“How do we, as a society, reduce stigmatization of the seriously mentally ill? As Patrick Corrigan persuasively argues in this thorough inquiry into the subject, we should listen to their stories, for then we will discover fellow human beings, and not the “other” we fear.”
~ Robert Whitaker, author of Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness
This week we’re featuring The Stigma Effect: Unintended Consequences of Mental Health Campaigns, by Patrick W. Corrigan, Distinguished Professor of Psychology at the Illinois Institute of Technology. In addition to being an author and a professor, Corrigan is principal investigator of the National Consortium on Stigma and Empowerment. Today, he shares his own experience with mental illness and discuss the stigma behind it in this Q&A.
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Q: Tell us about the stigma that is associated with mental illness. Is it strictly from the outside looking in or is it also self-applied?
Patrick Corrigan: Stigma may be as big a problem for people with mental illness as the symptoms and disabilities of the illness itself. The stigma of mental illness is in the same category as racism, sexism, and homophobia. Employers will not hire applicants labeled with mental illness. Landlords will not rent to them. Schools fall short in accommodating students with mental illness. Health care professionals provide a substandard of care.
And then there is the terrible irony of self-stigma. This occurs when persons with mental illness turn stereotypes about psychiatric disorders against themselves. It is hard enough dealing with the depression and anxiety of mental illness that undermines self-worth. On top of that, they have to deal with the shame that results. “I must be a weak person because I am mentally ill.”
As a result, people who might benefit from mental health services avoid getting help. “I am not going to see some psychiatrist and have everyone think I am nuts.” This is called label avoidance. People do not seek out mental health services in order to avoid stigmatizing labels.
Q: It seems that as a society, we are more open about discussing mental illness than we were in the past and that the stigma would be waning, but you claim that isn’t so. Can you elaborate on that point??
PC: You would think so because people on average seem to know more about mental illness than ever before. But research suggests the opposite. The stigma of mental illness is getting worse. One set of studies conducted by Bruce Link and colleagues at Columbia University showed that the public believes people with mental illness are MORE dangerous than ever before. Although this might seem reasonable because media often frames mental illness as violence, in fact, the population grossly overestimates the frequency of violence among individuals with psychiatric history. People with mental illness are more likely to be victims of crime than perpetrators.
So how come the equation “mental illness = violence” remains? One reason is the degree to which the public understands these god awful mass shootings that plague America. Adam Lanza at the Sandy Hook school. Jared Loughner in Tucson. James Homes in the Colorado theatre. “It must be unchecked mental illness!” Fear is a powerful motivator that skews perceptions of a group. I have a colleague in Australia, Tony Jorm, who showed that the stigma of mental illness increased in Australia after Sandy Hook.
Q: Progressive are advocating to erase the stigma. Why aren’t their efforts working?
PC: Beating stigma is fundamentally an issue of righting social injustice. Progressives are drawn to these kinds of challenges. They are a motivated group who bring important energy to battle. Unfortunately, their zeal to correct the status quo often leads to unintended consequences. The Stigma Effect is a summary of these mistakes. If we want to truly tear down stigma, we have to understand what does not work.
Q: Can you give as an example of an unintended consequence? Is there anything in particular people might assume would change stigmas that would not bode well?
PC: My research on stigma change began some 20 years ago with what I thought was an obvious fix: education. Westerners are confident that ignorance can be undermined with knowledge. We erase the stigma of mental illness by contrasting the myths of mental illness (e.g., All people with mental illness are violent) with facts (People with mental illness are mostly no more violent than everyone else).
There are, however, some sobering lessons that show that education in the public health arena does not work. Consider for example, parents who believe early childhood vaccinations cause autism, a false belief. This is a major concern because it exposes large numbers of children to unnecessary disease. Researchers have done studies on efforts to try to change this behavior. They teach parents the CDC facts on vaccinations. Lectures include compelling videos of hospitalized children suffering illnesses because they were not vaccinated. And how did this impact parents? Those who sat through the training were significantly LESS likely to have their kids vaccinated. Stigmatizing attitudes are stubborn.
Similar things have been seen in the mental health arena. George H.W. Bush and the National Institute of Mental Health launched the Decade of the Brain in the 1990s. One of many goals was to diminish stigma by framing mental illness as a brain disorder. Our research group, among many others, did studies teaching the public facts about the genetic origins of mental illness and ways it disrupts the brain. What were the results? The good news is that the public was less likely to believe people with mental illness were to blame for their condition. “It’s not a character flaw. It’s just the way they are biologically built.” But the bad news is that people are not going to get better. Symptoms are hard wired in your brain. “You might look good now but flip out at any time.” And beliefs about bad prognosis—no recovery—lead to employers not wanting to hire or landlords not wanting to rent to them.
Q: If education does not work to implement change, what is an effective approach to stigma change?
PC: Contact—interaction as peers among equals. An interaction with the LGBTQ community provides an example of how prejudice and discrimination can change over generations. My kids knew they had two gay uncles, gay ministers, and gay classmates. Brave souls tore down the stigma of LGBTQ status by coming out. And it’s the same way with mental illness. We have heroes who have come forward to tell their complex story of mental illness and recovery.
Who then should lead the anti-stigma agenda? The power resides with the person who has experienced stigma and is willing to openly tell the story of lived experience of mental illness, stigma, and recovery. Recovery is not an end state. “It’s over. No more symptoms.” Wrong. Recovery is a process. “Despite my symptoms, which may come back, I can achieve.” Life should be governed by hope and aspiration.
Q: You have chosen to bring this book alive by sharing personal experiences of your own mental illness. Can you explain why you chose this method as a way to connect with your readers?
PC: I wanted The Stigma Effect to provide a complex picture of the prejudice and discrimination that harm those labeled with mental illness. I approach this as a scientist knowing the “facts” about the ordeal. But I am a person with mental illness who has lived experience which has an equally important voice. I have been diagnosed with bipolar disorder, major depression, and generalized anxiety disorder. I know the shame of being in the hospital, calling my wife on the wall phone in the community room, and telling her I wouldn’t be at my daughter’s school function that night. Stigma is not an abstraction for me. It is something I have lived and struggled with. It gives me an authentic voice which I have slowly learned is necessary for my work.
My decision has evolved over time. I did not dare tell my colleagues in the University of Chicago Psychiatry Department about my own mental health struggles when I was hired there in 1990. I feared being judged less than competent by virtue of psychiatry diagnosis. But slowly, over many years, I realized my mental health struggles is part of who I am. “I am psychologist, professor, son, husband, father, not-so-good runner, and sometimes handyman. And I am a person with mental illness.” Absence of stigma means I can choose to share any or all of this when and where I wish in order to be a whole and authentic person.