by Megan Kennedy

​The mental health community is buzzing with talk about stigma. As a social work student, my mental health classrooms were filled with dialogue about the ongoing consequences of shaming individuals with mental health problems. As a professional, the effects of stigma are often detailed in the stories and everyday lives of my clients, and as an individual with a lengthy history of anxiety, I have personally felt the effects of stigma and witnessed stigma through others close to me. Considering roughly 18.6% of adults and 13.1% of children (ages 8-15) suffer from diagnosable mental health problems, chances are you have too. Most of us agree that stigma is harmful, but where does it come from and what can we do about it?

Researchers report two distinct types of mental health stigma - social stigma and self- stigma. Social stigma results from prejudice attitudes and discriminatory actions that target individuals with mental health issues due to the assignment of psychiatric labels. Self-stigma, on the other hand, is characterized by one’s internalization of perceptions of discrimination.

A number of factors contribute to stigma. Historically, individuals with mental health concerns have been treated differently, rejected and abused. Dr. Graham Davey, a British professor of Psychology, notes that this kind of treatment stems from mistaken views that mental health problems steer people to act in more violent or unpredictable ways than those without such problems, or somehow people with mental health concerns are abnormal or different. However, none of these views have any basis in fact. Dr. Davey also includes the medical model as an unintentional source of stigmatizing beliefs, as this model usually signifies diagnoses and diagnoses implies a label to a “patient.” Such labels are often associated with undesirable attributes, which perpetuate the idea that individuals with mental illness and/or diagnostic labels should be viewed with concern.
It’s no surprise that the most blatant perpetuation of mental illness stigma is at the hands of the media, as media portrayals often reinforce stigma with images of violence and homicide associated with mental health problems. Discussions concerning mass shootings and mental illness almost go hand in hand these days. Moreover, words used to represent mental illness are so common in our present-day vocabularies they almost always pass without comment or judgment. Psycho. Nut-job. Crazy. Insane. He’s lost his mind. She has some serious OCD. The list continues.

For some, the nastiest consequences of stigma aren’t social injustices but the effect stigma has on help seeking behavior of those affected by mental health problems. The Scattergood Foundation reports a mere 30% to 40% of people with mental health problems seek treatment in the U.S., and up to 70% of adults and youth worldwide do not receive services for mental and behavioral health problems. Public health researchers attribute stigma as a major causative factor driving these alarmingly low rates of treatment. Moreover, stigma hurts treatment outcomes and hinders effective recovery from mental health problems.
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The good news is, there are many simple actions we can all take to help challenge mental illness stigma which include:

• Be respectful. Use courteous and considerate language. Avoid using from derogatory language and correct people when you hear the use of such words and phrases. As mention earlier, unintentional yet derogatory words such as “crazy” or “insane” aid in the maintenance of stigma. I know I’m guilty of this one.    
• Talk about mental wellbeing and mental illness. Educate yourself and teach others when opportunities arise.
• Get to know people who have experienced mental health problems.
• Offer support to those who are experiencing mental health problems.
• Speak up about your own experiences. The more concealed mental illness remains, the more people continue to believe that it is shameful and should be hidden.

Stigma is personal. Stigma isn’t some kind of frivolous abstraction experienced by a highly sensitive and sparse few. It’s a social injustice that shames countless individuals with mental health concerns and damages them tremendously in the process. The consequences are deep and extensive. Public endorsement of prejudicial attitudes and discriminatory behavior towards individuals with mental health problems embrace stigma, and the social effects of this include exclusion and isolation, poor quality of life, a lack of social support and low self esteem. Adopting and internalizing the stigma of mental illness and targeting stereotypical, harmful attitudes towards one’s self leave people believing they are helpless and undeserving.  

John Gottman, marital therapist and researcher, identified four patterns of communication that are most disruptive in intimate relationships, so disruptive in fact, that they are predictors of divorce in married couples. I've found that describing these patterns to couples in counseling has been helpful in resolving communication problems. Gottman wrote about them in his book called The Marriage Clinic, calling them the "Four Horseman of the Apocalypse." (I'm on the fence about that name, but it is kind of amusing and easy to remember.) Here's a summary:

So what to do when you see the four horseman appear in your relationship?

Most importantly, know that a healthy relationship is not devoid of these negative patterns of communication. All relationships struggle. The goal is not to avoid having problems in your relationship, but rather to focus on healthy repairs when ruptures occur. 

Healthy repairs include recognizing when you are criticizing, defending, stonewalling, or contemptuous. Talking through differences with willingness to have the difficult feelings that come along with them is a healthy step toward mutual understanding. A couples counselor can help guide these difficult conversations in a productive way, and provide the couple with the tools to accept difficult emotions. Counseling also provides neutral territory where everyone's points are equally valid and everyone has equal opportunity to express their needs.