Stigma

At its essence, stigma is a form of discrimination and prejudice, often driven by misinformation and fear. It manifests when individuals disparage others based on their mental health diagnoses or symptoms. Common but harmful phrases such as 'He's a psycho' or 'She's so OCD' not only trivialize the real struggles associated with mental health conditions but also can reduce a person to a disorder, overshadowing their full humanity.

Stigma is sometimes also used to judge character. Individuals with depressive disorders might be unfairly labeled as 'lazy' or urged to 'just get over it,' implying a misperception that they choose to avoid responsibilities due to their symptoms. Stigma not only undermines the seriousness of these conditions but can also deter people from seeking help, due the myth that reaching out for support is a sign of weakness.

People with mental health challenges often face stigma even though societal views of mental illness are more progressive in the 21st century than in the past. The stigma surrounding mental illness has a long and complex history across cultures and societies, including in the following periods. 

Ancient beliefs and approaches

Several ancient civilizations, including Greek, Roman, and Egyptian cultures, attributed mental illness to supernatural forces such as evil spirits or as a punishment from godlike entities. As a result, individuals with mental conditions were often marginalized, shunned, or subjected to harsh treatment³ methods like trepanation, purging, exorcism, and bloodletting. 

The rise of scientific thought within Greek and Roman society changed the approach to mental illness among philosophers and physicians. For example, during this time, the Greek physician Hippocrates posited that, like physical disorders, mental health disorders arose naturally—most specifically from brain injury, disease, dysfunction, or hereditary factors.

Medieval and Renaissance periods 

Despite the scientific approach to psychology in ancient Greece and Rome, mental illness was often linked to witchcraft or demonic possession during the medieval period. During this time, people with mental disorders may have been subjected to exorcisms, torture, or imprisonment. 

With the Enlightenment period, a more scientific model of mental illness returned. Asylums emerged during this time as governments struggled to assist people with mental disorders and those caring for them in their homes. Some monasteries and hospitals were converted into asylums to help patients. However, overcrowding soon led to a breakdown in care, and the treatment of patients within such asylums remained inhumane. In some instances, treatment devolved beyond inhumane into the realm of exploitive and cruel, such as in the case of London's Bethlehem Hospital. 

18th to 19th century Enlightenment and the reform movement

The Enlightenment period in history gave rise to movements within the psychological community to better understand the origins of mental disorders, which reduced societal stigma and gave way to more humane treatments for individuals with mental health challenges.  

One of the first movements was the moral treatment movement in the US and Europe, in which professionals strove to change public perceptions, arguing that mental illness is a sickness akin to physical illness and that treatments should be based on respect, kindness, and a robust code of ethics. 

The mental hygiene movement in the US followed the same principles but focused on holistically integrating mental and physical healthcare. Treatments included, but weren't limited to, diet, exercise, and rest management. 

Despite the growing emphasis on humane treatment, asylums were overcrowded, and individuals received inadequate care. The stigma against mental illness persisted, and individuals with mental health disorders were often kept hidden from society, leading to continued misunderstanding and fear.

Early 20th century and the rise of psychiatry

The early 20th century saw the development of modern psychiatry and the understanding that mental illnesses could have biological and psychological causes. A more detailed study of mental illness symptoms led to better organization and classification of conditions, resulting in a better understanding of their nature and how to treat them effectively. 

However, eugenics movements like those practiced in Nazi Germany led to the forced sterilization and execution of individuals with mental disorders to prevent their conditions from "being passed on to future generations." The cruelty and ignorance of such movements caused a regression in the field of psychiatry and contributed to the stigmatization of people with mental illnesses. 

Mid-20th century deinstitutionalization

In the mid-20th century, deinstitutionalization began, aiming to shift the care of individuals with mental illnesses from large asylums to community-based settings. Part of this movement started because of the development of psychotropic medications to treat mental illness, but also due to the growing costs of psychiatric facilities and the associated poor living conditions and human rights violations.

While this change had some positive aspects, it also resulted in many individuals with severe mental illnesses being released without adequate support systems. Without necessary support and treatment, more people with severe disorders and psychotic symptoms were left homeless and, as a result, placed in public institutions ill-equipped to provide appropriate treatment, like prisons.

Late 20th century and beyond

Efforts to combat the stigma of mental illness gained momentum in the latter half of the 20th century. Advocacy groups were formed, and public awareness campaigns aimed to dispel misconceptions about mental health. However, negative stereotypes and discrimination persisted in various forms, affecting employment opportunities, social interactions, and adequate access to healthcare. 

21st-century mental health awareness

In the 21st century, there has been a significant increase in awareness and advocacy for mental health conditions and challenges. Celebrities, public figures, and media outlets have openly discussed their experiences with mental health challenges, reducing some of the stigma associated with seeking help. Some countries have enacted laws to protect the rights of individuals with mental illnesses and to ensure equitable access to mental health care. However, there are still steps to be taken to reduce stigma and discrimination.

Classification and labels around stigma can provoke debate, prompting professionals in sociology and the mental healthcare industry to examine how stigma impacts people on personal, societal, and systemic levels. While discussion continues, there are several recognized forms of mental health stigma that individuals face today, including the following. 

Self-stigma

At times referred to as internalized stigma, self-stigma in psychology occurs when individuals with mental health disorders internalize the negative stereotypes and beliefs about mental illness in their society or culture, leading to indignity and reduced self-esteem that can prevent them from seeking treatment due to fear of judgment. 

Public stigma

Public stigma occurs when the public holds negative attitudes and beliefs about individuals with mental health conditions or disabilities. Public stigma can lead to discrimination, exclusion, and social distancing. People may avoid interacting with those perceived as having mental illnesses due to fear or misunderstanding.

Structural stigma

Structural or systemic stigma refers to the discrimination embedded in societal institutions, policies, and practices. This type can include discriminatory laws, unequal access to healthcare, and limited opportunities for education and employment for individuals with mental health conditions. Structural stigma reinforces societal biases and can make it more difficult for affected individuals to participate fully in society.

Media stigma

Negative and sensationalized portrayals in movies, TV shows, news stories, and other media can contribute to public misunderstanding and perpetuate stigma.

Affiliation stigma

People like family members, friends, and partners of individuals with mental illnesses can experience affiliation stigma, leading to isolation and relationship challenges.

Perceived stigma

Perceived stigma refers to the anticipation or expectation that one will be stigmatized due to their mental health condition. This stigma can prevent individuals from seeking treatment or sharing their condition to others.

Cultural and ethnic stigma

Cultural norms and beliefs can shape mental health perceptions within different communities. In some cultures, seeking help for mental health issues is stigmatized, which can discourage individuals from seeking treatment.

Gender-based stigma

Gender stereotypes can lead to specific stigmas around mental health. For example, traditional masculinity expectations might dissuade men from conveying emotions or seeking assistance for mental health concerns.

Religious and spiritual stigma

Some religious or spiritual beliefs may stigmatize mental health conditions as a sign of moral weakness or spiritual deficiency, preventing individuals from seeking appropriate care.

The causes of stigma can be complex and are often the result of a combination of factors. On an individual level, people may discriminate against individuals with mental conditions because of past experiences or because they were raised in a household where prejudice was commonplace. Stigma also exists on a societal level in many instances, where an entire population is influenced by prejudice. 

Regardless of context, there are root causes of stigma that can affect people on any level, including the following: 

• Lack of understanding: Misinformation or insufficient information about the nature of mental illness and who it affects can contribute significantly to the spread of prejudice.
• Fear: People often react with fear when they encounter symptoms or behaviors they don't understand, including engaging with people with mental health conditions. Connection and interaction with people experiencing mental illness may educate others and reduce or eliminate fear.
• Media misrepresentation: Media portrayals of mental disorders are often hostile or misconstrued. This stigma isn't limited to movies, TV, and media outlets—stigmatization is also present in online platforms and social media.
• Spreading inaccuracies: Spreading inaccurate information about mental illness contributes to a lack of understanding, resulting in fear and stigmatization. Challenging myths and stereotypes can be crucial to reduce this impact.

Stigma's impact on society and individuals can be far-reaching and destructive, and the lines between the two are often blurred. 

On an individual level, people with mental illness may experience a range of mistreatment, including harassment, bullying, physical violence, and ostracization. Potential limitations of social and employment opportunities experienced by those with mental health conditions can be impactful on a personal and societal level.

Because of the threat of stigmatization, some people don't seek treatment. This challenge can lead to the decline of the individual's mental health and, in many circumstances, place a burden on those who care for them. A lack of appropriate support for those with mental health challenges can also contribute to societal consequences like homelessness, poverty, and crime.

Below are several statistics related to stigma and mental health in the US: 

• Fifty million American adults (21%) have a mental illness.
• Of the 50 million Americans with mental illness, almost 50% seek treatment. 
• Worldwide, approximately 88% of people affected by mental illness report discrimination.
• Though roughly 75% of employed persons in the US experience mental health challenges, eight out of ten say they have not sought care due to perceived stigma and shame.
• Despite the stigma associated with violence and mental health, only 3% to 5% of violent acts can be attributed to individuals with mental illness.