Research of Stigmatization of Mental Illness

Mental health has been becoming an increasing concern in modern society, with the lifetime prevalence of mental disorders estimated to be around 50%, and the 1-year prevalence to be as high as 30% (Stuart, 2016). While the topic is being increasingly addressed worldwide, especially in Western cultures, there is still a stigma that surrounds it. Although stigma is a familiar concept within the field of mental health, the concept is one of great complexity and more often than not tends to be over-simplified. In general terms stigma can be regarded as a mark or flaw that results from a personal or physical characteristic that is viewed as socially unacceptable (Wimsatt, Schwenk, & Sen, 2015). The term is often used to address negative attitudes, actions, and beliefs that are related to mental health aspects, but what also needs to be addressed is the social power structure that facilitates this stigma.

Stigmatization of mental illness is an increasingly observed phenomenon, which has thus increased public awareness of the topic and consequently the extent of stigmatization and the inquiry into this phenomenon. As a result, a spotlight is shown on the topic and has instigated interest in researchers to examine the topic from a scientific and public view (Living & Boyd, 2010). Addressing this topic corresponds to a pressing social need as rates of mental illness are steadily increasing and stigmatization of disorders may have devastating effects on both the individual, mostly in terms of recognition and help-seeking, which has impacts on society as a whole. More than 70% of people with mental disorders fail to seek help or do so very late due to fear of prejudice and expectation of being discriminate against (Henderson, Evans-Lacko, & Thornicroft, 2013).

Globally, mental health problems are the single most critical issue that young people face today (McGorry, Goldstone, Parker, et al., 2014). Studies indicate that mental disorders are highly prevalent on college campuses (Blanco, Okuda, Wright et al., 2008; Czyz, Horwitz, Eisenberg, Kramer & King, 2013) and over 90% of psychological counselling centers have reported substantial increases in the number of college students with mental health problems in recent years (Gallagher, 2011). Therefore targeting the student population is crucial. Early detection and intervention are of utmost importance in influencing trajectory and preventing life course recurrence (Birchwood & Singh, 2013). Symptom onset marks the beginning of a life course persistent pattern of mental illness and therefore if left untreated, it could impact the lifespan across a variety of domains, such as social adjustment, functioning, and economic productivity. It is thus of vital importance to address the problem in general, and in particular among groups with such high prevalence as seen in the student body.

Literature exploring the topic of stigmatization and mental disorders has generally found that there is a discrepancy between stigmatization of men and women, even with the same mental illness. It is thus imperative that we look at gender differences in relation to stigmatization, as findings tend to indicate that stigmatizing attitudes are stronger for men with mental disorders than they are for women. This disparity appears to stem from the “macho” image men are expected to hold within society, which can already have an impact of men from an early age. Rice, Purcell, and McGorry (2018) found that boys tend to disconnect from mental health care already during adolescence due to a multitude of factors, such as needing to overcome pervasive societal attitudes and self-stigma to access available services. As little as 13.2% of men aged 16-24 that are experiencing a mental health problem will access mental health services (Johnston, Browne, et al., 2007), therefore this population of young men is arguably underserved in regards to their mental needs.

This research will therefore aim to explore the extent to which stigmatizing attitudes are endorsed and whether these attitudes differ depending on the gender of the mentally ill. The review of literature will commence by exploring the varying definition of stigma. As the definition of stigma differs across literature, it is important to first address those differences in order to comprehend the variations as well as to understand the specific stigma that will be addressed in this research. Next, the stigmatization of mental disorders will be discussed, following with gender stigmatization of mental disorders. The paper will then narrow to the topics of depression and suicide, as these are the main focus of this research study due to their increasingly high prevalence rate and thus demand special attention. Depression is currently the leading disability globally and suicide rates are increasing annually, hence the urgency to inquire more into this topic. Possible explanations for and factors influencing these stigmatizations will be explored, as well as the effects that result from stigmatizing attitudes.

In scientific literature, there is substantial variation considering the definition of stigma. This variability exists as stigma is considered to be a complex construct that includes negative attitudes and behaviors directed at a particular group (Sheehan et al., 2016b). It is acknowledged across research, however, that it is a social construct as it relates to a process of social rejection, discrimination, and devaluation. Furthermore, it is generally accepted that stigma is present when elements of status loss, labeling, separation, stereotyping, and discrimination merge in situations that at least permit, if not tactically support, such elements (Ahmedani, 2011).

Goffman (1963) described stigmatized attributes as deeply discrediting to an individual and ones that disqualify them from full social acceptance by society. Thornicroft (2006), on the other hand, focused on three social psychological aspects of the problem: attitudes, knowledge, and behavior. He defined problems of knowledge as ignorance, problems of (negative) attitudes as prejudice, and problems of (rejecting and avoidant) behavior as discrimination. In regards to the problem of knowledge, Thornicroft argues that stigma results from a lack of knowledge about a particular group (Thornicroft, Rose, Kassam, & Sartorius, 2007). The concept of negative attitudes (i.e. prejudice) is commonly used to describe social groups that experience a disadvantage. Thornicroft and colleagues (2007) state that for the majority to act with prejudice in rejecting a minority group there must be emotions, such as resentment, hostility, anxiety, and anger, present in addition to negative thoughts. Due to the combination of emotions and thoughts which produce prejudice, Thornicroft et al. (2007) argue that prejudice may, in fact, predict discrimination more significantly that stereotypes. Lastly, problems of behavior and rejection of the mentally ill may explain the pattern created in society where these individuals are continuously being ostracized from it.

Stigma also plays a prominent role in regards to mental illness, where it is not just diverse in terms of how it is defined, but also in terms of how it is operationalized and reported (Oliffe et al., 2016). However, generally it is defined as either attributes or stereotypes that are associated with the perception of mental illness as an undesirable characteristic that is deeply discrediting and consequently may result in discrimination and social-distancing behaviors (Corbiere, Samson, Villotti, & Pelletier, 2012; Goffman, 1963; Jones et al., 1984; Link & Phelan, 2001). Thornicroft’s (2006) theory can be applied to understand the link between stigma and mental disorders. A lack of knowledge about the mentally ill and mental disorders in general, he argues, results in greater stigmatization (Thornicroft, Rose, Kassam, & Sartorius, 2007). Although prejudice is not a term commonly linked to mental illness, research has suggested that prejudice, functioning as a blend between emotions and thoughts, plays a significant in stigmatization. A study conducted by Graves, Cassisi, and Penn (2005) measured physiological stress of participants when presented an imaginary meeting with either labeled (patient with schizophrenia) or non-labeled individuals (control group) and found that there was an increase in physiological arousal (i.e. unpleasant feeling) when participants were exposed to the schizophrenia patient. Additionally, this tension was associated with the participant’s own self-reports of stigma. The authors therefore concluded that there is both a cognitive and physical component explaining why people may avoid and stigmatize against those with mental disorders.

The stigma of mental illness manifests itself in two ways: public stigma and internalized stigma (Corrigan & Watson, 2002). Whilst internalized stigma refers to the beliefs that members of stigmatized group have about themselves, public stigma refers to the negative attitudes, beliefs, and conceptions that individuals or communities in a society hold about or invoke on persons with mental illness. Self-stigma (i.e. internalized stigma) occurs when an individual recognizes and applies public stigma to themselves, as a result of their membership in a stigmatized group (Watson et al., 2007). Internalization of stigma results in lower self-esteem and negative effects on self-efficacy (Corrigan, 2014). As rates of public stigma of mental illnesses increase, the stigma these individuals apply to themselves does as well.

Regardless of how stigma may be determined and defined, it is important to acknowledge that it acts as a potent stressor to those stigmatized. Stigma often results in the rejection of the stigmatized individual due to social avoidance, fear, and discrimination. Some may argue that it is capable of constituting a risk factor for suicide, as will be discussed further on in the literature review.