Mental health stigma: The role of dualism, uncertainty, causation and treatability

Abstract

Public stigma on mental health has been defined as 'the set of negative attitudes and beliefs that motivate individuals to fear, reject, avoid and discriminate against people with mental illness'. Stigma causes immense suffering to people with mental disorders across the globe. According to a recent Human Rights Watch report, people with mental health conditions are still shackled in 60 countries. Nearly nine out of 10 mental health service users in England have experienced discrimination. Stigma can be perpetuated by people in all walks of life, including the family and friends of those with mental disorders, and healthcare professionals, including those working in mental health. The adverse consequences of stigma include shame, self-blame, isolation and discrimination. Examples of discrimination experienced by people with mental health disorders include others avoiding their company, and education, employment and housing opportunities being withheld. Stigma can deter people with mental health problems from seeking help and leads to poor adherence to treatment. People with mental disorders have high rates of physical comorbidity and higher mortality compared with the general population. The reasons for these health disparities are multifactorial, but discrimination and diagnostic overshadowing are believed to contribute. Mental health stigma has many causes including lack of knowledge and inaccurate beliefs, especially regarding the relationship between mental illness and violent behaviour. In this article, we highlight mind-body dualism and an underappreciation of the similarities that can exist between mental and physical disorders as contributory factors to stigma. Negative assumptions about psychiatry include it involving uncertainty, the causation of disorders being poorly understood and conditions having poor treatability. These are misleading generalisations, but more relevant to this article is the fact that these features can be encountered in both psychiatry and general medicine.