How You Can Do Your Part to Fight Mental Health Stigma
Fighting mental health stigma is not pretty. It can be awkward and weird. Just looking up the definition is confusing. If you scroll through the whole definition of stigma on Merriam Webster, you see various ways the word stigma can be used. You see references ranging from a “mark of shame” and diseased body parts to the makeup of flowers and religious ecstasy. Or when used in an old-fashion way, stigma is just a straight-up scar left from a branding, as in sticking a piece of metal into a hot fire and then pressing it into skin you want to brand. Like they do to, you know, livestock or Jack Sparrow in “Pirates of the Caribbean.”
So, what the hell? Why do most of these definitions point toward something burdensome, heavy or painful? Because that is what stigma can feel like and stigma is everywhere. And it is not just present day, we also have centuries of stigmatizing events and behaviors to untangle.
Traditionally, individuals with mental illness have been dismissed and their needs have been grossly overlooked. For hundreds of years, individuals with mental illness have been put into “madhouses,” “insane asylums” and “state hospitals” with little to no help for their mental illness. And even now, in the year 2021, we are still seeing people with mental illness locked up in asylums, but now we call it jail or prison. Is having a history of locking individuals with mental illness up as if they are dangerous criminals, stigmatizing? Yup.
Over the years, doctors have tried to find explanations or causes for mental illness, but have failed miserably in the past. Their hypotheses have included being possessed by the devil, overbearing mothers, curses, sinning, hysteria (women only! And only if that woman experiences *gasp* emotions!) and more. They tried a bunch of treatments that were equally as bizarre as their theories for mental illness including ice water baths, trepidation (drilling holes in a person’s head), cocaine, insulin shock therapy, electroconvulsive therapy, lobotomies (Google it. And Google the two other treatments right before, while you are at it) and what would become known as “modern” psychiatric medications.
And we can’t forget the eugenics movement in America sterilized individuals with mental illness and inspired the beginning of the widespread atrocities in Nazi Germany. Is labeling individuals as inherently flawed and then doing outlandish experiments on them stigmatizing? Yup.
With all these years of studying individuals with mental illness, you would think we have the situation under control, right? Do not get too excited about the state of modern-day psychiatry, because they still don’t know much. They have a bunch of theories of what might being going on, but still, not really in my opinion. You would think in this day in age, where we can 3D print a human heart from the patient’s own stem cells and we have over 10 different types of medication for erectile dysfunction, scientists and researchers would be able to point to exactly where it hurts and would know the remedy immediately. But, nah…
So, before I go off on multiple tangents, let’s refocus … stigma.
Mental health stigma deals with discrimination, prejudice, inequality, stereotyping and intolerance an individual with mental illness experiences throughout their life because of the symptoms of their mental illness or predetermined state of misunderstanding about mental illness from the general public. We cannot forget an individual with mental illness can also face injustice when it comes to other aspects of their life, such as race, gender, gender identity, age, ethnicity, culture, class, co-occurring disabilities, education, etc. This post deals primarily with stigma surrounding mental illness, but it would be incomplete to not mention these factors and the intersectionality that is common in our lives.
So, there are many different types of stigma. As mentioned above, there is general mental health stigma from the public. This is probably the most well-known type of stigma. Essentially, individuals with mental illness are viewed, in some way, as irretrievably flawed because of a diagnosis or assumption of mental illness and this is held against them. Another type of stigma is self-stigma. This means an individual with mental illness believes they are defective in some way and may limit themselves. They may believe the falsehoods about mental illness others have promoted. These people may be seen as having poor self-esteem or self-image, but in actuality, they may have taken societies’ opinions about mental illness to heart and are afraid to voice their opinion or opposition on account of being called “weird” or “strange” or worse, being involuntarily committed to a hospital or publicly shamed.
Now that we have that established, let’s talk outright stigmatizing events and behaviors and also, the smaller, quieter, sneakier, sort of stigma that can also have a tremendous impact on people.
Side note: If you find yourself repeating falsehoods or participating in any of the following scenarios, acknowledge your error, apologize, and move forward. It’s that simple. And the best apology you can give someone is changed behavior, so get it done.
Alright, so sadly, we live in a time where mass shootings are a pretty common occurrence. While there are many issues to address in that giant problem, one thing in particular is disturbing. Often, a perpetrator of these mass shootings is labeled as “mentally ill” prior to anyone having any evidence. And to be clear, racism, bigotry, hatred, involuntary celibacy and horrid orange spray tans are not mental illnesses or symptoms of any mental illness.
When we perpetuate this myth mass shooters and other perpetrators of violence are assumed to have a mental illness, it deeply hurts individuals with mental illness. It puts out a signal individuals with mental illness are volatile and not to be trusted. It is easy to see why some of this stigma is internalized because nonstop TV coverage throws it in our face over and over again. And BTW, research shows individuals with mental illness are more likely to be victims rather than perpetrators of violence.
How do we fix it? Refuse to accept all mass shooters have a mental illness unless diagnosed by a qualified mental health professional who has met and assessed the shooter. Correct people when they try to support this myth mass shooters automatically have a mental illness. Do some research and have some facts to back up your talking points.
Another less menacing, but still critical situation to consider is giving advice. We have to remember there are many different paths people choose for their recovery. To suggest any individual is doing their recovery “wrong” or you know better than them is kinda rude, to say the least. While some people are genuinely trying to help, let’s look at a couple things that may hurt and may lead to more stigma.
If not done in a manner that is sensitive to the individual’s needs, giving advice can be troublesome, especially when inquiring about treatments, including medications the individual is taking (or not taking). Unless they have indicated they would like advice, avoid the following types of questions:
Have you tried St. John’s Wart/thinking positively/the edibles at the dispensary in Evanston?
Are you getting enough exercise/fresh air/vitamin D from the sun?
What about your lavender-scented weighted blanket/healing crystals/bedtime routine of saying “live, laugh, love” into the mirror and then spinning in a circle three times?”
While these are probably not meant to be malicious in nature, it is difficult to hear the solution to your problems boiled down to just one little thing. But do not get me wrong, these things are often very beneficial to recovery, and they can definitely be added to any mental health repertoire, but for some people, it’s just not that simple.
And that is where the problem lies: An individual experiencing self-stigma may condemn themselves for not adequately responding to certain tools in the wellness toolkit that have greatly benefitted others. It is already heartbreaking and discouraging when certain options do not work; we shouldn’t rub it in people’s faces. Often, what works is a combination of a bunch of different remedies — it’s a bit of a balancing act sometimes.
How do we fix it? We cannot alienate people with mental illness because they don’t response to a certain course of treatment because, until there is a cure, there is no definitive solution or treatment protocol for mental illness. We have to support all paths to recovery, even when it looks different than the “traditional” or evidenced-based [insert latest mental health buzzword here] course of treatment.
Next, we need to look at the language we use to see how it can sustain mental health stigma. Today is a good day to stop using words like “insane” or “crazy” so freely. Examine if your vocabulary keeps stigma alive, but also be open to other people’s preferences for themselves. For example, when describing myself, I prefer to use the phrase “individual with a mental illness” or “a person in long-term recovery” while others may prefer the terms like “mental health condition,” “behavioral health concern” or just plain “in recovery.” All are fine and we should honor each other’s preferences.
However, certain phrases and words are no longer considered appropriate. For example, it no longer acceptable to use the term “the schizophrenic” and a much better way of saying it is “a person with schizophrenia.” The same is true when speaking about or with individuals with substance use disorders (which are mental illnesses). The terms or labels such as “clean” or “dirty” are demeaning and whoever thought to use these terms to describe people who are already experiencing a lot of pain, is a complete jackass in my opinion.
We also have to watch out so as not to pathologize certain behaviors or situations. For example, a sudden thunderstorm in the spring, should in no way mean meteorological conditions are “bipolar.” Also, it is insensitive to describe yourself as “OCD” when you appreciate cleanliness and organization. People with obsessive-compulsive disorder often experience severely debilitating symptoms that can include cleanliness and organization, but that is not the extent of the symptoms.
How do we fix it? Learn about what is called person-first language, where we see the individual as a complete person first and the diagnosis second (or third); however, remain flexible in your new knowledge and take into consideration how an individual chooses to identify themselves and then honor their wishes. And, again, if you slip up, correct yourself, apologize if necessary and move on while carrying the message to others.
And finally, let’s chat about our entertainment options. First, the following Halloween costumes are canceled, for eternity: mental patient, psych patient, person in a straightjacket, insane asylum patient, psychopath, lunatic, psychotic axe-murderer and crazy killer clown. They are done. Get over it. You look cuter as a sexy scientist, anyway. And let’s end the fascination with psychiatric hospitals or treatment centers as an edgy, avant-garde setting for television shows and movies. It’s not cute. I am talking to you “Stranger Things;” I saw your cast member roll call today on Facebook! And how has the show “Intervention” been on for 21 seasons and who in the first place approved a television show that showcases some of an individual’s most private and devastating moments with problematic substance use. “Hoarders” is also still on (same channel as “Intervention,” naturally).
How do we fix it? Certain Halloween costumes should not be worn, so focus your energy on examining how we became insatiable voyeurs of televised human struggling and how we can correct it. Much more potentially stigmatizing situations are everywhere, from work, to relationships, to doctor’s offices. We cannot let this continue to happen because the most devastating consequence of stigma is individuals forego treatment, which has deadly outcomes. So, yeah, join the crew. The National Alliance on Mental Illness (NAMI) has a “StigmaFree Pledge” you can take if you are so inclined, but realize the work is not done once you take the pledge. Make an authentic commitment to unconditionally support and improve the lives of individuals with mental illness. We would deeply appreciate it.
A version of this article was originally published on Sarah Lewis, LCSW
Getty image by Giuseppe Lombardo