We need more precision when discussing mental health stigma

I am grateful for the anonymous reviewer of one of my manuscripts several years ago, who criticized my own imprecision in the discussion mental health stigma; their comment inspired me to think more deeply about this topic.

In my psychology classes, students love to talk about mental health stigma. And rightly so: a better understanding of stigma is essential to improving access to mental health care for everyone around the world.

But as someone who studies and teaches about mental health stigma in the United States and elsewhere, I’m increasingly concerned about something: If we’re not thoughtful enough, our talk about mental health stigma mental health could become too diffuse and, ultimately, too simplistic. What I concluded about the Collectivism-Individualism Framework in Intercultural Teaching (Kim, 2021) also applies to managing mental health stigma: we need more nuance and specificity when discussing it.

Let me outline a few ways to accomplish this.

First, when we talk about mental health stigma, do we mean the stigma of search for professional servicesor the stigmatization of mental illness? Such intentional nuance will enable better design and implementation of interventions to combat stigma. In other words, if we want to combat the stigma associated with seeking services, we need to focus on a different type – perhaps emphasizing the behavioral aspects. But if we want to reduce the stigma of the illness, we could instead focus on increasing knowledge of psychopathology. You can imagine a person who is reluctant to seek advice for various reasons, but who has few stigmatizing opinions about their own situation; on the other hand, one can be incredibly negative about their own psychological state, but cannot hesitate to talk to a professional because the behavior of seeking advice does not pose a psychological threat to them. These two types of stigma may be correlated, but they are not the same thing.

Secondly, and remaining with the stigmatization of mental illness, stigma may differ depending on the disorder. Not all psychological disorders are equally stigmatized. Feldman and Crandall (2007) reported that disorders that are rare, considered dangerous, or perceived to be based on personal responsibility tend to be more stigmatized; in their study, a condition like antisocial personality trouble was a highly stigmatized disorder, while society phobia was relatively unstigmatized.

Third, in the same way that stigma can be broken down based on a disorder or condition, stigma can also take a different form in the area of ​​seeking professional help. More precisely, “Who stigmatizes?” » is a crucial question to ask. Stigma felt at a societal level is different from an individual’s perception of stigma from those they care deeply about (see Vogel et al., 2009 for important work on this topic of stigmatizing others). In my own research, we have found that perceptions of others’ attitudes toward help-seeking can impact individual attitudes toward professional counseling, particularly in contexts that emphasize hierarchy social (Kim and Park, 2009). Simply put: if I value interpersonal relationships, I will also value how others perceive seeking psychological help.

Additionally, another important source of stigma is self-stigma, or internalized stigma (again, see Vogel et al. 2006 for more). Whenever we discuss or study mental health stigma, we must be clear about which source(s) we are referring to.

Finally, I would be remiss if I did not mention the cultural influence on stigma, including religious influence. My former student Marcella Locke and I (Kim & Locke, 2023) recently wrote an article about how religious contexts can perpetuate certain beliefs on the search for services (and also on mental illness in general). Even more complicated, religious beliefs can intertwine with cultural beliefs (e.g., Korean cultural beliefs) to strengthen or weaken a stigmatizing view. So, to further nuance mental health stigma, you may need to clarify what type of cultural influence on mental health stigma you intend to discuss, e.g. cultural stigma or stigma religious.

I imagine there are other ways we can continue to improve specificity when discussing mental health stigma, in addition to the ones I’ve shared here. But I hope this article has given you some ideas about how we can be more specific in our discourse as we continue the important work of dismantling the stigma around seeking counseling services, so that everyone who would benefit from professional advice to use it.

To find a therapist, visit Psychology Today’s Therapies Directory.

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