Inaccurate & Damaging Mental Illness Stereotypes

Stereotypes are a way that we store knowledge about social categories. When a category is considered by society to be deviant, such as the group of people who are mentally ill, members of that category tend to be viewed as a homogeneous group that is accurately represented by stereotypes.

There may be a grain of truth to stereotypes in some cases, but they’re not accurate when applied uniformly across a group. Those of us with mental illness are all unique individuals, and we’re a very diverse group of people, but for the society that has Othered us, they may only see all stereotype, all the time. They also tend to assume that stereotypes are factual, even though they may be entirely inaccurate.

We all have both implicit and explicit beliefs. Explicit beliefs are conscious and voluntary, while implicit beliefs are unconscious and they come to mind automatically when we’re in a situation where those beliefs apply.

We learn many implicit beliefs through early socialization, including stereotypes associated with mental illness. Even if people express affirming explicit beliefs about people with mental illness, they may still have stereotypes stored implicitly that they’re not consciously aware of.

Some common public stereotypes

Here are some of the common stereotypes that the general public associates with mental illness.

Violence

Every time there’s a mass shooting, people start blaming it on mental illness. In particular, people tend to believe that those with psychotic illnesses are violent. However, a mental illness diagnosis doesn’t have any predictive value in determining who will commit mass shootings.

Most people who have a mental illness are no more likely to be violent than anybody else. There are a few exceptions, like people with antisocial personality disorder, substance use disorders, intermittent explosive disorder, or people experiencing command hallucinations to harm others.

Psychopathy, which isn’t a mental illness, is a significantly bigger risk factor for violence than having a mental illness. So is being male, but you don’t see anyone talking about limiting gun access to angry white men with a paranoid worldview (of the non-psychotic variety).

Unpredictability, unreliability

Unpredictability and unreliability are also common stereotypes, and they can fuel discrimination in contexts like employment and housing. The unpredictability stereotype often goes hand in hand with the violence stereotype. Watch out, you never know what the scary-crazy person might do!

Moral weakness

Some people see mental illness as a moral failure involving weak character, lack of control, and lack of willpower. They may blame us for the onset and continuation of our illnesses, and see us as undeserving of help as a result.

Moral contagion comes from the belief that spending time around someone who has a mental illness may result in “catching” that person’s presumed moral weakness.

Incompetence

Another common stereotype is that people with mental illness are incompetent, unable to work or function independently, and need others to make decisions for them. This stereotype may be approached in an authoritarian or a benevolent manner. An authoritarian approach can limit the rights and freedoms of mentally ill people, while a benevolent approach can mean the mentally ill person is treated like a child.

One of the beliefs that can go along with incompetence stereotypes is that people with mental illness are unhygienic. This is a good example of something that has a kernel of truth but isn’t true when applied broadly to all people with mental illness. Depression can make showering hard. So can negative symptoms of schizophrenia. The fact that hygiene deficits can sometimes occur as a result of symptoms does not in any way mean that everyone and their goat who has a mental illness is dishevelled, dirty, and/or smelly. Some of us are goaty. Most of us are not.

The “good patient” stereotype

I consider the “good patient” stereotype to be the expectations that many mental health treatment providers have about how a psychiatric patient “should” behave in the context of the treatment relationship. This stereotype isn’t universally endorsed by all treatment providers, but it’s pretty common, especially in hospital settings.

The specific expectations associated with the “good patient” can vary depending on the setting, but they can include:

• being cooperative and accepting whatever the treatment provider thinks is best
• not asking too many questions
• treating the health care provider as the authority
• not challenging the treatment provider(s)
• being willing to tolerate side effects
• being willing to tolerate symptoms that aren’t being addressed
• operating on the treatment provider’s timeline rather than the patient’s
• in hospital: not making requests outside of designated times, accepting without question the various arbitrary limits that have been created

The graphic below is a good example of the “good patient” stereotype in the context of chronic pain.

While these expectations aren’t necessarily conveyed verbally, they often exist as unwritten, unspoken rules. When patients don’t conform to these expectations, they may be brushed off by treatment providers as being difficult.

We are not stereotypes

I’ve been hit with the unpredictability/unreliability stereotype in the past in work contexts. Coworkers were fine, but management clearly saw me as unreliable.

I’ve encountered the incompetence stereotype from health care providers. The worse my psychomotor slowing has gotten, hence the more overt my illness is, the more I tend to be treated like I’m a complete dolt.

When I was in hospital, I encountered the good patient stereotype a lot. I was not interested in meeting the expectations of that stereotype, which definitely created friction.

Have you experienced stereotyping? What particular stereotypes seemed to be the most prominent?