Stop the Stigma

The “Good Patient” and Other Mental Illness Stereotypes

Common mental illness stereotypes: image of a person in a straitjacket

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 (of the non-psychotic variety) worldview.

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 “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?

A Brief History of Stigma: the more you know, the better the position you're in to advocate

This is part of a series of posts on topics that come up in my new book, A Brief History of Stigma.

You can find it on Amazon and Google Play.

39 thoughts on “The “Good Patient” and Other Mental Illness Stereotypes”

  1. People in general don’t understand eating disorders and body dysmorphia. They look at you and shrug if you appear “normal” on the outside because they assume you should look abnormal TO THEM. But I no longer feel the need to make anyone understand, so that’s nice…

  2. The good patient stereotype applies to just about everyone, particularly women and senior citizens…Don’t get me started…I battle it every single time I interact with the medical establishment.

      1. Or, you are old so you are stupid and deaf…Last year when I was in the hospital every day there was a new “team” – charge nurse, my assigned nurse, nurse assistant. One nurse assistant was a young male who comes in and says to me, talking r e a l l y slow “This is the tv remote..Do you know how to use it?”. I told the little shit that I was old, I wasn’t stupid. Seems he then reported me to the nurse who came in and asked if there was a problem. I said keep that little shit away from me. She asked if it was because he was male, I said no it’s because he’s a disrespectful little shit. Never saw him again. (And yes, I used the word ‘shit’)

  3. I have noticed the stereo type that if you seem to the care provider to have a good level of understanding or have experience in health care/medicines etc it is much harder to address concerns as they expect you that because you know what you should be doing that you can do it.

    For example I know why and how to take medication but I have struggled for a couple of years. Any time I have briefly mentioned it I get dismissed or its just assumed that because I know what to do I should be able to do so. So I act like I am doing what I should be doing.

    I think there is also a stereo type that people who can continue to work or who can seem happy around others are not struggling with their mental health. That they are functioning.

  4. They tend more to laugh at me and dismiss me as a hypochondriac. Or get mad if I’m persistent. I love when they suggest something, and when you bring that up next time, they dismiss it because they think it’s your idea, forgetting it was theirs.

  5. These stereotypes can apply to so many groups who are labelled by their differences. Thanks for shedding more light on how they just need to be dropped entirely. Sadly, after fighting against stereotypes for many years, I have indeed internalized that which I fight against. That’s another unfortunate outcome of stereotyping individuals.

  6. These are really sad. I like to hope awareness and kindness in society to each other is on a growth trajectory. Are there studies about that? Maybe it’d fall under social science.

    1. There were big social surveys done in the 1950s and again in the 1990s, and people were more aware of mental illness but also more likely to believe that mentally ill people are violent. Part of it seems to be that the whole brain disease idea has actually entrenched notions of mentally ill people being fundamentally different and unlikely to recover.

  7. ‘good patient’ is the standard ref to a co operative one… from most of the doctors.

    Sadly many doctors expect tall their patients to be ‘ good patients’ in spite of being aware of the patient’s condition.
    An interesting and in depth analysis Ashley
    Thank you

  8. This piece moved me greatly. Made me angry. Made me sad. How society treats folks as ‘others’. I don’t have a mental illness but as a sister POC am forever fighting labels of being unreliable, lazy, loud, violent, not smart, unwilling to be a ‘good black person’ meaning one who does not mention/discuss/react to obvious mistreatment. I was raised to basically suck it up, fit in, shut up and take the crumbs handed out. I so identify with all the wonderful commentors, on your blog and all the things you share, on the regular. You make me question, in a good way, all the things I have thought about myself and others. I have reread this post half a dozen times already. It can’t be easy fighting stereotypes whilst doing the best you can. I admire your strength and all of those who fight on. Keep changing lives by being you…

    1. “It can’t be easy fighting stereotypes whilst doing the best you can.” True, and there sure are a lot of people fighting stereotypes, whether it’s mentally ill, POC, LGBTQ, or so many other characteristics that society feels entitled to judge.

  9. I have social anxiety and depression. I feel like jobs don’t see me as qualified or a good fit because I am not as sociable and stutter a lot during interviews. I have also had some guests not like that I stutter sometimes. I do feel like my social anxiety has affected my ability to do well in college. My fear of participating in clubs like the school paper made it difficult for internships to accept me to finish my degree. I was afraid to join because it would involve communicating with a mass group of people. I also have a hard time building friendships because I am seen as unfriendly.

    I have had experience with an of the stereotypes you listed but this my experience.

  10. I love this post. The “good patient” stereotype is my life with medicine, at least since my mental health diagnosis became part of the file. I’ve even been threatened with a hold to make me comply. Sigh.

    “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.”

    I especially loved this paragraph. I’m grabbing “goaty” for my personal vocab 😄

  11. Thanks for this post…. Another stereotype that I have heard of but don’t have the facts to back it up is that in some cultures mental illness is a sign that the patient is possessed by the devil or evil spirits. How is that for cray-cray?

  12. Honestly, I don’t think a lot of people blame mass shootings on mental illness. People know it’s not really true, but they say that to take the attention off of what’s actually causing this sort of stuff. Access to guns, mostly.

    1. I agree that there’s an element of distracting from the gun issue, but I get the sense that a lot of people do actually believe that someone couldn’t commit mass violence without a mental illness. I think that ties in to the just world fallacy and people’s attempts to convince themselves that “normal” people wouldn’t do such a thing.

  13. As an occupational therapist, I work with children and young adults that experience all sorts of varying abilities/conditions/challenges, and my biggest frustration is that in schools kids are labelled as not appropriate or not compliant because they don’t fit into the mold. At our day program, the therapists work hard to individualize each client’s programming so their one on one workers can help them succeed. This often looks extremely different for every single child, but they do succeed and are incredible human beings! It’s frustrating that we have these incredible stories about our clients but in the community/school/home they are seen as behavioural or non compliant because they don’t fit the “norm” and need different ways to learn/process information. They just experience the world differently and I LOVE that about them. As someone with my one mental health challenges, I feel validated by the work I do with my clients because through working with them I have come to accept my own differences and needs to thrive in the world

      1. absolutely! I find that also a lot of struggles that the average individual have are pathologized with this population. For example, no one LIKES doing the dishes so it might be something you leave for a while until you have energy, but if my clients with depression, autism, anxiety etc slack on doing their dishes it’s because they are incapable of doing it and need to learn HOW to do it so that is their OT goal ???

  14. McDonalds didn’t want me because I said I’ve ptsd and “a brain injury”. Probably because I had to describe impairments with memory.

    I got a suggestion from my sister to say I’m burned out. I get her point but she’s not worked in manyyyyy years and people don’t understand severe burnout – I’ve said “burnout” a bunch of times….

    AND ptsd and “a brain injury” is more accurate as I legit can barely work. No matter wtf C or whoever thinks. As it is, I lie about my current part time job even though I’m stressed out as fuck by frustrated colleagues. I won’t say PTSD, I’m already viewed as “slow” (physically AND mentally” with huge memory problems. I’ll probably say “brain injury” as that has less stigma. I already got asked wtf is wrong with me so I said “invisible physical health problems” because that’s true – the mind and body are linked, I’ve all kinds of shit going on, and my endocrinologist told me PTSD can affect my thyroid hormones.

      1. Yeppp. >.< trouble processing instructions too due to people talking fast and impatiently, plus cognitive impairment and a really noisy environment

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