What’s in a word? Some words in our everyday lexicon hold a deeper, inexplicable meaning beyond their dictionary definition and become embedded in the way we think, feel, and act. “Stigma” is such a word that evokes a certain reaction when it is used. In general, it means a mark or a sign, usually of disapproval. In the context of mental illness or addiction, “stigma” can manifest itself in many ways.
Externally, those with mental or substance use disorders often experience stereotyping, negative attitudes, and discrimination from the people around them, including their communities, families, and friends. Internally, they may start to believe these stereotypes and negative attitudes about themselves, harming their self-esteem and their chance for recovery.
The National Survey on Drug Use and Health cites the cost of care as the number one reason for not receiving mental health services. However, there are other reasons, such as negative public opinion, a negative effect on the job, being concerned about confidentiality, and not wanting others to find out.1 These are social concerns that, when combined, become the second most important reason why people who need help are reluctant to seek it.
In addition, people living with mental illness or addiction often have to contend with “structural stigma,” where policies set by private and public organizations — employers or landlords, for example — can intentionally or unintentionally limit their opportunities for jobs and housing. With regard to health care systems, structural stigma could also be why access to behavioral health care is so limited and underfunded.
However, there is a problem with the word “stigma”—using it tends to create or even reinforce discrimination, whether consciously or subconsciously. Using the term reinforces the concept of the “other” – that people with behavioral health conditions are somehow different from the rest of us. This is important as social distance measures are increasing. Words like “discrimination” and “prejudice” are better choices to describe the inappropriate actions of those who shun or demean people who experience mental illness or addiction.
Over the last few years, we have attempted to move the health care field toward strategies that change behaviors as well as attitudes in order to accomplish more direct and immediate progress. Using the word “stigma” puts the burden on the illness and those who experience it rather than on all of us who need to work to understand these health conditions, and promote acceptance and inclusion of those who experience them. Consequently, SAMHSA avoids using the word stigma as it relates to mental or substance use disorders, as much as possible.
Words matter. Actions also matter. If we are to overcome the prejudice against those with mental and substance use disorders and make progress on prevention, treatment, and recovery, we need a language of action and commitment. A significant portion of all of us or members of our families will meet the criteria for one of these disorders at some point in our lives. Social acceptance and community support can make a difference in outcomes for all of us, especially those who have experienced or are living with mental illness or addiction.
This post was authored by Marla Hendriksson and originally appeared May 16, 2016 on the Substance Abuse and Mental Health Services Administration blog.
Len Van Nostrand, M.A., CCP
Certified Coach Practitioner