Mental Health: Why is stigma increasing?
Efforts have increased to combat mental health stigma over the past few decades. But why, paradoxically, are rates of prejudice and discrimination rising for those with severe mental illness? Research reveals that the biomedical model of mental illness has increased rates of stigma for those living with schizophrenia and bipolar disorder. Despite small gains in public perceptions of people living with anxiety and depression, policymakers need to radically rethink efforts to stamp out rising levels of discrimination for the most serious mental health conditions.
Enforced social isolation is a crucial predictor of mental illness. With the experience of lockdown, more people than ever before encountered mental health problems – bringing suicide and conditions like depression and anxiety to the forefront of public consciousness. Many were directly affected by mental health conditions during the COVID-19 pandemic or knew someone who was.
However, recent research has revealed that despite this growing awareness of the reality of mental illness and its prevalence – and despite significant campaigns to eradicate stigma for those who experience it – levels of discrimination and prejudice against people living with bipolar disorder and schizophrenia have increased.
Why is this?
Mental health stigma
Mental health stigma is destructive on multiple fronts. People living with mental health conditions can face barriers to education and employment and social exclusion from mainstream society. Unfortunately, that’s just the tip of the iceberg. Internalised stigma can exacerbate someone’s symptoms and reduce their quality of life.
A person’s overall prognosis is linked to how much they can resist external negative stereotyping and reject unjustified projected negative attributions, such as ‘dangerous’, ‘incompetent’, or ‘childish’. Internalised shame from stigma is a real danger.
TEDx talk by Heather Young Sarkis on mental health stigma.
Stigma stems from ‘fear’. Negative depictions in the media and mainstream entertainment frequently depict the exceptionally rare cases of people experiencing altered states committing violent acts.
Levels of public unease surrounding people who have experienced or are experiencing psychosis or manic states are partly a product of media representations of mental illness – not all of which are accurate. The way that mental health conditions are portrayed in the media is improving, but reporting often can still lack balance.
The truth is that many people with chronic mental health illnesses work in demanding careers, contribute positively to their wider community, and foster warm and loving interpersonal relationships. Moreover, the overwhelming majority are never violent. This is particularly the case for people living with the most severe mental health conditions, such as schizophrenia, schizoaffective, and bipolar disorders. These diagnoses attract the highest level of prejudice, stigma, and discrimination.
Biomedical model vs psychosocial
Previous efforts to reduce stigma have focused on a biomedical model, which promotes mental health conditions as an illness like any other; however, these efforts appear to have done more harm than good. Critics point to the increased influence of pharmaceutical companies on the conception and adoption of a mainstream biomedical model of mental illness. The brain is ‘broken’; medication will ‘fix it’. However, such an approach is limited in its understanding of the complex psychosocial experiences and trauma that interweave to create the conditions for mental health problems. No solely pharmaceutically based approach stands a chance of being effective without addressing the root causes of mental distress – it’s not all in the brain.
Unemployment, poverty, trauma, discrimination, lack of social support, and yes – stigma – all contribute to the likelihood of someone experiencing a mood disturbance or psychotic break. Some people will find medication helpful for managing these distressing experiences; others will not. However, working with the affected individuals to address the psychosocial causes of their altered states is essential in all cases.
Housing interventions, reasonable adjustments at work, access to financial support, and social activities can all reduce the likelihood of mental health illness or relapse. Such a psychosocial approach also stops essentialist thinking in the biomedical model, which creates a false dichotomy between the ‘mentally healthy’ and the ‘mentally unwell’. The accepted biomedical approach inadvertently perpetuates the very stigma it aims to combat.
Instead, conceptualising the experience of mental health on a continuum of ‘ups and downs’ that we all experience has been proven to reduce stigma. Psychosocial understandings of mental health conditions as arising from trauma, rather than being an innate characteristic, similarly evoke empathy rather than fear.
Luna Dewey is a UK-based writer blogging on the latest research topics.
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Sources:
Schomerus, G, Schindler, S, Sander, C, et al, (2022) Changes in mental illness stigma over 30 years – Improvement, persistence, or deterioration? European Psychiatry, 65(1), E78. doi.org/10.1192/j.eurpsy.2022.2337 [Accessed 11/01/23].
Hazell, CM, Berry, C, Bogen-Johnston, L, Banerjee, M, (2022) Creating a hierarchy of mental health stigma: Testing the effect of psychiatric diagnosis on stigma. BJPsych Open, 8(5), e174. doi.org/10.1192/bjo.2022.578.
Pescosolido, BA, Halpern-Manners, A, Luo L, Perry, B, (2021) Trends in public stigma of mental illness in the US, 1996-2018. JAMA Netw Open, 4(12), e2140202. doi.org/10.1001/jamanetworkopen.2021.40202 [Accessed 11/01/23].
Bullmore, E, (2022) The big idea: should we drop the distinction between mental and physical health? [online] The Guardian. www.theguardian.com/books/2022/sep/12/the-big-idea-should-we-drop-the-distinction-between-mental-and-physical-health [Accessed 11/01/23].
Sears, R, (2022) Mental health stigma varies by diagnosis, driven by fear and misunderstanding. [online] Mad in America. www.madinamerica.com/2022/10/mental-health-stigma-varies-diagnosis-driven-fear-misunderstanding/ [Accessed 11/01/23].
Sears, R, (2022) Stigma continues to increase for schizophrenia despite deliberate focus on the brain. [online] Mad in America. www.madinamerica.com/2022/12/stigma-continues-increase-schizophrenia-despite-deliberate-focus-brain [Accessed 11/01/23].
Mental Health Foundation, (2021) Stigma and discrimination. [online] www.mentalhealth.org.uk/explore-mental-health/a-z-topics/stigma-and-discrimination [Accessed 11/01/23].
Borenstein, J, (2020) Stigma, prejudice and discrimination against people with mental illness. [online] American Psychiatric Association. www.psychiatry.org/patients-families/stigma-and-discrimination [Accessed 11/01/23].
Medical News Today, (2020) What is mental health stigma? [online] www.medicalnewstoday.com/articles/mental-health-stigma [Accessed 11/01/23].