Stigma and Mental Health

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)

Stigma Intervention

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)

Further Reading:

Stigma & Mental Health