People with mental illness have long experienced prejudice and discrimination. To stigmatize someone is to regard them worthy of disgrace or great disapproval. For the individual who is struggling to maintain their overall health and wellness a stigma poses a barrier to them being a member of the community and to being able to love and fully accept themselves. The etiology of stigmas surrounding mental illness come from the misguided views that those individuals who have a mental illness are different than those who do not have one. Subsequently, society has stereotyped its views about mental illness and the way it impacts people’s lives. Furthermore, the media also continues to perpetuate this belief by reporting news stories often linking those who have a mental illness with violent crimes. The American Psychiatric Association breaks stigma down into three distinct categories:
- Public Stigma: which involves the negative or discriminatory attitudes that others have about mental illness.
- Self-Stigma: which refers to the negative attitudes including internalized shame that people with mental illness have about their own condition.
- Institutional Stigma: which is systemic and involves polices of both governments and private enterprise that intentionally or unintentionally limit opportunities for people with mental illness.
Public stigma often motivates individuals to fear, reject as well as avoid people who have a mental illness and as a result of these attitudes public stigma acts a pervasive barrier that prevents many individuals from engaging in mental health care and other mental health support activities. Additionally public stigma serves as the foundation for many of the systemic barriers that people with mental illness experience (Paracesepe, 2013). During the COVID-19 pandemic we became familiar with the phrase “socially distant,” however these actions have been occurring long before the pandemic started as many people would often distance themselves from those who have a mental illness instead of welcoming them into the community.
Self-stigma occurs when people internalize the negative public attitudes and suffer and subsequently suffer numerous negative consequences. For example, if a person with a mental illness continues to hear things, such as he or she is dangerous, the individual will then believe they are dangerous which has negative implications on their self-worth and can lead to isolation resulting in a disconnect from the community and a reluctance to engage in services or pursuing personal goals such as employment or education. While it is not uncommon for people with mental illness to internalize it, there are individuals who are able to display a righteous indignation at the injustice of these stigmas. These individuals have achieved a level of personal empowerment which they report being the catalyst to reducing self-stigma thus helping them achieve their life goals (Corrigan, 2012).
Institutional or structural stigma is stigmatization on a macro level often requiring legislative interventions to rectify. Unfortunately, all marginalized populations have experienced a form of structural stigma; for example, African Americans experiencing Jim Crow laws and same sex couples being unable to marry and openly show their love for one another. Additionally, it is these institutional prejudices that further perpetuate public stigma. These stigmas are also the driving force behind the social detriments to health and they must be addressed so that we can have an optimization of society (M.L., 2016).
Now that we have been able to identify and define the types of stigmas people with a mental illness experience, it is important to gain an understanding of the impact stigma has on those with a mental illness. Before we do that, I feel that it is important for you, the reader, to put yourself in the position of someone who has a mental illness. On one hand you are struggling internally. Perhaps you experience racing thoughts, an inability to concentrate, or auditory and visual hallucinations. You are in a state of torment and despair. The medications that you are prescribed often make you drowsy or make you appear that you are under the influence thus causing you shame. Perhaps you get so frustrated with prescribers not listening to you that you decide to take matters into your own hands and stop taking your medications or perhaps you choose to self-medicate. Whichever direction you choose, you often feel that there is no hope, and you are a small boat being knocked around in the waves. Now imagine experiencing all this pain alone, imagine experiencing an inability to speak to neighbors, friends, family, or coworkers because you are ashamed and do not have the strength to cope with the prejudices and misconceptions society has against people with a mental illness. And as a result of these internal and external barriers, the individual with a mental illness is unable to live his or her best life (Corrigna, 2002).
There is hope and together we can combat the stigma of mental illness. While mental illness is very common, it continues to remain misunderstood, and these misunderstandings continue to make things very difficult for people who are living with mental illness. The National Alliance on Mental Illness brilliantly lays out a nine-point plan on overcoming that stigma:
1. Talk Openly About Mental Health: Everyone in this country knows someone or has personally experienced a mental illness, yet not everyone is so willing to talk about it. According to Mental Health America, about 20% of Americans or 50 million people have personally experienced a mental illness. However, over half of all adults in the United States go without mental health treatment. These statistics alone emphasize the importance of having a discussion surrounding mental illness. Ad campaigns are great, but we must lead through action. Talking about thoughts and feelings should be cultural norm and should not be hidden away as if they were a burden.
2. Education: In my opinion education is the foundation for combating stigma because an educated society is a compassionate society. We must not only educate the community but we as clinicians must continue to educate ourselves so that we can provide culturally competent and individualized care to the people that we serve. The onus, however, must not solely be on the individual clinicians – agencies both public and private, for and nonprofit must invest in their staff as well as in their communities.
3. Change the language: Words matter and certain ways of talking about mental illness can and do alienate members of the community as well as continue to endorse the sensationalism of the media and further contribute to both stigma and discrimination.
4. Encourage equality between both physical and mental illness as the mind and body connection is constant. This concept is called “Parity of esteem” which means giving equal priority to both physical and mental illness. This is particularly important because individuals with severe mental illness are less likely to attend routine medical appointments and as a result of this their physical health deteriorates. As clinicians we must also remember that what is routine for us may not be routine for someone experiencing a mental illness so we must be there to support our consumers for them to take the necessary steps needed to attend medical appointments. Additionally, we as a mental health community must work to educate those working in the physical medicine practices so that they can not only be more empathetic to our population but so they to have the ability to both screen for mental illness and have information to provide their patients on any appropriate referrals that they may need (Glew, 2016).
5. Show compassion for those with mental illness: Asking for help is difficult for everyone, not just people who have a mental illness. That is why we must do our best to provide non-judgmental understanding and support to people so that they know they have someone to turn to if they need help. It is important to also remember that sometimes a simple “hi how are you” can go a long way. Another added benefit of showing compassion is that it activates oxytocin which in turn makes us feel good thus boosting our own wellbeing.
6. Choose empowerment over shame: Please do not let the diagnosis dictate who you are. We are all a culmination of our experiences, and we must be sure to always give ourselves credit for what we have achieved even if it is small as it is the little things that matter the most.
7. Be honest about treatment: Let your mental health needs be known. For example, if you broke your leg, you would not go walking around, you would ask for help. I encourage anyone who is reading this article to feel confident about asking for help. While it is important to ask for help it is equally as important to be honest with yourself. If you feel overwhelmed, as many of us are, its ok to just say no.
8. Let the media know when they are being stigmatizing: As a community we are strong. Let us stand together. Whether it is at community events or through media publications that we create. Let us show the people what the face of mental illness looks like; Everyone in this country has had mental illness affect them in one way or another.
9. Don’t harbor self-stigma: Empower yourself and provide yourself with positive affirmations because we are all individuals capable of doing remarkable things.
In conclusion, the reality of mental health stigma is real, and it can be as damaging and as heartbreaking as any mental illness. While stigmas will not go away overnight, we can start by taking the steps needed so that they do not have to last a lifetime.
Stephen Masiello, LCSW, is a Social Worker at the NYS Office of Mental Health’s Rockland Psychiatric Center.
References
Corrigan, P. W., & Rao, D. (2012). On the self-stigma of mental illness: stages, disclosure, and strategies for change. Canadian journal of psychiatry. Revue Canadienne de psychiatry, 57(8), 464–469. https://doi.org/10.1177/070674371205700804
Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness. World psychiatry: official journal of the World Psychiatric Association (WPA), 1(1), 16–20.
Glew, S., & Chapman, B. (2016). Closing the gap between physical and mental health training. The British journal of general practice: the journal of the Royal College of General Practitioners, 66(651), 506–507. https://doi.org/10.3399/bjgp16X687157
Hatzenbuehler M. L. (2016). Structural stigma: Research evidence and implications for psychological science. The American psychologist, 71(8), 742–751. https://doi.org/10.1037/amp0000068
Parcesepe, A. M., & Cabassa, L. J. (2013). Public stigma of mental illness in the United States: a systematic literature review. Administration and policy in mental health, 40(5), 384–399. https://doi.org/10.1007/s10488-012-0430-z
