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
What Is Stigma?
Stigma isn’t inherent in mental illness; rather, it comes from social beliefs about what’s considered “normal” and socially acceptable, and what kinds of identities are considered deviant. These deviant identities, like mental illness, are seen as encompassing the whole person. Stigma includes stereotypes, prejudiced attitudes, and discriminatory behaviours. Stereotypes are learned early and etched deeply in people’s minds.
Stigma occurs through a 4-step process:
- Distinguishing and labelling of human difference
- Linking those differences to stereotypes
- Separating “us” from “them,” making the person with mental illness Other
- Status loss and discrimination
Stigma can occur on multiple different levels:
- public stigma: public views and discrimination around mental illness
- individual: stigma applied on a one-to-one basis
- structural stigma: this is entrenched in laws and policies in governments and other institutions, and often involves arbitrary distinctions based solely on membership in the broad group of people with mental illness.
- 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
The Self-Stigma Process
Sometimes stigma is internalized to become self-stigma. This happens when stereotypes are seen as valid, resulting in those stereotypes being applied to the self. This can influence behaviours through a “why try” attitude.
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, enduring, 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. No matter how attached to it people are, though, the stereotype is not accurate.
The following posts address this:
- Are “Psycho Killers” Psychotic? (most likely not)
- Psychotic Does Not Mean Violent
- Why Psychosis Scares People
- Stigma in the News: “Psychotic” Abuser: a news article uses “psychotic” as an adjective, apparently intending it to mean violent
In article on the online magazine National Affairs, Manhattan Institute fellow Stephen Eide argued In Defense of Stigma. Among the points he made were that people with mental illness actually are violent, and people with schizophrenia are fundamentally different from everyone else. While off-the-cuff endorsement of such stereotypes isn’t that unusual, it’s a bit surreal to see someone writing an essay trying to justify it.
Strategies to Stop the Stigma
Three broad approaches are often used as part of stigma reduction campaigns. These are explored further in the post on fighting stigma most effectively, which 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.
- Bring Change to Mind
- Join the Conversation
- Like Minds, Like Mine (New Zealand)
- NAMI StigmaFree initiative
- SANE Australia Stigma Watch: monitors and responds to inappropriate media reporting
- See Me (Scotland)
- Stigma Fighters
- Stigma Free Society toolkits for rural, student, and COVID/youth
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. Coming out as having a mental illness and sharing both the challenges and obstacles overcome are powerful ways of demonstrating to the world what mental illness actually looks like without the stereotypes. You don’t have to be an influencer to do this; you just need to be a regular person who’s willing to share your truth.
- Jack.org speakers (young adults 18-26)
- NAMI has a few different speaker series; check with your local NAMI organization
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
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 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 don’t know why the wheels fall off when you sub in the word mental.
Mental health ≠ Mental illness
Person-First vs. Identity-First Language
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.
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.
Serenity Integrated Mentoring was a program adopted by almost half of NHS Trusts in England. It involved pairing high emergency service users (mostly people with borderline PD and a history of sexual abuse) with a police “mentor.” Under SIM, patients could be refused emergency services, including are at A&E after a suicide attempt. A grassroots coalition of mental health service users and allies called StopSIM forced the NHS to stand up and take notice, in a remarkable example of the impact people with mental illness can have when they come together.
These posts on stigma and health care are based on my own and others’ experiences:
- Adventures in Stigma in the ER
- “It’s all in your head”
- Just a Psych Patient? – Stigma in the ER
- My Negative Experiences as a Psych Patient
- 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
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
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 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
In 1991, the United Nations General Assembly adopted a set of principles for the protection of humans rights of people with mental illness. Talk is good, but action is what matters.
- 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.
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.
- 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.
- Willful Ignorance and Stigma: Speaking of ignorance, these gems come from Debate.org
The COVID-19 pandemic has brought mental health to the forefront, with governments and organizations putting out messaging around the importance of supporting one’s mental health. But will it bring about any change in stigma once the restrictions are over?
The media can play a major role in perpetuating stereotypes, especially the mentally ill = violent stereotype.
- Homelessness & Addiction: A Newspaper Embraces Stigma 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
A number of organizations have put together media reporting guidelines to support responsible reporting related to mental illness, including:
- Mind (UK)
- Mindframe (Australian)
- Mindset: Reporting on Mental Health (Canadian)
- TEAM Up Style Guide (US)
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.
Stop the Stigma – Further Reading
- 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
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!