Ever been called weird, crazy, or another damaging label?
If so, you know the discomfort, shame, and dehumanization that occurs.
Labeling others separates people based on actual or perceived differences. The stigma associated with being labeled aims at one’s identity and divides us and them.
The label linked to certain assumptions lingers, impacting impressions of the individual regardless of their behavior (Yanos, 2018).
The differentiation between us and them may seem minor. However, a closer look reveals the depth it reaches to the point of eroding social capital — the strength and benefits derived through societal cohesion.
This article discusses mental health stigma, its effects, and ways to reduce it.
The definition for the word stigma includes a brand, a mark of disgrace or infamy, and a mark of censure (Dobson & Stuart, 2021).
According to Ritzer (2021, p. 162), “stigma is a person’s characteristic that others find, define, and often label as unusual, unpleasant, or deviant.”
Labels aim to show the individual as unpredictable, unreliable, and potentially dangerous (Dobson & Stuart, 2021). A label effectively applied creates fear and distance between society and the one who is labeled.
Brief history of mental health stigma
Mental illness goes back to the earliest human writings from ancient Israel, China, and Greece, explaining it as bad luck or being cursed.
More recently, Erving Goffman’s seminal work Asylums (1961) analyzed the treatment of patients in psychiatric facilities and showed the negative impact punitive treatment had on their mental health (Dobson & Stuart, 2021).
Goffman’s work revealed that labeling and stigmatization can have enduring, if not permanent, effects on patients (Dobson & Stuart, 2021).
Mental health stigma and discrimination
According to Philip Yanos (2018, p. 10), author of Written Off: Mental Health Stigma and the Loss of Human Potential, stigmatizing labels “diminish people’s participation in community life and inhibit them from achieving their full potential as people.”
Yanos views mental health stigma as a social injustice and suggests focusing on society’s adverse reactions instead of eradicating symptoms.
Stigmatization leads to discrimination.
Discrimination became lethal in 1939 when Hitler created the heinous T-4 program to euthanize residents of private hospitals, psychiatric institutions, nursing homes, and others with psychiatric or neurological disorders (Yanos, 2018).
Sadly, discrimination toward mental illness is still in news headlines, media representations, hiring practices, and structural norms.
2 Real-Life Examples and Statistics
According to Kessler et al. (2007, p. 170), “nearly half (47.4%) of all individuals in the United States will meet the criteria for a mental illness at some point in their lives.”
Approximately 43.3% of US adults with mental illness will not receive help. They may avoid seeking treatment because they fear the label, stigma, and discrimination (Evans et al., 2023).
Simone Biles
As fervor for the 2021 Tokyo Olympics grew, finalists for the various teams were announced. Simone Biles was a top US gymnast with astounding strength and skills.
Soon after the Olympics began, it became clear that Biles was struggling. Citing a case of the twisties, she pulled out of the competition to tend to her mental health.
Biles returned to competition in 2023 after a two-year hiatus to win first place in the Core Hydration Classic (Holcombe, 2023).
Aaron Hernandez
The case of Aaron Hernandez is one of tragedy and missed opportunities. Hernandez found success playing football for the New England Patriots. Unfortunately, Aaron’s behavior spiraled out of control. He was ultimately found guilty of murder in 2015.
In 2017, Aaron committed suicide in jail. Autopsy results showed he suffered from chronic traumatic encephalopathy, a neurodegenerative disease often associated with symptoms similar to dementia, violence, and depression (Gregory, 2020).
4 Mental health myths and facts
A plethora of myths abound regarding mental illness. Let’s clarify a few that were obtained from the Substance Abuse and Mental Health Services Administration (2023).
Myth – Mental health issues cannot affect me.
Fact – In the United States, 1 in 5 adults experience mental health issues in a given year.
Myth – Mental health conditions result from character flaws or personality weakness.
Fact – Various factors, including physical illness, injury, brain chemistry, trauma, abuse, and family history, contribute to mental illness.
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22 Effects of Stigma According to Research
Yanos (2018) identifies three primary types of stigma.
Public stigma
Public stigma refers to creating intentional chasms between us and them through the labeling process.
Patient label – Identifying the individual as a patient requiring treatment or hospitalization.
Pejorative labels – Labels such as crazy or insane refer disparagingly to the individual.
Discriminatory public behaviors include:
Social isolation
Shunning
Gossiping about the individual
Being passed over for promotion
Concerns about reliability
A social experiment on mental health stigma
This YouTube video demonstrates the public’s perception of people who have mental illness.
Self-stigma
Self-stigma happens when the labeled individual will self-handicap, self-label, and use their label as an excuse for failure, limiting their development.
The effects of self-stigma can include:
Feeling damaged
Feeling weak
Feeling vulnerable
Dressing inconspicuously to be less visible in public
Not speaking up for themself
Holding back from seeking positions or promotions
Feelings of embarrassment, diminishment, and self-hatred
Discriminatory behaviors include:
Isolation
Limiting self to avoid stigma
Structural stigma
Yanos (2018, p. 3) states, “Structural stigma is again a sociological concept that identifies the inherent and intentional effects that derive from social power dynamics and the policies and practices of institutions to restrict the autonomy of people with a mental illness.”
Scenarios where this may apply include:
Involuntary hospitalization
Denial of insurance payments in cases of suicide
Restriction of individuals with a history of mental illness in specific career fields
Discriminatory behaviors include:
Enacting policies that prohibit insurance claims
Mental health screenings for specific social roles
Restricted health care for people with mental illness
How to Reduce Mental Health Stigma
When Simone Biles withdrew from the competition, she highlighted mental health (Holcombe, 2023).
Conversation about mental illness should be omnipresent. Often, we avoid it to spare discomfort. Meanwhile, the discomfort for those suffering hits a fever pitch.
How to reduce stigma in the workplace
Harvard Business Review discusses ways managers can help create an empathetic workplace culture (O’Brien & Fisher, 2019). These can also be generalized for other uses.
1. Focus on language
Terms used in gest or casual conversion can create or add to stigmatization. Using derogatory terms such as “Mr. OCD” or “schizo” can sound like an attack to those struggling.
2. Rethink sick days
Normalizing the idea of tending to mental health using sick days can contribute toward an environment of mental and physical health.
3. Open and honest conversation
Creating a space where people can talk openly about mental health issues without fear of rejection or judgment creates psychological safety.
4. Response training
Train employees in Mental Health First Aid, a national program that helps recognize those struggling and connects them to resources that will help.
Developing lesson plans for schools
Another way to promote positive mental health is through social emotional learning (SEL) curricula. Social emotional learning enhances strategic protective factors that buffer against the risks of mental health through responsive relationships, skill development, and emotionally safe environments (Collaborative for Academic, Social, and Emotional Learning, n.d.).
In addition to bolstering mental health and wellness, SEL exercises and activities help improve attitudes about self and others and decrease risky behaviors and emotional distress.
How social-emotional learning benefits everyone - Caige Jambor
This short TED talk explains the benefits of SEL and how to change perspectives.
8 Questionnaires, Questions, and Scales
The lowest level of marginalizing behavior and, perhaps, the most common are microaggressions.
Yanos (2018, p. 41) describes microaggressions as “subtle communications of prejudice toward individuals based upon memberships in marginalized social groups.”
Microaggressions include comments that are rude and insensitive. The comments may exclude or nullify one’s experiences.
Yanos and his colleague Lauren Gonzales (as cited in Yanos, 2018) used the Mental Illness Microaggression Scale-Perpetrator version to measure microaggressions. They found that 62% of respondents endorsed patronizing behavior with mentally ill individuals by talking to them more slowly. Furthermore, 81% of respondents reported frequently reminding them to take their medication.
Mental health quiz
Prejudice comprises preconceived negative attitudes, feelings, and beliefs toward members of a marginalized group. These notions come from unsubstantiated opinions or stereotypes (Ritzer, 2021).
One way to combat prejudice and subsequent stigma is to learn more about the targeted group.
The following 10-question quiz will help dispel harmful attitudes and misunderstandings regarding mental illness. Dispelling myths can help reduce stigma, creating an environment of inclusiveness.
Take this mental health quiz from the Centers for Disease Control and Prevention.
Questions to ponder
How does segregating groups of people in society impact your values?
What do you stand to lose if you stand up for someone with mental illness? What would you gain?
How does it make you feel when you hear about an individual with mental illness being stigmatized?
What is the underlying fear surrounding mental illness stigma?
Many people are uncertain about starting a conversation on mental illness and stigma. Below are ideas for getting started.
1. SAFE: Mental health facts for families
Because many veterans struggle with mental illness, Michelle Sherman and the Oklahoma Veterans Affairs Medical Center created the SAFE Program: Mental health facts for families.
The acronym SAFE stands for Support and Family Education. Each session provides questions and materials for a class or group.
In particular, session 18 helps families understand the stigma around mental illness (Sherman, 2008). The program includes facts about the impact of stigma on the family’s experience of mental illness and prompts compelling questions, such as:
What has been the most significant consequence of your loved one’s mental illness?
What kept them from seeking treatment?
This invaluable program and others like it help families and the diagnosed realize they are not alone, provide insightful information, and build empathy and compassion for their loved ones.
2. Discussion starter
This simple handout, Stigma Discussion Starters, analyzes what stigma looks like and means and asks questions about what it would feel like to have mental illness and experience stigma.
This handout can be used as a template for discussions in college classrooms, in the workplace, and in medical settings to create a deeper understanding of what mental health stigma looks and feels like.
3. Interactive website
The wonderfully interactive website Make It OK provides resources to help educate people about mental illness and videos on language to avoid. It provides various podcasts, questions, and interactions. For example, you can scroll down to take a quiz and also sign a pledge to do your part to erase stigma.
The site is also aimed at helping those struggling with mental illness, as it provides relatable stories and resources.
4. Helpful group activities
Mental health stigma has wide-ranging effects on those labeled and society. Dialogue is essential to effect change.
Talking circles
Talking circles are integral to restorative justice and help people connect with each other and themselves.
In Heart of Hope, Carolyn Boyes-Watson and Kay Pranis state (2010, p. 170), “Chronic conditions of unmet needs for dignity, respect, and basic necessities can induce the trauma response.” Unmet needs can lead to acting-out behaviors that can disconnect individuals from their true selves.
Boyes-Watson and Pranis (2010, p. 170) go on to say, “Acknowledging the harm of these structures and having an opportunity to tell the story of the harms in one’s life are essential in promoting resilience in the face of the harmful impacts.”
Talking circles are one way to listen and speak about societal injustices like mental illness stigma. Circles are used within the justice system, schools, and other contexts.
The process includes inviting members of the community and those harmed to sit together while they share personal stories and listen to the stories of others.
In order to address mental health stigma, the circle keeper could approach various topics such as respect, dimensions of identity, or empathy.
Peacemaking circle training with Kay Pranis
In this YouTube video, Kay Pranis captures the essence of talking circles and outlines the origins, objectives, and process.
Empathy Bingo
The Empathy Bingo worksheet provides an opportunity to demonstrate the difference between showing empathy and other responses. This activity works great in a therapeutic setting and other settings such as a classroom or the workplace.
The facilitator reads one of the 12 prepared scenarios and corresponding responses. Participants decide if the response exemplifies empathy or other choices provided, such as one-upping, correcting, or fixing it.
This exercise is a creative way to become aware of how our responses can be interpreted and how to build empathy, which is vital for reducing stigma.
Best Books to Educate Yourself and Others
The following books provide resources to understand mental illness and its stigma.
1. Written Off: Mental Health Stigma and the Loss of Human Potential – Philip T. Yanos
Written by Philip T. Yanos, the book conveys how the pervasive nature of stigma impacts those with mental illness, profoundly affecting their lives.
Yanos approaches the topic of stigma from the standpoint of social injustice, believing that when stigma prohibits mentally ill individuals from participating in society, it is not just a personal loss, but a communal one.
Yanos discusses negative attitudes and behaviors toward mental illness, community participation of those diagnosed, and ideas for changing perceptions.
2. Another Kind of Madness: A Journey Through the Stigma and Hope of Mental Illness – Stephen P. Hinshaw
Written by Stephen P. Hinshaw, it is a biographical depiction of his journey through his father’s mental illness.
After 18 years of silence, the life-changing revelation of his father’s mental illness came during a spring break from college.
Jolting as it was, it helped explain his father’s ups and downs and extended absences. It also awakened his journey to becoming a clinical and developmental psychologist and professor.
One way to internalize a lesson is through activities and exercises. Below are examples of both that can help formulate the building blocks of empathy and healing.
Participants will learn why positive relationships are crucial markers of wellbeing, the types of support needed, the benefits of building social capital resulting in stronger communities, perceptions about relationships, and how to manage relationships.
Learning to create and negotiate healthy relationships provides insight into relationship dynamics and helps change how individuals see and interact with others.
Recommended reading
If you too are intrigued by mental wellness, we have a great selection of articles that you will find interesting. Here is a short list of must-read articles:
Telling an Empathy Story is a worksheet used in dyads or groups to build empathy through storytelling. Participants can use someone else’s story or a biography. The storyteller uses art to help convey emotions and then shares it with another or a group, thus learning empathy and allowing for self-expression through art.
The Compassion Formulation exercise encourages psychological and emotional wellbeing by bolstering self-compassion and compassion for others. Participants will explore aspects of past influences, primary fears, protective behaviors, and unintended outcomes.
An activity for kids
This class exercise called Group Circle allows kids to show kindness and enjoy its benefits through talking circles. Participants can experience empathy by talking about a time they felt different.
Positive relationship tools
If you’re looking for more science-based ways to help others build healthy relationships, check out this collection of 17 validated positive relationship tools for practitioners. Use them to help others form healthier, more nurturing, and life-enriching relationships.
17 Exercises for Positive, Fulfilling Relationships
Empower others with the skills to cultivate fulfilling, rewarding relationships and enhance their social wellbeing with these 17 Positive Relationships Exercises [PDF].
The butterfly effect posits that positive shifts could ultimately create global waves of change.
This blog post presents a challenge and an opportunity. It contains questions, books, resources, and ideas to change perspectives on mental illness.
We can create a space for those struggling with mental illness to feel accepted, understood, and validated.
This change also transforms us by opening our minds and hearts and building empathy muscles. In addition, it builds social capital through communities where empathy trumps fear.
Stigma affects those struggling with mental health, as it
Limits participation in society
Creates obstacles to seeking treatment
Inhibits the ability to be authentic
What causes stigma?
Stigma is most often caused by:
Fear
Lack of knowledge and understanding
Lack of empathy
Negative media portrayals
Labeling
Pejorative terms
How to cope with stigma?
If faced with stigma, the best way to cope is to:
Seek professional help
Find a supportive community
Use coping mechanisms to reduce stress and anxiety
What are the 3 types of stigma in mental health?
Public stigma: “Patient” labeling and pejorative labeling
Self-stigma: Feeling damaged, weak, or vulnerable; holding back from sticking up for yourself
Structural stigma: Built into societal institutions
References
Boyes-Watson, C., & Pranis, K. (2010). Heart of hope resource guide: Using peacemaking circles to develop emotional literacy, promote healing and build healthy relationships. Center for Restorative Justice at Suffolk University.
Collaborative for Academic, Social, and Emotional Learning. (n.d.). SEL and mental health. Retrieved September 17, 2023, from https://casel.org/fundamentals-of-sel/how-does-sel-support-your-priorities/sel-and-mental-health/.
Dobson, K., & Stuart, H. L. (Eds.). (2021). The stigma of mental illness: Models and methods of stigma reduction. Oxford University Press.
Evans, L., Chang, A., Dehon, J., Streb, M., Bruce, M., Clark, E., & Handal, P. (2023). The relationships between perceived mental illness prevalence, mental illness stigma, and attitudes toward help-seeking. Current Psychology, 1–10.
Goffman, E. (1961). Asylums. Doubleday & Company.
Gregory, H. (2020). Making a murderer: Media renderings of brain injury and Aaron Hernandez as a medical and sporting subject. Social Sciences & Medicine, 244.
Holcombe, M. (2023, August 9). What we can learn from Simone Biles’ mental health break. CNN. Retrieved September 8, 2023, from https://www.cnn.com/2023/08/09/health/biles-mental-health-break-wellness/index.html.
Kessler, R. C., Angermeyer, M., Anthony, J. C., De Graaf, R., Demyttenaere, K., Gasquet, I., De Girolamo, G., Gluzman, S., Gureje, O., Haro, J. M., Kawakami, M., Karam, A., Levinson, D., Medina Mora, M. E., Oakley Browne, M. A., Posada-Villa, J., Stein, D. J., Adley Tsang, C. H., Aguilar-Gaxiola, S., … Bedirhan Ustun, T. (2007). Life-time prevalence and age-of-onset distributions of mental disorders in the World Health Organization’s Mental Health Survey Initiative. World Psychiatry, 6(3), 168–176.
O’Brien, D., & Fisher, J. (2019, February 19). 5 ways bosses can reduce the stigma of mental health at work. Harvard Business Review. Retrieved September 12, 2023, from https://hbr.org/2019/02/5-ways-bosses-can-reduce-the-stigma-of-mental-health-at-work.
Ritzer, G. (2021). Essentials of sociology (4th ed.). SAGE.
Sherman, M. D. (2008, April). Support and family education: Mental health facts for families. University of Oklahoma Health Sciences Center. Retrieved September 17, 2023, from https://www.ouhsc.edu/safeprogram/index.html.
Substance Abuse and Mental Health Services Administration. (2023, April 24). Mental health myths and facts. Retrieved September 8, 2023, from https://www.samhsa.gov/mental-health/myths-and-facts.
Yanos, P. T. (2018). Written off: Mental health stigma and the loss of human potential. Cambridge University Press.
About the author
Dr. Chris Wilson holds a Ph.D. in conflict analysis and resolution and specializes in relationships, boundaries, and self-limiting mindsets as a coach. She’s passionate about people and partners with them to figure out how to change what isn't working and move toward a life of fulfillment.
Ever been called weird, crazy, or another damaging label?
According to Kessler et al. (2007, p. 170), “nearly half (47.4%) of all individuals in the United States will meet the criteria for a mental illness at some point in their lives.”
The lowest level of marginalizing behavior and, perhaps, the most common are microaggressions.
