Stigma
Overview
Stigma occurs when we have negative attitudes (i.e., prejudices) and make negative cognitive generalizations about people in a social group based on defining characteristics of the group.[1,2] Equivalent to negative stereotyping, this social attitude[3] can lead to the unjust treatment of individuals, and beliefs can be perpetuated by further generalizations present in the information that people engage with every day. Stigmas are at the root of numerous societal, political, and social issues and remain a significant challenge in the realm of mental health and discrimination. Stigmas also hinder the well-being and recovery of individuals experiencing mental illnesses. These beliefs negatively label the “them” from “us” and emphasize problematic power imbalances in society.
Manifestations
Stigmas may take the form of internal beliefs, public comments or actions and may be related to many facets of a person’s identity such as ethnicity, gender, language, education, and financial or social status. Some examples of statements with stigmas include:
“People with mental illnesses are violent.”
“People with substance addiction are morally weak.”
“Obese individuals are lazy.”
“Women cannot drive well.”
“People with tattoos are unprofessional.”
There is a range of diverse possible stigmas that exist and can vary by culture, geography and value systems. Stigma can result in violence, blame, rejection, isolation and exclusion of individuals.[4] Further, social rejection and disapproval of treating mental health can be the reason for institutional issues of mental illness, affecting laws and policies. For example, Parcesepe & Cabassa (2013) note that:[5]
People with mental illnesses experience a higher likelihood of employment and housing discrimination as well as restricted financial autonomy due to a lack of perceived competency.
Ideas about people with mental illnesses being violent are common and have increased over time. These perceptions have led to increased social distancing to those with mental illness.
It is important to note that health insurance and employment typically function in tandem, and people with mental illnesses may have a more difficult time receiving the treatment that they need if they are unable to maintain steady employment. On a positive note, a survey of Midwest US states by HealthPartners (2017-2019) adds that mental health stigmatization has decreased with more people being comfortable with informing others that they have a mental illness (from 34% to 41%).[6] While such change is beneficial, stigma remains a prevalent phenomenon to try to effortfully reduce. A recent study by Robin et al. (2023) found that among Latino communities, the belief that “people with schizophrenia are dangerous” was common.[7] High stigma was also associated with perceptions that people are responsible for their own mental health problems.[8]
Cyber aggression is another way for stigmas to be fueled and spread to audiences, reinforcing negative stereotypes. Sylvia et al. (2014) note that upon a quantitative review of 2.2 million Twitter posts, misogynistic weight jokes were the most common and retweeted amongst obesity-related content; cyberbullying and direct attacks were also prevalent.[9] Further, the researchers only found limited positive/supportive sentiments regarding obesity-related content.[10]
Self-Stigma
Self-stigma is a common experience for individuals struggling with mental health. This occurs when societally-created stigmas are internalized by an individual possessing characteristics relating to that stigma, impairing that person's life and recovery significantly. Dubreucq et al. (2021) found that 31.3% of people with a serious mental illness (SMI) such as bipolar disorder or major depression, report high self-stigma.[11] Self-stigma requires awareness, agreement and application of the stigma to oneself.[12] Self-stigma, therefore, diminishes a person’s possible empowerment.[13] Moreover, Yanos et al. (2020) note that self-stigma of severe mental illnesses results in low self-esteem, increased psychiatric symptoms, decreased probability of staying in treatment and decreased hope.[14]
Causes
Social norms and power dynamics within cultures typically drive the creation and sustaining effect of stigmas. A lack of accurate information surrounding the stigmatized group can often cause negative stereotypes to be formed.[15] Along with a lack of knowledge, fear, and lack of awareness additionally play roles in the development of stigmas.[16] Public stigma also can lead to social segregation and exclusion, creating a self-reinforcing cycle of separation and stigmatization in society.[17]
Intervention
Reducing stigma is a critical way to help people feel like they can seek and receive the treatment that they need, for mental health to be taken seriously and for institutional change to occur.[18,19] An effort to increase mental health literacy as well as positive personal contact with individuals with mental illness are ways to combat stigmas in society. The same can be said for stigmas disregarding mental illness, as more knowledge of the stigmatized group will result in less generalization and more informed perceptions.
Education Mental Health Literacy
Anti-stigma campaigns make it their mission to promote the spread of mental health information, and emphasize recovery-oriented and rehabilitation-based practices in an effort to reduce ideas of moral blame of mental illness.[20] For example, the “Make It OK” campaign based in Saint Paul, Minnesota seeks to change negative attitudes about mental health through awareness and information.[21] According to a survey by HealthPartners in 2019, 35% of respondents were aware of a community campaign with the goal of reducing mental health stigma.[22]
Personal Contact
Contact with people in a stigmatized group is another effective way that stigma can be lessoned in communities; Corrigan (2011) notes that contact with people with mental illnesses results in positive outcomes on attitudes and behaviors, and that they last longer than the impacts of education.[23] Increased contact may also take the form of online social marketing to make mental health awareness more frequently viewed and normalized.[24] Unfortunately, media portrayals of mental illness and other stigmatizing stereotypes are primary sources of the information that many people receive; these can result in viewer fear, rejection, and ridicule of those struggling with mental health.[25] Stuart (2006) explains that correcting these negative media images will aid in challenging stereotypes to improve the impaired self-esteem and recovery of people affected by the stigmatization of mental illness.[26]
Such change can inform cognitive generalizations to reduce the resulting negative effects of stigma. This information is extremely relevant to a number of social issues impacted by stigmas such as mental illness in prisons, drug policy and healthcare discrimination.
If one is experiencing impairing stigmatization or self-stigma, please reach out to a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) for guidance and support. Psychotherapeutic modalities such as cognitive behavioral therapy (CBT) can effectively reduce the self-stigma of individuals with mental illnesses[27] as well as help with the stressors of other socially-imposed prejudicial and discriminatory stigmas.
Contributed by: Phoebe Elliott
Editor: Jennifer (Ghahari) Smith, Ph.D.
References
1 American Psychological Association. (2023). Stigma. In APA Dictionary of Psychology. https://dictionary.apa.org/stigma
2 American Psychological Association. (2023). Prejudice. In APA Dictionary of Psychology. https://dictionary.apa.org/prejudice
3 American Psychological Association. (2023). Stereotype. In APA Dictionary of Psychology. https://dictionary.apa.org/stereotype
4 Subu, M. A., Wati, D. F., Netrida, N., Priscilla, V., Dias, J. M., Abraham, M. S., Slewa-Younan, S., & Al-Yateem, N. (2021). Types of stigma experienced by patients with mental illness and mental health nurses in Indonesia: a qualitative content analysis. International journal of mental health systems, 15(1), 77. https://doi.org/10.1186/s13033-021-00502-x
5 Parcesepe, A. M., & Cabassa, L. J. (2013). Public stigma of mental illness in the United States: a systematic literature review. Administration and policy in mental health, 40(5), 384–399. https://doi.org/10.1007/s10488-012-0430-z
6 HealthPartners. (2020). Stigma of Mental Illnesses Decreasing, Survey Shows. https://www.healthpartners.com/hp/about/press-releases/stigma-of-mental-illnesses-decreasing.html
7 Gearing, R. E., Brewer, K. B., Washburn, M., Carr, L. C., Burr, S., Manning, K., & Torres-Hostos, L. R. (2023). Public stigma toward schizophrenia within latino communities in the united states. Community Mental Health Journal, 59(5), 915-928. doi:10.1007/s10597-022-01075-w
8 Ibid.
9 Chou, W. -. S., Prestin, A., & Kunath, S. (2014). Obesity in social media: A mixed methods analysis. Translational Behavioral Medicine, 4(3), 314-323. doi:10.1007/s13142-014-0256-1
10 Ibid.
11 Dubreucq, J., Plasse, J., & Franck, N. (2021). Self-stigma in Serious Mental Illness: A Systematic Review of Frequency, Correlates, and Consequences. Schizophrenia bulletin, 47(5), 1261–1287. https://doi.org/10.1093/schbul/sbaa181
12 Corrigan, P. W., Larson, J. E., & Rüsch, N. (2009). Self-stigma and the "why try" effect: impact on life goals and evidence-based practices. World psychiatry : official journal of the World Psychiatric Association (WPA), 8(2), 75–81. https://doi.org/10.1002/j.2051-5545.2009.tb00218.x
13 Ibid.
14 Yanos, P. T., DeLuca, J. S., Roe, D., & Lysaker, P. H. (2020). The impact of illness identity on recovery from severe mental illness: A review of the evidence. Psychiatry Research, 288, 112950. https://doi.org/10.1016/j.psychres.2020.112950
15 Committee on the Science of Changing Behavioral Health Social Norms; Board on Behavioral, Cognitive, and Sensory Sciences; Division of Behavioral and Social Sciences and Education; National Academies of Sciences, Engineering, and Medicine. (2016). Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change. Washington, DC: National Academies Press. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK384914/
16 Ibid.
17 Ibid.
18 Ibid.
19 Corrigan et al. (2009)
20 Committee on the Science of Changing Behavioral Health Social Norms; Board on Behavioral, Cognitive, and Sensory Sciences; Division of Behavioral and Social Sciences and Education; National Academies of Sciences, Engineering, and Medicine. (2016)
21 HealthPartners. (2020). Stigma of Mental Illnesses Decreasing, Survey Shows. https://www.healthpartners.com/hp/about/press-releases/stigma-of-mental-illnesses-decreasing.html
22 Ibid.
23 Corrigan P. W. (2011). Best practices: Strategic stigma change (SSC): five principles for social marketing campaigns to reduce stigma. Psychiatric services (Washington, D.C.), 62(8), 824–826. https://doi.org/10.1176/ps.62.8.pss6208_0824
24 Ibid.
25 Stuart H. (2006). Media portrayal of mental illness and its treatments: what effect does it have on people with mental illness?. CNS drugs, 20(2), 99–106. https://doi.org/10.2165/00023210-200620020-00002
26 Ibid.
27 Young, D. K.-W. (2018). Cognitive Behavioral Therapy Group for Reducing Self-Stigma for People With Mental Illness. Research on Social Work Practice, 28(7), 827–837. https://doi.org/10.1177/1049731516681849\