In order to cultivate understanding, empathy, and courage, Safe Space Radio broadcasts stories and conversations about subjects that are difficult to talk about. Topics like mental illness, racism and sexuality are heavily stigmatized, so it can be difficult to discuss these issues without feeling shame. Insidious as it is ubiquitous, the force of stigma exerts influence over everything from interpersonal relationships to government policies.
The origin of the word stigma comes from the Ancient greek practice of branding the skin of enslaved peoples and those charged with a crime (Falk, 2001). For instance, if someone failed to pay back their debt, they were branded to warn others not to trust them. The ‘stig’ permanently marked certain individuals and groups as no longer trustworthy or credible.
The World Health Organization defines stigma as “a mark of shame, disgrace, or disapproval that results in an individual being rejected, discriminated against, and excluded from participating in a number of different areas of society” (WHO, 2001). Patrick Corrigan, principal investigator at the National Consortium for Stigma and Empowerment, clarifies this definition by distilling stigma into three parts: stereotyping, which has to do with thoughts and assumptions; prejudice, which includes negative feelings; and discrimination, which results in changed behavior and access to opportunity for stimatized groups. (Corrigan, 2014). Each of these components occur in the context of a power differential, where the person is in a minority and therefore has less power (Rüsch, Angermeyer, and Corrigan, 2005).
There are four types of stigma: self-stigma, public/social stigma, and structural/institutional stigma, and label avoidance (Livingston and Boyd, 2010; Corrigan, 2014). The chart below details the ways in which these different levels impact our daily lives.
This chart and the diagram below are inspired by Dr. Patrick Corrigan’s work in ‘The stigma of disease and disability: Understanding causes and overcoming injustices’ (2014).
Relationship Between Mental Illness and Stigma
Mental illness has a long, painful history of stigmatization; people with mental illness have nearly always been ostracized and misunderstood by the societies where they live. From Ancient Greece to the dawn of Christianity to the Medieval Era, mental illness was assumed to be the work of demons. These early Western narratives linking mental illness with concepts of evil, instability, and impurity endure in the kinds of stigma we see today (Falk, 2001).
Negative social and institutional attitudes towards afflictions such as depression, anxiety, bipolar disorder, and PTSD discourage individuals living with mental illnesses from seeking treatment. Stigma interferes with the diagnostic process in more ways than one, as people struggling with mental illness face more obstacles to getting care than people struggling with other forms of illness. One such barrier is a phenomenon known as “diagnostic overshadowing.” This term refers to the widespread tendency among clinicians to treat patients with mental illness differently, and to dismiss their physical symptoms as merely an expression of mental illness, instead of diagnosing and treating them as legitimately ill. Even health professionals are not immune to the power of stigma (Thornicroft, 2013).
Stigma and Its Consequences
- Data from the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that in 2014, only 2.5 million of the 21.2 million individuals struggling with mental illness accessed treatment (Heath, 2017)
- According to The Centre for Addiction and Mental Health, stigma prevents 40% of people with anxiety or depression from seeking medical help (https://www.camh.ca/en/driving-change/addressing-stigma)
- In England 44% of survey responders would turn down an individual for a second date if they revealed they had a mental illness, compared to 42% who would turn down someone who had been in prison and 19% who would turn down someone who revealed a physical health problem (http://www.time-to-change.org.uk/news/unlucky-love-try-dating-mental-illness)
- Studies show that mental illness stigma has negative economic consequences including employment discrimination, income, and healthcare allocation (Sharac et al., 2010)
According to a survey conducted by the American Psychological Association in 2019, stigma regarding mental illness may be beginning to ease. Out of more than1000 adults, 87% said a mental disorder is nothing to be ashamed of and 86% said they believe that people with such disorders can get better (Preidt, 2019). However, even as public stigma surrounding mental health and other sensitive topics decreases in intensity, it is still vital to interrupt the perpetuation of stigma.
Patrick Corrigan asserts that protest, education, and contact are the three most effective ways of confronting stigma (Corrigan, 2014). As a public health intervention on the air, Safe Space Radio combines the latter two methods: offering contact with personal storytellers, and education from experts along with a host who is a practicing psychiatrist. While it takes great courage to share the experiences that we feel shame about; this form of courage is tremendously powerful in helping us unlearn prejudice.
This chart is inspired by Dr. Patrick Corrigan’s work in ‘The stigma of disease and disability: Understanding causes and overcoming injustices’ (2014).
Under the broad categories of protest, contact, and education, there have been numerous successful approaches to combating stigma. Interestingly, educational approaches have been shown to be more effective for adolescents, whereas contact is more effective for adults (Corrigan, 2012). Combining contact and education has proven to be the most powerful method of fighting stigma (Corrigan, 2014). Story-driven educational mass media projects like the Time To Change campaign in England, for example, have been successful in regards to changing attitudes and behaviors (Thornicroft et al., 2016).
As a public health-oriented radio show and podcast that broadcasts personal stories and reflection, Safe Space Radio is another example of a project that combines contact and education. In terms of how to reduce mental health stigma specifically, other ideas include: implementing anonymous screenings, integrating behavioral and mental healthcare into the primary care system (this can reduce depression scores by up to 50%), and educating patients using strategies such as posters or short videos (Heath, 2017).
Safe Space Radio & Stigma Reduction
We conducted a year of research with third year medical students during their psychiatry training at Maine Medical Center. The students listened to one podcast a week for five weeks and reported that their empathy increased, their stigmatizing assumptions were challenged, and they felt more humble about the limits of medical treatments and the importance of listening to their patients as experts on their own experiences. You can read that article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10014135/
Data from past listener surveys show that:
- 84% of listeners report that their stereotypes were challenged after listening to a show from the Can We Talk series (2019)
- 83% of listeners agree that the show helped to reduce shame (2019)
- 91% felt that the shows offer useful suggestions for how to bring up stigmatized subjects (2019)
- 53% of listeners felt safer to share their experiences with others, Can We Talk series (2019)
- 93% of listeners felt increased appreciation for the challenges that refugees and asylum seekers face (2016)
- 84% report feeling motivated to learn more and share that with others (2016)
Stigma & Mental Health
- Understanding the impact of stigma on people with mental illness (Patrick Corrigan)—World Psychiatry
- The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. (Patrick Corrigan)—Psychological Science in the Public Interest
- The Stigma of Disease and Disability: Understanding Causes and Overcoming Injustices (Patrick Corrigan—American Psychological Association
- Understanding Stigma as a Mental Health Barrier—Xtelligent Healthcare Media
- Medicalizing versus psychologizing mental illness: what are the implications for help seeking and stigma? A general population study.—Social Psychiatry and Psychiatric Epidemiology
- Stigma, Negative Attitudes and Discrimination Towards Mental Illness Within the Nursing Profession: a Review of the Literature.—Journal of Psychiatric Mental Health Nursing
- Public stigma and self-stigma: differential association with attitudes toward formal and informal help seeking.—Psychiatric Services
- Internalized stigma among psychiatric outpatients—Psychiatric Research Journal
- Internalized stigma and quality of life among persons with severe mental illness—Psychiatric Research Journal
- The impact of internalized stigma on the well-being of people with Schizophrenia—Psychiatric Research
- Stigma: ignorance, prejudice or discrimination?—British Journal of Psychiatry
- ‘Diagnostic overshadowing’: worse physical health care for people with mental illness—Acta Psychiatrica Scandinavica
- Not sick enough: Experiences of carers of people with mental illness negotiating care for their relatives with mental health services—Psychiatric and Mental Health Nursing
- Dangers of Diagnostic Overshadowing—New England Journal of Medicine
- Diagnostic Overshadowing of the Psychiatric Population in the Emergency Department: Physiological Factors Identified for an Early Warning System—Journal of the American Psychiatric Nurses Association
- The Mortality Experience of a Population with Psychiatric Illness—American Journal of Psychiatry
- Human Trafficking, Mental Illness, and Addiction: Avoiding Diagnostic Overshadowing—AMA Journal of Ethics
Impact of Stigma on Health Outcomes
- Stigma in Health Facilities: Why It Matters and How to Change It—BMC Medicine
- “The Land of the Sick and the Land of the Healthy”: Disability, Bureaucracy, and Stigma Among People Living with Poverty and Chronic Illness in the United States.—Social Science & Medicine
- HIV and Tuberculosis: the Construction and Management of Double Stigma—Social Science & Medicine
- Felt and Enacted Stigma Among HIV/HCV-Coinfected Adults: the Impact of Stigma Layering.—Qualitative Health Research
- Examining the Associations Between HIV-Related Stigma and Health Outcomes in People Living with HIV/AIDS: a Series of Meta-Analyses.—BMJ Open
- The dimensionality of stigma: a comparison of its impact on the self of persons with HIV/AIDS and cancer.—Journal of Health & Social Behavior
- Stigma and Demographic Correlates of Help‐Seeking Intentions in Returning Service Members—Journal of Traumatic Stress
- Stigma associated with PTSD: perceptions of treatment seeking combat veterans.—Psychiatric Rehabilitation Journal
Stigma & Suicide
- Suicide and Stigma—Centre for Suicide Prevention
- Correlates of suicide stigma and suicide literacy in the community—Suicide and Life-Threatening Behavior
- Does prolonged grief or suicide bereavement cause public stigma? A vignette-based experiment—Psychiatry Research
- “Nobody Hears a Silent Cry for Help”: Suicide Attempt Survivors’ Experiences of Disclosing During and After a Crisis.—Archives of Suicide Research
- Sociocultural Factors Associated with Attitudes Towards Suicide in Australia—Death Studies
- Implementing a Stigma Reduction Intervention in Healthcare Settings.—Journal of the International AIDS Society
- Combating HIV Stigma in Health Care Settings: What Works?—Journal of the International AIDS Society
- Effects of Stigma and Discrimination Reduction Trainings—Rand Health Quarterly
- Evaluating the effects of NAMI’s consumer presentation program, In Our Own Voice—Psychiatric Rehabilitation Journal
- Re-thinking HIV-Related Stigma in Health Care Settings: A Qualitative Study—Journal of the Association of Nurses in AIDS Care
Stigma & SUD’s—General
- Developing a research agenda for reducing the stigma of addictions, part II: Lessons from the mental health stigma literature.—American Journal of Addiction
- Stigma predicts residential treatment length for substance use disorder—American Journal of Drug & Alcohol Abuse
- Stigma and social support in substance abuse: Implications for mental health and well-being.—Psychiatric Research Journal
- The association between perceived stigma and substance use disorder treatment outcomes: a review—Substance Abuse & Rehabilitation
- Review of the effects of self-stigma and perceived social stigma on the treatment-seeking decisions of individuals with drug- and alcohol-use disorders.—Substance Abuse & Rehabilitation
- The Specter of Shame in Substance Misuse—Substance Use & Misuse
Shame & Relapse with SUD’s
- Nonverbal Displays of Shame Predict Relapse and Declining Health in Recovering Alcoholics—Randles and Tracy, 2013. Clinical Psychological Science
- Shame and Relapse Issues with the Chemically Dependent Client (Full article not online)—Alcoholism Treatment Quarterly
- Guilt, shame, and depression in clients in recovery from addiction. (Full article not online)—Journal of Psychoactive Drugs
- Is Shame a Proximal Trigger for Drinking? A Daily Process Study with a Community Sample—Clinical and Experimental Pharmacology and Physiology
- Slow and Steady Wins the Race: A Randomized Clinical Trial of Acceptance and Commitment Therapy Targeting Shame in Substance Use Disorders—Journal of Consulting and Clinical Psychology
- On the importance of distinguishing shame from guilt: Relations to problematic alcohol and drug use—Addictive Behaviors
- Cultural Differences and Shame in an Expressive Writing Alcohol Intervention—Journal of Ethnicity in Substance Abuse
Stigma & MAT
- Underuse of Medication-Assisted Treatment—PCSS (summary page)
- Addiction, Stigma, and Discrimination: Implications for Treatment and Recovery—PCSS (Webinar)
- Medication-Assisted Therapies—Tackling the Opioid-Overdose Epidemic—New England Journal of Medicine
- Research Network Involvement and Addiction Treatment Center Staff: Counselor Attitudes toward Buprenorphine—American Journal on Addictions
- Probation clients’ barriers to access and use of opioid use disorder medications—Health Justice
- Attitudes toward Methadone among Out-of-Treatment Minority Injection Drug Users: Implications for Health Disparities—International Journal of Environmental Research & Public Health
- Addressing Stigma—Centre for Addiction and Mental Health (CAMH)
- What is Weight Stigma?—National Eating Disorder Association
- 9 Ways to Fight Mental Health Stigma—NAMI
- Attitudes Toward Mental Illness—CDC
- Stigma Literature Review (Sara Powers)
- Health-related shame: an affective determinant of health?—Medical Humanities
- Shame Around Mental Illness May Be Fading, Survey Shows—Health Day
- Ashamed and Afraid: A Scoping Review of the Role of Shame in Post-Traumatic Stress Disorder (PTSD)—Journal of Clinical Medicine
- A Relational Model of Sexual Minority Mental and Physical Health: The Negative Effects of Shame on Relationships, Loneliness, and Health—Journal of Counseling Psychology
- Two Faces of Shame: Understanding Shame and Guilt in the Prediction of Jail Inmates’ Recidivism—Psychological Science
- An exploration of shame, social rank and rumination in relation to depression—Personality & Individual Differences