By Anjum Khan, MA, PMP, PMI-ACP
In the many facets of culture and society, across time and place, the one thing that remains universally unchanged is the stigma attached to mental illness. Despite the development of some successful tests and treatments for many mental illnesses, it is sadly astonishing that at least half of the affected people avoid seeking, receiving, or completing appropriate mental health treatment simply due to stigma (1). With every fifth adult American experiencing some form of mental illness each year (2), this means that at least half of these people suffer without getting the treatment that they need and is available. Considering that many children and adolescents also suffer from some type of mental illness and they, too, struggle with similar challenges (2), the actual amount of people not getting the help they need because of stigmatization is, indeed, profoundly staggering.
What is Mental Health Stigma?
The American Psychological Association (APA) defines stigma as “the negative social attitude attached to a characteristic of an individual that may be regarded as a mental, physical, or social deficiency. A stigma implies social disapproval and can lead unfairly to discrimination against and exclusion of the individual”(3). When such stigma is targeted towards mental illness, that is mental health stigma. It is the negative attitude towards mental illness, the “societal shame and disapproval on people who live with a mental illness or seek help for emotional distress, such as anxiety, depression…or PTSD” (4).
As such, stigma is like a three-point tong that grips someone firmly: first, a person gets stereotyped due to a negative perception or belief about mental illness (primarily because of a misconception or lack of correct information); then the individual faces prejudice created by that negative belief; and finally, the person is being discriminated against because of that prejudice (5 ). There are two types of mental health stigma: public/social stigma and self-stigma. Social stigma is external, reflecting society’s acceptance, endorsement, and encouragement of said stigma; self-stigma is internalized, creating a feeling of worthlessness, inadequacy, and even guilt or denial (6). Both work with the same harmful three-point tong: belittling, discrediting, and eroding a person.
The Impact of Mental Health Stigma
Several studies (1,7,8) over the past decade consistently validate one key theme: mental health stigma continues to be a formidable obstacle to mental health care, not only influencing tendencies by affected people to evade getting the appropriate diagnosis and treatment, but also perpetuating discrimination and prejudice against persons with mental illness. In fact, some empirical evidence indicates that mental health stigma has actually worsened today, rather than showing any signs of reducing (9)
These studies and others (5,6,8,10) have shown that mental health stigma has a potent, negative impact on those suffering from any form of mental illness, mild or severe, short-term or long-term. They reveal that the impact is detrimental in various ways. Primarily, there is the fear of being shunned by society, leading to missed opportunities for care and recovery to a chance at a normal healthy life. This is because once ‘labeled’ as having a mental illness, these individuals face ostracization and discrimination not only from family and friends, but also from basic things such as getting decent housing or jobs. Further, social stigma entails a misinformed perception that people are responsible for their own mental illness and should be held accountable for their disabilities—resulting in a lack of empathy. Self-stigma also emerges, as self-esteem and self-confidence start to wither for many. The reality is that the scope of the impact of mental health stigma is like a volcano bursting, far reaching—it explodes in the public image, tarnishing one’s identity and worth in society; and implodes one’s self-image, destroying self-worth and hope for a quality life.
Is Change Possible?
With the correct information, education, and advocacy on mental health, it is possible to diminish and perhaps even stop both social stigma and self-stigma. Negative attitudes and mistaken beliefs, myths and stereotypes about mental illness need to be consistently countered with positive attitudes and correct facts and knowledge. Engaging both the affected people and the community at large in mental health literacy is a necessity in order to successfully accomplish the goal of defeating mental health stigma. The message should first be that it is okay to talk about mental health. Be aware that there is no shame in having mental health issues and help is available. Wiping out self-stigma may make a good barrier against social-stigma. Making oneself internally strong may help create that immunity against social stigma, thereby mitigating the latter’s impact, and hopefully, negating it completely.
In its entirety, mental health stigma is an obstruction to care. Stemming from continued ignorance, fallacy, and misunderstanding about mental illness, mental health stigma undoubtedly plays a significant role in the continued associated disease burden. The question is, and should be, why can’t we talk about mental health?
1. Corrigan, Patrick W et al. “The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care.” Psychol Sci Public Interest. 2014. Oct;15(2):37-70. From https://pubmed.ncbi.nlm.nih.gov/26171956/
2. National Institute of Mental Health (NIMH). “Mental Health Information. Statistics.” 2021. January. From https://www.nimh.nih.gov/health/statistics/mental-illness.shtml#:~
3. American Psychological Association (APA). “Stigma.” APA Dictionary of Psychology. 2020. From https://dictionary.apa.org/stigma
4. Zoppi, Lois. Medically reviewed by Caldwell-Harvey, T. PhD. “What is mental health stigma?” Medical News Today. Nov 9, 2020. From https://www. medicalnewstoday.com/articles/mental-health-stigma
5. Corrigan, Patrick, W. & Watson, Amy, C. “Understanding the impact of stigma on people with mental illness.” World Psychiatry. 2002. Feb;1(1):16-20. From https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/
6. Ahmedani, Brian K. “Mental Health Stigma: Society, Individuals, and the Profession.” Journal of social work values and ethics. 2011; 8(2): 41-416. From https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3248273/
7. Holder, Sharon M., et al. “Stigma in Mental Health at the Macro and Micro Levels: Implications for Mental Health Consumers and Professionals.” Community Ment Health J. 2019. April; 55(3): 369–74. From https://link.springer.com/article/10.1007%2Fs10597-018-0308-y
8. Parcesepe, Angela M, and Leopoldo J Cabassa. “Public stigma of mental illness in the United States: a systematic literature review.” Administration and policy in mental health vol. 2013; 40(5): 384-99. From https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3835659/
9. Schomerus, Georg & Angermeyer, Matthias. “Changes of Stigma over Time.” Abstract. 2017. From https://www.researchgate.net/publication/306035656_Changes_of_Stigma_over_Time
10. Rüsch, Nicolas, et al. “The stigma of mental illness: concepts, forms, and consequences.” Psychiatr Prax. 2005. July;32(5):221-32. From https://pubmed.ncbi.nlm.nih.gov/15983885/