Robin Williams, Proud and Loving FatherWhat Is Mental Health Stigma?

Mental health stigma is the widespread, systemic devaluing in our society against people with mental health illnesses. Stigma is very pervasive in our society, and it is a reason why so many people with completely treatable conditions suffer needlessly, and sometimes tragically.   It is a generic term, but covers all negative actions, perceptions, beliefs and attitudes towards people who deal with issues pertaining to mental health. Millions of people struggle with their mental health, and we need to be a society that does not discriminate or ostracize people because of mental illness, but instead we should accept and embrace them, rally and support them, just as we would for someone who is fighting a physical illness such as cancer.

Why Do We Need To Reduce Stigma?

Bringing to light and raising discussions and awareness about mental health will have a positive impact on our society.  The late Robin Williams, who touched millions of people, was affected by stigma, and it was a factor in his decision to take his own life.  People often possess ignorant assumptions about someone suffering mental illness.  In the case of Robin Williams, who suffered severe depression, the television media and social websphere exploded with questions such as "How could he do this to his children?  What was he thinking?", etc.  These very questions themselves are proof of stigma in our society as they demonstrate a lack of understanding about mental illness.   We have stigmatized mental health for far too long, and the effects of these prejudices are readily apparent, and easy to find if you look for them.  When someone suffers from a mental health illness, they can live in tremendous fear of embarrassment and humiliation if their condition is found out.  The pressure this creates in addition to the weight of their illness can be overwhelming and unbearable. 

Here are some of the reasons why reducing mental health stigma an important goal for us today. Get Beyond Stigma

Reducing Stigma Will:

  • Help people better recognize mental illness and be more equipped to avert harmful acts.
  • Help those who struggle with mental health to obtain the best help and treatment.
  • Reduce discrimination and hostility against people with mental health illness, thereby empowering them for more successful outcomes.
  • Better enable caregivers and loved ones to have the most effective support for those who need it.
  • Result in a safer society for us all, as those who deal with the most severe diagnoses will be less likely to render harm to themselves or others.

Mental Health Awareness and Advocacy:  Ending Stigma

How To Reduce and End Mental Health Stigma:

The acronym U.N.I.T.E. is easy to remember and will help you in spreading this positive message to your sphere of influence. UNITE to End Stigma.

UNITE to End Stigma

U: Understand. This means we need to educate ourselves and learn all we can about mental health issues. If you don't know the signs of depression, or if you don't understand words like "psychosis", or you aren't sure why a particular child with autism might act a certain way, then you need to take the time to learn and understand. Understanding is the first key to ending stigma. Absorb information. Be a 'sponge' and learn about this vast world that psychologists have expounded on for more than a hundred years. Here at Theravive, we have a great practical encyclopedia that will help open the door to learning about all things mental health. 

N: Nurture Mental Health. In today's health-conscious society, we hear all the time about proper bodily nutrition. We are inundated with the right ways to eat, diet, and exercise. You can turn on your TV and within minutes you will see some kind of ad about taking care of your body.   But just as important as nurturing your body, is nurturing your mental health- your emotions, and inner self. We must be aware of our own emotional health, and that of our children and loved ones. Do things to nurture the mental health of yourself and your family and encourage others to do so.   Don't just take care of your body, take care of your inner self as well.

I: Include Others. Inclusiveness is critical and a key part of reducing stigma. People who have mental illness often have compounding difficulties when they also have to deal with the terrible effects of shame and humiliation. Remember to include everyone. Treat all as equal. Do not discriminate. We must be more inclusive as a society, so that no one is left out.  Promoting diversity is a vital part of advancing inclusion.

T: Talk. Start talking! Start speaking up- whether in forums, in blogs, in person, to your family, or friends...everywhere. When you are on your social media channels, and there is an opportunity to talk about mental health awareness, take it. When you learn of an event or tragedy in the news and people want to blame or focus on things like politics, gun control, or movies...bring up the topic of mental health. Far too many times after a tragedy, politicians act quickly to score points and take the spotlight away from mental health and put it on policy debates. Mental health is apolitical. It doesn't care about partisanship, and if this fight will be successful, we need to talk about mental health awareness and bring it to light. Initiate the discussion. Shine a light on the realm of mental health so people can start thinking about it, and focusing on it. Teach others what you have learned. If you have a website, consider placing our seal below on it (or place one of yours), to announce to the world that you are part of a larger effort to reduce and end stigma.

E: Embrace Therapy. Here is a sentence that all of our society should believe:  "There is no shame in therapy."  We must stop this notion of embarrassment over seeing a therapist. When an employee tells someone at work "I have a doctor's appointment", no one bats an eye. But to say "I have an appointment with my counselor (or psychologist)" suddenly people start mumbling, "Oooh, did you hear so-and-so is seeing a therapist?  Must be dealing with something serious"...and thus the rumor mill begins to churn, and stigma has won.   We call on people everwhere to please stop this and take a new and brighter view of the work of therapists and mental health professionals.  A doctor helps to take care of our physical health, just like a therapist is there to help take care of our mental health. There is no shame in seeing a therapist. We need to start recognizing the many benefits that therapy can give us, and view it as something positive. Talk about counseling and therapy openly as something that is healthy, and not shameful. Therapy is a good thing. We can say it, and fully believe it, because it is true.

How Does Stigma Happen?

Stigma is the result of a failure to understand behavior, appearance, or communication in a way that causes prejudice or stereotyping due to someone perceived as not being "normal".  Most people have an idea of what is considered "normal."  This concept of normalcy is based on developed schemas within our minds and personality that formulate presuppositions of how people are expected to behave in any given situation.  These schemas are automatically created as a result of being raised in our society, that is, they are the culmination of a completion of childhood development. For example, we have a schema for how a person should behave when standing in line, eating at a restaraunt, sitting in a class room, or walking in public.    Behavior that deviates from a schema a little bit is overlooked and easily shrugged off.   But if someone behaves in a manner that far outside our schema for what is “normal”, this is when prejudice and stigma begin to take hold.  Let's illustrate this concept with a brief example.

Consider a man who uses his fingers occasionally to pick up pieces of his salad at a nice restaurant.  Now, perhaps this would be extremely distasteful to some and utterly inappropriate.  But for many it may seem a bit odd, but nothing too extreme.  But now imagine he uses his hands and fingers to eat his steak.  He just picks it up and eats it.  He isn’t making noise, he isn’t disturbing anyone, and certainly no one has to watch him.  But think of all the instantaneous judgments that might be happening.  This kind of behavior is not merely outside of our schema for what is “normal”, it is severely outside of it.  For many people, it is entirely abnormal.   This is an example of how stigma is formed.  We see a behavior or see a person that deviates a long way from our idea of normal, and instead of trying to understand, we make personal judgments, or worse, have strong negative emotional reactions (.e. "I'm offended and disgusted!") to things that might not even be actually hurting or negatively affecting us.

The History of Mental Health Stigma

Stigma against mental illness has a long, pervasive past in our society, and frankly, accross the world.  Throughout history, people who behaved in a way that wasn't seen as "normal" have been ostracized from the rest of the population.  This concept of normalcy is completely different from one era to another, and from civilization to civilization. Take the highest role model from any ancient civilization and that person would be an outcast almost anywhere today. Throughout our history, people who are "abnormal" have undergone a full manner of horrible treatments. For example, during the mideval era, such people were considered to be cursed or possessed, and they could be imprisoned, executed, or "treated" with various grotesqueries such as "skull drills" via a barbaric procedure called trepanning. 

By the early 20th century hundreds of thousands of “lunatics” were institutionalized in asylums, often against their will. The conditions of these facilities were akin to that of a prison. Patients were crammed into over crowded rooms, and lived under physical restraint. Experimental “therapies” that included shock, isolation, ice water "baths", lobotomies, and many others that today would be considered torture were commonly accepted.  The horror stories that have arisen from this era may seem like fiction, but the truth is sometimes more shocking than a made up story.   One single man, Walter Freeman, the developer of the trans-orbital lobotomy, performed so many thousands of them, he was labeled "The Travelling Lobotomist".  Using an icepick, he could perform the procedure in just a few minutes. 

Yet despite tremendous advances in the psychological and psychiatric sciences over the last hundred years, and despite our modern humane treatment of institutionalized people, many widely held social perceptions against people with mental illness have nonetheless endured.  


Examples of Mental Health Stigma Today

Where is stigma found?

Stigma is not gone.  Today you will still find widespread negative and/or false beliefs regarding mental illness.  One common misperception is the notion that many conditions are self-inflicted.  For example it might be easy to say a person struggling with anorexia caused it on himself or herself.  Really?  Are you sure?  Consider this notion for a moment:  imagine a young boy born in a war torn nation on the other side of the world. This child is brainwashed by rebels from a very early age how to hold a gun, and how to kill.  And indeed, this child ends up killing another person while kids his age on the other side of the world run around in playgrounds and enjoy loving families. Did this child "bring it on himself?"  Eventually, when this child becomes a man- and a killer - he may be held responsible for his actions in life.  But at the same time, so much of his life was assailed on him.  He could have become so different, had only he not been raised in an environment of hatred and war.  Many of those people who were institutionalized in the early 19th century in America were civil war veterans who were struggling with severe emotional and psychological trauma.  These vets- people who gave themselves for their country-  were eventually thrown into "lunatic asylums" and sometimes treated as less than human by the people whose very freedom they fought and bled for.   Do not assume someone who has a mental health condition "caused it" themselves, nor should we assume that someone is always "in control" of it as well.  While it is certainly true that some people bring things on themselves (we are not advocating people are not responsible), we also cannot make judgment against all people. These presuppositions are stigmatic. 

Imagine a woman who survives a crash, and in doing so witnesses her two children die.  Such a traumatic event could easily cause severe PTSD among numerous other potential and long lasting issues. Did she "cause" the potentially devastating psychological effects that will most certainly ensue?  What about people who are abused, violated, and assaulted? No one would say it is their fault. We must resist the notion that people self-cause mental illness, and equally we must dismiss the idea that they can 'control' it.

We also find stigma at schools.  Children may be left out of groups, harrassed, or bullied.  Anyone who has ever been "picked last" for a team remembers how insignificant they felt, and they may remember that one single event their entire lives.    Can you think of a time in your life where you were ostracized or made to feel insignificant?  Do you remember how you felt?    For children who may not be what others think of as "normal", this same feeling can be replicated on a daily basis.  Imagine the internal trauma that could cause to a developing life to have that same experience repeated over and over again.

Workplace Stigma
We can find negative attitudes on the job.  When considering to hire someone, for example, an employer might discriminate based on false assumptions.   Someone who is austistic may be fully qualified to perform a particular job, and the fact that they have autism should in no way be a factor in considering their capability to perform.  Obviously an employer should not be forced to hire someone, but let the person's job performance determine their qualifications, and not preconceived perceptions regarding their mental health. 

Negative Beliefs In Families

Sadly, families can be a harbor for stigma.  If someone in a family has a "diagnosis" it becomes so easy to label that person as the diagnosis, and a label can help create the perception and bring it to reality.  For example, lets imagine a person named Susan who is diagnosed with Bipolar Disorder.  The moment Susan starts thinking of herself as "I'm a bipolar" instead of "I am living with bipolar" she has created a stigma within herself.  Families must not reinforce a label.  The problem is, once you have a label, you tend to act within the label.  So, if you have a child with ADD, do not reinforce that label.  Don't let your child develop a sense of "Oh, I'm an ADD person, that means I'm expected to act a certain way."  Why is this important?  Because when we slap a label on someone, over time, that label becomes an identity.  A child who learns they have ADD may very easily come to start behaving a certain way not because of ADD, but because it is expected.  Labels prevent people from recovering, they lower expectations.  Labels are stigmas in and of themselves.   We should not take a diagnosis and turn it into an identity or a label.  When a diagnosis becomes an identity, then stigma has prevailed.    

Roots of Stigma Some Specific Examples of Mental Health Stigma
How many of these assumptions do you hold, or do you imagine other people hold?

"Depressed people are unstable."
"Someone with schizophrenia is dangerous."
"A person in a mental institution is insane."
"Someone with an eating disorder can control it."
"That person is seeing a therapist.  There's something wrong with them."
"Mental illness is similar to insanity."
"Depressed?  C'mon already, snap out of it, stop being such a downer!"
"Someone who is bipolar is difficult to get to know."
"Someone with borderline means they are close to being crazy."
"He has ADD, he is supposed to act that way."
"You are responsible for your mental issues."
"Go see a shrink!" (Used as an insult against someone).
"Stop using (INSERT CONDITION) as a crutch!  Man up and be responsible for once."
"Oh she has (INSERT CONDITION), we should lower our expectations of her."

Are any of these familiar?  Can you think of more?  If you can, please share them in the comments below.  You likely have heard some or all of these in one form or another.  In many cases you could insert any of a variety of conditions and the statement will hold itself as a prime example of stigma.   (I.E Someone with __________(insert issue)  is unstable.).   It is assumptions like these that directly contribute to widespread negative beliefs against people who are living with a mental health issue or illness. 

Acts of Violence and Mental Health:
This is a common fear we associate with mental illness.  We hear about people who 'snap' and go on a shooting spree and suddenly it may raise fears we have about people who have a similar diagnosis.  The Santa Barbara shooter, Elliot Rodger exhibited many classic signs of Antisocial Personality Disorder, and then committed horrible acts of violence.   He had been to therapists since he was 8 years old.  For a while the nation had the chance to discuss mental health and we had an opportunity to start the conversation about some important issues.  But instead, the media and politicians put all their focus on guns.  And while guns may indeed be an important issue worth talking about, there was very little national emphasis on the mental health component.  It was an unfortunate loss of an opportunity to start a discussion about our own society and how we deal with psychological illness.   

We must remember that just because one individual does something terrible, that is not the equivalent of everyone else having that condition doing something similar.  Many people with ASPD have never hurt anyone.   We cannot look at one violent person who may have a mental illness and then "stereotype" everyone else with the same diagnosis as being equally prone to the same violence. 

Mental illness has been with us for all of our existence, and with it, so has stigma.  When someone doesn't act "normal", throughout all cultures and across all of history, there is a tendency to ostracize those people.   The treatment of people with mental illness has a very dark and terrifying history stretching back hundreds, if not thousands, of years.  And while in todays world we finally have grown more humane when it comes to professional treatment of people with mental illness, many negative stereotypes and perceptions remain embedded in society.  It is incumbent on all of us to do our part to help lessen and reduce the stigmas that are pervasive in our culture.  Doing so will not only result in far better treatment outcomes for those who live with mental illness, but it also will result in a much more tolerant, loving and safer society for all of us.  So remember the acronym "U.N.I.T.E." and do your part to make our world a better place for everyone.  We are in this together.

Let's all do our part to help end the negative perceptions about mental illness and raise awareness whenever we can. 

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