Mental health is an area many people are uncomfortable with. American’s are suspicious of individuals who tend to appear mentally ill. It creates fear and presents the unknown; therefore, stigma. Stigma is defined as disgrace and discredit, which lead to devaluation of an individual. This devaluation creates significant barriers for those who are the target of social discrimination due to their mental state, such as isolation, fear and shame.
Mental illness affects not only the mentally ill individual, but could also their family and friends creating discrimination and disadvantages for them as well, also referred to as “courtesy stigma”.
Society can gain a better understanding and reduce the stigma of mental illness through education and understanding that mental health disorders are chemical malfunctions in the brain, and are equally as real as physical disorders that are physically visible.
Stigma and Mental Illness – the Stereotype
Unfortunately, discrimination and prejudice occur every day. We may not perceive stigma as prejudice, but that is exactly what it is. A stereotype based on our presupposed ideation of what or who a person is based on their behavior, label or appearance. Mental illness does not discriminate. It affects the old, young, wealthy, poor, those in perfect health and those who are terminally ill. People fear most of the mentally ill to be potentially dangerous, unstable and have no concept of reality and that, at any second, they could fly off into some crazed tangent and begin to murder, maim or rape. Too many horror movies, such as Psycho, have contributed to the immediate stereotype of a person diagnosed with a mental illness. This is an unjust, uneducated and ignorant assumption; however, it is propelled by the media in many instances. News, magazines, television and film, books and music often narrate stories of mental illness in a negative light.
This prejudice refers to certain groups, such as those with mental illness, physical disabilities and minorities, just to name a few, as undeserving and of lower status. Their everyday lives consist of constant stressors: the inability to hold a job, lack of income, constant scrutiny by society and even family. For the purpose of this report, the stigma associated with mental illness will be the main focus. That being said, “nearly three-fourths of clients who are hospitalized with severe [mental] disorders will improve and go on to lead productive lives” (Wing Sue, D., and Sue, S., 2006). Many people think mentally ill individuals have no chance of ever being “normal”; however, this is incorrect, as are many assumptions about mental illness. Individuals who suffer from mental illness are, unfortunately, still thought of as “weak” and just need to have more “willpower”. A national study based on the experience of stigma and discrimination surveyed 1301 individuals.
The results were based on the survey responses as well as the follow up with 100 of those individuals. The answers given revealed that the stigma these subjects experienced came from many sources including mental health professionals, church, relatives, communities, caregivers and co-workers. “The majority of respondents tended to try to conceal their disorders and worried a great deal that others would find out about their psychiatric status and treat them unfavorably. They reported discouragement, hurt, anger, and lowered self-esteem as results of their experiences, and they urged public education as a means for reducing stigma.” (Wahl, 2013).
Due to shame and embarrassment, many individuals do not seek professional help. This is the number one reason for avoiding services among this population. “There is robust support for a hierarchy of acceptance for people with varying types of disability, where people with “mental disabilities” – particularly individuals with intellectual disabilities (ID) or mental illness (MI) – are consistently found to be the least socially accepted relative to other disability groups” (Ditchman, N., S. Werner, K. Kosyluk, N. Jones, B. Elg, and P. W. Corrigan).
Stigma, Mental Illness and Education
In many cases, individuals with mental illness are capable of learning, can pursue education and are every bit as intelligent as individuals who are not mentally ill. Some of these individuals include: Temple Grandin, Ph.D. in Animal Science, Assistant Professor Colorado State University, best-selling author, diagnosed with autism spectrum disorder; Barbara Streisand, actor/musician, diagnosed with social phobia; Ben Stillar, actor, diagnosed with bipolar disorder; and Hershel Walker, NFL football player, diagnosed with dissociative identity disorder (also known as multiple personality disorder). There are a variety of issues that can occur with learning ability and mental health; however, they do not have to be a barrier to education and personal growth. “Many barriers are associated with seeking mental health services.
Three of the most common ones reported by young people are stigma associated with seeking help, not recognizing one has an illness and not knowing where to go for help” (Powers, H., I. Manion, D. Papadopoulos, and E. Gauvreau, 2012). Individuals with higher education tend to have a higher self-worth, which could dramatically impact the mental health of the individual and could also be used to educate society about the illness itself, and stigma, as Temple Grandin has. “Stigma affects people adversely. Academic achievement is lower for members of stigmatized groups as compared with nonstigmatized groups, and members of stigmatized groups are at greater risk for both mental and physical diseases” (Ping Tsao, Carol I., M.D., J.D., Aruna Tummala, M.D., and Laura Weiss Roberts, M.D., M.A.).
Stigma, Mental Illness and Employment
In a survey of 502 employers, there were a number of concerns about hiring an individual with mental illness. These concerns included: threat to safety of other employees or clients (17%), person would be incapable of handling stress (14%), strange or unpredictable behavior (11%), work performance concerns, particularly impaired job performance (20%), work personality concerns, particularly absenteeism (29%), administrative concerns including level of monitoring needed (7%) and negative attitude of other employees (2%) (Occupational Medicine, 2013). When applying for employment, many will not disclose mental illness for fear of discrimination. Employers are mandated by the Americans with Disabilities Act when screening potential employees.
This law prohibits discrimination based on race, religion, sex, national origin, other characteristics and protection of rights for the disabled. Approximately 60 to 90%, depending on the severity of the illness, of individuals who suffer from mental illness are unemployed. One of the reasons for this is self-stigma and the expectation of being devalued and rejected. It has been reported that individuals have been turned down for employment or job offers have been rescinded after a mental illness was revealed. About half of the jobs obtained by those who have a mental illness diagnosis will terminate due to difficulty with interpersonal skills or another difficulty directly related to their illness. This fear of rejection due to mental health stigma affects confidence and some begin to view themselves as unemployable.
Stigma, Mental Illness and Poverty
Low economic status and the prevalence of mental illness are noticeably, actually significantly, linked. “Psychiatric disorders have been consistently shown to be more common among people in lower social classes. The prevalence of psychiatric disorders, including neurotic disorders, functional psychoses and alcohol and drug dependence, was investigated in the 1995 survey published by the Office of Population Censuses and Surveys” (Meltzer, H., Gill, B., Petticrew, M, 1995). The question is, which came first; the mental illness or living in poverty? Living in poverty has its own stigma, as this social class is thought of as unequal and undeserving. Those in the lower socio-economic class are likely to indulge in risky behavior as a coping mechanism, seeking relief from a stressful life. They are generally exposed to more stressors and also exposed to more dangerous environments.
They have limited resources making them more vulnerable to poor health and chronic diseases, a higher mortality rate, limited education, substance abuse, crime, homelessness and a lower possibility of recovery – from mental illness or substance abuse. It is a snowball effect for some. Mental illness combined with poverty can go hand-in-hand with many negative outcomes. Still, the reality is, it is more common for a mentally ill person to be the victim and not the violator even in this less than desirable situation. The mentally ill are about five times more likely to be the victim of a violent crime. These individuals are less likely to report crimes committed against them due to feeling as though they will not be taken seriously. Every day, simply standing in the grocery checkout with food stamps can create shame and the feeling of being victimized by those who roll their eyes or snicker at their “poorness”.
Stigma, Mental Illness and the Family
“Family members experience stigma through their association with the person with mental illness. Erving Goffman called this courtesy stigma, namely, the stigma experienced by parents, siblings, spouses, and children of people with mental illness”, (Larson, J.E., and Corrigan, P., 2008). Family stigma creates shame and negatively impacts individuals due being blamed for their family members’ mental illness and can lead to alienation of that family member. Neglectful or bad parenting is sometimes seen as the reason for a child’s mental illness, as is incompetence. Family members may choose to try to hide the mental illness in the family due to embarrassment.
Close association with a stigmatized individual can lead to the avoidance of friends, neighbors, social activity and can cause lower self-worth and isolation. Family stigma research has not received a lot of attention; however, The National Alliance on Mental Illness (NAMI) has introduced 3 programs that are helpful when dealing with family stigma. Regarding siblings, mental illness and bullying, “the most negatively affected group….children under the age of 9 who had been mildly physically assaulted by a sibling” (Dinkmeyer, S., 2013).
Family, in many cases, view arguing and fighting between siblings as normal behavior; however, the mentally ill child is affected more negatively. “About 16% to 22% of children and adolescents have a diagnosable mental or addictive disorder during a year (U.S. Department of Health and Human Services, 1999, 2000)” (Haskin, D, J., A. Kouzis, and P. Richard, 2008). These children are more susceptible to being bullied at school, as well as home, due to being different.
Stigma, Mental Illness and Mortality
In the United States the mentally ill have a life expectancy of about 25 years less than that of a person who is not mentally ill. In Arizona, that number is even higher at 32 years. This population is at a high risk for developing chronic diseases, such as diabetes, cardiovascular problems, hyperlipidemia and renal issues. This risk is primarily caused by the lack of healthcare they receive. Not only because of not seeking the healthcare when they are aware they should, but also because some doctors ignore their physical health complaints. Doctors sometimes dismiss physical issues as if they were “all in their head”. Doctors sometimes view mental health patients as their diagnosis and not as a person.
As a result, these mentally ill patients receive inadequate treatment for their physical issues. This is common in primary care and, surprisingly, also by mental health providers. While this is a glaring concern, the behaviors that cause mortality are equally concerning. This population has a higher rate of smoking cigarettes, poor dietary habits and co-morbidity. This may be due to lack of education, or it may simply be because the behaviors that cause the physical issue are enjoyable.
Suicide is another contributing factor. A staggering number – more than 90% of those who have committed suicide were diagnosed with a mental illness. In general, women attempt suicide more than men; however, men complete suicide more than women. About 30% of those individuals who threaten suicide will actually kill themselves and the demographic at the highest risk of suicide is the elderly.
Reducing Mental Illness Stigma
Reducing stigma begins with education. Although some are set in their ways and continue to believe myths, such as: the mentally ill can never be productive in society, or there is nothing wrong with those people, they are just lazy and want an excuse, there are others who are willing to listen and learn. Early intervention can play a key role in teaching individuals about their mental illness, which allows them to empower themselves and feel more confident – especially youth. Anti-stigma programs for youth can influence them before the negative stigma can. Most youth do not seek help for fear of being ostracized or made fun of. With these programs, recovery is a reality for those with mental illness. “Corrigan and Penn (1999) have argued that the three most effective approaches for reducing stigma attached to mental illness are protest, education and contact.
Among the three, education is the approach that has been most widely used” (Economou, M., E. Louk, L. E. Poppou, C. C. Gramandan, L. Yotis, and C.N. Stefanis). The National Alliance on Mental Illness (NAMI) has programs to help families learn about mental illness together. Encouraging and teaching problem-solving strategies and creating a positive environment are key in recovery. Programs like these allow people to come together and know that they are not alone, learn about treatments, share stories among peers and encourage self-empowerment. These learning experiences can create positive lifestyle changes and improve self-esteem. Some individuals who became involved in these programs to learn have gone so far as to become mental health advocates. They have suffered and have been able to overcome and now teach others who are in need. For an individual who is in need of support and guidance, this advocate represents resiliency and are probably the best educators of stigma and self-love.
Dinkmeyer, Stephanie. “Sibling Bullying Linked to Poor Mental Health.” National Alliance on Mental Illness (NAMI). N.p., n.d. Web. 22 Dec. 2013.
Ditchman, N., S. Werner, K. Kosyluk, N. Jones, B. Elg, and P. W. Corrigan. “Stigma and Intellectual Disability: Potential Application of Mental Illness Research.” APA PsycNET. US: American Psychological Association, May 2013. Web. 22 Dec. 2013.
Economou, M., E. Louk, L. E. Poppou, C. C. Gramandan, L. Yotis, and C.N. Stefanis. “Fighting Psychiatric Stigma in the Classroom: The Impact of an Educational Intervention on Secondary School Students’ Attitudes to Schizophrenia.”International Journal of Social Psychiatry. N.p., 9 Aug. 2011. Web. 22 Dec. 2013.
Haskin, Darrell J., Anthony Kouzis, and Patrick Richard. “Children’s and Adolescents’ Use of Mental Health Care Is a Family Matter.” SAGE Journals. N.p., 1 Oct. 2008. Web. 22 Dec. 2013.
Larson, John E., Ed.D., and Patrick Corrigan, Psy.D. “The Stigma of Families with Mental Illness.” PsychiatryOnline. N.p., 1 Mar. 2008. Web. 22 Dec. 2013
Meltzer, H., Gill, B., Petticrew, M., et al (1995) OPCS Surveys of Psychiatric Morbidity in Great Britain: 1995. London: HMSO.
“Occupational Medicine.” Stigma and Discrimination of Mental Health Problems: Workplace Implications. N.p., n.d. Web. 22 Dec. 2013.
Ping Tsao, Carol I., M.D., J.D., Aruna Tummala, M.D., and Laura Weiss Roberts, M.D., M.A. “Stigma in Mental Health Care.” PsychiatryOnline. Academic Psychiatry, Dec. 2007. Web. 22 Dec. 2013.
Powers, H., I. Manion, D. Papadopoulos, and E. Gauvreau. “Stigma in School-based Mental Health: Perceptions of Young People and Service Providers.” Wiley Online Library. N.p., 19 June 2012. Web. 22 Dec. 2013.
Wahl, Otto F. “Schizophrenia Bulletin.” Mental Health Consumers’ Experience of Stigma. N.p., n.d. Web. 22 Dec. 2013.
Wing Sue, Derald, and Stanley Sue. “Chapter 2/Stereotypes about the Mentally Disturbed.” By David Sue. 8th ed. Boston New York: Houghton Mifflin, 2006. N. pag. Print.