Centuries-Old Barrier Hindering Mental Health Victories

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Overview

Our understanding of mental illness has evolved from demonization and cruelties in the Middle Ages to compassionate views in the late 1700s. However, prejudices swelled during the Nazi era as countless individuals living with mental illnesses met horrific fates. [1] 

While advances have been made through deinstitutionalization and medications, achieving full understanding and support of mental health remains ongoing. Even today, psychological struggles impose undue burdens due to lingering stigma. Many are uncomfortable openly discussing conditions in personal and work lives.

What progress has been made to reduce stigma? What hinders stigma elimination? By addressing these questions, we can break through barriers holding us back from winning the fight against mental illness.

What is Stigma?

According to the Britannica Dictionary, “stigma” refers to unfair group beliefs about something or someone. Regarding mental health, stigma involves misguided views and prejudices associated with mental illnesses and disorders. Stigma manifests in various forms, as outlined below.

People experiencing mental health issues frequently face social disapproval, discrimination, and unfair treatment due to stigma. Stereotypes, prejudices, and discrimination from stigma create enormous burdens and feelings of deep shame and isolation for those battling such issues. 

The weight of stigma significantly impedes seeking help. Feeling ashamed and cut off from others, people are less likely to access treatment that could greatly help conditions and well-being. Without addressing pervasive stigma, many suffering will not receive needed support.

Types of Mental Health Stigma

Researchers have identified different types of mental health stigma, namely, public stigma, self-stigma, and institutional stigma:

Specifically, public stigma refers to negative societal views of those with mental illnesses. The resulting discrimination (e.g., reduced opportunities for employment and housing, etc.) deprives those affected of quality life.

Furthermore, self-stigma refers to those with mental health conditions internalizing negative stereotypes about their conditions, struggling with shame, low self-esteem and reluctance to seek help or share details with others.

In addition, institutional stigma involves discriminatory attitudes and unfair generalizations by healthcare, education, and governmental organizations against those with mental illnesses. This manifests through unequal resources for mental health services, biased policies, and practices within institutions. [2]

Trends in Mental Illness Stigma Over Last Two Decades

A study examined changes in public stigma toward mental illness in the US from 1996 to 2018. The researchers analyzed data from 4,129 adults who participated in the National Stigma Studies in 1996, 2006, and 2018. Perceptions of the causes, dangerousness, and desire for social distance related to schizophrenia, depression, and alcohol dependence were assessed.

Over this time period, attributing these disorders to biological factors like genetics and chemical imbalance grew from 1996 to 2006. Additionally, views of depression improved by 2018 as social distance desires decreased in work, activities, relationships and living arrangements. However, perceptions of schizophrenia did not change during this time; in fact, views of dangerousness increased from 1996 to 2018. Similarly, attributing alcohol dependence to personality rose too.

Based on these findings, the researchers found that stigma levels varied most significantly according to generational factors. Specifically, younger cohorts were found to display more progressive attitudes. Therefore, while stigma against depression declined, more work is needed to address unchanging or worsening perceptions of other disorders to better support treatment and societal well-being. [3]

Progress Made In Fighting Stigma

There has been significant progress in reducing mental health stigma, especially through efforts that are most evident in the following key areas:

Establishment of advocacy groups and support organizations dedicated to raising mental health awareness, fighting misconceptions, and supporting those with needs. After Mental Health America established in 1909, groups like the National Alliance on Mental Illness and Anxiety and Depression Association of America formed later with shared goals.

Advancement in research and clinical practice provided more accurate information on causes, symptoms, and treatment options of illnesses. Such developments critically debunk myths and misinformation around mental illness, ultimately helping reduce stigma.

Changes in public policy and legislation have helped address mental health stigma, such as the 1963 Community Mental Health Act (CMHA), the 2008 Mental Health Parity and Addiction Equity Act (MHPAEA), and the Affordable Care Act (ACA) of 2010. The Biden administration has proposed a new rule to strengthen MHPAEA.

Digital communication platforms and social media have created new channels for open discussions of mental health by enabling individuals to share their lived experiences and struggles so that empathy and understanding can be achieved among diverse audiences.

More efforts have been made to educate the public about mental health in schools, workplaces, and communities. These efforts have also helped us combat stigma by promoting empathy, reducing biases, and encouraging help-seeking behaviors among students, employees, and the general public.

Formidable Hurdles In Ending Stigma

Although much has been done to end mental health stigma, it remains a staunch hurdle to overcome. Several cultural and societal barriers still significantly influence how mental illness is perceived and those who experience it are treated.

One such hurdle stems from the way different races and ethnicities view mental health issues through their own cultural lenses. For example, African Americans tend to perceive mental illness as associated with shame and embarrassment. [5] Similarly, Asian Americans have cultural beliefs that seeking treatment is shameful to the family. [6]

These cultural influences are compounded by discriminatory attitudes that persist within our social systems. In the workplace, discrimination against those with mental health conditions presents a major barrier to overcoming stigma, as it impedes their ability to attain jobs.

Only 38.1% of adults with significant psychiatric disabilities have full-time jobs versus 61.7% without disabilities [6], highlighting inequities despite protections under the Americans with Disabilities Act (ADA). Furthermore, the ADA National Network reports that individuals with mental health problems face higher rates of stigma and potential harassment within the workplace.

Reinforcing these discriminatory attitudes are the negative portrayals of mental illness that permeate our media and entertainment. However, they consistently depict dramatic and distorted images of mental illness, such as dangerousness, criminality, and unpredictability.

Moreover, the media often present negative reactions like fear and rejection as the natural way to view those with mental health issues. Such skewed representations shape public perceptions and prescribed ways of interacting with those experiencing mental illness. [7]

Final Thoughts

While significant advances have been made in understanding, educating, and legislating against mental health, stigma remains deeply entrenched in our social fabric. Centuries of misconceptions surrounding mental illness have taken root in cultural norms and institutional practices that continue to undermine equity today. Even as acceptance grows, stigma still influences how people experiencing the issues are being viewed in society.

Clearly, new approaches are needed to tackle stigma’s most formidable bastions. We must re-examine societal and systemic biases and devise tailored solutions that empower communities to overcome cultural stigmas from within. It is also important to encourage more accurate, sympathetic media portrayals that forge connections, not divisions. By addressing stigma at all levels, we can hope to make that final push towards a future where mental illness meets understanding, not unjust burden. Our work is not yet done.

Sources:

  1. Wulf Rössler. (2016). The stigma of mental disorders. EMBO Reports17(9), 1250–1253. https://doi.org/10.15252/embr.201643041
  2. Stigma, Prejudice and Discrimination Against People with Mental Illness. (2023). Retrieved May 15, 2024, from Psychiatry.org website: https://www.psychiatry.org/patients-families/stigma-and-discrimination
  3. Pescosolido, B. A., Halpern-Manners, A., Luo, L., & Perry, B. L. (2021). Trends in Public Stigma of Mental Illness in the US, 1996-2018. JAMA Network Open4(12), e2140202–e2140202. https://doi.org/10.1001/jamanetworkopen.2021.40202
  4. https://www.facebook.com/verywell. (2020). Exploring the Mental Health Stigma in Black Communities. Retrieved May 15, 2024, from Verywell Mind website: https://www.verywellmind.com/exploring-the-mental-health-stigma-in-black-communities-5078964
  5. CHOC. (2020, August 4). Understanding the role of cultural stigma on seeking mental health services. Retrieved May 15, 2024, from CHOC – Children’s health hub website: https://health.choc.org/understanding-the-role-of-cultural-stigma-on-seeking-mental-health-services/
  6. Luciano, A., & Meara, E. (2014). Employment status of people with mental illness: National survey data from 2009 and 2010. Psychiatric Services, 65(10), 1201-1209.
  7. Stuart, H. (2006). Media Portrayal of Mental Illness and its Treatments. CNS Drugs20(2), 99–106. https://doi.org/10.2165/00023210-200620020-00002

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