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1.10: Mental Disorders and Stigma

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    Learning Objectives
    • Describe types of stigma associated with mental disorders and ways to challenge these stereotypes
    Image result for stigma against psychological disorders
    Figure \(\PageIndex{1}\): Though awareness of mental health issues continues to increase, there is still a stigma associated with many mental disorders that should be addressed, both at an individual and societal level.

    Public-opinion studies have confirmed the widespread existence of negative stereotypes about individuals with mental health problems: they are considered dangerous, unpredictable, and difficult to talk to. These negative stereotypes can have detrimental consequences on the users of mental health services through processes of public stigma, self-stigma, and stigma expectations with regard to such outcomes as self-efficacy, depressive symptoms, self-esteem, life satisfaction, client satisfaction, work, income, and social relationships, in addition to treatment continuation and medication adherence. A stereotype, in general, refers to an expectation that people might have about every person of a particular group. A stereotype is distinct from stigma. Public stigma refers to a set of negative attitudes and beliefs that motivate individuals to fear, reject, avoid, and discriminate against people with mental illness (Corrigan and Penn 1999).[1]Self-stigma is thought to be particularly damaging, and is said to occur when individuals internalize stigmatizing social attitudes and come to believe the negative societal conceptions and stereotypes associated with their condition (Corrigan and Watson, 2002; Watson et al., 2007; Corrigan and Rao, 2012). Whether stigma is only anticipated or directly experienced, self-stigmatizing beliefs can lead to withdrawal from social support, rejection of help, avoidance of treatment, treatment withdrawal, and limited prospects for recovery (Link and Cullen, 1990; Link, 2001; Corrigan, 2004; Vogel et al., 2007).[2]

    Watch It

    This short clip highlights the importance of removing the stigma surrounding mental health conditions.

    You can view the transcript for “#StigmaFree: Mayim Bialik” here (opens in new window).

    #Stigma Free

    Words can hurt. Many derogatory words and phrases are used in relation to mental illness. However, these words maintain the stereotyped image and not the reality about mental illness. “Mentally ill people are nuts, crazy, wacko.” How often have we heard comments like these or seen these types of portrayals in movies, television shows, or books? We may even be guilty of making comments like them ourselves. Is there any truth behind these portrayals, or is that negative view based on our ignorance and fear? Try not to use these words, and encourage others not to use them. It is more appropriate to people-first language and to refer to “a person who has a mental illness” when speaking about someone. For example, you would say "A person with schizophrenia" instead of referring to the person as "a schizophrenic". Each of those preconceptions about people who have a mental illness is based on false information. Very few people who have a mental illness are dangerous to society. Most can hold jobs, attend school, and live independently. A person who has a mental illness cannot simply decide to get over it any more than someone who has a different chronic disease such as diabetes, asthma, or heart disease can. A mental illness, like those other diseases, is caused by a physical problem in the body.

    In fact, not all brain diseases are categorized as mental illnesses. Disorders such as epilepsy, Parkinson’s disease, and multiple sclerosis are brain disorders, but they are considered neurological diseases rather than mental illnesses. Interestingly, the lines between mental illnesses and these other brain or neurological disorders is somewhat blurring. As scientists continue to investigate the brains of people who have mental illnesses, they are learning that mental illness is associated with changes in the brain’s structure, chemistry, and function, and that mental illness does indeed have a biological basis.[9]

    Challenging Stereotypes about Mental Illness

    Recovery from mental illness is a complex process. As with all serious illness, the well-being of recovering individuals is affected by the attitudes that surround them. Despite increasing sensitivity about most disabilities, mental illness all too often remains a target for ridicule and misrepresentation in advertising, entertainment, and the mainstream media.

    Most of what we know as individuals comes not from personal experience, but from the stories that surround us from birth. In the past, it was families, religious institutions, schools, and respected members of the community who instilled cultural attitudes. But “Today, this is done by the mass media,” says George Gerbner, founder of the Cultural Environment Movement, and a researcher whose career includes 30 years of monitoring the cultural impact of television on society. Television is, in Gerbner’s words, “the wholesale distributor of the stigma of mental illness.” Gerbner’s research has shown that characters portrayed on television as having mental illnesses have four times the violence rate and six times the victimization rate of other characters. Gerbner notes that “Violence and retribution are shown as inherent in the illness itself and thus inescapable. No other group in the dramatic world of television suffers and is shown to deserve such a dire fate.”

    The portrayal of mental illness in the movies is similarly distorted. In the late 1980s, Steven E. Hyler of Columbia University and his colleagues identified six categories of psychiatric characters in films: homicidal maniac, narcissistic parasite, seductress, enlightened member of society, rebellious free spirit, and zoo specimen. Hyler concluded that these predominantly negative stereotypes had a damaging effect on the viewing public and on the patients themselves, their family members, and policy makers. More recently, Otto F. Wahl of George Mason University, an authority on public images of mental illness, found that in the decade from 1985 to 1995, Hollywood released more than 150 films with characters who have mental illnesses, the majority of them killers and villains. There can be no doubt that Hollywood stereotypes are a large part of what people know, or think they know, about people with psychiatric vulnerabilities. Newspaper reports about mental illness are often more accurate than the characters one sees in TV entertainment and movies. Still, people with psychiatric histories generally are reported negatively. In 1991, researchers Russell E. Shain and Julie Phillips found that 86% of all print stories dealing with former mental patients focused on violent crime. Media stereotypes of persons with mental illness as villains, failures, buffoons—together with the misuse of terms like “schizophrenia” and “psychotic” in negative contexts—have far-reaching consequences. On the most deeply personal level, biased stereotypes damage the sense of self-worth of millions of persons diagnosed with serious psychiatric illnesses. On the social and economic levels, negative stereotyping may result in large-scale discrimination against an entire class of people in the areas of housing, employment, health insurance, and medical treatment.

    Increasingly, the media are doing better work; at times, their efforts are excellent. Diana Ross’s moving and realistic portrayal of schizophrenia in Out of Darkness, an ABC television drama, was praised by mental health activists. “Good” characters with mental illness are appearing from time to time in prime-time television entertainment. Feature stories about the achievements of individuals diagnosed with mental illness—such as a New York Times business section feature about John Forbes Nash, Jr., the winner of a Nobel Prize for economics—also help shatter stereotypes. In 1959, Nash began showing clear signs of mental illness, and spent several years at psychiatric hospitals being treated for paranoid schizophrenia. After 1970, his condition slowly improved, allowing him to return to academic work by the mid-1980s. His struggles with his illness and his recovery became the basis for Sylvia Nasar’s biography, A Beautiful Mind, as well as a film of the same name starring Russell Crowe as Nash. And increasingly, people with first-hand experience of mental illness are writing books, appearing on television news and talk shows, producing documentaries and radio programs, and contributing articles to the print media. The disparity between mental illness as it is perceived by much of the public and mental illness as it is lived and experienced is a gulf to be bridged.

    Link to Learning

    There are countless examples of mental disorders in movies and TV shows, but only sometimes do they get it right. This video clip from Mojo highlights some of the more accurate portrayals of mental disorders in media.

    Learning Activity: Reduce Stigma About Mental Illness

    You can promote fair, accurate, and balanced portrayals of mental illness in the media. Your voice does make a difference. Whether you handwrite it, type it, or email it, it’s your passion and knowledge that persuade, that get your letters read (and published), and that change hearts and minds.

    Use the Challenging Stereotypes: An Action Guide to help decrease the barriers of prejudice toward people who have mental illnesses by calling attention to media portrayals of mental illness that are stigmatizing, stereotyping, and/or inaccurate.

    Try It

    Glossary

    public stigma: refers to a set of negative attitudes and beliefs that motivate individuals to fear, reject, avoid, and discriminate against people with mental illness

    self-stigma: occurs when individuals internalize stigmatizing social attitudes and come to believe the negative societal conceptions and stereotypes associated with their condition

    stereotype: an expectation that people might have about every person of a particular group

    stigma: a label that causes us to regard certain people as different, defective, and set apart from mainstream members of society

    1. 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↵
    2. Bracke P, Delaruelle K and Verhaeghe M (2019) Dominant Cultural and Personal Stigma Beliefs and the Utilization of Mental Health Services: A Cross-National Comparison. Front. Sociol. 4:40. doi: 10.3389/fsoc.2019.00040 ↵
    3. Bracke P, Delaruelle K and Verhaeghe M (2019) Dominant Cultural and Personal Stigma Beliefs and the Utilization of Mental Health Services: A Cross-National Comparison. Front. Sociol. 4:40. doi: 10.3389/fsoc.2019.00040. ↵
    4. Goffman E. Stigma: Notes on the Management of Spoiled Identity. Harmondsworth: Penguin, 1963 ↵
    5. Chaudoir, S. R., Earnshaw, V. A., & Andel, S. (2013). "Discredited" Versus "Discreditable": Understanding How Shared and Unique Stigma Mechanisms Affect Psychological and Physical Health Disparities. Basic and applied social psychology, 35(1), 75–87. https://doi.org/10.1080/01973533.2012.746612↵
    6. Scambler G. Stigma and disease: changing paradigms. Lancet 1998;352: 1054-5 [PubMed] ↵
    7. Gray A. J. (2002). Stigma in psychiatry. Journal of the Royal Society of Medicine, 95(2), 72–76. https://doi.org/10.1258/jrsm.95.2.72↵
    8. Chaudoir, S. R., Earnshaw, V. A., & Andel, S. (2013). "Discredited" Versus "Discreditable": Understanding How Shared and Unique Stigma Mechanisms Affect Psychological and Physical Health Disparities. Basic and applied social psychology, 35(1), 75–87. https://doi.org/10.1080/01973533.2012.746612↵
    9. National Institutes of Health (US); Biological Sciences Curriculum Study. NIH Curriculum Supplement Series [Internet]. Bethesda (MD): National Institutes of Health (US); 2007. Information about Mental Illness and the Brain. Available from: https://www.ncbi.nlm.nih.gov/books/NBK20369/↵
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