Understanding What Causes Stigma

We often discuss how much of a problem stigma is and how much it impacts those who live with mental illness. However, it is somewhat rare for us to focus on the foundation stigma roots itself in. But this is something discussed in detail in Living and Working with Schizophrenia, a book by Dr. Marjorie Baldwin. She explains five possible components that may be leading to the persistent and institutionalized problem of stigma.

There are so many people who deal with stigma every day, in every aspect of life. People like Alan, a 30-year-old accountant who lives with bipolar disorder. And if we understand stigma’s roots, we may better understand how to improve the lives of people like Alan.

1. Responsibility

Alan sits at a bar with his friend Jack. Alan slumps in his stool and stares at his half-empty beer bottle. Jack sighs loudly as he looks around the room.

After a long silence, Jack finally says, “Remember senior year when we never slept? We were always doing something—partying, playing basketball, occasionally going to class?”

“Yeah, I remember.” 

“Is there any chance of you being like that again? Lately it seems like the life’s been sucked out of you.”

“I don’t know.”

“Can’t you just snap out of it?”

Too often, those living with mental illness are held responsible for their conditions—as if they are intentionally selecting a life with symptoms, rather than without. When people believe that an individual has a choice in this matter—that they are in control of their mental illness, they are then blamed for their symptoms. When this happens, they receive little sympathy and more stigma.

2. Uncertainty

If a person’s condition is uncertain (as in it is unlikely to be improved), they are more likely to be stigmatized and avoided by friends and family. The more hopeless the situation seems, the more it is viewed as a waste of time.

“I can’t do this anymore,” Alan’s wife blurts out at the dinner table.

Alan looks up from his plate and stares at her with a puzzled expression.

“I want a divorce” she continues. “I know things aren’t easy for you… But I just can’t bare another silent meal, another loveless embrace, another cycle of you going from making me breakfast at 3 a.m. because you can’t sleep to sleeping through my birthday. I hate that I can’t help you—this whole thing just feels endless.”

3. Unpredictability

While uncertainty focuses on the long-term outcomes of someone living with a mental health condition, unpredictability focuses on short-term outcomes. Those who experience symptoms are sometimes perceived as unpredictable and erratic on a day-to-day basis. Unjust social distance may occur because of this.

Alan’s two friends from college, Jack and Dan, are sitting on the couch at Dan’s house, watching basketball.

“I’m telling you…he’s different than he used to be,” Jack tells Dan.

“Different how?”

“I just never know what’s going to happen when I meet up with him. Sometimes he’s fine, but sometimes he acts really weird…” Jack suggests. “Last time I saw him, he kept having to get up from the bar to pace around the room.”

“What? That’s really strange.”

“Yeah. I’m honestly trying not to hang out with him anymore.  It’s embarrassing when he does stuff like that.”

4. Incompetence

Unfortunately, people view those living with mental health conditions as unable (or too incompetent) to make rational decisions. This is what leads to stigmatizing laws and practices that prohibit individuals living with mental illness from having the same rights and opportunities as other people—such as the right to hold office, the right to vote, the right to serve on a jury, etc.

Alan sits in his cubicle, plugging numbers into a spreadsheet.

His boss, Bill, walks over to him apprehensively. Bill pulls up a chair, rests his elbows onto his thighs and puts his face in his hands. “I’m sorry to tell you this, but we had to go with someone else for the account manager position.”

Alan’s face sinks as he pauses to take this in.

After a breath, he slowly responds, “I don’t understand… I’ve worked here for five years. My job is leading up to this position.”

“It seems that some of the higher-ups don’t see you as management material.”

5. Dangerousness

Alan’s brow furrowed, as he turned to Bill and said, “I’m frustrated to hear this. I think this decision is unfounded. I have diligently worked for this for five years!”  

“I’m sorry, but there’s nothing I can do.” Bill says as he quickly stands up and backs away from Alan like a scared child coming across a snake. He scurries to his office and closes the door.

Dangerousness is when unpredictability manifests into fear. People often avoid those with mental illness because they are afraid of random acts of violence.

But the truth is, we all know someone like Alan. And more often than not, he’s not dangerous or unpredictable or incompetent or hopeless. He’s just Alan.

Alan—and the millions of people who go through similar struggles—needs people to be more understanding, compassionate and educated about mental illness. He needs people to recognize that his symptoms are not his fault. He needs people to believe that recovery is possible. He needs people to understand that having mental illness does not mean he is any less competent or intelligent than any other person. He needs people to know that living with a mental health condition does not automatically make him violent.

Alan needs people to see him, not his condition.

Can you?

To help us continue the fight against stigma,
share your #IStopStigmaBy story & support NAMI