In 2014, a couple of researchers published an article on the topic of perceived stigma in the public and personal domain. The authors noted that, to date, “no studies have examined perceptions or misperceptions of how the study participants themselves would be treated by the general public for seeking treatment for mental health concerns” and also analyzed specific factors (e.g., mental health symptoms, demographics) that might be connected to the perceptions.
A couple of terms must be defined before considering the findings, and extending a conversation started in my initial installment of this series. Public stigma is characterized as “the degree to which the general public holds negative views and discriminates against a specific group [in this case, those with mental health difficulties].” Personal stigma captures “how one actually would view and treat others themselves.” That being said, research uncovered a number of interesting results. Initially it was found that perceived public stigma was rated at a significantly higher level than personal stigma. On the topic of personal stigma, 93% indicated “disagreement” that they themselves would view someone with mental health difficulties negatively while 0.8% “agreed” they would have a negative view of such individuals. 9 out of 10 raters indicated that those with mental health issues should not feel embarrassed, worry about their reputation, or see themselves as weak or think less of themselves in this situation.
Certain factors were significantly correlated with these findings. Individuals who reported higher levels of anxiety themselves were more likely to rate increased public stigma. A more negative view of mental health treatment by the rater was also associated with heightened perceptions of public stigma. In regards to personal stigma, men of Asian descent were more likely to acknowledge increased personal stigma (i.e., looking at the person in a negative way) while like with public stigma, an increased negative view of mental health treatment was associated with higher personal stigma levels. Also, differences between a rater’s perception of public vs. personal stigma were associated with the following factors: female gender and increased anxiety/depression scores of the raters. In other words, females who were depressed/anxious tended to report a greater discrepancy between personal and public stigma than other raters, most likely with heightened public stigma reported (as noted prior).
Overall, the researchers found that raters endorsed much more elevated perceptions of public vs. personal stigma. In many ways, the raters seemed to say that while they felt the public often judged people with mental health problems differently, personally they would rarely or never do so. The authors concluded, with much further discussion of mitigating factors, that the “general consensus towards mental health treatment may not be as negative as one believes.”
Before further discussion around these conclusions can ensue, it is critical that we look at all the factors that may have influenced or distorted the data in any manner, and which may have resulted in a perception of reality than may not be accurate. The first is the social desirability factor, which in this case would potentially lead raters to answer in ways that preserve their own sense of integrity and positive image. It is understandable that many might be leery about acknowledging their own negative attitudes towards others, even though the research was done confidentially. Secondly, participants were college students. Arguments can be made that 1) they are especially prone to the social desirability bias, and 2) do not represent a larger sample of individuals who have truly struggled with mental health issues, although certainly some in the sample did. Third, the nature of the statements that were answered and how this influenced raters should also be considered. For example, Pair 1 included the following statements regarding public vs. personal stigma, respectively: “It would be too embarrassing” versus “They should feel embarrassed.” Most of us reading this would likely feel uneasy ever asserting that someone should feel embarrassed (even if we felt this way), especially given circumstances with which they may not have been responsible (e.g., childhood abuse). Fourth, there is a big difference between what we say we would do (or think) versus what actually occurs. A huge body of research exists that indicates our unconscious behaviors may reveal stereotypes or discrimination that our conscious selves would deny. Certainly, this is not an exhaustive list of possible influential or misleading agents, but it is a beginning. I encourage others to provide comments about potential explanations that might alter findings that I have not included.
That being said, there is one final possibility even if the strength of the findings is compromised to a certain degree. It is the one with which researchers concluded, which indicates that public perception of mental health stigma does not entirely reflect a reality that exists. Many of you reading this that have experienced truly negative reactions from others (due to mental health concerns and/or treatment) may be angered or offended by this proposition. However, no one (especially myself) is saying that stigma is not a serious concern that doesn’t need to be addressed. It is. Although in some ways I do feel that people can seek out treatment with less apprehension today than decades ago, there is no doubt that many still experience negative reactions (intentionally or unintentionally) from what others perceive in them.
Still, I feel that this is an important discussion that has long since been neglected when the topic of stigma arises. As I said before, I do not believe (like almost anything else that exists in humanity) that stigma is entirely a one-way street. In fact, when it is described this way, I feel that it does a disservice to both the person accused of stigmatizing and the person who feels stigmatized. It has a way of widening a gap that needs to be shrunken and further fortifying an us vs. them mentality that needs to be bridged and destroyed. Practically speaking, what often happens is that two groups of people who probably really need to talk and get to know, and respect, and maybe even love each other end up avoiding and despising each other instead. I am not trying to be pollyannaish or unrealistic about this topic. I am not suggesting that some people, no matter what the circumstances, may not hold to negative, discriminating beliefs. But I do believe that division and unilateralism, in action, word, or belief, never leads to real progress.
Over the years, I have had many opportunities to confront my own explicit and implicit biases, and they almost always seem to happen when I finally get to know someone for who they are. As a young mental health technician working on an adolescent unit just out of undergrad, I remember so often hearing about the reports of individuals as they were coming onto the floor. What happened over and over again was that when I would finally meet them, and get to know them, they would almost never live up to the reputation that preceded them; more importantly, I started to see them as the person they were and the struggles that had led them to me. I started to recognize the similarities we shared even if our stories sounded very different. And I found that I could not help but empathize and care for them, and see the value that each person had to me, our society, and our Divine Creator.
But when a real, empathetic human experience does not occur in some manner, individuals in all positions feel disconnected. I think this happens often when the term “stigma” is thrown out as if the case is closed and no further discussion ensues. Certainly many times the “offender” may have actually done something to discriminate or disrespect an individual with mental health difficulties; however, it is just as reasonable to assume that sometimes, a stigmatizing act may not be what it seems, just like a bump in a hallway may either be accidental or malicious – no matter what we think. This idea coincides with the researchers’ findings that increased anxiety and depressive symptoms intensifies a perception of public stigma. It is not surprising in that we all know that when we are feeling down or anxious we are often more likely to perceive a negative side in others than when we are feeling well.
As civil rights activists were planning the Montgomery Bus Boycott (as detailed in the Pulitzer Prize winning book Bearing the Cross), there was a clear sense that although activists were working against the injustices of bigotry and segregation, they also had to be particularly acute to the mistakes and misattributions of their own, as they knew that this might derail an otherwise noble undertaking. Whether this was illegal or violent behavior, or misinformation or misperceptions put forth, leaders of the civil rights movement knew that they must acknowledge where they might have gone wrong (in deed or thought) so that right could be done. So it seems, too, for the movement to provide the utmost care, respect, and love for anyone dealing with mental health challenges. Everyone needs to go truth-seeking if “we shall overcome.”
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.