COVID-19 has caused a collective crash in our mental health that has drawn much public attention, but the menacing shadow of mental illness – stigma – can be even more devastating than the illness itself.
Four decades of public education on mental health have failed to remove the stigma – and actually made it worse. Only a recent change in how we talk about mental health is starting to make a positive impact.
“Stigma has always been important to me because I recognize it as one of the things that stopped me from getting any help,” says University of British Columbia researcher and professor Jehannine Austin. “I had PTSD after a car crash. No one wanted to talk about how I was psychologically struggling. People just kept saying, ‘But you’re OK, though’ because all I had was bruises.
“It was one of the worst and most isolating experiences. I came out of it very much feeling like I was not going to be acceptable to people if they knew about my depression and anxiety and that I certainly wasn’t a good candidate to make the sort of difference in the world as a leader that I wanted to make.”
Now, as Canada Research Chair, Executive Director of the B.C. Mental Health & Substance Use Services Research Institute, and founder of the Adapt Clinic, Austin is a celebrated leader pushing to change the way we talk about mental health.
Her Adapt Clinic is the first and only clinic in Canada to provide free counselling to B.C. residents for a better understanding of why they might have mental health problems and how to protect their mental health.
What is stigma?
Austin says stigma is hard to define and often oversimplified into a single, discrete entity – which it isn’t.
There’s stigma at the institutional level. “If you have a history of mental illness, you’re at the bottom of the list for organ transplant,” she says. “In the U.S., there are many states where you can’t hold office if you’ve had a history of mental health problems.”
There is stigma at the societal level, where a person with a mental health condition is often marginalized. For example, a Canadian survey of the general public in 2008 found high levels of stigma toward people with mental health conditions:
- 42 per cent would no longer socialize with a friend diagnosed with mental illness;
- 55 per cent wouldn’t marry someone who suffered from mental illness;
- 25 per cent were afraid of being around someone who suffers from mental illness; and
- 50 per cent would not tell friends or coworkers that a family member was suffering from mental illness.
And there’s stigma at the individual level. “When people internalize these messages – ‘Oh you’re not as good,’ or ‘You’ll never achieve as much’ – it’s the most damaging bit for people who live with psychiatric disorders,” says Austin.
Four decades of doing it wrong
Since the 1960s and 1970s, psychiatrists have argued that mental health conditions are as real as any other disease, says Joel Braslow, professor of Psychiatry and History at the University of California, Los Angeles. Public education campaigns spotlighted the biological aspects of mental health conditions – “a disease like any other” – and framed them as “brain disorders,” aiming to reduce stigma through a biological understanding of the illness.
“The studies (on the campaigns) have been done and that’s not what we find at all,” says Austin. As the public adopted a more biological conception of mental health conditions, the stigma got worse. Biological attributions were linked to less blame but also created a desire for social distance, avoidance and perceptions of unpredictability and dangerousness, resulting in an “us versus them” mentality and defining those with mental health conditions as fundamentally different and broken. Mental health conditions were seen as more persistent and serious and people living with them viewed as unlikely to recover.
The same studies, however, also showed that talking about mental health conditions in the context of psychological or social stressors normalized symptoms, creating a healthier public perception of mental health problems.