By McKenzie Roller
In her interview with the Southern Oral History Project, Chasity Hargrove, a white woman from Newton Grove, NC, shares some details of her mother’s battle with mental illness. Hargrove describes how her mother “would try to medicate herself, like lots of people do” (00:03:45-00:03:48). Unfortunately, for Chasity’s mother, the stigma towards mental health prevented her from seeking the care she needed. Instead, her self-medication resulted in living in a nursing home for the rest of her life after taking something that was laced and caused serious physical illness (Hargrove). Stigma towards mental health costs people their lives. It impacts how individuals experiencing mental health challenges see themselves and how they choose to approach care, as well as how their support networks and healthcare systems see them.
Stigma towards mental health is one of the most studied areas in stigma research (Tomar 9). Studies have found that stigma towards mental health is shaped by cultural norms and attitudes about mental health, as well as actions, such as social distancing, that perpetuate negative perceptions and harmful beliefs including shame, punishment, and blame in relation to those with mental illness (Parcesepe and Cabassa). This stigma impacts the “around 10.4 million adults living with a serious mental illness in the United States” (Tomar 4) as well as those with less severe mental health challenges. The negative perceptions and actions associated with stigma prevent patients with mental illness from seeking proper care and result in a healthcare system that does adequately meet patient needs. This contributes to worsening health outcomes for individuals with mental health challenges that could otherwise be avoided (Shim and Rust).
This reality is depicted again through the story of William Sessions. William Sessions is a Black man who grew up in rural North Carolina. While he battled with many mental health challenges himself, he expresses the presence of stigma towards mental health when describing his grandmother’s experience with mental illness. Sessions describes that his grandmother combated depression with alcoholism. He believes that the reason she self-medicated through alcohol was because “she came along during an era where mental health, especially mental health for the Blacks, was like, a taboo, no-no, you know. You just didn’t do that. It means you’re crazy or something like that” (00:10:09-00:10:29). Sessions’ narrative demonstrates how an individual’s own understanding of stigma in their community impacts how they see themselves and how they approach their own care.
Although attitudes toward seeking professional help for mental health problems have improved among the American public over time (Parcesepe and Cabassa), it is still true that “from a patient-level perspective, stigma about mental illness (including self-imposed and perceived stigma) is a major factor that contributes to lack of treatment or undertreatment” (Shim and Rust). Stigma leads to a conflict of blame and shame for individuals with mental illness that impacts their perception of themselves and how they address their own needs. This internalization of stigma is influenced by community beliefs and symbols passed on through culture in a society where norms and institutions such as the media perpetuate stigma towards those with mental illness constantly (Tomar 73). As a result, the negative perceptions about mental illness that exist throughout the United States can vary in form in different communities depending on the specific history, culture, beliefs, and actions of the community. It will also impact each individual differently based on their own identity and experience of their mental illness.
Mental health stigma extends beyond influencing individuals’ self-perception and actions, impacting how the healthcare system functions as a whole. In his interview with the Southern Oral History Project, Nicholas Stratas, a white psychiatrist born in 1932, reflects on how mental healthcare has changed throughout his time in the profession. When discussing today’s increased availability of treatments for a wider range of mental health challenges, Stratas negatively remarks, “‘Get a life,’ you know? ‘Get it together. So your mother was bipolar and your father shit on you. You know, we live in the present. Get on with it’” (1:01:31 – 1:01:46). This narrative speaks to recent improvements in access to mental health care that are reflective of positive shifts culture and stigma in recent years, but it also demonstrates how professionals perpetuate stigma through their work. This clinician’s stigma reflects a larger systemic failure to provide necessary support to all patients in need of care.
Existing research says there is “agreement among scholars that a feedback loop between stigma at an individual- and structural-level exists” (Parcesepe and Cabassa). The negative stigmas that permeate the public also influence policy makers’ decisions which “directly influence rights and services for the consumers” (Tomar 76). Stigma in the general public results in a negative view of policies that would support better care, such as increased government spending on mental health care or better insurance coverage (McSween 773). This negative stigma and lack of adequate policy is consistent with the bias that exists among clinicians like Nicholas Stratas. It can also be seen in the stories of Sessions and Hargrove, whose narratives reflect the reality that most treatments and responses to addiction are not as effective as they could be, blaming the individual for personal failures instead of providing necessary care and treatment for the mental illness (Morse).
The narratives of Chasity Hargrove, William Sessions, and Nicholas Stratas provide first-hand examples of the ways that stigma towards mental health challenges negatively impact the patient experience for those battling mental health challenges and/or illnesses. Individuals often internalize stigma, preventing them from seeking adequate care, while also impacting what options they even have in terms of accessing care due to stigma’s influence on healthcare policies and systems. In order to better meet the needs of these individuals battling mental health challenges, this negative stigma needs to be effectively addressed at all levels, from individuals and communities to structures and institutions. Public health intervention approaches may offer a framework to begin to effectively address this stigma and improve healthcare options and health outcomes for individuals facing mental health challenges (Shim and Rust).
Hargrove, Chasity. Interview with Shelby Smith. 15 July 2019 (Y-0101). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
McSween, Jean L. “The Role of Group Interest, Identity, and Stigma in Determining Mental Health Policy Preferences.” J Health Polit Policy Law, vol. 27, iss. 5, 2002, pp. 773–800. doi: https://doi.org/10.1215/03616878-27-5-773
Morse, Eric D. “Addiction is a Chronic Medical Illness.” North Carolina Medical Journal, vol.79, iss. 3, 2018, pp. 163-165. https://www.ncmedicaljournal.com/content/79/3/163.
Parcesepe, Angela M., and Cabassa, Leopolodo J. “Public Stigma of Mental Illness in the United States: A Systematic Literature Review.” Administration and Policy in Mental Health and Mental Health Services Research, 40, 2013, pp. 384–399. https://doi.org/10.1007/s10488-012-0430-z.
Shim, Ruth, and Rust, George. “Primary Care, Behavioral Health, and Public Health: Partners in Reducing Mental Health Stigma,” American Journal of Public Health, 103, 2013, pp. 774-776, https://doi.org/10.2105/AJPH.2013.301214
Sessions, William. Interview with Joanna Ramirez. 27 June 2018 (Y-0049). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Stratas, Nicholas. Interview with Caroline Efird. 19 February 2019 (Y-0066). Southern Oral History Program Collection (#4007), Southern Historical Collection, Wilson Library, University of North Carolina at Chapel Hill.
Tomar, Nikhil. An Ethnographic Analysis of Stigma Towards Mental Illness and Mental Health Care at Clubhouses in North Carolina, The University of North Carolina at Chapel Hill, Ann Arbor, 2018. ProQuest, http://libproxy.lib.unc.edu/login?url=https://www.proquest.com/dissertations-theses/ethnographic-analysis-stigma-towards-mental/docview/2110557697/se-2?accountid=14244.