Society’s Stigma Towards Mental Illness Essay
You would never tell someone to get over a fractured bone. You would never tell someone who is battling cancer that they are faking it. You would never tell someone who is paralyzed in both legs to walk because it’s all in their mind. You would never tell any of these people this because they didn’t bring it on themselves. We live in a society where mental illness is overlooked by physical pain. Even though it is just as real but not as visible. We live in a world where stigma costs lives. This stigma is everywhere. It’s in our actions, words and even on the TV screen. Society’s Stigma Towards Mental Illness Essay. Have you ever related to a character on a TV show? You’ve probably related over Carol crying over her boyfriend who broke up with her over text or Jimmy being really angry over his sister eating the last cookie. This may give you ideas of what mental illness may feel like but not what it truly is.
Mental illness contains biological factors from an individual’s own genetic makeup which can contribute to the risk of developing a mental illness. Now let me tell you this, I can guarantee you that at least one person you know experiences a mental illness. A brother, a father, a neighbor a solider, a child. And I can assure you that at least one of these people have not seeked help due to stigmatization. We have been taught that mental illness should be kept in the shadows. We have been taught that if we express how we feel we are weak. Not only that, we have been taught that people with mental disorders are seen upon one light. Depressed, crazy, mental, that girl is so retarded. Well that girl, and all the rest of us battling with illness are so much more than a diagnosis. So much more than the pills prescribed by the doctor, so much more than the voices, the heavy breathing. And I tell you this, ‘people don’t die from suicide, they die from sadness’ it’s not a commitment to take your own life. It’s being mentally unwell. It’s being sick. It’s not wanting to get out of bed. It’s not even wanting to shower. It’s not wanting to care.
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Don’t you think it’s sad that people feel so worthless that they result in thoughts of ending their own life? Approximately 65,300 Australians attempted suicide in the past year. And the number keeps rising. How many more lives will be taken? How many more families have to be dismantled due to this silent killer? It is time for us to be the change, to break down this shameful wall. We know the biological makeup of the mind, we know that there are many factors that influence someone’s mental state. It’s not a form of madness, karma or the devil.
Mental disorders are real and are impacted by genetics and life experiences. It’s not something that can be repaired over time. It’s with us every day. It changes the way we view the world. To make matters worse, all over the world, in so called ‘developed’ countries that people fighting a mental illness are being frowned upon by the health care system.Society’s Stigma Towards Mental Illness Essay. What’s that saying again, ‘if you need help you receive help’ was wrong. Because from my understanding, if you have a cut or a toothache you are held by the hand, whilst when you suffer from a serve depression or anxiety, people run the other way. It’s ironic isn’t it, that society is all for freedom of speech but is also the one that silences people when it comes to mental illness. We all need to see change. Imagine the amount of lives we could save through conversation about this issue. How many more people won’t feel neglected, shame or doubt. How many more people won’t have to overhear someone saying, ‘just kill myself’ over a spilt coffee on their white blouse, how many more people won’t have to hear, ‘oh I am so OCD about those tables.’ We need to stop glamorizing mental health. It’s not ‘fashionable,’ ‘cool’ or being ‘special.’ It’s a destructive and complex thing that one battles with every day. In our society, it has become an honor, but also an excuse for everything. “sorry mum, I can’t clean the bathroom. I have anxiety” “No dad, I can’t take the bin out, I’m depressed.” But do you know what it really feels like? To feel heavy. To carry a burden around everywhere you go, even though you don’t want to. Do you know what it feels like to be stuck between what ifs and self-doubt? No, you probably don’t. Even though, mental illness is a complex thing, it is something that needs to be addressed and understood by society. I need you to understand that anyone can experience a mental illness. Regardless of social status, ethnicity, race or gender. And these people are being denied treatment, care, love and support due to this shameful killer called stigma. And you may wonder, if mental illness is such a predominant issue, why do schools not educate students on how to cope with it?
Society’s stigma towards mental illness has prevented awareness being taught in schools which heightens the ideas that mental illness is something that should not be spoken about. I believe local governments need to become proactive in ending stigma towards mental illness. Alongside this, public schools need to make mental illness being talked about in a classroom compulsory. Considering exercise and nutrition is so broadly covered, is it asking too much for in depth conversation on how to cope with a mental illness, where to seek help and ways to improve someone’s mental state? Education ends the cycle of stigma and I have hope that we can all transform opinions of mental illness from stigma to acceptance. To conclude this, I ask everyone to do one simple thing. And that is to be nice to people. You never know what someone is going through. Society’s Stigma Towards Mental Illness Essay.
Abstract
Mental health stigma operates in society, is internalized by individuals, and is attributed by health professionals. This ethics-laden issue acts as a barrier to individuals who may seek or engage in treatment services. The dimensions, theory, and epistemology of mental health stigma have several implications for the social work profession.
In 2001, the World Health Organization (WHO) reported that an estimated 25 percent of the worldwide population is affected by a mental or behavioral disorder at some time during their lives. This mental and behavioral health issue is believed to contribute to 12 percent of the worldwide burden of disease and is projected to increase to 15 percent by the year 2020 (Hugo, Boshoff, Traut, Zungu-Dirwayi, & Stein, 2003). Within the United States, mental and behavioral health conditions affect approximately 57 million adults (National Institute of Mental Health [NIMH], 2006). Despite the high prevalence of these conditions, recognized treatments have shown effectiveness in mitigating the problem and improving individual functioning in society. Nonetheless, research suggests that (1) individuals who are in need of care often do not seek services, and (2) those that begin receiving care frequently do not complete the recommended treatment plan (Corrigan, 2004). For example, it has been estimated that less than 40 percent of individuals with severe mental illnesses receive consistent mental health treatment throughout the year (Kessler, Berglund, Bruce, Koch, Laska, Leaf, et al, 2001). Society’s Stigma Towards Mental Illness Essay.
There are several potential reasons for why, given a high prevalence of mental health and drug use conditions, there is much less participation in treatment. Plausible explanations may include (1) that those with mental health or drug use conditions are disabled enough by their condition that they are not able to seek treatment, or (2) that they are not able to identify their own condition and therefore do not seek needed services. Despite these viable options, there is another particular explanation that is evident throughout the literature. The U.S. Surgeon General (1999) and the WHO (2001)cite stigma as a key barrier to successful treatment engagement, including seeking and sustaining participation in services. The problem of stigma is widespread, but it often manifests in several different forms. There are also varying ways in which it develops in society, which all have implications for social work – both macro and micro-focused practice.
In order to understand how stigma interferes in the lives of individuals with mental health and drug use conditions, it is essential to examine current definitions, theory, and research in this area. The definitions and dimensions of stigma are a basis for understanding the theory and epistemology of the three main ‘levels’ of stigma (social stigma, self-stigma, and health professional stigma).
2. Stigma Definitions & Dimensions
The most established definition regarding stigma is written by Erving Goffman (1963) in his seminal work: Stigma: Notes on the Management of Spoiled Identity. Goffman (1963) states that stigma is “an attribute that is deeply discrediting” that reduces someone “from a whole and usual person to a tainted, discounted one” (p. 3). The stigmatized, thus, are perceived as having a “spoiled identity” (Goffman, 1963, p. 3). Society’s Stigma Towards Mental Illness Essay. In the social work literature, Dudley (2000), working from Goffman’s initial conceptualization, defined stigma as stereotypes or negative views attributed to a person or groups of people when their characteristics or behaviors are viewed as different from or inferior to societal norms. Due to its use in social work literature, Dudley’s (2000)definition provides an excellent stance from which to develop an understanding of stigma.
It is important to recognize that most conceptualizations of stigma do not focus specifically on mental health or drug use disorders (e.g., Crocker, Major, & Steele, 1998; Goffman, 1963). Stigma is relevant in other contexts such as towards individuals of varied backgrounds including race, gender, and sexual orientation. Thus, it is important to provide a definition of mental disorders, which also include drug use disorders, so that it can be understood in relationship to stigma. While each mental health and drug use disorder has a precise definition, the often cited and widely used Diagnostic and Statistical Manual of Mental Disorders (4th Ed., Text Revision [DSM-IV-TR]; American Psychiatric Association [APA], 2000) offers a specific definition of mental disorder which will be used to provide meaning to the concept. In this text, a mental disorder is a “clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom,” which results from “a manifestation of a behavioral, psychological, or biological dysfunction in the individual” (APA, 2000, p. xxxi). While this definition provides a consistent base from which to begin understanding how stigma impacts individuals with mental health and drug use disorders, it is important to recognize the inherent danger in relying too heavily on specific mental health diagnoses as precise definitions (Corrigan, 2007), which is why the term is being used just as a basis for understanding in this context.
The next important step is to understand the constructs underlying the concept of stigma. These constructs detail the multiple pathways through which stigma can develop. Building from Goffman’s initial conceptualization, Jones and colleagues (1984)identified six dimensions of stigma. These include concealability, course, disruptiveness, peril, origin, and aesthetics (Feldman & Crandall, 2007; Jones et al, 1984). Society’s Stigma Towards Mental Illness Essay. In addition, Corrigan and colleagues (2001; 2000) identified dimensions of stability, controllability, and pity. It is important to understand that these dimensions can either present independently or simultaneously to create stigma. Further, stigma is more than a combination of these elements impacting each person as an individual, since stigma is believed to be common in the structural framework of society (Feldman & Crandall, 2007).
The first dimension of stigma is peril – otherwise known as dangerousness. Peril is often considered an important aspect in stigma development, and it is frequently cited in the research literature (Corrigan, et al, 2001; Feldman & Crandall, 2007; Angermeyer & Matschinger, 1996). In this instance, the general public perceives those with mental disorders as frightening, unpredictable, and strange (Lundberg, Hansson, Wentz, & Bjorkman, 2007). Corrigan (2004) also suggests that fear and discomfort arise as a result of the social cues attributed to individuals. Social cues can be evidenced by psychiatric symptoms, awkward physical appearance or social-skills, and through labels (Corrigan, 2004; Link, Cullen, Frank, & Wozniak, 1987; Corrigan, 2007). This particular issue highlights the dimension of aesthetics or the displeasing nature of mental disorders (Jones, et al, 1984). When society attributes, upon a person or group of people, perceived behaviors that do not adhere to the expected social norms, discomfort can be created. This often leads to the generalization of the connection between abnormal behavior and mental illness, which may result in labeling and avoidance. This also may be why society continues to avoid those with mental and behavioral disorders whenever possible (Corrigan, Markowitz, Watson, Rowan, & Kubiak, 2003).
Another dimension of stigma that is often discussed in the research on stigma is origin.As in the definition provided earlier, mental and behavioral disorders are often believed to, at least in-part; develop from biological and genetic factors – i.e., origin (APA, 2000). This has direct implications for the dimension of controllability (Corrigan, et al, 2001). Within this dimension, it is often believed in society that mental and behavioral disorders are personally controllable and if individuals cannot get better on their own, they are seen to lack personal effort (Crocker, 1996), are blamed for their condition, and seen as personally responsible (Corrigan, et al, 2001). Society’s Stigma Towards Mental Illness Essay.
A recent report by Feldman and Crandall (2007), found that individuals with disorders such as pedophilia and cocaine dependence were much more stigmatized than those with disorders such as posttraumatic stress disorder. This supports the controllabilityhypothesis in which pedophilia and cocaine dependence could be viewed as more controllable in society than a disorder believed to be caused by a traumatic experience (PTSD). It also supports the pity dimension, in which disorders that are pitied to a greater degree are often less stigmatized (Corrigan, et al, 2000; Corrigan, et al, 2001). In this case, individuals within a culture or society may have more sympathy for disorders that are perceived as less controllable (Corrigan, et al, 2001).
Concealability, or visibility of the illness, is a dimension of stigma that parallels controllability, but also provides other insight into the stigmatization of mental and behavioral disorders. Crocker (1996) suggests that stigmatized attributes such as race can be easily identified, and are less concealable, allowing society to differentiate and stigmatize based on the visibility of the person. This is supported by research that shows that society attributes more stigmatizing stereotypes towards disorders such as schizophrenia, which generally have more visible symptoms, compared to others such as major depression (Angermeyer & Matschinger, 2005; Lundberg, et al, 2007).
The final three dimensions, course, stability, and disruptiveness, also may have some similarities among each other and compared to the others presented. Course and stabilityquestion how likely the person with the disability is to recover and/or benefit from treatment (Corrigan, et al, 2001; Jones, et al, 1984). Further the disruptivenessdimension assesses how much a mental or behavioral disorder may impact relationships or success in society.Society’s Stigma Towards Mental Illness Essay. While disorders are frequently associated with an increased risk for poverty, lower socioeconomic status and lower levels of education (Kohn, Dohrenwend, & Mirotznik, 1998), the stability and disruptiveness of the conditions have implications as to whether an individual will be able to hold down a successful job and engage in healthy relationships, as evidenced by differences in stigma based on social class status. This demonstrates that if disorders are less disruptive, in which case they may be perceived as more stable, they are also less stigmatized (Corrigan, et al, 2001). This also expresses that some flexibility exists within each type of mental or behavioral disorder, as each diagnosed person is not stigmatized to the same extent (Crocker, 1999). Figure 1depicts stigma as a latent variable constructed from the dimensions discussed above.
The dimensions of stigma
3. Levels of Stigma: Theory & Epistemology
Illustrating the constructs underlying the formation of stigma helps us understand three specific levels of stigma – social stigma, self-stigma, and professional stigma. In this context, ‘levels’ does not refer to a hierarchy of importance for these varied stigmas, but rather to represent different social fields of stigma that can be differentiated from each other. In addition, further definition and theory behind these three ‘levels’ of stigma must be presented. First, stigmatized attitudes and beliefs towards individuals with mental health and drug use disorders are often in the form of social stigma, which is structural within the general public. Second, social stigma, or even the perception that social stigma exists, can become internalized by a person resulting in what is often called self-stigma. Finally, another, less studied level of stigma is that which is held among health professionals toward their clients. Since health professionals are part of the general public, their attitudes may in part reflect social stigma; however, their unique roles and responsibility to ‘help’ may create a specific barrier. The following theories are presented as an aid to understanding how each ‘level’ of stigma may develop in society. Society’s Stigma Towards Mental Illness Essay.
Social Stigma
The first, and most frequently discussed, ‘level’ is social stigma. Social stigma is structural in society and can create barriers for persons with a mental or behavioral disorder. Structural means that stigma is a belief held by a large faction of society in which persons with the stigmatized condition are less equal or are part of an inferior group. In this context, stigma is embedded in the social framework to create inferiority. This belief system may result in unequal access to treatment services or the creation of policies that disproportionately and differentially affect the population. Social stigma can also cause disparities in access to basic services and needs such as renting an apartment.
Several distinct schools of thought have contributed to the understanding of how social stigma develops and plays out in society. Unfortunately, to this point, social work has offered limited contributions to this literature. Nonetheless, one of the leading disciplines of stigma research has been social psychology. Stigma development in most social psychology research focuses on social identity resulting from cognitive, behavioral, and affective processes (Yang, Kleinman, Link, Phelan, Lee, & Good, 2007). Researchers in social psychology often suggest that there are three specific models of public stigmatization. These include socio-cultural, motivational, and social cognitive models (Crocker & Lutsky, 1986; Corrigan, 1998; Corrigan, et al, 2001). The socio-cultural model suggests that stigma develops to justify social injustices (Crocker & Lutsky, 1986). For instance, this may occur as a way for society to identify and label individuals with mental and behavioral illnesses as unequal. Second, the motivational model focuses on the basic psychological needs of individuals (Crocker & Lutsky, 1986). One example of this model may be that since persons with mental and behavioral disorders are often in lower socio-economic groups, they are inferior. Finally, the social cognitive model attempts to make sense of basic society using a cognitive framework (Corrigan, 1998), such that a person with a mental disorder would be labeled in one category and differentiated from non-ill persons.
Most psychologists including Corrigan and colleagues (2001) prefer the social cognitive model to explain and understand the concept of stigma. One such understanding of this perspective – Attribution Theory – is related to three specific dimensions of stigma including stability, controllability, and pity (Corrigan, et al, 2001) that were discussed earlier. Using this framework, a recent study by these researchers found that the public often stigmatizes mental and behavioral disorders to a greater degree than physical disorders. In addition, this research found stigma variability based on the public’s “attributions.” For example, cocaine dependence was perceived as the most controllable whereas ‘mental retardation’ was seen as least stable and both therefore received the most severe ratings in their corresponding stigma category (Corrigan, et al, 2001). These findings suggest that combinations of attributions may signify varying levels of stigmatized beliefs.
Sociologists have also heavily contributed to the stigma literature. These theories have generally been seen through the lens of social interaction and social regard. The first of these theorists was Goffman (1963) who believed that individuals move between more or less ‘stigmatized’ categories depending on their knowledge and disclosure of their stigmatizing condition. These socially constructed categories parallel Lemert’s (2000)discussion on social reaction theory. Society’s Stigma Towards Mental Illness Essay. In this theory, two social categories of deviance are created including primary deviance, believing that people with mental and behavioral disorders are not acting within the norms of society, and secondary deviance, deviance that develops after society stigmatizes a person or group. Similarly, research demonstrating that higher levels of stigmatization are attributed towards individuals with more “severe” disorders (Angermeyer & Matschinger, 2005) also resembles these hierarchical categories and the disruptiveness and stability dimensions of stigma.
Furthermore, Link and Phelan clearly illustrated the view of sociology towards stigma in their article titled Conceptualizing Stigma (2001). Link and Phelan (2001) argue that stigma is the co-occurrence of several components including labeling, stereotyping, separation, status loss, and discrimination. First, labeling develops as a result of a social selection process to determine which differences matter in society. Differences such as race are easily identifiable and allow society to categorize people into groups. The same scenario may occur when society reacts to the untreated outward symptoms of several severe mental illnesses; i.e., Schizophrenia. Labels connect a person, or group of people, to a set of undesirable characteristics, which can then be stereotyped. This labeling and stereotyping process gives rise to separation. Society does not want to be associated with unattractive characteristics and thus hierarchical categories are created. Once these categories develop, the groups who have the most undesirable characteristics may become victims of status loss and discrimination. The entire process is accompanied by significant embarrassment by the individuals themselves and by those associated with them (Link & Phelan, 2001).
While social psychology and sociology are the primary contributors to the stigma literature, other disciplines have provided insight as well. Communications, Anthropology, and Ethnography all favor theories that revolve around threat. In Communications literature, stigma is the result of an “us versus them” approach (Brashers, 2008). For example, the use of specific in-group language can reinforce in-group belongingness as well as promote out-group differentiation (Brashers, 2008). This is referenced in research on peer group relationships such that youth often rate interactions with their same-age peers more positively than with older adults (whether family members or not) (Giles, Noels, Williams, Ota, Lim, Ng, et. al., 2003). This can also be applied to those with mental disorders in that individuals in the out-group (mental disorders) are perceived less favorably than the non-ill in-group. Society’s Stigma Towards Mental Illness Essay.
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Anthropology and Ethnography also prefer the identity model. From this perspective, the focus is on the impact of stigma within the lived experience of each person. Stigma may impact persons with mental illnesses through their social network, including how it exists in the structures of lived experiences such as employment, relationships, and status. Further, the impact of stigma is a response to threat, which may be a natural or tactical self-preservation strategy. However, it only worsens the suffering of the stigmatized person (Yang, et al, 2007). It is important to note again that while many disciplines have been leaders in social stigma theory, social work-specific literature has been mostly void of discussion on this topic. This is particularly unusual, since stigma is an obvious factor that impacts the lives of social work clients on a daily basis.
Self-Stigma
Crocker (1999) demonstrates that stigma is not only held among others in society but can also be internalized by the person with the condition. Thus, the continued impact of social/public stigma can influence an individual to feel guilty and inadequate about his or her condition (Corrigan, 2004). In addition, the collective representations of meaning in society – including shared values, beliefs, and ideologies – can act in place of direct public/social stigma in these situations (Crocker & Quinn, 2002). These collective representations include historical, political, and economic factors (Corrigan, Markowitz, and Watson, 2004). Thus, in self-stigma, the knowledge that stigma is present within society, can have an impact on an individual even if that person has not been directly stigmatized. This impact can have a deleterious effect on a person’s self-esteem and self-efficacy, which may lead to altered behavioral presentation (Corrigan, 2007). Nonetheless, Crocker (1999) highlights that individuals are able to internalize stigma differently based on their given situations. This suggests that personal self-esteem may or may not be as affected by stigma depending on individual coping mechanisms (Crocker & Major, 1989). Society’s Stigma Towards Mental Illness Essay.