• Pre-Collegiate Global Health Review

The Silent Burden of Stigma 

Andreanna Ulery, Saline High School, Saline, Michigan, USA



“People suffering from mental illness are dangerous.”

“You can just snap out of it.”

“Those who are mentally ill are unpredictable and unreliable.”


These phrases are all examples of how mental illness is often perceived in society, forming the basis of the stigma against those diagnosed. The media has played a large role in developing the idea that those who are mentally ill are dangerous, unstable, or unable to function properly (Corrigan, et al., 2002). For example, movies and television shows in popular culture tend to portray characters with mental illness as violent (Corrigan, et al., 2002). Two notable examples of such misrepresentation are the 2019 film Joker and the 2016 movie Split. In Joker, the eponymous main character is depicted as having an unspecified mental illness and suddenly becomes very violent, enhancing the stereotype (Corrigan, et al., 2002). Split tells the story of a man with Dissociative Identity Disorder (DID) who becomes a violent kidnapper (Nedelman, 2017). This film compounds the idea that those with DID have a higher probability of becoming violent, when in fact those with DID have been shown to be much more of a risk to themselves than to others (Foote, et al., 2008).


However, public stigma is not the only type of stigma that surrounds mental illness. Both self-stigma and institutional stigma prevent the mentally ill from seeking help (Borenstein, 2020). Self-stigma refers to the internalization of negative ideas surrounding mental illness, which manifests in lower self-esteem, difficulties socializing, and reduced likelihood of seeking treatment (Mayo Clinic, 2017). Additionally, institutional stigma refers to organizational policies that intentionally or unintentionally limit opportunities for those with mental illness (Borenstein, 2020). Stigma surrounding mental illness is an issue that has pervaded every country across the globe - “there is no country, society, or culture where people with mental illness have the same societal value as people without a mental illness” (Rössler, 2016).


The stigma accompanying mental illness is a devastating one, leading to lack of treatment and a tragic preponderance of preventable deaths. 76-85% of people suffering from mental disorders in low to middle-income countries do not get the treatment they need (WHO, 2019). However, this mental health crisis is not just an issue in low and middle-income countries. In high-income countries, anywhere between 35% to 50% of the mentally ill do not seek treatment (WHO, 2019), which stems from all three types of stigma. Societal stigma makes patients fearful that their diagnosis will lead to social ostracization (Corrigan, et al., 2014). Self-stigma influences a patient to internalize one’s mental illness as his or her identity (ex. “I am schizophrenic,” vs. “I am a person with schizophrenia”) (Rössler, 2016). Institutional stigma often leads to reduced funding for mental health resources, such as emergency psychiatric care and fear of job loss for speaking up about mental health struggles (Geraldo da Silva, et al., 2020). Whether it be self, social, or institutional, stigma has become a global barrier to treating mental illness.


A massive number of lives are lost annually because of the negative societal issues of those with mental illness, inadequate access to mental health resources, and poor physical health. According to a NIH study, about 8 million people globally die each year due to mental illness (Walker, et al., 2015). Often, those with mental illnesses have poor physical health not only from medicinal side effects but also from inaccessible healthcare services (Vigo, 2016). Prejudice from those in the medical community contributes to decreased quality of care and misdiagnosis due to preemptive assumptions that the patient’s mental illness is causing physical distress (Vigo, 2016). The tragic fact is that millions of lives could have been saved if the global perspective on mental illness had not been clouded with fear and ignorance.


The status quo continues to perpetuate a vicious cycle of stigma, which hinders treatment delivery and contributes to millions of preventable deaths annually. However, there is still hope to alleviate mental illness stigma, starting with oneself. Everyone can make a difference, no matter how small, to mitigate the presence of stigma in societies across the globe. Start by educating yourself on the symptoms of mental illness, being conscious of your language pertaining to mental illness, supporting and being compassionate towards those with mental illness, and, if applicable and if you feel comfortable, speaking out about your own experience with mental illness (Greenstein, 2017). Stigma surrounding mental illness is a pervasive concept, but if we can find the confidence to refute it in our daily lives, we can not only revolutionize the way our world approaches treatment but also begin to rewrite the narrative around those suffering from mental illness.

References


Borenstein, J. (2020, August). Stigma and Discrimination. American Psychiatry Association. https://www.psychiatry.org/patients-families/stigma-and-discrimination.


Corrigan, P. (2006, May). Mental Health Stigma as Social Attribution: Implications for Research Methods and Attitude Change. Clinical Psychology: Science and Practice. https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.1028.5210&rep=rep1&type=pdf.


Corrigan, P., & Watson, A. (2002, February). Understanding the impact of stigma on people with mental illness. World psychiatry: official journal of the World Psychiatric Association (WPA). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/.


Corrigan, P., Druss, B., & Perlick, D. (2014). The Impact of Mental Health Stigma on Seeking and Participating in Mental Health Care. Association for Psychological Science. https://www.researchgate.net/profile/Deborah-Perlick/publication/279239872_The_Impact_of_Mental_Illness_Stigma_on_Seeking_and_Participating_in_Mental_Health_Care/links/55d4a28208aef1574e9756aa/The-Impact-of-Mental-Illness-Stigma-on-Seeking-and-Participating-in-Mental-Health-Care.pdf.


Foote, B., Smolin, Y., Neft, D. I., & Lipschitz, D. (2008). Dissociative disorders and suicidality in psychiatric outpatients. The Journal of nervous and mental disease, 196(1), 29–36. https://doi.org/10.1097/NMD.0b013e31815fa4e7.


Geraldo da Silva, A., Baldaçara, L., Cavalcante, D. A., Fasanella, N. A., & Palha, A. P. (2020, June 3). The Impact of Mental Illness Stigma on Psychiatric Emergencies. Frontiers in Psychiatry. https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00573/full.


Greenstein, L. (2017, October 11). 9 Ways to Fight Mental Health Stigma. NAMI. https://www.nami.org/blogs/nami-blog/october-2017/9-ways-to-fight-mental-health-stigma.


Kleinman, A. (2009, August 22). Global Mental Health: A Failure of Humanity. The Lancet. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61510-5/fulltext.


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Mayo Clinic Contributors. (2017, May 24). Mental health: Overcoming the stigma of mental illness. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/mental-health/art-20046477.


Nedelman, M. (2017, January 23). What Shyamalan's 'split' gets wrong about dissociative identity disorder. CNN. https://www.cnn.com/2017/01/23/health/shyamalan-split-movie-dissociative-identity-disorder/index.html.


Rössler, W. (2016, September). The stigma of mental disorders: A millennia-long history of social exclusion and prejudices. National Institutes of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5007563/.


Sharac, J., McCrone, P., Clement, S., & Thornicroft, G. (2009, December 13). The economic impact of mental health stigma and discrimination: A systematic review. King's College London. https://www.researchgate.net/profile/Paul-Mccrone/publication/49780072_The_economic_impact_of_mental_health_stigma_and_discrimination_A_systematic_review/links/54be84a50cf2e4062674f823/The-economic-impact-of-mental-health-stigma-and-discrimination-A-systematic-review.pdf.


Stuart, H. (2016, May 10). Reducing the stigma of mental illness: Global Mental Health. Cambridge University Press. https://www.cambridge.org/core/journals/global-mental-health/article/reducing-the-stigma-of-mental-illness/261AB4B0FCF056F137883350AF1133BF.


Wainberg, M., Scorza, P., Shultz, J., Helpman, L., Mootz, J., Johnson, K., Neria, Y., Bradford, J.-M., Oquendo, M., & Arbuckle, M. (2017, May). Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective. National Institutes of Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553319/.


Walker, E., McGee, R., & Druss, B. (2015, April). Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. National Institutes of Health. https://pubmed.ncbi.nlm.nih.gov/25671328/.


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