Have you ever been in a conversation where you just can’t quite get the words out? I know I have. It may seem like a physical feeling, something stuck in your throat. Perhaps you mutter, or avoid looking your friend in the eye. We’ve all been in conversations surrounding difficult topics.
While the details may look different to all of us, this scene is common in talking about deeply personal issues. It’s especially common in talking about one’s mental health. The frequency at which this plays out suggests that it’s not influenced entirely by a person, but rather, is a reflection of larger forces at play.
Any quick Google Search of “why is it difficult to talk about mental health” brings up a variety of different articles, but almost all of them mention society’s stigma against mental health to some degree or another.
While we all know there is a stigma around mental health, how does this really make it more difficult to talk about it?
We all know what stigma is, even if we can’t quite define it. In the most basic sense of the word, stigma is the harmful separation of “us” versus “them”. Stigma forms in three stages: from stereotypes, to prejudice, to discrimination. Stereotypes are something called “cognitive knowledge structures” – a trick our minds create to help us remember groups of information by oversimplifying characteristics. These apply to everything from thinking all apples are sweet, to thinking all British people sound like their Queen. Some stereotypes are harmful, some are harmless. Crucially, we don’t have to accept them as truth, even if our brains have them grouped that way.
It’s an unfortunate reality that most stereotypes around mental illness are negative. Not everyone agrees with the negative associations, understanding that they are an oversimplification of an individual, and often untrue. But some people do, which leads to prejudice against those who deal with mental illnesses. This prejudice, in turn, leads to increasing discrimination against them. If a large enough number of people are prejudiced, this discrimination is largely accepted, and a social stigma is created.
Social stigma toward mental illness helps explain why it’s difficult for people to talk about mental health in public. What about in private spaces? We’ve learnt that stereotypes can be accepted or rejected as truths. Why is it difficult to talk about one’s mental health to those closest to us, who know the stereotypes to be false?
Any of us who suffer from discrimination sometimes internalise the stigma, and self-discriminate. Some of us do not. What separates the two is a question psychologists have been trying to answer for quite some time, and have a few potential explanations. Self-stigma, the process by which those in a discriminated group discriminate themselves, begins at the recognition of social stigma. While this seems quite obvious, it’s a key step in the process of internalisation. If the recognised stigma is accepted as truth, then self-esteem drops and people begin to self-discriminate. However, if the social stigma is recognised as false, something interesting happens. High association with the group – someone who identifies strongly as people with mental illness, for example – psychologists have shown to lead to a strong outrage at the stereotype, and a strong sense of empowerment. People with these traits often become activists, vocal opponents of discrimination and prejudice. Low association with the group – those who recognise the prejudice but don’t identify with the group prejudiced against – are largely indifferent and don’t internalise stigma. The degree of self-stigma in a person appears to be a major influence on how hard it is to open up about their mental health.
Talking about one’s mental health is difficult, especially when we’re surrounded by negative stereotypes against it. Erasing social stigma will take years of all of us working against it, but self-stigma can be individually fought. This is where the models built by psychologists can come in useful.
Much like stereotypes, models in science are always an oversimplification of the truth. But they’re often useful oversimplifications, allowing us to figure out how we can influence outcomes. Using our models of self-stigma, we can start to try to and make it just a little easier to talk about mental health. For example: recognising that stigmas are not a reflection of an individual person, but rather a larger issue in how our society functions, can make it more likely to reject a harmful stereotype, grouping us into the empowered category. This has been used extensively in other areas where discrimination is present, such a racism in Black communities. By recognising that many stereotypes around Black people have their roots in society, instead of individuals, communities have been empowered to fight back. Another example is how closely one identifies with a stereotyped group. The way mental illness is discussed in society labels them as part of someone’s identity, rather than an illness like the flu. By recognising that mental illness doesn’t define a person, but is rather something that happens to someone – “I’m not depressed, I have depression” – can reduce association with the stereotype and moves us to the indifferent category, where we are aware of the stereotype but we recognise it doesn’t apply to us.
At the end of the day, our mental health is a deeply intimate topic. It’s a product of our individual situations, unique to every one of us. But we’re not completely independent from the world around us, and the stigma that surrounds conversations around mental health affects us all. It’s something worth remembering the next time your words get caught in your throat, trying to start a conversation many of us have been unwittingly conditioned to avoid.
If you’re interested in the fascinating research behind stigma and self-stigma, check out the works I used in researching the question! We make sure to take our findings from credible, peer-reviewed, and expert sources.
A few good reviews on stigma and self-stigma:
The Stigma of Mental Illness by Patrick Corrigan and Andrea Bink
Mental Illness Stigma: Concepts, consequences, and initiatives to reduce stigma by Nicolas Rüsch et al.
Internalisation process of stigma of people with mental illness across cultures: a meta-analytic structural equation modelling approach by Ben CL You et al.
The Stigma Complex by Bernice Pescosolido and Jack Martin
Conceptualizing Stigma by Bruce Link and Jo Phelan
A couple of case studies applying models of self-stigma to patient populations:
Internalised Stigma of Mental Illness by Jennifer Boyd Ritsher et al.
Applying Corrigan's Progressive Model of Self-Stigma to People with Depression by Nele Cornelia Göpfert et al.
Examining a Progressive Model of Self-Stigma and its Impact on People with Serious Mental Illness by Patrick W Corrigan et al.
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