The Roots of Mental Health Stigma

A survey on the barriers of mental heath issues lists stigma as the fourth reason, why people do not seek or continue treatment.

A reason to explore the reasons behind the mental health stigma.

1. A Brief history of mental health stigma in western countries.

In ancient as in modern times, labeling someone as mentally ill has been equivalent to branding someone as being of lesser social value. Prefabricated opinions and attitudes about people suffering from mental health issues are:

They are unreliable, unpredictable, maybe the family is blameworthy, and they can be out of control with all the negative social consequences of withdrawal, that prevents them from their human rights and social participation.

The term stigma comes from the ancient Greek and refers to a tatoo mark that was cut or burned into the skin of criminals, slaves and traitors. Though people with mental illness were not brand marked, they were nevertheless seen as having lost their rational reasoning and with this their full human functioning. Banishment was the social response over hundreds of years.

In the Middle Ages mental illness became linked to sin and punishment of God. People with mental disorders were seen as possessed by the devil that could be only driven out by exorcism, torture or death. 

After these dark time in the beginning of the 18. Century institutions were built to nurse people suffering from mental disorders back to health. Though these early asylums were protective, over time they degenerated and long-term institutionalization was the only mental health treatment up to 1960. Mental disorders were seen as a result of a defect in the nervous system and controversial treatments such as electrotherapy and lobotomy were used.

However, some physicians at that time proposed that mental disorders were not merely rooted in the physical but also in the psychological. It was assumed that hypnosis could uncover unconscious memories and therefore heal a person's psyche.

A detrimental impact on mental health stigma had the genetic and biological explanations of mental disorders in the beginning of the 19. Century. As a mental illness was seen as inherited and degenerative to the brain, people were seen as not in control of themselves and not curable.

A deterioration of this perspective were the forced sterilization of mentally impaired people in the US and the murder and sterilization of thousands of mentally ill people during the Nazi reign in Germany.

Around 1960 mental health treatment was expanded to community based outpatient treatments. Reasons were campaigns against the hospitalization and banishment of people with mental health disorders from society and the development of psychopharmaca drugs with its notion of chemical imbalances in the brain.

Nowadays there are many treatment options that are clinically proven for depression, anxiety, bi-polar depression and PTSD ranging from medication, psychotherapy, transcranial magnetic stimulation (TMS), psychedelic drugs with administered psychotherapy, hypnotherapy, EMDR combined with nutrition, exercise and community support.

Summary: Mental disorders have a long history of stigmatization in many societies around the globe. Whatever the ideology around the etiology of mental disorder was, the “Treatment” was adjusted. Looking at the history biased prejudice and stereotypes of mental disorders are still common among people from all ages, gender and societies. 

Another contributor to stigmatization are the media.

     2. The Media

What images come up when you think of mental health?

With most people evil movie characters like Arthur Fleck (The Joker) or Norman Bates (Psycho) emerge or news reports of mass shootings by mentally sick people.

“Our mainstream perception of madness are still fixed with movie scenes”, writes Arwa Haider, in the bbc film section. She highlights the biased images of the main characters for the sake of sensationalism, however acknowledges that newer movies open up to more sensitive portrayals of mental illness.

Additionally, the mass media disproportionately emphasizes the link between mental illness and violence, though the prevalence of crime of people with mental illness is only 3-5%. From these media coverage stereotypes (prefabricated opinions about members of groups) about mentally ill people are formed. 

    3. Self Stigmatization

With Self-Stigmatization an individual internalizes the stigma when he/she experiences the first episode of a mental disorder. The individual takes an assumed personality characteristics such as “people with bi-polar disorder tend to be aimless and disorganized” and projects it to self as “thus I am disorganized too.” The result of this attribution is often a low belief in the ability to cope with the disorder in life: “I am not able to achieve anything, because I am not focused.”

Conclusion:

Stigmatization has consequences for the individual with mental disorder: critical impairment in seeking professional help and higher dropout rate from treatment.

It is important to question our own biases and stereotypes about people suffering from mental health disorders and inform ourselves about symptoms from mental health disorders and proven treatments.

In an article in FORBES I will reflect on "How To Reduce Mental Health Stigma In The Workplace". Stay tuned.

What did you learn from this article? And most importantly what will you change in your approach to mental health?

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