What is the Stigma Effect?: Part 2

Unintended impact of programs meant to challenge the stigma of mental illness.

Posted Jan 30, 2019

In my previous post, I introduced the Stigma Effect as unintended consequences made by progressive advocates seeking to right social injustice, but doing so with errors. Two examples were provided from recent history: (1) colorblindness, an attempt to erase racism by ignoring skin color but which asked people of non-white ethnic groups to ignore their rich heritage, and (2) Don’t Ask-Don’t Tell, an approach by Bill Clinton to stop homophobia in the military by asking personnel to go into the closet with their LGBT experiences. I wrote The Stigma Effect: Unintended Consequences of Mental Health Campaigns as a first step in making sense of unintended consequences. Let’s understand what does not work so we better recognize that which does.  Three sets of unintended consequences come to mind for efforts seeking to decrease mental illness stigma.

  1. Education, especially of adults, about the myths and facts of mental illness may yield little benefit, instead adding to misconceptions about psychiatric disorders.  This may seem counterintuitive, especially in Western cultures who are convinced we can educate away most social ills.  Unfortunately, teaching people about racism or sexism or homophobia never erased corresponding prejudice and discrimination.  “I don’ care what you teach me about mental illness; they’re still nuts and dangerous!”  It was once popular to attack stigma by teaching that mental illness was a brain disorder.  Education programs were illustrated with impressive PET scans which showed the occipital lobes of the cerebrum lighting up in the brain of someone with schizophrenia when hallucinating.  Unfortunately, this kind of message actually worsened prognoses of people with mental illness.  Beliefs about whether people with mental illness will ever recover worsened.  After all, the symptoms and dysfunctions are hard-wired into their neurons.
  2. Campaigns to decrease stigma in order to get people into treatment by framing depression as a treatable illness seems to have exacerbated stigmatizing notions of difference.  These kinds of messages stress the idea that people with treatable illness are not like me.  People who are different from the observer, whether because of skin color, age, or mental illness, are more likely to be viewed with disdain.
  3. Broad-based population campaigns using social, entertainment, and news media seem to have significant limits.  While such public service campaigns seem to be potentially large scale strategies to decrease stigma, their benefits rarely last.  Members of the public are rarely able to recall the public service announcement or show it impacted their attitudes.  Moreover, famous people coming out with their mental illness does not change the stigma story.  Demi Lovato, Jim Carrey, and Prince William have all discussed their travails with mental illness in order to decrease the corresponding stigma.  Effects are somewhat limited, however, because the average person responds, “Prince William is not really like me!” This difference undermines any benefit leading to stigma change.
Free-Images
Source: Free-Images

A focus on unintended consequences of anti-stigma efforts has several benefits.  Advocates of all stripes need to understand what fails to work, especially when evidence contradicts preferred perspectives. Through these cautions, broader and deeper understandings of stigma and stigma change emerge.  I believe that the stigma against people with mental illness is in the same category as racism, sexism, ageism, and homophobia. Hence, solutions should rest solely on the agenda of people with lived experience harmed by these stigmas. Programs that lead to enduring and meaningful success in stigma change are led by people with lived experience of mental illness.