We Need More Precision When Discussing Mental Health Stigma

I am grateful for the anonymous peer-reviewer of one of my manuscripts several years ago, who provided a critique of my own imprecision in discussing mental health stigma; their comment inspired further thinking about this topic on my part.

Across my psychology classes, students love to bring up the topic of mental health stigma. And rightly so: A better understanding of stigma is critical for improving mental healthcare access for all people around the world.

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But as someone who studies and teaches about mental health stigma in and outside of U.S. contexts, I am increasingly concerned about something: If we are not deliberate enough, our discourse about mental health stigma might become too diffused and, ultimately, too simplistic. What I concluded about the collectivism-individualism framework in cross-cultural teaching (Kim, 2021) also applies to the handling of mental health stigma: We need more nuance and specificity when discussing it.

Let me articulate a few ways that this can be achieved.

First, when we say mental health stigma, do we mean the stigma of seeking professional services, or the stigma of mental illness? Such intentional nuance will allow for a better design and delivery of interventions to address stigma. That is, if one wants to counter the stigma of seeking services, a different type of emphasis is needed – perhaps an emphasis on behavioral aspects. But if one wants to reduce the stigma of illness, then one might instead focus on the increase in knowledge of psychopathology. You can imagine a person who is hesitant about the act of seeking counseling for various reasons, but has little stigmatizing views about their own conditions; on the other side, one can be incredibly negative about their own psychological conditions but might not hesitate to talk to a professional because the behavior of seeking counseling is not psychologically threatening to them. These two types of stigma might be correlated, but they are not the same thing.

Second, and staying with the stigma of mental illness, stigma can differ across disorders. Not all psychological disorders are equally stigmatized. Feldman and Crandall (2007) reported that disorders that are uncommon, seen as dangerous, or perceived as based on personal responsibility tend to be more stigmatized; in their study, a condition like antisocial personality disorder was a highly stigmatized disorder, whereas social phobia was relatively low in stigmatization.

Third, similar to how stigma can be broken down by disorder or condition, stigma can also look different within the domain of seeking professional help. Specifically, “Who is doing the stigmatizing?” is a critical question to ask. Stigma felt at the societal level is different than the individual perception of stigma from those that they deeply care about (see Vogel et al., 2009 for important work on this topic of stigma from others). In my own research, we found that perception of others’ attitudes about seeking help can impact individual attitudes about professional counseling, especially in contexts that emphasize social hierarchy (Kim & Park, 2009). Put simply: If I value interpersonal relationships, I will also value how others view seeking psychological help.

Moreover, another significant source of stigma is the self – 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’d be remiss to not mention cultural influence on stigma, including religious influence. My former student Marcella Locke and I (Kim & Locke, 2023) recently wrote a piece about how religious settings might perpetuate certain beliefs about seeking services (and also about mental illness generally). Even more complicated, religious beliefs can intertwine with cultural beliefs (e.g., Korean cultural beliefs) to strengthen or weaken a stigmatizing view. As such, more nuance in mental health stigma might mean qualifying what kind of cultural influence on mental health stigma you intend to discuss, e.g., cultural stigma or religious stigma.

I imagine there are other ways that we can continue to improve specificity when discussing mental health stigma, in addition to those I have shared here. But I hope that this post has given you some ideas about how we can be more precise in our discourse as we continue the important work of dismantling the stigma of seeking counseling services, so that all those who would benefit from professional counseling will be able to utilize it.

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