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Freedom From Stigma

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Freedom from stigma is the first of the four freedoms proposed by the Austen Riggs Center that are foundations of mental health.

Freedom from stigma is the first of the four freedoms that are foundations of mental health.

In the United States, estimates are that nearly 45 million adults have mental illness; yet fewer than half reportedly seek treatment (National Institute of Mental Health, 2018). Most people have either struggled with symptoms of a mental illness at some point in their lives or know someone who has. Despite this shared experience, stigma toward mental illness persists.

Perceived stigma is often cited as one of the barriers to seeking treatment (Mann & Himelein, 2008). While some studies show progress in reducing stigma through mass media interventions (Clement, et al., 2013), individuals with mental illness continue to face prejudice and stigma, which in some instances is more debilitating than mental illness itself (Thornicroft, Rose, Kassam, & Sartorius, 2007). 

Among the many factors contributing to the stigma toward mental illness, portrayals in the media are particularly challenging. In both entertainment and the news media, individuals with mental illness are often inaccurately and disproportionately depicted as dangerous and unpredictable. This has negative repercussions both for those struggling with mental illness and for the public’s understanding of mental illness. The fact is that individuals with a mental illness are far more likely to be victims of violence than perpetrators of violence (Stuart, 2006). 

Entertainment media 

The entertainment industry has produced nuanced and accurate depictions of mental illness; but exaggerated and inaccurate depictions are far more common. Moreover, troubling stereotyped representations of mental illness persist in some children’s programming and movies (Stuart, 2006). Early exposure to negative stereotypes about mental illness can certainly play a role in solidifying false perceptions and prejudicial feelings or actions toward those with a mental illness during an important developmental period. A literature review by Muller, Callanan, and Greenwood (2015) of social communications to children about mental illness confirms the negative stereotypes children in middle childhood (7–11 years of age) are exposed to in the media. This coupled with an observed general silence and stigma around mental illness that they encounter from educators, peers, and their parents can have a lasting impact. 

News media 

The news media produces some sensitive and accurate reporting on mental illness, but at times is guilty of stigma-reinforcing, negative, and inaccurate information, particularly as it relates to the association of mental illness with violence or crime 

(Stuart, 2006). While there appear to be more open conversations about mental illness–celebrities are speaking out and there is a broader acknowledgment of the widespread incidence of mental illness–the depiction of mental illness in the news has changed little over time (Stuart, 2006). 

This is problematic for a number of reasons, not the least of which is news media’s identification as a frequent source of health information for the general public (Peek, et al., 2015). The depiction of individuals with mental illness in a negative light leads to conscious and unconscious bias, prejudice, and discrimination. 

Mental health professionals and mental health treatment are often depicted in a negative light in the media as well, which can lead to “widespread distrust of mental health providers and avoidance of psychiatric treatments” (Stuart, 2006, p. 103) by those who would likely benefit. 

While a number of interventions, including psychoeducation and mass media campaigns, can increase public knowledge about mental illnesses and decrease prejudice, the overall rate of “mental health literacy” is relatively low, tends to be focused on symptomatology rather than broader individual contexts and histories, and has had little impact on larger issues of discrimination against those with mental illness.  

Addressing issues

To help address some of the issues around stigma, Riggs is engaged in a number of activities including:

  • Recognizing patients as capable individuals who come to us with both problems and strengths and deserve dignity, respect, and a voice in their treatment and in their lives.
  • Conducting research that aims to better understand the struggles faced by those with mental illness, in order to better help them lead self-directed lives.
  • Establishing a Four Freedoms of Mental Health Award
  • Honoring excellent reporting on mental health with a Prize for Excellence in Mental Health Media.
  • Supporting an engaged Alumni Community of former patients, staff, and Board members through regular meetings and an active online community.

Progress is being made, but there is much work to be done. Those of us who work in the field, struggle with mental illness ourselves, or know someone who does can take the lead in providing accurate information about mental illness. In addition, we can point out and correct inaccurate information or depictions of mental illness when we see, hear, or read them, while at the same time recognizing and commending those individuals and organizations that get it right. This shared responsibility can make a difference.

 

References

Clement, S., Lassman, F., Barley, E., Evans-Lacko, S., Williams, P., Yamaguchi, S., . . . Thornicroft, G. (2013). Mass Media Interventions for Reducing Mental Health-Related Stigma (Review). Cochrane Database of Systematic Reviews, 1-33.

Mann, C., & Himelein, M. (2008). Putting the Person Back in Psychopathology: An Intervention to Reduce Mental Illness Stigma in the Classroom. Social Psychiatry & Psychiatric Epidemiology, 43, 545-551.

Muller, J., Callanan, M., & Greenwood, K. (2015). Communications to Children About Mental Illness and Their Role in Stigma Development: An Integrative Review Journal of Mental Health, 25(1). Retrieved from http://www. tandfonline.com/doi/abs/10.3109/09638237.2015.1021899

National Institute of Mental Health. (2018, February 27). Mental Illness. Retrieved from National Institute of Mental Health: https://www.nimh.nih.gov/health/statistics/mental-illness.shtml

Peek, H., Richards, M., Muir, O., Chan, S., Canton, M., & MacMillan, C. (2015). Blogging and Social Media for Mental Health Education and Advocacy: A Review for Psychiatrists. Current Psychiatry Reports, 17(88).

Stuart, H. (2006). Media Portrayal of Mental Illness and its Treatments: What Effect Does it Have on People with Mental Illness? CNS Drugs, 20(2), 99-106.

Thornicroft, G., Rose, D., Kassam, A., & Sartorius, N. (2007). Stigma: Ignorance, Prejudice or Discrimination? The British Journal of Psychiatry, 190(3), 192-93. doi:10.1192/bjp. bp.106.025791

Wahl, O. (2001). Mass Media and Psychiatry. Current Opinion in Psychiatry, 14(6), 530-531.

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