouldn’t DARE talk about like say…erectile dysfunction or birth control methods, if ppl didn’t talk about them. So while talking about mental health awareness may seem mundane, slow…lazy it needs to be made part of our conversations

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