Speaking of Psychology - Fighting the stigma of mental illness, with Patrick Corrigan, PsyD

Episode Date: February 16, 2022

Despite how common mental illness is, people with mental illness often keep their diagnosis a closely guarded secret in the face of widespread stigma and discrimination. Patrick Corrigan, PhD, editor of APA’s journal Stigma and Health, discusses where this stigma comes from, how it affects people’s lives, why it’s important for those with mental illness to share their stories, and whether or not celebrities’ new openness about mental health is decreasing stigma. Learn more about your ad choices. Visit megaphone.fm/adchoices

People with physical illness are often open about discussing their ailments with family, friends, and even sometimes with virtual strangers. But mental illness is often a deep and sometimes shameful secret. People with serious mental illness are feared or even pitied and can face discrimination in nearly every aspect of their lives, from finding jobs to finding housing to getting adequate medical care. Where does this stigma come from and why is it so pervasive? How does stigma affect the lives of people with mental illness? illness and what does the research say about how to fight it? Has the new openness with which some celebrities discuss their mental health struggles made a difference in reducing stigma? Is mental illness less stigmatized than it used to be or is stigma as pervasive as ever? Welcome to

Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I'm Kim Mills. Our guest today is Dr. Patrick Corrigan, a distinguished professor of psychology at the Illinois Institute of Technology. Dr. Corrigan has spent decades studying stigma and mental health and developing anti-stigma intervention programs. He is the editor of APA's journal Stigma and Health and has written more than 400 peer-reviewed articles and authored or edited 15 books. He's also written about living with mental illness himself, and he's part of the team that developed the honest, open, proud series of anti-stigma programs, which we'll talk about with him today. Thank you for joining us, Dr. Corrigan.

Thank you for having me. You've been studying mental health stigma for decades. How pervasive is it, and what does the research say about the extent to which people with mental illness are stigmatized in their daily lives? I think if you ask that from an epidemiologic standpoint, it would be a little hard to say what percent of the population. However, looking at it differently, people clearly know the stigma of mental illness is as big a problem as the symptoms themselves. As you said, it adds this notion of shame. I always think this is terrible irony to issues like depression. Not only you have to deal with sadness, you should be ashamed to yourself.

and the impact on people might be looked at in terms of public stigma, what happens when you're the butt of stereotypes and prejudice or self-stigma, what happens when you internalize it? And we pretty much agree that the stigma of mental illness is the same category as racism and sexism and ageism. And just as that's a priority in American culture, so it falls to mental health and other. their health conditions. So how does stigma prevent people from getting the care that they need? I know that you've written about that.

Interesting thing about the stigma of mental illness compared to, for example, a stigma of race. So if I'm in a room of 100 people and you're a different color than me, a white man, and I'm a racist, I can tell, I can see it in you. Or if you're a different gender, I can see that in you. You can't tell somebody with mental illness has a mental illness. We might think we can, but in fact, something to consider for the group is something between 25 and 40 percent of the population meet a DSM category for a mental illness. So how do you get the stigma of mental illness?

You get labeled. You get seen coming out of a psychiatrist's office. Hey, that's here. You're coming out of Dr. Jones' office. He must be nuts. And so people don't want that stigma. So the way they avoid the labels, they don't get to. care. And research suggests whether it's a pretty serious mental illness like schizophrenia or a more

benign experience like a reactive disorder. Up to 40% of people will not seek out care. Part of the reason because of stigma. My sense is that people with mental illness are sometimes blamed for their predicament or that some people believe that mental illnesses are no big deal like depression or anxiety and that people should just be able to snap out of it. Do you see the those attitudes in your work? And if so, how can we overcome them? Well, the first one, perhaps based on the research, is a bit easier. I would say what are the stereotypes about people mental illness? Again, something familiar to people. We know the stereotypes about the LGBTQ community or black citizens. And those

stereotypes lead to all sorts of discrimination. The stereotypes about people who series mental illness are dangerous. And so you might look good, right? You can snap in any moment. You're going to be violent, so employer's not going to hire you or landlord's not going to rent to you. You're to blame for it. You're incompetence. And sometimes there's this moral component to it. Those are the stereotypes that emerge and the research. What to do about it? Could be the entire remainder of our session. We, over the last 20 years, began our research. We began our research. with what we now realize is a naive assumption that education is the best way to get rid of stigma, that if we educate the public that mental illness is a brain disorder,

and we show them pictures of MRIs where the brains are lighting up because they're hallucinating, they'll decrease stigma. And it's true that that decreases blame. If I teach people that mental illness is a genetic disorder, I must likely to blame them. But, But the bigger problem is you also list like they think they're going to get better. They're not going to recover. And so I'm not going to hire you because you can look good now. You can snap in any moment. And so the idea of educating stigma away in the meta-analysis we did in 2015 just is not supported.

What is supported is there is a social psychologist named Gordon Olport in the 50s who said that one of the ways we got rid of, got rid of. We decreased racial bigotry is contact between white people and black people. And so that led to the contact hypothesis. And what we find pretty much with mental illness is the best way to decrease the stigma of mental illness is to have contact between people with mental illness and the rest of the public as peers. And that kind of contact greatly tears down stigma. Except that people with mental illness are not, they may be reluctant to tell. people that they have a mental illness. And so sort of like gay people 20, 30 years ago, who didn't come out and you didn't know that you had gay people in your family, they were

your friends and your neighbors, and maybe the same thing is happening right now with people who have mental illness, right? I mean, how do we change that? Amen. So some stigmas are obvious. Racial stigma is mostly obvious. You can tell by skin color. Sexism is mostly obvious. You can tell by body type. Old age is obvious. You can tell by gray hair. You can't pretty much tell the stigma of mental illness. And in that way, it's a lot like the stigma LGBTQ is what's happened in our lifetime is the stigma LGBTQ has changed hugely, improved greatly. And they'll get me wrong, we still got a long way to go.

But improved greatly because 30, 40, 50 years ago, courageous men and women came out and told their stories. It becomes easier for them as a community arose and it now can do this embedded in other like-minded people. So the same thing is with serious mental illness, the degree to which you come out is the degree to which you'll challenge a stigma. But you're right, there's huge risks to it. And so how to change the world so that people can come out with less risks. In addition to being a researcher, you're also a person with mental illness, and you've talked and written about your experience.

Could you tell us a little bit about that and how it's affected the way you approach your work? So I've been diagnosed over the last 40-some years, ultimately with bipolar disorder, major depression, generalizing anxiety disorder. I've been on meds. I took them this morning. I've been hospitalized in crises. I know the shame of having me to go to an inpatient unit in that one phone on the wall and call my wife and tell her that I won't be at my daughter Elizabeth's school that night.

And so stigma is not an abstraction to me. It's a reality. And I think stigma efforts should be led by the group of people at lived experience. I'm hugely for gay rights. I am a straight male. My goal is to be an ally to people with lived experience in the gay world and support them. So to beat stigma, it's people with lived experience that should do it. I'm not doctors. I am also a doctor, but my authority in this comes with my own lived experience. There's been a lot of talk about mental health in the news over the past couple of years with

celebrities like Naomi Osaka, Simone Biles, discussing their mental health struggles, and then more general discussions about the mental health toll that the pandemic has taken on all of us. So do you think the growing awareness and conversation about mental health is doing anything to reduce stigma now? So the one bit of sobering news is the meta-analysis, a systematic review, we did some years ago, is pretty much finding the stigma is getting worse. and in post-hockeying the data, our best guess is the degree to which dangerousness, violence, mass murders, especially in the United States, are connected to mental illness.

And so every time there's a mass shooting, I'd frequently end up on the radio to respond to the interviewer that, in fact, people's serious mental illness are not more dangerous, not likely to snap, and not let you go out to shoot people. That's a very compelling story and really keeps a stigma up there. What's changing it are famous people coming out. And that's a good step. And I think some of the people who come out like Simone Biles is very courageous and very important to us. And become a little concerned some of the famous people coming out are doing it more for the PR than actually trying to make a difference.

But we actually did a research study where we compared the impact of Mariah Carey, who is a person with bipolar disorder, to somebody named Malia, who is, if there's a way of putting it, an average person with bipolar disorder. And what its impact is on the viewer. And Malia had a much bigger impact because when you asked about Mariah, people say, she's just not like me. You know, Mariah is not your typical person with mental illness. So to the listener today, who's going to make the impact, and again, I use this word hesitantly, is the average person with mental health challenges that you sit next to at work, or on the train on the way home, or in your faith-based community, or extended family, the degree to which they come out and tell their stories of recovery,

which, again, we need to marine people as a reality. And the other problem, the other big source of stigma is mental health psychiatry and psychology itself. I mean, when I was a student, I learned schizophrenia was a kiss of death diagnosis, and the best thing you could ever happen is you live on the back ward of a hospital. And the reality to that from long-term follow-up research for schizophrenia, which is the prototypic bad mental illness, is a rule of thirds. If you follow them for 10 to 20 years, about one third will get over it like a respiratory disorder. About one third will have to manage it like a tough case of diabetes. Watch your lifestyle, take your meds, talk to health care providers. About one third of those people is what we think of with people, serious mental illness.

And about two thirds of them will do just fine if there's rehabilitation programs, state-of-the-out rehabilitation programs available. So recovery is a reality. and that really is the messes that changes things. And the way your average next door neighbor shares that with you is the biggest source of changing stigma. And yet that's probably one of the biggest hurdles

because I think it's not generally understood by the public that you can recover from or live a reasonable life with a serious mental illness such as schizophrenia. Again, going back to the LGBT world, I grew up in a time that I reluctantly say this, that gay people were looked at as sick perverts. And there's almost no educational way to challenge that. It's actually meeting gay, lesbians, bisexual people as peers.

That that tears down the stereotype. You know, you're not a sick pervert. And the more gay people you meet, the more it colors the picture differently and it changes stigma. So recovery is a reality, but people aren't going to believe it. I mean, they don't believe we're in the middle of COVID in need a vaccine. What will change it is somebody who says, hey, you know, I had a history of bipolar disorder. I was hospitalized. And despite that, despite the key word, despite that, I'm able to go to school, get a job, be independent, have 2.3 children, and have a good life.

So I want to talk about the role of language in perpetuating stigma. I mean, you just used a word that was used commonly around LGBT people, that they were perverts. And a lot of people use words like crazy or insane very casually. And, I mean, police are constantly saying that, well, this person who shot up that school is crazy. But I think we really need to rethink the way that we use words because they can perpetuate stigma. At APA, we're aware of the power of stigmatizing words, and we recently changed the name of our Journal of Abnormal Psychology to the Journal of Psychopathology and Clinical Science. How important is language in stigmatizing and destigmatizing mental illness?

Well, I'm going to surprise you because as a focus, I think people put too much energy in it. Let's be clear, the N-word is totally intolerable. such that people that are white like you and me can't even say it and shouldn't. And you may know by act of Congress, the MR word has now been replaced by intellectual disability. So the MR word is probably the closest thing in behavioral health to an N word. But separate from that, there are no real clear N words in mental health. For example, there's a big debate on whether we should say mental illness. And I actually talk a lot publicly, and I talked about the challenges of mental illness.

I'm sorry, I talked about the harm of mental health challenges. And somebody came up and buttonholed me and said, I have a mental illness. Don't decrease it. I want to be respectful if I'm talking to a group and they want to handle things in a certain way. Okay. There is a group called Schizophrenics Anonymous, which nowadays seemsly, a little awkward, but they're still around and have a big presence. But here's the bigger issue with language is it leads to word police, which can be pretty prominent in mental illness.

And I consulted with a group in Colorado once about stigma, and they had met for three months before I got there, and they were still fighting amongst themselves on whether they're stigma of mental illness, stigma of mental health challenges, the prejudice of mental illness, and we, the advocates, the progressives, we don't need to fight among ourselves about this because we're not trying to change our ideas. We're trying to change the average person. My aunt Lillian, who worked at Walmart, we're trying to change her idea. And she doesn't know this mental health challenges versus mental illness thing.

She doesn't understand the journal of abnormal psychology. So, yes, we should be careful about language. I ask people to go back and listen to what I'm saying now. I always use person first language. I agree with that. However, we need to be careful on a degree to which we punch this because some people reduce that to, well, all we need to do is change the words and we're fine. And that's not going to do it at all.

It clearly did not happen. We went from Negro to colored to African-American. And so it's not going to happen in the mental health side. So that raises the question. of what does work, and I know you've been involved in anti-stigma campaigns. You make the case that a lot of public education campaigns that try to educate people about mental illness don't really reduce stigma and can backfire. Why is that? Well, as I said before, interestingly enough, George H.W. Bush, I think around 1990, had National Institute of Mental Health

launched the decade of the brain. And in part, there was a justifiable point that. I mean, was still a bit of a new idea that a lot of mental illness is the result of brain disorders. And so they would show pictures of brains that were diseased and say, see, this is a biological problem. But that doesn't change attitudes about whether the person's really different than me. You're broken. Now I can see it here. And I don't want to be with broken people. And so this attempt to reduce mental illness to a brain disorder or genetic disorder or inevitable

inheritance does not change stigma. So what campaigns and messages actually have been shown to help reduce stigma? So most major Western countries in the world other than the U.S. have done nationwide anti-stigma programs. And most have come to the conclusion that educational programs don't work. Contact does work. How the heck do you do contact? And most of them support grassroots organizations where people live experience, go talk to their peers about their life experience.

So in Canada, they would hire people in Calgary with mental illness to go to community groups, Kowanas to talk to the community leaders about mental illness stigma in order to change it. So we believe, again, using LGBTQ as an example, I think one of the ways we got to gay marriage is more and more and more gay people came out. And it first challenges the stigma of only a weird set of small group of people have LGBTQ because it's not case. There's a lot of people LGBTQ. And as that group increased, it just physically suppresses bigotry. I mean, if I'm a gay bigot, I'm less likely to do it, at least in a large city where there's gay neighborhoods and say bad things. And so mental illness is the same thing. The more people, mental illness

come out, the more it will suppress bigotry and it will promote what we would call affirming attitudes. And there's two affirming attitudes. One is the reality people of mental illness do recover. And two, therefore, they should have hopes and aspirations just like everybody do. So how useful are allies? Because you talk about the LGBTQ population, which we don't know exactly how big it is, but there are many more mentally ill people in the world, I would argue, than there are LGBTQ people. So how can allies participate, help, and be effective? Because they don't necessarily have the lived experience. So if you want to go with population research and anybody who's listening to those statistics, they lie. LGBTQ, depending on you're looking at, it's about

10 to 15 percent of population. People with mental illness according to DSM is about 40 percent. So you're right, a lot more of us. And people are going to sit there and they're going to say, no way. And that's because people, mental illness, are in the closet, just like gay people usually be in the closet. Or they're not diagnosed. Or they're not diagnosed, though I want to be careful with that because that might suggest the more we diagnose people, the less will decrease stigma. And again, I think stigma is fundamentally a social construction, not a medical one. There are a lot more of us with mental illness, and the more we come out, the better. Allies are good. again, for the LGBTQ community, there is a group, I think, called P flag, which are parents

family and friends of lesbians and gays. There you go. Which is allies. And that's good. They need to support. But in no way can we say the only reason why tearing down the stigma of gay makes sense is because they have parents, friends, and allies. The parents, friends, and allies are there to support.

the agenda of persons that are gay. Also, they're there to support the notion that Mr. gay individual, your job is not to pass as straight. Your job is to live as a gay person and me as an ally to support you where you are. I think allies is even a bigger deal in mental health, partly because the stigma as people of mental illness are broken and they They don't know any better and they need doctors to tell them what to do. And so generally, discussions about mental health are led by people in white coats. And so the message here is no, you're an ally. You can help the person with lived experience push the agenda, but their voice needs to be first.

Do you see generational differences in the level of stigma? there's often a lot of talk about how millennials and Gen Z and Gen X that they're more open to the idea of, first of all, treating mental health like you would treat your physical health and that maybe they don't see it as being such a shameful thing. Well, my first response to anything like that is we definitely have to do the research. However, anecdotally, I think yes. I think one of the ways my own personal history is, again, I grew up in a very gay, phobic time. And my kids, when we went to high school, escaped all of that. They didn't

understand what the big deal was. They had gay flags. They had gay groups. And they had personal gay friends. They have a gay uncle. They have a gay minister. And they just didn't get it. And so I believe the current high school and college students are someone in that position right now. They don't get it. Why do I have to keep it a secret? And we have an anti-stigma program that we present to people with mental illness. And they're like, yeah, I'm going to come out and disclose. What's the big deal? So I hope there's a cohort effect. That said, we always need to be careful because we would hope there's a cohort effect against racism. And yet, none of us should think we've gotten rid of racism. And so there are still segments of the population that tend to,

to be unresponsive to whatever their cohorts doing. I mentioned in the introduction that one of your projects is the honest, open, proud, anti-stigma program. Can you tell the listeners what that is and how it works? So if I believe the way you deal with public stigma, with public bigotry, is have more people come out. And if I believe the way you deal with self-stigma, the shame is strategically to come out, They're not as open proud as a program to help people with mental illness decide when and where and how they want to come out with their mental health challenges. Three lessons. First lessons consider the pros and cons of coming out, which by the way vary depending on when you're talking about coming out at work versus your extended family versus your faith-based community. The second lesson is ways to learn to strategically come out.

So I'm a person with mental illness. I work next to you in the office, Kim. You seem to be. be a nice person. I take you to Starbucks. I said, do you ever see this movie called Silver Linens Playbook? I don't remember that movie. Well, it's this thing with Bradley Cooper and Jennifer Lawrence and he has bipolar disorder. What do you think? And if you said, I'm sick and tired of Hollywood showing those crazy people, you're probably not a good person for me to come out to. So I can test generically your attitudes about mental illness before I give mine own story. And then the third task is it's your story. What are you going to say? And how do people access this program?

If you go to www.hopprogram.org, you can download on the program for free. Program varies depending on who the group is. It was originally developed for my strong suit, which was adults with serious mental illness. My students said, this don't play for us. So we adapted it for college students. It has a section on social media. Do you come out and how do you come out? We're not prescriptive on anything.

We don't tell you whether we should or should not come out online. We tell you the pros and cons and you take it with peers and you can discuss it with them. There's a version for youth. There's a version for college students. There's a version for high school students. The big difference there is legality, whether they're adults or not, a version for veterans. and it's been translated and transposed to about 12 different cultures around the world. So what's next for you, research-wise?

What are you working on? So honest, open-proud is still the base of what we believe. Again, using the LGBTQ community. And what we think was really a strong social movement, the more people, mental illness come out and find like-minded people, and start communities of support like gay areas. Chicago has a Boys Town. The one of that's going to make a big difference.

It's already happening. There are groups called Mad Nation, Mad Pride. They're already out there. We started extending it to other groups. So we are now interested in the stigma of substance use disorder, which we find is socially and legally quite different than mental illness. whether you stigmatize people with mental illness, the law protects them. Not so with substance use disorder.

You could criminally be arrested for certain substance use disorders. You could civilly be in trouble. The American with Disabilities Act does not protect somebody who's in relapse from substance use disorder. We've also moved one of my colleagues, Lindsay Sheehan, has moved to honest, open proud for people who've attempted suicide. I always like to tell my students' suicide is the atomic bomb of mental health. When a patient tells me their suicidal, everything kicks in. I take over, I stop listening to them. I just go through my protocol and I get them hospitalized. So the experience of suicide is

really different than the experience of serious mental illness. So how to deal with the stigma of suicide in that life. And then we're working with a colleague on fetal alcohol spectrum disorder to remind people, if you don't know if you're pregnant, you should not drink alcohol. Actually, oversimplify it. Alcohol is a grotesque poison compared to almost anything else. And so that leads to significant developmental disorders, actually to a degree greater than the presence of autism. And the problem is it makes natural sense. What's wrong with you? How could you drink?

What are you a gutter snake? And the problem with that is the more you call these women who drank alcohol while they're pregnant bad words, the more you drive them in the closet, the more we ignore the fact that there are aspects of substance abuse disorder that do not simply reduce to an issue of choice. there's this being disrespectful of them. But the big issue is, and we're doing research on this right now, is stigma is quite present in FASD and mothers don't want to go see pediatricians about it because they don't want to be scolded for it. So generally FASD is better treated the earlier you get it. But if they feel like the pediatrician is going to discipline them for it,

they're not going to go. And that's a stigma issue. Well, Dr. Corrigan, I think you've given our listeners a lot of good advice, a lot of information that I hope that they can use. We'll have some links in our show notes that will help them find your program. And I appreciate you're taking the time to talk to me today. Thank you. Thanks for having me. You can find previous episodes of Speaking of Psychology on our website at www.combeatingof psychology.org or on Apple, Stitcher, Spotify, or wherever you get your podcasts. And if you're listening on Apple Podcasts and you like what you hear,

please leave us a review. If you have comments or ideas for future podcasts, you can email us at speaking of psychology at APA.org. Speaking of psychology is produced by Lee Weinerman. Our sound editor is Chris Condyenne. Thank you for listening. For the American Psychological Association, I'm Kim Mills.