Where Does The Stigma Associated With Mental Illness Come From?

Why is there so much stigma and derogatory comments made about people with psychiatric disorders?

I think it is pretty obvious that the usual reaction in our society to the idea of psychiatric illness is either dismissive (“it’s just all in your head”), judgmental (“you just act that way on purpose”), or angry and condemning (“you’re nothing but a nutcase”).

Just look at how people with psychiatric disorders are portrayed in the popular media. They’re almost always mass murderers, serial killers, or scary suicidal lunatics who are destructive and completely out-of-control.

Look at how the people who treat mental illness — psychiatrists and psychologists — are portrayed, too. They are often serial killers, scary lunatics, or goofy, messed up nutcases!

Where does the stigma come from? I think there are several origins.

The first is the discomfort that many people feel with the world of emotions. I was at a meeting recently with three other professors from a medical school who were talking about some new courses for their students. The other professors were a neurologist and two scientists who work on the nervous system. We had decided to set up a series of introductory lectures about the anatomy and embryology of the brain. I then proposed a session for the students where they would learn about assessing a patient’s behavior and mental status.

“We should make this first session a little longer than usual,” I suggested, “Because this is the first time the students are getting together in a small group session and they should have some time to introduce themselves to each other and to get to know each other before they get into the teaching material.” I went on to explain that the students will have to work closely together over the next few months and they will have to talk about some difficult topics, like genetic testing, prenatal diagnosis, and diagnosing fatal illnesses. I said, “It would be good if they felt a sense of camaraderie and trust with one another at the very start.”

As I said this, the three other professors rolled their eyes and made some disparaging comments about “touchy-feely junk,” about how next I was going to ask all the students to close their eyes and hold hands together, and about how they weren’t sure they wanted a psychiatrist having so much input into the teaching sessions, since it was going to mess up their course with all this emotional stuff. They talked as if the day-to-day life of a physician — at least a good physician — does not involve understanding and respecting the emotional life of the people around him or her! But let’s face it, in medical training, and in society in general, the world of emotions is dismissed as soft, touchy-feely, embarrassing, stupid, or worthless.

The second reason for the stigma is fear. When I think back on the meeting with the other professors I realize that most of their condescending attitude came from fear and anxiety. They are people who are made anxious by the world of emotions and behavior. At some level, they are frightened by the fact that people (even medical students!) have feelings, and that it is appropriate and even useful to respect the feeling side of a person’s experience. In a similar manner, I think that many people are frightened by the unpredictable, emotional, confusing, and “irrational” behavior they see when someone has a psychiatric illness, and so they condemn it.

The third reason for the stigma is simple ignorance. Most people are only beginning to understand that our brains and our behavior are linked, and that many of the disturbed, maladaptive, and confusing behaviors we can observe in people with psychiatric illnesses are the result of disturbances in brain function. To this day, a lot of people (including most doctors) believe that these behaviors are being done “on purpose” and that the person “could control herself if she really wanted to.”

It’s a subtle issue, because there are ways that people can either optimize their health and wellness, or choose behaviors that are bad for their well-being. It’s easy to say that such people need to make better choices about their behavior by using “will power” or “self control” or “motivation,” but often it’s not that simple. Making appropriate choices and decisions is a brain function like any other, and is the result of prior learning, past experiences, and current appropriate information processing. Being motivated is a brain state also. As anyone with depression or schizophrenia can tell you, sometimes it’s hard to even figure out what the best choice is, and sometimes there is just no way to evoke a feeling of motivation.

It’s my hope that as we move forward in the 21st century, our society will discover more understanding and compassion towards the world of emotions and behavior. I hope we will be able to rise above fear and ignorance so that we can offer respectful teaching, training, evaluation, and treatment for all aspects of mental functioning.

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