We’re nearing the end of mental health month, so I’d like to talk a little bit about anti-stigma campaigns, public awareness, and advocacy. There seems to be this belief that combating stigma is something that’s largely “done.” People think this because we have the royal family talking about it, celebrities identifying as having mental health conditions, public outrage about movies like “Split,” and lime green ribbons dancing around in our heads. Yes, all of those things are good. Yes, all of those things help. But no, none of those things have eliminated stigma.
We have largely destigmatized (sometimes to the point of glamorizing) the most “relatable” of the mental health conditions. Most people experience sadness, anxiousness, mood swings, irritability, and perfectionism at some point in their life, so conditions in which those are prominent symptoms, like depression, anxiety, mild bipolar disorder, and a very specific kind of OCD are seen as common and even normal to have. We often praise people who come out as having these conditions and throw glitter and sunshine all over their stories of recovery. Because we lack a visceral distrust and fear of these specific individuals, we think stigma is a thing of the past.
Truth: Stigma is getting worse, not better
Over the last 20 years, the public has drastically improved their understanding about mental health conditions and how they’re treated. However, over that same period, there has been a substantial increase in the number of people that believe that people who have mental health conditions, especially the less common ones like schizophrenia, are dangerous, violent, or frightening. Fewer and fewer people are willing to accept a person with a mental health condition as a coworker or neighbor. At this point, less than half of all people in the US, Scotland, Germany, Great Britain, and New Zealand are okay with that, but in the 90’s, before this huge movement to eliminate stigma, that figure was nearly 70% in some countries.1
Why? Well, there’s a lot of reasons, but the big one is the media and our culture’s insatiable hunger for speculative explanations of violence that make us feel better about being human. The easiest explanation is that people who act violently aren’t as human as the rest of us because they aren’t right in the head. Unfortunately, that’s not really true.
Truth: Media coverage of people with mental health conditions has gotten worse, not better
Despite the fact that incidents of mass violence have remained steady over the last 20 years, depictions of these acts has risen from 9% of all news stories in the 90s to 22% of all news stories today. Only 1% of front page news was about mental illness and violence from 1994 to 2005, but that rose to 18% from 2005-2014. A full 38% of stories about violence mention mental illness as a contributing or causal factor.2
How do we know that this contributes to stigma? Well, a survey of public attitudes in Germany before and after a highly-publicized incident of violence committed by someone diagnosed with schizophrenia showed that:
- The percent of people unwilling to sublet to a person with schizophrenia increased from 44% to 68%
- The percent of people unwilling to have a neighbor with schizophrenia increased from 19% to 36%
- These increases in desire for social distance remained persistent for years after the incident3
“But Kate,” you may say, “that research is old!” No worries, because a 2013 study renewed these findings. It showed that people who read stories about mass shootings that correlate (even if incorrectly) the act with a mental health condition are more likely to perceive individuals with mental illness as dangerous, refuse to accept a person with mental illness as a coworker or neighbor, and support gun control measures that target people with mental illness.4
Truth: We scapegoat people with mental health conditions to make ourselves feel better about being human
Yes, people with mental health conditions sometimes commit violence. However, mental health status alone cannot reliably predict violence because it is not directly correlated. What is directly correlated is younger age, being male, being low-income, history of parental abuse, substance dependence, comorbid substance dependence and mental health condition, unemployment, and previous victimization.5 We don’t talk about that because that’s too close to home. Half of us are male, lots of us are teenagers or young adults, low-income Americans make up a massive proportion of the population, substance misuse is common, and most people are unemployed at some point or another. When we describe these as contributing or causal factors, we make people who commit violence out to be humans just like us. Which they are.
I know that it’s tempting to look at acts of violence with appalled bewilderment and think that, of course, there must be something not right in the head. We speculate that imaginary voices told him to do it, that she had delusional persecutory beliefs, that the fact that he visited a psychiatrist once in college means he’s obviously going to plead insanity. Unfortunately, the truth is, some people are taught to use violence, feel that they need to use violence, or just plain like to use violence. That’s all there is to it.
Truth: We’re just getting started with anti-stigma advocacy and we have a long way to go
When a quarter of our news talks about how people with serious mental illness are violent, our culture is of course going to internalize this belief. It encourages discriminatory gun legislation. It promotes the use of traumatizing involuntary treatment orders. It makes using jails as holding facilities for people in crisis acceptable*. It creates a culture in which people with mental health conditions are not trusted to make treatment decisions, help each other recover, have a voice in policymaking, or even live and work in the rest of society.
This is what stigma is now, and advocacy work is more important than ever. Throwing glitter and sunshine on celebrities who overcame depression is a good start, but it doesn’t erase the overwhelming majority of messages that say our more unusual symptoms and diagnoses are terrifying. It doesn’t erase the fact that we wake up every day to stories that paint us as monsters. It doesn’t erase the reality that more and more Americans want to get further and further away from us, which is the exact cultural attitude that leads to oppression. Until we start erasing those messages deliberately, stigma will continue to dominate our cultural dialogue.
We are not finished. Not even close.
1 Schomerus, G., Schwahn, C., Holzinger, A., Corrigan, P. W., Grabe, H. J., Carta, M. G., & Angermeyer, M. C. (2012). Evolution of public attitudes about mental illness: A systematic review and meta‐analysis. Acta Psychiatrica Scandinavica, 125(6), 440-452. doi:10.1111/j.1600-0447.2012.01826.x
3 Matthias C. Angermeyer, Herbert Matschinger, The effect of violent attacks by schizophrenic persons on the attitude of the public towards the mentally ill, Social Science & Medicine, Volume 43, Issue 12, 1996, Pages 1721-1728, ISSN 0277-9536, http://0-dx.doi.org.skyline.ucdenver.edu/10.1016/S0277-9536(96)00065-2.
4 McGinty, E. E., Webster, D. W., & Barry, C. L. (2013). Effects of news media messages about mass shootings on attitudes toward persons with serious mental illness and public support for gun control policies. American Journal of Psychiatry, 170(5), 494-501. doi:10.1176/appi.ajp.2013.13010014
5 Elbogen EB, Johnson SC. The Intricate Link Between Violence and Mental DisorderResults From the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2009;66(2):152-161. doi:10.1001/archgenpsychiatry.2008.537
*Colorado just banned the use of jails as holding facilities with SB207! YAY PROGRESS!