Mental Illness Stigma and Stereotype Threat

A Global Health Concern

Mental illness and its corresponding social stigma continues to be a widespread public health concern. Globally, approximately 1 billion people live with a mental disorder, and 75% of those in developing countries do not receive treatment (Johns Hopkins Medicine, 2021). In the United States, roughly 26% of adults - about 1 in 4 - suffer from a diagnosable mental disorder annually (World Health Organization, 2020). These statistics represent individuals struggling not only with impairments to daily functioning, but also pervasive social stigma, prejudice, and discrimination. While rooted in innate psychological processes, these cultural attitudes create additional mental health challenges that include the experience of stereotype threat.

Origins in Evolutionary Psychology

From an evolutionary perspective, human survival is dependent upon affiliation with a larger social group. Social psychology research has demonstrated that positive relationships significantly influence the quality of our physical health, cognitive development, emotional functioning, and holistic well-being (Over, 2016). Behaviors are thus consciously and unconsciously driven by the core social motive to assimilate and belong. Indeed, cultural expectations and societal attitudes are deeply influential on our individual psyche and functioning. Because strong connections are achieved through remaining sensitive to the mental and emotional states of others, negative attitudes and instances of rejection can have powerful deleterious effects. In 1996, psychologists Geraldine Downey and Scott Feldman identified the common experience of rejection sensitivity whereby individuals develop anxious expectation of social rejection. Such sensitivity may undermine opportunities to cultivate meaningful relationships (Downey & Feldman, 1996).

Mental Illness Stigma

All societies engage in exclusionary behavior whereby certain minority populations are designated as outgroups (Hinshaw, 2007). Motivations for such ostracization often originate in the accumulation of stereotypes, prejudice, stigma, and discriminatory behavior. Prejudice against individuals with mental health challenges involves prejudgment and rigid stereotyping, and often stems from fear, ignorance, and the belief that mental illness is a sign of deviance or dysfunction (Kenny et al., 2018). Stigma describes the process of branding these individuals as disgraceful and relegating them to a degraded status. This frequently results in discriminatory actions the impinge on social opportunities including hiring potential, housing access, and access to medical treatments (Corrigan, 2004). Institutionalized stigma including discriminatory policies and laws further reinforce prejudice toward this vulnerable population. Unsurprisingly, a vicious cycle occurs whereby distancing magnifies public ignorance and perpetuates prejudiced behaviors.

Internalized Social Stigma

Due to the influence of rejection sensitivity, ostracized individuals are at risk of internalizing stereotypes. Self-stigma occurs when individuals personalize negative feedback, believe themselves to be of lesser value, and experience low self-esteem and decreased confidence (Corrigan & Watson, 2002). Coping responses including secrecy, concealment, and diminished help-seeking can exacerbate mental health issues. Further, the intersectionality of identifiers including race, ethnicity, socioeconomic status, and gender can complicate the experience of mental illness self-stigmatization. First explored by civil rights advocate and lawyer Kimberly Crenshaw, intersectionality is concerned with the perpetuation of discrimination and inequality by social systems based on an individual’s external attributes (Grzanka et al., 2017). Such social categorization prevents individuals from achieving their core social motive of belonging. For those with a mental illness, these responses can trigger relapse, influence development of additional mental disorders, and impede mental health recovery (Link et al., 2017).

Stereotype Threat Defined

Stereotype threat represents a psychological consequence of the social realities of rejection sensitivity and intersectionality. First coined by psychologists Claude Steele and Joshua Aronson in 1995, the phenomenon of stereotype threat occurs when an individual is confronted with a challenge intended to confirm the stereotypes of the group to which they belong (Burgess et al., 2010). Cues in the individual’s environment highlight public judgments and trigger distressing psychological and physiological experiences. Numerous studies have explored the impact of this external labeling on outcomes including neuropsychological performance, social behavior, academic testing, and memory. The phenomenon has been studied in a wide range of social contexts including addictions, aging, parenting, and race relations. Understandably, individual reactions to stereotype threat reflect the innate stress of experiencing stigmatization. Variables that exacerbate poor outcomes include anxiety, evaluation apprehension, perceived performance expectations, and individuation tendencies (Pennington et al., 2016).

Stereotype Threat and Mental Illness

Initial research on stereotype threats and mental illness has focused on how stereotypes of individuals with psychosis, schizophrenia, obsessive compulsive disorder, attention-deficit/hyperactivity disorder, and intellectual disability lead to social and cognitive difficulties. Simulated situations have included test-taking in hospital and academic settings, and social interactions where the individual believes their diagnosis has been made public. These studies have revealed the presence of stereotype threat as a confounding variable influencing environmental threats and interpersonal functioning (Henry et al., 2010). This relationship underscores the concern surrounding public disclosure of mental illness diagnoses. Some researchers have posited that personal disclosure can mitigate stress associated with concealment and secrecy, and can contribute to dismantling public prejudice (Corrigan & O’Shaughnessy, 2007). Alternative evidence suggests that intentional disclosure results in increased discrimination and loss of critical social opportunities.

Personal Protective Factors

Thankfully, there exist individual protective factors that can help to mediate the effects of stereotype threat. One factor is consistent external attribution of negative feedback. By viewing stigma as a public health concern perpetuated by the prejudiced and uninformed, individuals can avoid developing self-stigma and experiences of self-sabotoge (Rutgers, 2021). The presence of righteous anger in response to unjust attitudes and treatment can also catalyze personal empowerment. Identifying the social injustice can also lead to advocacy opportunities. A third protective factor is the rejection of group labelling in favor of a more well-rounded view of the self. By identifying with personal attributes and actively deconstructing mental illness self-schema, individuals can remain differentiated and cultivate self-esteem (Desombre et al., 2019). Another resource is mindful disengagement from distressing situations and relationships that reflect stigmatized attitudes. Finally, high group identification can generate feelings of social belonging and collective influence.

External Protective Factors

There are also public interventions that must be sustained in order to counteract stigmatization and support individual well-being. One element is to avoid creating situations that trigger stereotype threat by presenting tasks in ways that de-emphasize social categorization. A broader response is encouraging celebration of neurodiversity as a reflection of uniqueness instead of pathology (Doyle, 2020). This movement has the potential to break down exclusionary structures through promoting recognition of human diversity. Thirdly, anti-stigma campaigns must amplify the platforms of individuals who have overcome mental health challenges and defied social conventions. These role models can offer powerful inspiration. Finally, therapeutic and educational programs can support stigma resilience and promote self empowerment through providing practical coping strategies for daily life encounters. Encouraging self-efficacy and self-esteem can enable individuals to respond to stigma with healthy indifference or appropriate indignation (Zelst et al., 2014). Such sustained systemic action can serve to counteract social devaluation and support the well-being of this vulnerable population

Sources

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Corrigan, P.W., & O’Shaughnessy, J.R. (2007). Changing mental illness stigma as it exists in the real world. Australian Psychologist, 42, 90–97.

Corrigan, P., & Watson, A. (2002). The paradox of self-stigma and mental illness. American Psychological Association, 9(1). http://www.mifras.org/know/wp-content/uploads/2014/04/The-Paradox-of-Self-Stigma-and-Mental-Illness.pdf

Desombre, C., Jury, M., Bages, C., & Brasselet, C. (2019). The distinct effect of multiple sources of stereotype threat. The Journal of Social Psychology, 159(5), 628-641. https://doi.org/10.1080/00224545.2018.1544540

Downey, G., & Feldman, S.I. (1996). Implications of rejection sensitivity for intimate relationships. Journal of Personality and Social Psychology, 70(6), 1327-1343. https://psychology.columbia.edu/sites/default/files/2016-11/merp.pdf

Doyle, N. (2020). Neurodiversity at work: A biopsychosocial model and the impact on working adults. British Medical Bulletin, 135(1), 108-125. https://doi.org/10.1093/bmb/ldaa021

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Rutgers. “Stereotype Threat”. 2021. https://philosophy.rutgers.edu/climate-v2/climate-issues-in-academic-philosophy/stereotype-threat

World Health Organization. (2020, August 27). “World mental health day: An opportunity to kick-start a massive scale-up in investment in mental health.“ https://www.who.int/news/item/27-08-2020-world-mental-health-day-an-opportunity-to-kick-start-a-massive-scale-up-in-investment-in-mental-health

Zelst, C., Nierop, M., Orrschot, M., Myin-Germeys, I., Os, J., & Delepaul, P. (2014). Stereotype awareness, self-esteem and psychopathology in people with psychosis. PLOS One. https://doi.org/10.1371/journal.pone.0088586