Mental Health Stigma
Mental health stigma refers to negative beliefs people may hold about those with mental illness, which can lead to stereotypes, prejudice, and discrimination. Public awareness and literacy have increased substantially over the years, yet some entrenched stigmas persist today.
Mental health stigma involves marking and discrediting people due to their differences, which can instill feelings of shame or worthlessness. Those with mental health conditions may be labeled, stereotyped, or discriminated against as a result. For example, someone with a mental health condition may be called “crazy” or “dangerous”. Another may be denied a job due to their diagnosis.
Different models of stigma propose different structures for the construct. One views stigma as a combination of three components: cognitive (ignorant beliefs), emotional (negative feelings of dislike or fear), and behavior (ostracization and oppression). Another defines stigma by the process through which it arises. This involves distinguishing and labeling differences, linking labels to negative stereotypes, placing labeled people in distinct categories, decreasing their status, and limiting access to social, economic, and political power, which perpetuates rejection and discrimination.
Mental health stigma has been categorized into three types. Public stigma refers to the negative attitudes society has toward people with mental illness. Self-stigma or internalized stigma is when an individual with mental illness internalizes these negative attitudes. Institutional stigma is systemic and includes laws or policies from the government or other organizations that, intentionally or not, discriminate against those with mental illness. An example of institutional stigma is the insurance coverage disparities between psychiatric treatment and medical treatment.
Personally accepting and agreeing with stereotypes and prejudices held against oneself is called internalized stigma or self-stigma. Some believe that it results in part from the stress of experiencing stigma. Internalized stigma is linked to emotional distress, feelings of low self-worth, and loss of self-efficacy. There can be practical ramifications as well; for example, internalized stigma may stop someone from applying for a job because they don’t believe they are capable.
What people stigmatize varies from culture to culture; culture informs how people perceive and explain differences. America tends to value individualism and independence, which some argue perpetuates stigma by placing responsibility or “blame” solely on the individual. People in many other parts of the world don’t blame individuals for their differences or their struggles. They may blame God, the family, a malevolent spirit, karma, or the stress of war, poverty, and other sociopolitical forces.
Stigma forces people to not only struggle with their disorder but to cope with prejudice and rejection. This can lead people to develop feelings of self-blame and low self-esteem, and prevent them from seeking treatment or social and professional opportunities. A systematic review demonstrates these repercussions, finding that mental health stigma negatively affects employment, income, and public views about resource allocation and healthcare costs.
People with mental disorders have been blamed, vilified, and ostracized throughout human history. While attitudes about mental illness, and treatment for those conditions, have improved dramatically over the last century, stigma has not disappeared. Yet individuals, organizations, and societies are continuing to address mental health stigma and its consequences.
The evolution of stigma over time is complex. Today there is greater awareness, information, and literacy than in years prior. Yet that doesn’t always translate into attitudes and beliefs. For example, a recent study that assessed trends in the stigma of mental illness in the U.S. between 1996 and 2018 found a substantial decrease in stigma for major depression but not for schizophrenia or alcohol dependence. The study also reported a substantial increase in acceptance of biomedical causes of mental illness, but that acceptance didn’t lead to less social rejection. While there has been progress, it’s far from uniform or all-encompassing.
Research suggests that awareness and literacy, though important, are not always effective at reducing stigma. One experience that does seem to reduce stigma is interacting with people with mental health conditions. Proximity to and relationships with people with mental illness, and being open about those relationships with others, can shift attitudes. In the absence of live interactions, depictions in television and movies can be helpful substitutes. Similarly, celebrity disclosures can be beneficial as well.
There are several actions individuals can take to fight stigma in their lives and their communities. They can educate themselves by reading about mental health, stereotypes, and myths. They can research the factors that contribute to stigma such as culture, stress, and poverty. They can explore any self-stigma and if so practice self-compassion and empowerment. And they can help others by volunteering or advocating on behalf of those with mental health conditions.
People with mental health conditions can respond to stigma by continuing to seek treatment, even when it feels difficult. They can join a support group, share their story, and reframe experiences of stigma. Speaking to a mental health professional can also help people process painful experiences, develop coping skills, and build resilience.
Yes. A systematic review found that self-stigma interventions are generally effective in reducing internalized stigma, and they take the form of group-based programs that involve psychoeducation, cognitive behavioral theory, and disclosure-focused exercises. Two examples of treatments that target internalized stigma are narrative enhancement and cognitive therapy and coming out proud.