Mental illness may be difficult to live with, but the associated stigma can be even more challenging. It’s time to let the light in to shine on those of us working hard every day to make the most of the hand that mental illness has dealt us. We all have the power to be stigma warriors. It’s time to come together to stop the stigma around mental illness.
Stop the Stigma – Page Outline
What Is Stigma?
In the 1960s, sociologist Erving Goffman, a pioneer in stigma research, explained that stigma is not inherent in mental illness; rather, it comes from the associated social response. The degree of social distance from the individual has a greater impact on the perceived “craziness” than any direct effect of the illness.
The term stigma encompasses stereotypes and the prejudiced attitudes and discriminatory actions that can result. It involves a 4-step process, which is dependent on power differentials:
- Distinguishing and labelling of human difference
- Association of those differences with negative attributes that are linked to stereotypes, which often occurs automatically
- Separating “us” from “them,” thus othering the person with mental illness
- Status loss and discrimination experienced by the person with mental illness; this discrimination may be individual or structural (built into institutions like governments, schools, and employers)
Stigma can occur on multiple different levels:
- public stigma: public views and discrimination around mental illness
- individual: public stigma applied on an individual level
- structural stigma: entrenched in laws and policies in governments and other institutions
- self-stigma: occurs when public stigma is internalized
- label avoidance: perceived and individual level stigma related to a particular illness leads to attempts to avoid having that label attached to oneself
- feared vs. experienced: even if prejudice and discrimination aren’t presently occurring, the expectation that they’re likely to occur and the hypervigilance that results are also very damaging
Connecting with others within the mental illness community, including peer support, can be an important way of combatting self-stigma.
Violence and Other Stereotypes
One of the most common and damaging stereotypes about mental illness is that mentally ill people are chronically dangerous and violence-prone. This stereotype, which is regularly reinforced by the media, evokes fear, leading to discriminatory behaviours, avoidance and social withdrawal. The problem is, no matter how attached to it people are, the stereotype is not accurate.
The following posts address this:
- Are “Psycho Killers” Psychotic?
- Psychotic Does Not Mean Violent
- Why Psychosis Scares People
- Stigma in the News: “Psychotic” Abuser
Strategies to Stop the Stigma
Three broad approaches are often used as part of stigma reduction campaigns. The post on fighting stigma most effectively explores this further, and is based on Patrick Corrigan’s excellent book The Stigma Effect.
Protest strategies call out stereotypes and discrimination, and call on people to address the injustices identified. However, they may end up triggering reactance, a form of psychological resistance that arises from a sense that one’s freedom threatened. This actually tends to promote the opposite of the intended effect, with people doing the opposite of what’s being asked in order to exert their freedom.
Education about mental illness can provide corrective information to counteract stereotypes. These types of strategies can be done on a large scale and are relatively low-cost to implement. However, this approach assumes that lack of information is the cause of stigma, which isn’t necessarily the case.
Contact with people who have a mental illness is the most effective way to decrease stigma. Specifically, it’s most effective when the contact involves:
- equal social status
- one-on-one contact
- engaging together in a rewarding activity
- interactions that moderately disconfirm stereotypes (but the person is still “convincing” as someone who has a mental illness)
These are just a few of the organizations doing some amazing work by promoting dialogue around mental health and stigma on a broader scale. On their sites, you can get involved in awareness initiatives and read the stories of others living with mental illness. What if the Elephant in the Room Could Speak? was a piece I wrote on Bell Let’s Talk Day looking at some of the important things that don’t always make it into the conversation.
You can also check out the anti-stigma pledges on these sites, which you can share across your social channels:
- b stigma-free pledge
- Join the Conversation pledge to end stigma
- Make It OK pledge to erase stigma
- National Alliance on Mental Illness (NAMI) StigmaFree pledge
- Stamp Out Stigma pledge to recognize, reeducate, and reduce stigma
Raise Your Voice
In order to stop stigma, we need to speak up. Research has shown that the most effective way to fight stigma is for those of us with mental illness to come out loud and proud. Contact with regular people with mental illness is the most effective way to bring about change in people’s stigmatized attitudes.
Want to share your mental health story? Ways to share your mental health story contains links to major mental health sites where you can submit stories.
For MH@H community features, I welcome guest posts from new mental health bloggers as part of the Emerging Blogger series. The Wounded Healer interview series showcases people with mental illness who work in helping fields.
Responding to stigma
Ignorance and stigma seem to be all around us, so how best to respond? My recommendation would be to not waste your energy on people who are clearly ignorant by choice, because they’re just likely to feed off of your reaction. You’re more like to see positive results focusing on people who are ignorant through lack of information or perspective.
The following posts explore this further:
Language and Stigma
Language matters, in the sense that language can cause harm. However, language choices arise from beliefs, not the other way around. If the underlying attitudes remain the same, attempts at language change will only work superficially, if at all. Research has shown that language policing isn’t effective, and can actually worsen stigma, so it’s important to be careful about where we direct our efforts.
It’s also important to consider the target audience. If language change efforts target people with mental illness or those who support us, we’re aiming at the wrong people.
The Euphemism Treadmill is a fascinating way of looking at the way the “correct” language for a concept because tainted and is then replaced by new “correct” language that means essentially the same thing. It’s not the word that’s the problem; it’s negative attitudes toward what’s being named/described.
These MH@H posts have more on this topic:
- Is It Helpful to Sanitize Mental Illness?
- “Rules” for Talking About Mental Illness
- Stigma and Pathologizing Normal Human Experience
- What’s in a Name? Labelling and Mental Illness
Taking the illness out of mental illness?
We all have mental health, ranging from poor to excellent, but only some of us have mental illness. Yet for some reason, this seems to be unclear, and even people with mental illnesses use them synonymously.
Yet no one seems to have trouble differentiating physical health from physical illness, so I truly have no idea why the wheels fall off when you sub in the word mental.
Mental health ≠ Mental illness
Person-first vs. illness-first language
Person-first: “He has bipolar disorder.”
Identity/illness-first: “He is bipolar.”
Person-first language has become the “correct” way of talking about illness and disability, with the idea being that an illness doesn’t define someone. The thing is, though, there are a fair number of people who use illness-first language with respect to themselves, especially among people with bipolar disorder. The push for person-first seems to have been driven by mental health organizations rather than arising from a preference expressed by people with mental illness. Yet person-first language doesn’t make stigmatized beliefs spontaneously vanish.
If I talk about being female or brown-haired, it doesn’t mean that either of those defines the sum total of who I am. So why should it be any different if I identify as mentally ill? If someone has a problem with me because I’m female, that’s probably because of misogyny rather than the word “female.” Likewise, if someone has a problem with me because I’m mentally ill, that has a lot more to do with the stereotypes in their minds rather than the fact that I say “mentally ill” instead of “person with lived experience of mental illness.”
An interesting exception to the way people commonly talk about mental illness is with narcissistic personality disorder and the whole narcissistic abuse phenomenon. Armchair diagnosis is embraced, as is language that would be cringeworthy if one were to substitute in the name of any other diagnosis.
In the US, treatment for mental illness and substance use disorders is often referred to using the term behavioural health. My question, though, is how is any of that a “behaviour” disorder? Is labelling it that way actually a reflection of stigma?
People with mental illness are likely to have our physical health concerns dismissed as being a result of the mental illness. This is true in primary care settings as well as emergency departments. Multiple studies have shown that people with a mental illness diagnosis are less likely to receive preventative care, routine health maintenance care, or emergency interventions compared to people without a psych diagnosis.
Posts on stigma and health care:
- Adventures in Stigma in the ER: recounts two experiences in the emergency department when they assumed my problems were 100% psych
- “It’s all in your head” looks at how concerns may be dismissed as “just” anxiety
- Just a Psych Patient? – Stigma in the ER: looks at a story reported in the news
- The Problem with Involuntary Psychiatric Treatment
Mental health professionals may use labels like
- “attention-seeking” is a bad thing, while “help-seeking” is a good thing
- “drug-seeking” is a bad thing, while “medication compliance” is a good thing
- If you’re a “difficult patient,” you may be labelled a “borderline”
- If you have borderline personality disorder, you’ll probably get labelled as manipulative.
And if you do try to complain about getting inadequate care? Your official complaint might just be treated like a joke.
Health professions legislation
Health professionals who have a mental illness may face licensing hurdles that someone with a physical illness wouldn’t have to deal with. I live in British Columbia, Canada, where provincial the Health Professions Act requires hospitals to report any regulated health professional who is hospitalized for psychiatric reasons. This has nothing to do with a determination individual risk; it’s simply whether someone has a physical condition (e.g. brain tumour) or mental condition (e.g. depression). That kind of arbitrary difference is one of the fundamental characteristics.
You can read more about this issue in these posts:
- Legislated Stigma
- The Health Professions Act and the Fight Against Stigma
- Open Letter to BC’s Minister of Mental Health and Addictions
The documentary Alien Boy examines the police brutality that killed a man with schizophrenia.
A Police Wellness Check/”Arrest” Gone Wrong looks at how a police “wellness check” on nursing student Mona Wang turned into a police officer dragging her along the floor while semi-conscious and in handcuffs, and stepping on her head. To compound the problem, a local newspaper headline said she was “arrested” by police, when in fact she was apprehended under the Mental Health Act and taken to hospital.
Retraumatization and a Police Wellness Check Gone Wrong tells another story of a wellness check that went south when police entered the wrong home, retraumatizing residents who had already been traumatized by police .
Defunding the Police: What It Could Mean for Mental Illness questions why police are the de facto emergency mental health service rather than having it dealt with as a health issue by health services.
Should People in Mental Health Crisis Be Handcuffed? was written after my encounter while working as a nurse with a local police force that, as standard practice, handcuffs anyone being taken to hospital because of a mental health crisis. I addressed a stigmatized comment on that post in There’s a Name For That — It’s Stigma.
Other structural stigma
- Disclosing Mental Illness at Work: the good, the bad, and the ugly
- Employer discrimination
- Job interviews: the unique challenges with mental illness
- NIMBYism and Mental Health Housing
- We All Deserve a Roof Over Our Heads, yet people with mental illness are at increased risk of homelessness. Hospitals may discharge patients from a psychiatric ward to an emergency shelter because there’s nowhere else to go.
In some rather surprising statistics from 2008, 55% of Canadians said they would be unlikely to marry someone with a mental illness, 46% saw mental illness as an excuse for bad behaviour, and 27% would be afraid to be around someone who was mentally ill. Those numbers seem incredibly high for not all that long ago.
In some cultures, mental illness is believed to come from God, or from demons or evil spirits. Attempts to manage the illness are religious rather than medical in nature. People may be chained to trees for years at a time.
The media can play a major role in perpetuating stereotypes, especially the mentally ill = violent stereotype.
- Homelessness & Addiction: Embracing Stigma in a Third-Rate Newspaper looks at a newspaper editorial that expressed negative views towards homeless people experiencing addictions
- Stigma in the News: “Psychotic” Abuser looks at a news story that used psychotic as a synonym for violent
Stigma in film
- A Prescription for Murder is a documentary that blames psychiatric medication for James Holmes’ 2012 mass shooting in Aurora, Colorado.
- Letters from Generation Rx is a documentary that argues psychiatric medications turn people into killers.
- Take Your Pills is a Netflix documentary that offers a very skewed look at the stimulant medications used to treat ADHD, suggesting that they’re basically the same as crystal meth and they’re mostly misused.
- TED Talks on Stigma: There is some light shining in the darkness, including these TED Talks.
Stigma in online communities
Sometimes the nonsense people come out with online is so absurd it’s hard to tell whether to be offended or just laugh at the stupidity of it.
- Gems of ignorance from Quora: Quora.com is a hotbed of ignorance to begin with, and some of the questions (and answers) posted there absolutely reek of stigma. Since there’s just so much stupidity to go around, there are several follow-up posts: Dumb and Dumber, More from Quora, and Maybe stupidity is contagious.
- Willful Ignorance and Mental Illness Stigma: Speaking of ignorance, these gems come from Debate.org.
Further Reading on Stigma
- A Series of Unfortunate Stereotypes by Lucy Nichol
- No One Cares About Crazy People by Ron Powers
- Nobody’s Normal by Roy Richard Grinker
- The Stigma Effect by Patrick Corrigan
- Written Off by Philip T. Yanos
Together we have the power to stop the stigma!