Understanding What Causes Stigma

DEC. 28, 2016

By Luna Greenstein


We often discuss how much of a problem stigma is and how much it impacts those who live with mental illness. However, it is somewhat rare for us to focus on the foundation stigma roots itself in. But this is something discussed in detail in Living and Working with Schizophrenia, a book by Dr. Marjorie Baldwin. She explains five possible components that may be leading to the persistent and institutionalized problem of stigma.

There are so many people who deal with stigma every day, in every aspect of life. People like Alan, a 30-year-old accountant who lives with bipolar disorder. And if we understand stigma’s roots, we may better understand how to improve the lives of people like Alan.

  1. Responsibility

Alan sits at a bar with his friend Jack. Alan slumps in his stool and stares at his half-empty beer bottle. Jack sighs loudly as he looks around the room.

After a long silence, Jack finally says, “Remember senior year when we never slept? We were always doing something—partying, playing basketball, occasionally going to class?”

“Yeah, I remember.” 

“Is there any chance of you being like that again? Lately it seems like the life’s been sucked out of you.”

“I don’t know.”

“Can’t you just snap out of it?”

Too often, those living with mental illness are held responsible for their conditions—as if they are intentionally selecting a life with symptoms, rather than without. When people believe that an individual has a choice in this matter—that they are in control of their mental illness, they are then blamed for their symptoms. When this happens, they receive little sympathy and more stigma.

  1. Uncertainty 

If a person’s condition is uncertain (as in it is unlikely to be improved), they are more likely to be stigmatized and avoided by friends and family. The more hopeless the situation seems, the more it is viewed as a waste of time.

I can’t do this anymore,” Alan’s wife blurts out at the dinner table.

Alan looks up from his plate and stares at her with a puzzled expression.

“I want a divorce” she continues. “I know things aren’t easy for you... But I just can’t bare another silent meal, another loveless embrace, another cycle of you going from making me breakfast at 3 a.m. because you can’t sleep to sleeping through my birthday. I hate that I can’t help you—this whole thing just feels endless.”

  1. Unpredictability

While uncertainty focuses on the long-term outcomes of someone living with a mental health condition, unpredictability focuses on short-term outcomes. Those who experience symptoms are sometimes perceived as unpredictable and erratic on a day-to-day basis. Unjust social distance may occur because of this.

Alan’s two friends from college, Jack and Dan, are sitting on the couch at Dan’s house, watching basketball.

“I’m telling you…he’s different than he used to be,” Jack tells Dan.

“Different how?”

“I just never know what’s going to happen when I meet up with him. Sometimes he’s fine, but sometimes he acts really weird…” Jack suggests. “Last time I saw him, he kept having to get up from the bar to pace around the room.”

“What? That’s really strange.”

“Yeah. I’m honestly trying not to hang out with him anymore.  It’s embarrassing when he does stuff like that.”

  1. Incompetence

Unfortunately, people view those living with mental health conditions as unable (or too incompetent) to make rational decisions. This is what leads to stigmatizing laws and practices that prohibit individuals living with mental illness from having the same rights and opportunities as other people—such as the right to hold office, the right to vote, the right to serve on a jury, etc.

Alan sits in his cubicle, plugging numbers into a spreadsheet.

His boss, Bill, walks over to him apprehensively. Bill pulls up a chair, rests his elbows onto his thighs and puts his face in his hands. “I’m sorry to tell you this, but we had to go with someone else for the account manager position.”

Alan’s face sinks as he pauses to take this in.

After a breath, he slowly responds, “I don’t understand… I’ve worked here for five years. My job is leading up to this position.”

“It seems that some of the higher-ups don’t see you as management material.”

  1. Dangerousness

Alan’s brow furrowed, as he turned to Bill and said, “I’m frustrated to hear this. I think this decision is unfounded. I have diligently worked for this for five years!”  

“I’m sorry, but there’s nothing I can do.” Bill says as he quickly stands up and backs away from Alan like a scared child coming across a snake. He scurries to his office and closes the door.

Dangerousness is when unpredictability manifests into fear. People often avoid those with mental illness because they are afraid of random acts of violence.

But the truth is, we all know someone like Alan. And more often than not, he’s not dangerous or unpredictable or incompetent or hopeless. He’s just Alan.

Alan—and the millions of people who go through similar struggles—needs people to be more understanding, compassionate and educated about mental illness. He needs people to recognize that his symptoms are not his fault. He needs people to believe that recovery is possible. He needs people to understand that having mental illness does not mean he is any less competent or intelligent than any other person. He needs people to know that living with a mental health condition does not automatically make him violent.

Alan needs people to see him, not his condition.

Can you?


To help us continue the fight against stigma,
share your #IStopStigmaBy story & support NAMI  


JAN, 06, 2017 01:01:21 PM
My son, Michael is the most amazing person I know. He is loving, kind, spiritual, helpful, intelligent, dependable, responsible and funny. When Michael is experiencing symptoms, while his behavior changes, he is still Michael. He is not his symptoms or his illness. I respect Michael more than anyone I know because he is worthy of it and has earned it. His friends have run from him because of not understanding or being educated about it. They allow their own insecurities and fears to keep them away from someone they really love. I know Michael will return in his glory because he always does. The Illness has symptoms but Michael is not his illness. Spring and Summer always return following a cold harsh Winter. Michael has never been violent. I love you Michael. I am your strongest advocate! Mom

JAN, 06, 2017 05:07:01 AM
Ray Lay
For me, fighting stigma is a win win. I am a NAMI In Our Own Voice presenter and i tell my story very often and I always use I statements. Telling my story is like a special medicine to me and as people hear my story they understand that recovery is possible.I always state that the best way to treat a person with a mental health condition is like a person. We are humans with a human condition.

DEC, 29, 2016 11:23:19 PM
Janice Meich
By talking freely about family mental illness, I'm hoping to break down the stigma. However, my son is violent but refuses medication. He pulled a knife on his father. I was able to have him sent for an observation instead of being arrested. Still refused medication. We are afraid of him. How do I handle this? I let him know I love him unconditionally.

DEC, 29, 2016 05:00:23 PM
Me, Myself and I
You know what's the most upsetting is getting your children taken away because of the trauma you have experienced in your own life. Your family abandons you, as an "adult" so does your 18 yr old daughter because she thinks I chose to have DID.

DEC, 28, 2016 10:45:54 PM
Camille Danne
Awareness leads to more and more answers which promotes safety.

DEC, 28, 2016 10:19:29 PM
Jay Gilpatrick
Love and peace of mind need to be considered. It is a solution for all people. Diversity has a definite value and that includes people who have a mental health disorder. When people accept each other no matter their differences, it opens the door to love and peace. I have schizophrenia. I deal with it most days. I've dealt with the discrimination. It is real. When we hold our heads high, be positive role models and live with dignity, love and peace this stigma starts to melt away. That is what is best for everyone whether they live with a mental illness or not.

DEC, 28, 2016 07:24:51 PM
Jamie Brown
Stigma is because of Ignorance about it. People are afraid of what they don't understand. People assume because you have an illness you are a certain way. They may hear of a criminal who had mental illness on the news. ( but these are extreme cases usually drug related where the person wasn't being treated). People may be afraid of mental illness- because they don't understand it. Many people with mental illness are not a danger to others but are the most vulnerable in society and often victims. I find it helpful to connect with others who struggle. It takes one who struggles to truly understand -- but others can still show compassion & empathy.

DEC, 28, 2016 06:07:59 PM
Lynette Hemsath
I would add another category:
6. FEAR of Looking Weak Themselves,
"Bill realizes that once in a while, in private moments, he has experienced the same feelings Alan is feeling. Bill never admits this to anyone because he is afraid of being perceived as "weak or crazy." In Bill's mind the best way to prevent anyone from suspecting him of this weakness is to always show intolerance of it and anyone who suffers from it.

Submit to the NAMI Blog

We’re always accepting submissions to the NAMI Blog! We feature the latest research, stories of recovery, ways to end stigma and strategies for living well with mental illness. Most importantly: We feature your voices.

Check out our Submission Guidelines for more information.