Mental healthcare professionals have long understood the direct relationship between mental health conditions of different types and suicidal ideations and the actual taking of a person’s own life. What is coming into sharper focus at this juncture in time is the link between the stigmatization of mental health and suicide. A dire relationship can develop between the stigma of mental health and suicide for a significant percentage of individuals laboring under a mental health condition or issue.
Definition of Stigma
The English definition of the word “stigma” is stark and blistering. Stigma is defined as a “mark of disgrace associated with a particular circumstance, quality, or person.”
History of Stigma
As is the case with a host of words used in the English language, “stigma” has a history. You would be hard pressed finding a word used in modern parlance today that has a profound history as does “stigma.”
In ancient Greece and Rome, a stigma was a brand or mark that was placed on a person of an inferior caste, as a slave. In today’s world, people in the United States are not branded or marked to set them a part of an inferior caste or cohort. With that said, the stigma that remains attached to mental health is pervasive and continues to set people apart in U.S. society as being somehow inferior.
Understanding Mental Health Stigma
Psychological professionals have broken mental health stigma into a couple of distinct categories:
- Social stigma
- Perceived stigma or self-stigma
Social stigma is the characterization through discriminatory behavior and prejudicial attitudes directed towards an individual laboring under some type of mental health condition. Perceived stigma or self-stigma is the internalization by an individual with a mental health condition of his or her perceptions of discrimination and prejudice. In the overall scheme of things, perceived stigma has the most profound connection to seeking mental health assistance and suicide.
As is discussed in greater detail shortly, perceived stigma is powerful in preventing a person with a mental health issue from seeking professional assistance in the first instance. The perceived stigma magnifies feelings of shame, which results in the closeting of a person’s mental health issue. A person laboring under a self-stigma believes that engaging a mental health professional for assistance will only further expose him or her to social stigma.
Even when a person laboring under a mental health condition seeks professional assistance, perceived stigma impacts treatment outcomes. The bottom line is that perceived stigma arising from mental health issues can negatively impact treatment outcomes as well.
The Pervasive Nature of Social Stigma
Despite the concerted efforts of organizations like the National Alliance on Mental Illness and the American Psychological Association as well as the work of esteemed mental health treatment providers like the Menninger Foundation, John Hopkins, and the Mayo Clinic, the stigmatization of people with mental health conditions in the United States and around the world is pervasive and profound. Indeed, prejudicial attitudes are commonly held among the general population. Discriminatory behavior is commonplace.
Researchers in the United States and the United Kingdom have determined that a trio of prejudicial beliefs about people with mental health conditions are widespread:
- people with mental health issues are dangerous
- mental health issues are self-inflicted
- people with mental health problems are poor communicators, hard to talk to
What is perhaps most striking about this research is that these prejudicial beliefs cross a myriad of demographic classifications. For example, many people presented with the idea that stigma related to mental illness persists would conclude that it is far more prevalent among older people than younger individuals. In fact, prejudicial beliefs and discrimination are nearly consistently evident among adults of all ages.
Level of education doesn’t appear to make an appreciable impact on prejudicial mindsets and discrimination when it comes to mental health conditions. Prejudicial beliefs and discriminatory conduct are exhibited in a similar manner no matter the level of education of a person. Indeed, but for providers who work directly with individuals with mental health conditions, even among healthcare professionals, prejudice and discrimination are widespread.
Research studies have also consistently revealed that people with loved ones afflicted with mental health conditions are also prone to prejudicial mindsets and discriminatory conduct. They oftentimes chalk this up to an attitude of “I’ve seen this first hand.” In most cases, this unsophisticated conclusion is largely due to a failure to undertake any significant self-education about the reality, dynamics, and medical foundation of mental health conditions.
Self-Stigma of Mental Illness
Although social stigma is a factor in preventing a person from seeking appropriate professional mental health assistance, self-stigma is the primary motivator in blocking an individual from obtaining suitable aid, support, and treatment. As will be discussed shortly, not seeking professional mental health assistance can cause a person’s condition to degrade and does lead to suicidal ideations, suicide attempts, and actual suicides in some cases.
The National Institutes of Health has overseen and been associated with a number of research projects examining self-stigma. These studies have made it abundantly clear that individuals afflicted with mental health conditions of different types, including depression, anxiety disorders, schizophrenia, and others, are highly vulnerable to accepting or endorsing negative stereotypes about themselves. (These are stereotypes developed as a result of social stigma, underscoring the dreadful interconnection between social stigma and self-stigma.
This internalization of negative stereotypes results in low self-esteem and poor self-efficacy. When this occurs, the course of an individual’s mental health condition worsens, largely because of a failure to seek professional assistance and a growing inability to engage in appropriate self-care.
The Devolution of Mental Health as the Result of Self-Stigmatization
The National Institutes of Health reports a four-stage process when it comes to the devolution of mental health self-stigmatization:
- Awareness: An individual recognizes that the public has negative perceptions of people with mental health issues.
- Agreement: An individual ends up agreeing with the prejudices of the public at large.
- Apply: An individual internalizes these prejudices and negative perceptions of a person with mental illness.
- Harm: Ultimately, if the stigmatization proceeds unabated, an individual considers his or her self not worthy and of little or no value and may then develop suicidal ideations, attempt suicide, or take his or her own life.
The bottom line: There is a direct link between the stigma – stigmas (social and self) – associated with mental health issues and suicide. Thus, the stigma of mental health must be addressed as part and parcel of an overall, comprehensive effort to prevent suicide.
Important Facts About Suicide in the United States
As part of recognizing the connection between the stigmatization of mental health and suicide, it is important to understand the essential facts associated with suicide. In 2017, the last year a full set of statistics is available, 47,173 people in the United States were reported to have died by suicide. On average, there are about 130 reported suicides in the United States every day of the year.
The number of suicide deaths in the country is underreported. The reality is that a portion of suicide deaths are not reported as such. The stigmatization of mental health and suicide extends beyond the death of a person at his or her own hand. Stigmatization and shame impact the family of survivors of suicide loss, resulting in misreporting of suicide deaths in an unknown number of cases. Based on reported cases alone, suicide is the 10th leading cause of death in the United States.
The same holds true when it comes to the reporting of suicide attempts in the United States. In 2017, an estimated 1.3 million people attempted to take their lives in the U.S.A. Attempting to ascertain how many individuals in the country have suicidal ideations during the course of any given year is a herculean task. Nonetheless, self-reporting provides at least some clue to the extent of suicidal ideation in the country. Once again, it is important to bear in mind that relying on self-reporting provides a lower number of people with suicidal ideations than actually exist.
8.3 million adults in the United States self-report that they had relatively concrete thoughts of suicide during the course of the past year. Of that number, 2.2 million adults report that they started to make plans towards taking their own lives.
Preventing Suicide by Challenging Mental Health Self-Stigmatization
The National Institutes of Health reports researchers have developed three categories for people with mental health issues when it comes to stigmatization. One group of individuals reports no impact from the stigmas associated with mental health conditions. A second group does report an internalization of self-stigma and suffer damage to self-esteem and self-efficacy.
Interestingly, researchers have identified a third group of people afflicted with a mental health issue when it comes to stigma. This group represents individuals who report what fairly can be described as “righteous indignation” at the injustice of the stigmatization of mental health issues. Experts in the field are beginning to conclude that this group of individuals suggest that there exists an antidote to self-stigma, which in turn will serve as a means of suicide prevention in some (perhaps many) cases. In basic terms, experts have begun to classify this antidote as self-empowerment.
These mental health professionals and researchers are suggesting that self-empowerment is the proverbial flip side of stigma. They maintain that self-empowerment includes:
- Righteous indignation
- Sense of individual power
Self-empowerment in regard to self-stigma appears to fairly consistently result in:
- Higher self-esteem
- Improved quality of life
- Enhance social support
- Increased satisfaction with mutual support programs
- Lessening of suicidal thoughts and ideations
Disclosure of a Mental Health Issue to Battle or End Self-Stigmatization
In the case of a growing percentage of individuals who have had or currently do have a mental health condition, empowerment is coming in the form of disclosure. While a considerable number of people are “in the closet” when it comes to a mental health issue, more and more people are sharing either a past or a current experience with a mental health condition with others. This disclosure comes in a number of different ways, all of which appear to be empowering and capable of reducing self-stigma to varying degrees.
Researchers and mental healthcare professionals have identified five methodologies through which people do or do not publicly share their personal mental health statuses:
- Social Avoidance: People in this category with a mental health issue avoids social settings. The theory they espouse is if they’re not around other people, their status cannot be ascertained.
- Secrecy: In this category, people do go out and about into the world and public settings. They do not disclose in any way that they have a mental health issue.
- Selective Disclosure: People share some information about their mental health
statuses with specific people who they perceive as potentially understanding.
- Indiscriminate Disclosure: Individuals in this category do not hide their mental health status from others. It is in this category that the prospect for self-empowerment as a means of challenging stigma can begin to occur.
- Broadcast: People who broadcast have no shame about their mental health diagnosis. They are no more shameful about a mental health condition than they would be about a broken bone. They positively share their condition in a manner that empowers themselves but also lends support and even empowerment to other individuals afflicted with mental health conditions.
As is discussed in this article, mental healthcare professionals and researchers have concluded that a mental health condition need not result in self-stigmatization. As a consequence, the linkage between the self-stigmatization of mental health and suicidal ideations can be broken.