Mental Illness: Stop the Stigma

Mental illness: Stop the stigma - graphic of face and megaphone with the words "speak up"

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.

My next book, A Brief History of Stigma, will be released later in 2021.

Stop the Stigma – Page Outline

You can find all of the posts on MH@H related to stigma here.

Suicide in particular is the target of a great deal of stigma, with selfishness being a major theme. There’s more on this on the Straight Talk on Suicide page.

What Is Stigma?

Stigma isn’t inherent in mental illness; rather, it comes from social beliefs about what’s considered “normal” and socially acceptable. It encompasses stereotypes and prejudiced attitudes and discriminatory behaviours that may result. Stereotypes are learned early and etched deeply in people’s minds.

Stigma occurs through a 4-step process:

  1. Distinguishing and labelling of human difference
  2. Linking those differences to stereotypes
  3. Separating “us” from “them,” making the person with mental illness Other
  4. Status loss and discrimination

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
  • 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
Model for how self-stigma happens

Self-Stigma

Sometimes stigma is internalized to become self-stigma. This happens when there is agreement with stereotypes, and those stereotypes are seen as applying to the self.

Connecting with others within the mental illness community, including peer support, can be a powerful 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:


How do we fight stigma most effectively? Education? Language change? Protest? Contact?

Strategies to Stop the Stigma

Three broad approaches are often used as part of stigma reduction campaigns. Theses are explored further in the post on fighting stigma most effectively, which is based on Patrick Corrigan’s excellent book The Stigma Effect.

Protest

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

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

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)

Anti-stigma organizations

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.

Join the movement. #SickNotWeak logo
Stigma Fighters logo
NAMI stigma-free
Bring Change to Mind logo
Makeitok.org logo
NoStigmas logo

Raise Your voice

In order to stop stigma, we need to speak up, and show that we are not the stereotypes that people try to force onto us.

Ways to share your mental health story

Want to share your mental health story?  Ways to share your mental health story contains links to a variety of 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? I would recommend not wasting 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 & stigma - graphic of tree made up of dialogue bubbles

Language and Stigma

We choose language based on our beliefs, not the other way around. 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 make sure that the message is directed at the right audience; trying to change language choices by people with mental illness targets the wrong audience.

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:


Taking the illness out of mental illness?

Contrasting mental health and 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 don’t know why the wheels fall off when you sub in the word mental.

Mental health ≠ Mental illness


Person-first vs. illness-first language

person-first language and mental illness

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. However, not everyone identifies themselves that way

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 a 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, along with language that would be considered stigmatized and cringeworthy if one were to substitute in the name of any other diagnosis.


Structural stigma: icons of where it occurs

Health care

Mental health care and research has not kept up with the resources allocated to physical health. Adequately funding community mental health care could make a huge difference with better service levels and reduced spending on high-cost acute care over the longer term. By addressing this social disparity, people with mental illness can gain greater autonomy and improved prospects for recovery.

An oddity of the mental health care system in the US is they use the term behavioural health. How is mental illness a “behaviour” disorder? Is labelling it that way actually a reflection of stigma?

When those of us with mental illness seek care for physical health problems, there’s a very real risk that the health care provider could get caught up in diagnostic overshadowing. This means they’re so caught up in the psych diagnosis that they fail to realize someone’s having a heart attack. This is actually very literal; people with a psych diagnosis presenting to ER with heart attack symptoms are less likely to be accurately diagnosed and sent to the cardiac catheterization lab for treatment.

These posts on stigma and health care are based on my own and others’ experiences:

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.

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:


Police

police wellness check gone wrong - graphic of police badge and handcuffs

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. Compounding 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 Another 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 That’s Stigma.

The documentary Alien Boy examines the police brutality that resulted in the death of a man with schizophrenia.


Other areas of structural stigma

Employment

Housing


Social stigma: Outline of a woman's head with the words "we judge because we don't understand"

Social Stigma

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

The media can play a major role in perpetuating stereotypes, especially the mentally ill = violent stereotype.


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.

Stigma in online communities

Sometimes, the nonsense people come out with online is so absurd that it’s hard to tell whether to be offended or just laugh at the stupidity of it.


multicoloured open book with butterflies

Stop the Stigma – Further Reading


TED Talks on Stigma

In this talk, Sangu Delle addresses the stigma faced by African men experiencing mental health problems. He shares the results of a Nigerian study, in which 34% thought mental illness was due to drug use, 19% thought divine wrath was the cause, and 12% blamed witchcraft. Sounds like there’s a lot of work to be done!


This powerful talk by Max Silverman speaks to the ways that mental illness is treated differently than mental illness.


In this passionate, high-energy talk, Ruby Wax uses humour to address common stereotypes and misconceptions about mental illness.

Together we have the power to stop the stigma!