Mental health: Overcoming the stigma of mental illness

Progress is being made to remove the stigma of mental illness and mental health disorders. Meantime, you can take positive steps to combat stigma.

You've probably heard the hurtful words before — words like "psycho" and "schizo." Or you've seen the jokes about mental health on television referring to "loony bins" and characters in straitjackets.

But if you or a loved one has a mental illness or has been diagnosed with a mental health disorder, you know that these words and gimmicks aren't just harmless fun. They perpetuate the stigma attached to mental health conditions. Stigma may make you angry and upset, and it can cause the public to misunderstand mental illnesses. But while the stigma of a mental health disorder can be painful and shaming, you can find ways to cope with it and even combat it.

Stigma begins with labeling someone

Stigma, by definition, is a mark of disgrace or shame. Stigma has four components:

• Labeling someone with a condition
• Stereotyping people who have that condition
• Creating a division — a superior "us" group and a devalued "them" group, resulting in loss of status in the community
• Discriminating against someone on the basis of their label

Labels can be useful, though, and they're not always negative. In health, for instance, a diagnosis is, in essence, a label. A label can offer reassurance that your condition has a medical cause, and it can help steer you toward appropriate treatment.

Labels don't always result in stigma, either. Many illnesses today are gaining acceptance and empathy. Breast cancer is a shining example. Survivors used to feel shamed and kept their condition secret for fear of being stigmatized. Today, though, survivors and advocates openly talk about the condition, hold fundraisers or wear ribbons or wristbands to show support.

Why mental health disorders still face stigma

While most people would never think of mocking someone with breast cancer, mental health disorders and conditions still remain fair game for ridicule.

Mental vs. physical
Why does stigma of mental illnesses continue? For one thing, the term "mental illness" suggests that it's not the same as a medical or physical illness. To some, the word "mental" suggests that the illness is not a legitimate medical condition but rather a problem caused by your own choices and actions. People may blame you and think your condition is "all in your head." They may think that a mental health disorder means that you're weak or lazy. They may think that you should just "get over it." And you may begin to think these things about yourself, too.

In reality, mental illnesses have very complex causes, often a mix of your genetics, your biology and your life experiences — most of which are beyond your control. Neuroimaging studies, for instance, show physical changes in the brain associated with mental disorders. And studies show that some mental illnesses run in families, suggesting that they may be due in part to your genes.

Crime and violence
Some people also believe that if you have a mental health disorder, you must be dangerous and violent. This perception is often inflamed by media accounts of crime in which someone is vaguely referred to as "mentally ill."

Statistics, however, don't bear out a connection between mental illnesses and violence. Most people who have a mental illness are neither violent nor criminals.

Stigma worse for some conditions

As a result of such misperceptions, stigma continues, and mental health conditions remain the butt of jokes in popular culture. Negative portrayals of people with mental illnesses fuel fear and mistrust and reinforce distorted perceptions. That leads to even more stigma, causing a vicious cycle.

Some mental health disorders face more stigma than others, though.

Schizophrenia, for instance, is more highly stigmatized than depression is. It's routinely mocked and is less likely to generate compassion. Depression, on the other hand, is less often ridiculed, perhaps because an onslaught of advertising for antidepressant medications has made the disorder more mainstream and more acceptable.

Harmful effects of stigma

For someone with a mental illness, the consequences of stigma can be devastating — in some cases, worse than the illness itself. Some of the harmful effects of stigma include:

• Trying to pretend nothing is wrong
• Refusal to seek treatment
• Rejection by family and friends
• Work problems or discrimination
• Difficulty finding housing
• Being subjected to physical violence or harassment
• Inadequate health insurance coverage of mental illnesses

Open discussion can help erase stigma

Not all the news is bad, though. Today, the stigma surrounding some mental health disorders is slowly eroding. That's due in part to greater public understanding of mental illnesses and the biological basis that many of them have. As causes of mental illnesses and better treatments for them are discovered, stigma may fade even more.

In addition, many celebrities and public figures have openly discussed their experiences with a mental health condition. This also helps bring the topic out of the closet of shame.

Coping with stigma

So what can you do about stigma? If you have a mental illness, you can decide who to tell, if anyone, and how much to tell. You may not be comfortable telling anyone anything at all about your condition. On the other hand, if you confide in people you trust, you may find much-needed compassion, support and acceptance.

Perhaps you want to actively combat stigma. You may only be comfortable pushing for more awareness within a close circle of family and friends by gently reminding them about the harm in jokes and stereotypes. Or if you're more comfortable tackling bigger challenges and facing bigger risks, you may decide to make your cause more public.

In either case, here are some ways you can cope with and help end stigma:

• Get appropriate treatment. Don't let the fear or anticipation of being stigmatized prevent you from seeking treatment for your illness. For some people, a specific diagnosis provides relief because it lifts the burden of keeping silent and also underscores that you aren't alone — that many others share your same illness and issues.
• Surround yourself with supportive people. Because stigma can lead to social isolation, it's important to stay in touch with family and friends who are understanding. Isolation can make you feel even worse.
• Make your expectations known. People may not know how to support you, even if they want to help. Offer specific suggestions and remind people of appropriate language.
• Don't equate yourself with your illness. You are not an illness. So instead of saying "I'm bipolar," say "I have bipolar disorder." Instead of calling yourself "a schizophrenic," call yourself "a person with schizophrenia." Don't say you "are depressed." Say you "have depression."
• Share your own experiences. Speaking at events can help instill courage in others facing similar challenges and also educate the public about mental illness. Until you gain confidence, you may want to start at small events, such as talks at a support group or church community.
• Monitor the media. If you spot stigmatizing stories, comic strips, movies, television shows or even greeting cards, write letters of protest that identify the problem and offer solutions.
• Join an advocacy group. Some local and national groups have programs to watch for and correct archaic stereotypes, misinformation and disrespectful portrayals of people with mental illnesses.

Don't let stigma create self-doubt and shame

In the face of insensitive comments or crude advertising gimmicks, it may be difficult to feel good about yourself. Remember that you have a medical condition, that it's not your fault and that effective treatments are available. Try not to feel shamed, embarrassed or humiliated if someone knowingly or unknowingly makes light of or pokes fun at your illness. Therapy may help you gain self-esteem and put less stock into what others think of you.

And if you're comfortable enough to speak up, you may be able to help educate people about the hurt that can result from stigmatizing mental illnesses. The tide is slowly turning.

• See Also

• Friendships: Enrich your life and improve your health
• Social support: Tap this tool to reduce stress
• Forgiveness: How to let go of grudges and bitterness
• Resilience: Build skills to endure hardship
• Anger management: Explore your anger to gain control
• Self-esteem: Boost your self-image with these 5 steps
• Being assertive: Reduce stress, communicate better
• Stress assessment
• Intervention FAQ: Help loved ones overcome addiction and abuse