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 illenss.
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 to it. The degree of social distance from the individual has a greater impact than any direct effect of the illness.
The term stigma encompasses both prejudiced attitudes and discriminatory actions that can result. It involves a 4-step process, driven by 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.
Strategies to Stop the Stigma
Three broad approaches are often used as part of stigma reduction campaigns. The post How Can We Fight 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.
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.
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
Sometimes, the problem with anti-stigma campaigns isn’t what they’re talking about, but what they don’t talk about. 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 make it into the conversation.
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.
On MH@H, 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? Should you challenge it, or is it sometimes better to just ignore it? Should You Challenge or Ignore Ignorance on Social Media? talks more about that.
My personal choice is most often to focus on people who are ignorant due to lack of corrective information and ignore people who are clearly ignorant by their own choosing. It’s easy to waste a lot of cognitive and emotional energy trying to convince someone who has no interest in being convinced.
The post How Do You Respond to Stigmatized Language? refers to research findings that a wide variety of stigmatized terms for mental illness are learned at a young age. Do we want to make an issue of people using some of these terms like “crazy” or “insane”? Perhaps reappropriation of language, such as what the LGBTQ+ community has done with terms like “queer” and “dyke”, can be a means of greater empowerment.
Language and Stigma
Language matters, in the sense that language can cause harm. However, language arises 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.
Taking the illness out of mental illness?
We all have mental health, 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, just like physical health, is a dimension of health we all have, and it can range from poor to excellent. Mental illness, like physical illness, is a pathological condition that impairs the health of certain individuals.
Person-first vs. illness-first language: the war on adjectives
Person-first: “He has bipolar disorder.”
Illness-first: “He is bipolar.”
We’re “supposed to” use person-first language, 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. This seems to be particularly common 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.
If stigmatized beliefs are attached to a particular disorder, those beliefs are the issue, regardless of whether someone uses person-first or illness-first language. The use of person-first language doesn’t make bad attitudes go away.
The war on adjectives can also start to feel rather absurd. If I talk about being female, it doesn’t mean that being female 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.”
If we’re expected to use euphemisms like mental health problem/challenge/condition, because the reality of mental illness is just too scary, I would argue that’s actually likely to fuel stigma by suggesting the reality of mental illness shouldn’t be talked about.
When we try to counter stereotypes by santitizing mental illness to make it more palatable for outsiders, and present only well people as the public face of illness, that leaves out all the people who aren’t so well. Just because a stereotype is bad doesn’t mean that going to the opposite extreme is helpful or representative. There are a lot of people in between those extremes, and it’s really not serving anyone to brush them aside.
These MH@H posts have more on the topic of stigma and language:
- “Rules” for Talking About Mental Illness
- Stigma and Pathologizing Normal Human Experience
- Stigma Is Bad… Except for one Diagnosis?
- The Problem with Language Policing
- What’s in a Name? Labelling and Mental Illness.
Structural stigma goes beyond stigma that occurs on an individual level; it’s woven into the fabric of our social institutions. This kind of stigma can have huge consequences for people with mental illness, but it’s hard to fight back against.
Disclosing Mental Illness at Work talks about the good, the bad, and the ugly that can result from opening up; I’ve experienced all three since I chose to be open about my illness. My choice has always been to disclose, mostly because circumstances haven’t allowed for much choice in the matter. There are pros and cons either way, and what’s right for each individual will depend on a number of factors.
Employer discrimination against people with mental illness is illegal, but unfortunately, that doesn’t stop it from happening.
Facing Job Interviews with Mental Illness can be difficult, especially when questioned about resume gaps that may be due to illness.
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 this topic:
- Adventures in Stigma in the ER: recounts two experiences in the emergency department when they assumed my problems were 100% psych
- Just a Psych Patient? – Stigma in the ER: looks at a story reported in the news
- “It’s all in your head” is as real as it gets looks at how concerns may be dismissed as “just” anxiety
Stigmatized attitudes among mental health professionals sometimes show up in the ways they use labels. For example, “attention-seeking” is a bad thing, while help-seeking is a good thing, and “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,” and if you have borderline personality disorder, you’ll probably get labelled as manipulative.
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. There’s more about this disturbing practice in the post Mentally Ill People In Chains – A Disturbing Reality.
Health professions legislation
Legislated Stigma tells my story of experiencing stigma as a result of health professions legislation in my province. This legislation requires hospitals to report any regulated health professional hospitalized for psychiatric reasons to the appropriate regulatory body. The nursing regulator gave me the non-choice of voluntarily giving up my practicing RN license or having them take it away from me.
The Health Professions Act and the Fight Against Stigma includes an email message I sent to my provincial Minister of Health speaking up against the stigma enshrined in that piece of legislation. An Open Letter to BC’s Minister of Mental Health and Addictions follows up on the same issue a year later.
NIMBYism and Mental Health Housing: Not-in-my-backyard attitudes, which may lead people to protest new mental health housing developments in their neighbourhoods, are just another form of stigma.
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.
Alienation and Brutality looks at the documentary Alien Boy and 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.
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.
There’s a Name For That — It’s Stigma was written in response to a comment I received regarding police handcuffing those with mental illness.
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.
Social stigma is arguably the greatest when it comes to psychotic illnesses; this triggers fear and activate stereotypes, especially those related to violence. Yet, just like most stereotypes, they don’t match up with the reality.
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
- The Stigma Effect by Patrick Corrigan
- Written Off by Philip T. Yanos
Together we have the power to stop the stigma!