What is wrong with this picture? You’re a work supervisor, and you get an early morning telephone call from one of your employees. The employee tells you that his panic attacks have him paralyzed this morning and that he will be late into work. You tell him that you are glad he called and that he should come back to work as soon as he can.
If I’ve illustrated my point properly, what seemed odd to you was that any employee would even consider calling in sick with an anxiety disorder—a mental illness. That this would be an odd event to you is evidence for what May’s editorial/essay is about: the stigma attached to mental health issues and disorders.
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Key takeaways
- Mental illness stigma can make disclosure and help-seeking difficult in everyday settings such as work.
- Scapegoating links social fear and ignorance with exclusion of people perceived as different.
- Education, advocacy, and greater awareness can challenge stigma and improve access to mental health support.
What mental health stigma means
As I’ll use the phrase, mental health stigma refers to the stereotyped set of negative attitudes, inaccurate beliefs, and fears about mental health issues that influence how mental health issues are understood. There is no inherent reason why mental illness should be thought to be any more of a negative or frightening thing than any physical illness, and yet it is.
In the paragraphs ahead, I’ll see if I can introduce some ideas for why this should be: where mental health stigma comes from, what its dimensions are, and what can be done about it.
Scapegoating and social exclusion
It is hard to understand how one thing gets stigmatized while another thing does not without also understanding one of the important ways that stigmas get applied: the process of scapegoating. The term scapegoating refers originally to a rather ancient sort of magical ritual, used extensively in religious practices, to clean a community of sin.
In the scapegoating ritual, the sins of a community are magically transferred from the community members onto an animal—a goat or other animal suitable for sacrifice—and then the animal is destroyed or driven away from the community. The community practicing scapegoating believed that, through the destruction or segregation of the sacrificial animal, which magically now carried all the sin for the community, the community was cleansed in front of whatever form of deity might be judging them.
If you look at this scapegoat practice with a literal eye, it seems absurd. How stupid were these people to think that their personal sins, guilts, crimes, and the like could be transferred to a goat? How much stupider were these people to think that the destruction of this sin-laden animal could cancel out their own sin, guilt, or crime?
To make sense of this ritual, it must be understood that the process of transfer of sin was a psychological (and spiritual?) one, and not a physical one. Psychologically, what was actually being transferred was a set of negative judgments. The judgments were being transferred from one object to another: from the self-concepts of the guilty, sinful community members to the goat.
The psychological act of transferring personal sin away from the self and onto something else did create palpable relief in the minds of the community members who participated in the scapegoat ritual. While literal sacrifice of scapegoated animals is less popular today than it used to be, the psychological practice of scapegoating has remained alive and well and has shaped our cultural attitudes toward mental illness.
Historical perspectives on stigma
In his landmark book, Madness and Civilization, the cultural historian Michel Foucault described an interesting scapegoating practice that took place during medieval Europe of the 1500s and later. Europe at the time was in a transition period. In the recent past, the terrible medical disease of leprosy had been rampant, with many persons infected.
As you might expect when dealing with a disease that involves having your flesh rot off your living body, lepers were in many cases forced out of society into isolated colonies. In contrast to the scapegoated lepers, the mentally ill of the day were not segregated from society but rather were an accepted part of society. Some mentally ill people were even reverently thought to have been favored by God as “holy fools.”
As the plague of leprosy retreated from Europe and was no longer a threat, the Europeans began to convert their now-empty leper colonies into hospitals and to populate these hospitals with the mentally ill, who came to be increasingly viewed as a threat to society.
It was as though the Europeans needed to maintain a scapegoated class, and when there were no more lepers to segregate and look upon as sinful and threatening, a “scapegoat vacuum” was created. This vacuum was ultimately filled by making the mentally ill into the new scapegoats for society. The mentally ill appear to have been a primary target of this stigma-creating scapegoating process ever since.
How stigma affects people today
The modern stigma attached to mental health has two major component beliefs, neither of which has any substantial basis in reality:
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- The belief that the mentally ill are violent and a threat to society. The mentally ill are stereotyped as crazed killers who hear voices telling them to kill other people and then do so. \n
- The belief that mentally ill persons are weak and that they are moral failures. Mental illness is viewed as evidence of a failure of strength. Mentally ill persons are assumed to have been able to prevent their illnesses or pull themselves out of them if only they were not so weak. \n
Society acts on these mistaken and unsupported beliefs in profound ways:
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- There is inadequate national funding for research or treatment of mental illness. \n
- Private-sector mental health institutions can barely meet expenses and frequently lose money simply because they cannot get public-sector health coverage to pay for necessary services. \n
- Health insurers offer much less adequate coverage for mental health problems than they do for physical health problems and fight grassroots efforts to mandate equal treatment of recognized disorders. \n
- Employees with a history of mental illness must be careful about disclosing their treatment history for fear of discrimination. \n
- Television shows like ABC’s Wonderland reinforce stereotypes of the violent killer mental patient. \n
- Media pay close attention to mentally ill persons who commit violent crimes but not to mentally ill persons who get better and lead productive lives. \n
Challenging stigma and supporting change
You can work to combat these injustices by recognizing them when they occur and working to correct them through responsible social pressure. A primary way to achieve this goal is to support the activities of groups that exist to combat mental health stigma.
Two notable groups come to mind that are worth your attention:
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- The National Alliance for the Mentally Ill (NAMI) is a grassroots, self-help, and family advocacy organization solely dedicated to improving the lives of people with severe mental illnesses such as schizophrenia, bipolar disorder (manic depression), major depression, obsessive-compulsive disorder, and panic disorder. \n
- The National Mental Health Association (NMHA) strives to improve attitudes toward mental illness and the mentally ill, improve services for the mentally ill, work for the prevention of mental illness, and promote mental health. They are active in legislative efforts to get insurance companies to provide payments for needed services. \n
If there is a lesson in this editorial/essay, I hope it is this: People create stigma out of their own fears and ignorance. Through education and awareness, people can also undo the harmful stigmas they have created and maintained.
Reference: Dombeck, M. J. (May 2000). Scapegoating and Mental Illness Stigma [Online].
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