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Stigma

What is Stigma?  Why Does it Matter?  What Can We Do About It?

Perhaps you’re raising child or adolescent with behavioral, emotional, or learning problems but you’re embarrassed, even ashamed, at the prospect of asking for help.  After all, isn’t it your fault for having raised such a kid?   That’s what most professionals believed to be the case for much of the last century—that parents directly caused their offspring’s mental disorders..

Similarly, if you’re a professional working clinically or educationally with youth facing such issues, you may find yourself struggling to help families overcome their resistance to obtaining assessments or treatment plans or to convince school districts that such conditions are real.  Or as a researcher in child and adolescent clinical psychology, perhaps you can’t figure out why “physical” illnesses like cancer receive more prestige and funding than do mental or developmental disorders.

A key issue underlying these questions and dilemmas is stigma.  This term comes from the ancient Greeks, signifying a brand or mark burned into the skin of an individual from a devalued group.  Today, rather than a physical brand, stigma is mainly psychological. Although bias still remains, we’ve certainly made real inroads in combating stigma and prejudice against people from racial, sexual, and religious minorities.  Yet stigma is still rampant with respect to behavioral, emotional, and neurodevelopmental conditions in youth—as well as in adults.

In point of fact, although public knowledge of mental and developmental disorders has rapidly increased over the last 50-60 years, fundamental attitudes have hardly budged—and in some ways are worse, especially related to fears of danger or violence.  This remaining stigma makes the seeking of treatment really difficult for far too many families, lowers the prestige of professions like clinical child psychology and child psychiatry, and reduces funding levels for basic and applied research in the whole area.  Even for families willing to take the risk and seek services, it’s still far too difficult for them to access evidence-based care, given the lack of training opportunities for professionals in the field and the long waiting lists that exist.

Some stigma is structural.  That is, physical disorders are prioritized over mental conditions; we still don’t have ‘parity’ for mental health care; insurance coverage is limited; and people admitting to mental disorders can still lose fundamental rights.  Although public school accommodations for children and adolescents with Individual Education Programs are mandated by law, chronic funding shortages in schools too often place parents and schools in direct conflict.

Some stigma lies within our disciplines.  Although it’s now widely known that combinations of biological and environmental factors predict risk for mental and neurodevelopmental disorders, parents continue to receive unjust blame.  What’s needed is to absolve parents from this toxic blame—but not from the responsibility to seek the best treatments possible.

Also relevant is self-stigma—the pervasive feeling in parents and youth that they fit the stereotypes and are thus not deserving of treatment.

The ultimate paradox here is that evidence-based treatments for youth (e.g., CBT, parent management training, DBT, family therapy, school-based programs—as well as medications when indicated) can and do work, as documented in other posts on the ECT website.  Yet stigma fuels a vicious cycle of shame, lack of access to treatment, continued impairment and suffering, and reduced hope.

What can families and professionals do?  At a “top-down” level, we must continue to fight for enforcement of antidiscrimination policies (such as the Americans with Disabilities Act) and for adequate reimbursement of evidence-based assessments and treatments.  We must insist, as well, for a far more humanized set of media images of mental and developmental disorders.  At a grass-roots level, families should challenge themselves to discuss openly their children’s struggles.  If things are kept in the closet, both policy-makers and the general public will remain “off the hook.” It takes courage to disclose, but with support, rehearsal, and the right timing, we can put mental health conditions on the national agenda.

After all, this is what has happened with cancer over the past two generations: Remember, in the early-to-mid 20th century, cancer received high levels of stigma—a family would never put in an obituary that a relative died of cancer, which was believed to relate to low moral fiber and personal will.  Now, a formerly scorned condition is now a ”cause.”

We need to do the same for mental and developmental disorders.  Families need to bond and receive support from one another; new generations of professionals must work to disseminate the evidence-based treatments that can and do foster recovery. The future of our children—and of our national economy and well-being—depends on our doing so.

 

Readings:

Henderson, C., & Gronholm, P. C. (2018).  Mental health related stigma as a ‘wicked problem’:

The need to address stigma and consider the consequences.  International Journal of

            Environmental Research and Public Health, 15, 1158-1171.

Hinshaw, S. P. (2017). Another kind of madness: A journey through the stigma and hope of

            mental illness.  New York: St. Martin’s.

Hinshaw, S. P., & Stier, A. (2008).  Stigma as related to mental disorders.  Annual Review of

            Clinical Psychology, 4, 269-293.

Martinez, A., & Hinshaw, S. P. (2016).  Mental health stigma: Theory, developmental issues,

and research priorities.  In D. Cicchetti (Ed.), Developmental psychopathology. Vol 4:

            Risk, resilience, and intervention (3rd  ed., pp. 997-1039).  Hoboken, NJ: Wiley.

Mukolo, A., Heflinger, C. A., & Wallston, K. A. (2010).  The stigma of childhood mental

disorders: A conceptual framework.  Journal of the American Academy of Child and

            Adolescent Psychiatry, 49, 192-198.

Pescosolido, B. A., Martin, J. K., Long, J. S., Medina, T. R., Phelan, J. C., & Link, B. G. (2010).

‘A disease like any other’? A decade of change in public reactions to schizophrenia,

depression, and alcohol dependence.  American Journal of Psychiatry, 167, 1321-1330.

 

Partner Sites:

Evidence-based Services Committee of Hawaii