Does Stigma About Mental Health Persist in the US?

Does Stigma About Mental Health Persist in the US?

With July 4^th approaching, I’ve been reflecting about culture in our country. In particular, the values, attitudes, and beliefs that we have about mental health have given me pause. It’s been nearly 20 years since I graduated from medical school and decided to become a psychiatrist. I also happened to be asked this question on a recent appearance I made on a recent episode of the Carrigan and Company podcast. So milestones like this makes me wonder: does stigma about mental health persist?

Stigma refers to the markers of shame or disapproval attached to specific attributes that result in prejudices, stereotypes, and discrimination. The topic of stigma often arises in public discourse when a well-known figure or celebrity reveals to the media that they’ve struggled with a psychiatric disorder – for instance, a substance use disorder, postpartum depression, or anxiety. I would argue that this marks a major step in destigmatizing mental health conditions because such public disclosures normalize seeking help. Similarly, as someone who is active on social media, I consistently see people posting about mental health conditions. On TikTok, entire communities are formed around the discussion of specific psychiatric disorders. This shows me that there is a generation of individuals who feel empowered to talk about their personal experiences with mental health to broad audiences.

But despite apparent progress, I do wonder whether mental health remains fundamentally stigmatized. Why? Because of the day-to-day conversations, statements, and remarks I either hear or read about mental health. My first example of this are attitudes toward treatments for psychiatric disorders. As with all medical specialties, psychiatric treatments don’t work for everyone. Yet, I tend to see individual narratives about mental health decry psychiatric care more than any other medical treatment. Second, while I’ve spent the last 8 years of my career investigating ways to mitigate workplace burnout, I recognize how common it is for people to prefer the label of burnout to depression when they often co-exist. This is especially relevant in healthcare where burnout becomes a social acceptable way to discuss symptoms that tread into the territory of mood or trauma-based disorders. Third, I find that many people will disclose their stress but rarely their anxiety disorder. While all medical conditions are often considered a private matter, people still have a higher level of comfort discussing their diabetes, for instance, more than their depression.

Social neuroscience explains how stigma develops. Brain regions involved in emotion and threat (the amygdala) overwhelm brain regions involved in perspective taking, emotional regulation, and expression of empathy (the prefrontal cortex). What’s counterintuitive in the medical research about stigma is that biological explanations for psychiatric disorders reduce blame but perpetuate stigma by reinforcing an “us” versus “them” explanation. So then, how do we diminish stigma effectively?

Combining neurobiological understanding with lived experience on the efficacy of treatment and stories of recovery is critical. Psychiatric disorders are common AND treatable. Now, more than ever, I can offer people novel treatments that simply weren’t accessible a decade ago. That’s what I find uniquely energizing about being a psychiatrist: the recognition that the field is constantly evolving and identifying more effective options. And as I celebrate July 4^th this year, I feel hopeful about the possibility that there will be a day when seeking psychiatric care is viewed no differently than seeking treatment for any other medical condition. I believe THAT is is the milestone we will reach that shows me what a culture free of stigma would look like.