Why Stigma Resistance Is Still Needed in Mental Healthcare

Editor’s note: If you struggle with self-harm, the following post could be potentially triggering. You can contact the Crisis Text Line by texting “START” to 741-741. For a list of ways to cope with self-harm urges, click here.

“Hey Dawn,* have you ever worked with a ‘cutter?’” asked one of my co-workers to another.

Dawn audibly sighed and with an eye roll said, “No way, I don’t work with those people… Why?”

“I was just wondering, because, I mean, I don’t get it. Why would you do that to yourself? I know it’s supposed to be some sort of a relief, but come on! Just smoke a cigarette or something.”

I heard this conversation between my co-workers from my cubicle a few rows over. As a past “cutter” myself, I sat in stunned silence to hear such words spoken amongst mental health professionals. These are people trained and educated to help others through mental health issues and yet their lack of compassion and empathy absolutely stunned me. I understand not everyone will be able to conceptualize what would make someone want to harm themselves in the way we traditionally consider “self-harm” (After all, aren’t we all harming ourselves in one way or another? We don’t do what is best for us 100 percent of the time and that’s just part of being human); but what hit me like a slap in the face was the audible disgust and discrimination shown through the words of my co-workers, who are trained in helping people through mental health crises.

It hurts my heart to know that stigma around mental health issues is still so pervasive, even amongst helping professionals. While we have absolutely come a long way from the “insane asylums” of the past, it is obvious we still have so much work to do, particularly amongst those who are supposed to be a support for those in the midst of mental illness. I wrote about this phenomenon amongst psychiatrists, but it’s easy to naively assume psychiatrists think that way because they are trained in a medical model that focuses more on interactions between medications than mental health itself.

However, this lack of understanding and empathy is obviously not limited to those who go through medical school or the general public who may be uneducated on mental health issues. This problem reaches into the minds of social workers, counselors, therapists, caseworkers and so on, all who are specifically trained in the challenges those with mental illness face and supposedly educated on larger social issues such as stigma and discrimination based on a person’s neurodivergence.

I’m not immune to this way of thinking, even as someone with an active mental illness and a history of self-harm. The idea that those who are struggling, or ever have struggled, with mental health issues are somehow less than those who have always demonstrated socially acceptable mental health is reinforced everywhere we look in society. From the smallest act of using the word “crazy” to being kept from joining the military if you have a mental health diagnosis, to the non-existence of mental health days, to flat-out lack of adequate and timely care for those experiencing mental health symptoms – we are told that those with mental illness are less valuable to society as a whole. When we are taught this day after day, it is nearly impossible not to internalize this message and stigmatize ourselves as well as others struggling with mental illness.

It’s embedded into our institutions and determines whether or not we allow people access to care. For example, at my place of employment, we are required to ask people about their mental health history:

“Have you ever had a history of mental health treatment?”

“Have you ever been diagnosed with a mental health condition?”

“Have you ever, or are you currently, taking any medications for a mental health condition?”

The way this is done is, in and of itself, stigmatizing because of the lack of person-centric language and the not-so-subtle subtext that the answers to the questions should be “no.” Depending on how individuals answer these questions determines whether or not they get access to short-term counseling. The idea behind this fact-finding mission is one of positive intent – it’s supposed to weed out those who require longer-term counseling so they can receive the appropriate level of care. While I can appreciate it may be harmful to a person to establish a relationship with a counselor for a limited number of sessions, only to be cut off from that counselor with issues potentially unresolved, I also have to ask: Are we doing more harm than good by not getting someone help, even if it is limited and short term? Is it better to turn someone away than offer them what little help we can?

I struggle with holding a position where I simultaneously feel like I’m trying to do good in the world while also being an agent in upholding the unhelpful and dysfunctional status quo. I suppose that’s just part of working in our current society – there’s no place untouched by stigma and discrimination. And at the same time, I don’t want to be complacent. I don’t want to further contribute to the social injustice and oppression that is unfairly placed upon those with mental illness — myself included.

So where does this leave me? First, I try to gently and compassionately push for change when and where I can while also acknowledging I need to keep my job to be able to provide for my family and remembering I can’t change the whole system overnight. Secondly, I have to learn and practice and teach lots of stigma resistance. Whatever I can do to destigmatize mental illness for myself and others has to be a daily practice. Sometimes, this is something as simple as checking my language and finding adjectives other than “crazy” to describe something unbelievable and sometimes this is writing about my experiences with mental illness and refusing to be silenced by the stigma so easily offered to me.

Finally, I have to believe the work I am doing is making a positive change in our society — that just by me listening to one person tell their story, I’m allowing them to be heard and validated. If I do that with enough people, perhaps change will occur because they are no longer silenced or feel they have something to be ashamed of. Maybe that’s unrealistic, but I’ve always been a dreamer.

* Name changed for the purposes of confidentiality.

If you or someone you know needs help, visit our suicide prevention resources page.

If you struggle with self-harm and you need support right now, call the crisis hotline at 1-800-273-8255 or text “START” to 741-741. For a list of ways to cope with self-harm urges, click here.

Getty Images photo via shironosov