Stigma surrounding early serious mental illness (ESMI) remains a significant barrier to treatment and well-being with deep impacts to individuals and communities. In her memoir Elyn Saks gives voice to her traumatic experience of being held in restraints while experiencing psychosis. Afterwards, her colleague, unaware of her diagnosis, justified the use of restraints based on the false belief that people with schizophrenia experience pain and fear differently. This powerful anecdote highlights how misconceptions can negatively impact clinical decision-making and underscores the need for accurate understanding, acceptance, and empathy within the behavioral health system.
In sociology, stigma is defined as an "attribute that is deeply discrediting," which can be visible, such as physical characteristics, or concealed, as with behavioral health conditions. Stigma shows up in many way – through systems, personal interactions, and even how we see ourselves. It is often linked to power and discrimination. For communities that have faced historical oppression and social exclusion, stigma hits even harder. It can make people hesitant to seek help, lead to misdiagnoses and inadequate care, and worsen health inequalities.
While stigma around common conditions like anxiety and depression has decreased, especially among younger generations, attitudes toward conditions like schizophrenia remain largely unchanged and perhaps has even increased in recent decades, and media representations perpetuate negative stereotypes. Despite gains in mental health literacy and more widespread acceptance of a biological model of mental health, harmful stigmatizing attitudes persist and impact treatment access and quality.
To ensure early recognition and effective treatment, we all have a part to play in reducing stigma. As the National Institute for Mental Health’s Stigma and Discrimination Research Toolkit indicates, the language we use to talk about health plays a critical role in shaping attitudes and beliefs. Proactively using language that empowers individuals and communities and learning from individuals with lived experience are key in working to improve our health systems as well as health outcomes for those impacted.
Additionally, resources exist through New Journeys for screening and early intervention for treatment. Visit the New Journeys website for more information and to make a referral to a treatment provider in your community.
References
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Goffman, E. (1963). Stigma: Notes on the Management of Spoiled Identity. New York: Simon and Schuster.
Hinshaw, S. P., & Stier, A. (2008, April). Stigma as Related to Mental Disorders. Annual Review of Clinical Psychology, 4, 367-393. doi:10.1146/annurev.clinpsy.4.022007.141245
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Pescosolido, Bernice A, Halpern-Manners, Andrew, Luo, Liying, Perry, Brea. (2021, December). Trends in Public Stigma of Mental Illness in the US, 1996-2018. JAMA Netw Open, 1(4).
Saks, E. R. (2007). The Center Cannot Hold: My Journey through Madness. New York: Hatchett Books.
Smith, S. L. (2023). Mental Health Conditions Across 300 Popular Films: A Researsch Update from 2026 to 2022. Los Anageles: USC Annenberg Inclusion Initaitive.
Stuart, H. (2016, May). Reducing the stigma of mental illness. Glob Ment Health (Camb), 10(3). doi:10.1017/gmh.2016.11
Thomas Ungar, S. K. (2016, April). Theoretical and Practical Considerations for Combating Mental Illness Stigma in Health Care. Community Mental Health J, 3(52), 262-271. doi:10.1007/s10597-015-9910-4
Thornicroft, G. (2006). Shunned: Discrimination Against People with Mental Illness. Oxford: Oxford University Press.
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