Mental Health and Stigma
Physical illnesses are usually talked about openly and in a “matter of fact” way with family members, friends, and even with strangers. So why is it that mental illness is considered a deep, shameful secret for so many people?
Mental illness is often ignored and not considered a legitimate health issue. However, according to the CDC, mental illness is among the most common health conditions in the United States. More than 50% of U.S. adults will need mental health treatment at some point during their lifetime.
That being said, the American Psychiatric Association (APA) has found that more than half of people who struggle with mental illness never even seek treatment for their illness (2020).
Nearly 9 out of 10 people with a mental illness feel that the stigma and discrimination that goes along with it negatively impact their lives (Mental Health Foundation).
People suffering from mental illnesses are frequently judged unfairly - either blamed for their condition, or stereotyped as weak and cowardly. They are often told to “get over it” or even worse, they may be labeled as being “crazy” and dangerous for no logical reason.
These stigmas can cause people to feel ashamed about something that’s out of their control and certainly not their fault. To make matters worse, the stigma could compound the condition itself and prevent someone from seeking the medical care they need, robbing them of the equal opportunities they deserve to live a quality life. These stereotypes create discrimination affecting employment, rent and housing, and acceptance into society. Due to these misguided conceptions, more than half of people with mental illness don't even seek out care for their condition out of fear of losing their jobs or of what people might think of them.
Unlike physical disabilities, people with mental illness are perceived by the public to be in control of their disabilities and even responsible for causing them. What’s even worse is, people with mental health issues may start blaming themselves and can’t understand, themselves, why they just can’t be stronger and overcome, often leading to lower self esteem and hopelessness.
Compare this scenario to someone who broke their bone while playing a sport. They decide not to seek treatment due to being perceived as weak because they were not able to prevent the injury and were even blamed for bringing this upon themselves. As a result, the fracture does not heal and they become potentially handicapped for the rest of their life. This is a completely avoidable situation. So, why is it any different than seeking mental health treatment?
Let’s address some common myths about mental illness…
Myth 1: Mental illness is due to a character flaw and weakness and should be overcome by trying harder.
Fact: Mental illness is a medical diagnosis and can be caused by various factors including biological factors such as genetics, injuries, altered brain chemistry, and life experiences such as trauma or abuse
Individuals with mental health problems who receive proper treatment can get better and recover completely.
A great example of proof that mental health issues don’t mean you are weak is everyone's favorite actor and ex-pro wrestler Dwayne “The Rock” Johnson. He is known to be one of the toughest men around, yet he has been publicly open about his struggles with depression.
Myth 2: People with mental health problems are violent and harmful.
Fact: Most people with mental health problems are not violent. In fact, they are more likely to be a victim of a violent crime. According to Mentalhealth.gov, 3-5% of violent acts occur by individuals who have been diagnosed with a serious mental illness. Many people with mental health problems are highly active and productive members of our communities.
Myth 3: I can’t do anything for a person with a mental health problem.
Fact: You can be a huge positive influence as a friend or a loved one by treating them with respect and encouraging them to reach out for the treatment they need.
Mental health stigma often comes from lack of understanding or fear.
Media can perpetuate stereotypes by creating misleading representations of mental illness. Frequently, the villain is shown to have a mental illness.
Let’s look at a recent example through the hugely popular movie, Joker, which came out in 2019 portraying the lead character as an extremely violent, mentally ill person. A study was conducted and found that viewing the film "was associated with higher levels of prejudice toward those with mental illness." Additionally, the authors suggest, "Joker may exacerbate self-stigma for those with a mental illness, leading to delays in help seeking."
Roy Richard Grinker, an award-winning professor of anthropology and international affairs at George Washington University and an expert on mental illness stated,” Who is crazy? Who is normal? From an anthropological perspective, there is nothing called normal. Principally, everybody is as crazy as everybody else.”
According to Grinker’s book, Nobody's Normal: How Culture Created the Stigma of Mental Illness, the main cause of stigmatization against those with mental illnesses and disabilities is based on the social, cultural, and historical contexts which we live in.
Let’s take a few moments and delve back into the perceptions of mental health throughout history.
Mental illness has a long history of being stigmatized around the world, going back to ancient societies. As a result, treatment has historically been brutal and inhumane and not based on science until relatively recently.
Ancient History and Stigmas
Humans have lived for hundreds of thousands of years on earth and achieved advancements in so many different fields. However, in most cases, it was easier to tackle material concepts rather than more vague and baffling concepts of the human mind and behavior. Early humans could not figure out why a physically healthy person would behave in a certain way and did not have the science we have now to explain these different behaviors. The unknown has always been associated with danger and instigated fear in society. So, links were immediately drawn between neurodivergent individuals and abnormal forces, historically often associated with witchcraft or evil.
Ancient beliefs of mental illness revolved around the idea that victims were possessed by evil spirits, supernatural forces, and demonic possession. These thought processes led to primitive treatment practices such as the use of amulets or charms with magical powers, exorcism, atonement, incantations, prayers, and in some cases, quite dangerous practices such as trephining - a practice in which a hole was was chipped into the skull using crude stone tools to create a way for the evil forces to leave the affected person’s head. This custom was actively adopted in many civilizations for quite a long time, in spite of the known danger involved.
Additionally, in many cultures, the suffering individual was blamed for their own mental illness as a sign of bad luck or as a sign of punishment for upsetting the Gods in some way. In these cases, a priest played a large role in attempting to heal the person by connecting them to God and forgiveness.
Finally, between the 5th and 3rd centuries BCE, Hippocrates, considered the Father of Modern Medicine, introduced a new perspective on mental health. He stated that mental illness was not due to demonic and unearthly forces, but rather stemmed from an alteration of body chemistry and medical changes in the brain. Hippocrates encouraged treating the brain just as one would treat other physical ailments in the body. Accordingly, new treatments began to emerge, targeting brain pathology including herbs, medications, and other therapies. In Greece and some other societies, art therapy became a popular treatment. Some cultures believed that bad blood was responsible for these ailments so treatments to remove blood such as leeches, bloodletting, and laxatives were used.
Unfortunately, negative attitudes towards mental illness persisted and little progress was achieved throughout the Middle Ages. The aggressive sociopolitical climate of the time shut out mentally ill people from society and forced them into prisons and mental asylums which were cruel places of physical restraint and solitary confinement.
In the mid 18th century, institutionalized care became the answer to centuries of mistreatment of mental illness. Mental hospitals evolved to start to provide more moral and medical treatments. The first hospital in the United States - Pennsylvania Hospital - opened its doors in 1753 to those who needed care. The revolutionary, Dr Benjamin Rush, known as the father of American psychiatry promoted the promise of quality care with dignity and compassion. Although he had good intentions, there were still many roadblocks.
It was not until the late 19th and early 20th centuries that modern theories of psychopathology began to emerge.
In the 19th century, mental health advocate Dorothea Dix became one of the first people to openly fight the stigma of mental illness. She worked with the government, policy makers, and lobbyists to build more mental hospitals and institutions, focused on providing moral and scientifically sound care.
Finally, after World War II, mental health advocates and those living with mental illness started promoting and embracing deinstitutionalization as a liberating, humane alternative to restrictive care. The introduction of more effective drugs and treatments meant that people could access shorter outpatient care, and wellness and recovery started to become more real. The prospect of receiving treatment while remaining a part of the community became an empowering concept for those living with mental illness.
Ancient history has played a role in deep rooted beliefs and stigmas revolving around mental health perception and care. Although we have evolved to provide much more moral and scientific based practices over time, it is painfully clear that the stigma of mental illness continues to be a barrier to treatment and recovery.
Unfortunately, this stigma is universal. However, it is especially an issue in some diverse racial and ethnic communities. Culture has been shown to shape our emotional expressions and communication styles, thereby determining who is more likely to seek out psychological treatment. Examples of cultural differences include the belief that, mental health providers cannot be trusted over family members, engrained cultural values of maintaining strong emotional restraint and avoiding shame lead to self-reliance and trying to overcome mental issues through willpower, and not prioritizing oneself over family which would be construed as selfishness in some cultures.
These cultural stigmas result in lack of treatment of psychiatric illness, high treatment dropout rates, and poor treatment adherence and outcomes (Byrne, 1999).
People often make judgements based on lack of knowledge rather than a true understanding of the facts. It is important to acknowledge and accept your condition and recognize when you need to take action towards treatment, seek support, and help educate others.
Here are some things you can do to cope and overcome stigma:
Get treatment - Try not to let other people’s lack of knowledge influence how you feel about yourself. Mental illness is not a sign of weakness. It is a medical problem and is rarely something you can deal with on your own.
Educate yourself about your condition and connect with others who have mental health conditions similar to yours
Reach out to someone you trust to support and encourage you
Do not define yourself by your illness. You are not an illness.
Speak out against stigma
Join a support group to help you realize you are not alone. There are many others dealing with the same feelings and experiences that you are
Unfortunately, individuals with mental illness are marginalized and discriminated against in various ways, but we can all do something to help to reduce the stigma and create a more compassionate community.
Protest against inaccurate representations when we see them, especially in the media. Don’t believe everything you hear... educate yourself objectively rather than taking on biased media opinions as your own.
Promote education in yourself and others - treating mental health is just as important as treating physical health. As Kristen Bell, Hollywood actress, stated “Mental health check-ins should be as routine as going to the doctor or the dentist. After all, I’ll see the doctor if I have the sniffles.”
Talk openly about mental health in a factual yet compassionate way
Interact with people with mental illness to realize what they are going through and understand their perspectives. When we know someone with mental illness, it becomes less scary and more real and relatable.
Listening to and sharing personal stories can be a huge source of encouragement to those suffering with mental health issues. Many celebrities have publicly shared stories of their challenges and brought the discussion much more into the general media and everyday conversation. However, celebrities aren’t the only ones who can make a difference. In fact, many people in the community sharing their stories may make an even bigger impact because they can be more relatable.
Any disease including mental health disease is a disability, not a choice, and we can’t necessarily control it. Other illnesses like heart disease or arthritis aren’t stigmatized and are treated appropriately, and mental illness should not be any different.