The History and Lasting Impacts of Mental Health Stigma

Mental health stigma has come a long way, but it still stops people from getting the help they need. Read on to learn about the history of mental health stigma and its lasting impacts.

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More people are affected by mental health conditions than you think. According to national data, almost one in four adults and one in seven children in the United States have a mental health condition. That means even if you don’t struggle with mental health yourself, there’s a solid chance that someone you know does. 

And yet, despite how common these challenges are, mental health stigma persists. Many people feel ashamed to open up about their mental health and hesitate to ask for help from a loved one or seek mental healthcare, especially if they need a more intensive form of treatment. 

Read on to learn more about where mental health stigma comes from, how it still shows up today — particularly around higher levels of care — and what we can do to change the conversation.

What is mental health stigma?

“Mental health stigma refers to the negative attitudes, beliefs, or stereotypes that society holds about individuals who experience mental health challenges,” says Beth Couture, MSS, LSW, a Charlie Health Experiential Therapist.

Unfortunately, this stigma hurts millions of people. “It may cause individuals to feel ashamed, isolated, or reluctant to seek help or talk about their mental health struggles,” says Chris Hinto, LPC, a Charlie Health Group Facilitator. 

According to the therapists, there are three main types of stigma:

1. Public stigma

“This refers to negative views from society or the public, such as the belief that people with mental health issues are dangerous, weak, or unpredictable,” Hinton says. This kind of stigma is sometimes called perceived stigma.

2. Self-stigma

Self-stigma occurs when you internalize these societal attitudes. Hinton says this internalized stigma can lead to feelings of shame, low self-esteem, and guilt.

3. Institutional/structural stigma

“This is when policies or practices in institutions, like workplaces or schools, inadvertently discriminate against people with mental health conditions,” Hinton says. This may be intentional or unintentional, but regardless, these policies and practices make it more difficult for someone with a mental health condition to navigate the world successfully. 

The history of mental health stigma

Discrimination and stigma surrounding mental illness are, unfortunately, nothing new and come along with a tragic past. In ancient times, many people believed that mental illness was a result of being possessed by demons. This led to early doctors cutting or drilling a hole into the skull, so the evil spirits could be released — obviously not resulting in any meaningful treatment. 

Eventually, in Ancient Greece, Hippocrates (a famous Greek philosopher and physician) took a different stance on mental illness, viewing it as something more equitable to a physical health condition. He believed that mental illness was the result of imbalances in bodily fluids, or what he called “humors,” rather than spiritual possession. This was a major step toward understanding mental illness as a medical concern rather than something supernatural.

However, the Middle Ages saw views on mental illness take a step back, reverting to religious and superstitious roots, with many believing that mental illness was a punishment from God. Again, they believed these people were possessed, and they were treated horribly, chained to the walls or bed in a penitentiary, or even burned at the stake, in some cases.

It wasn’t until the 1700s that the term “patients” began to be used more broadly to describe people with mental illness. This reflected a shift in society’s view of mental illness as a medical issue rather than a supernatural one. Before that, individuals were often referred to as “lunatics,” or even “the insane.” However, even after the term “patient” gained traction in clinical settings, many stigmatizing terms continued to be used in public and institutional contexts. 

Also in the 1700s, people with mental illness were able to receive care (although the “care” was likely questionable) in general hospitals. In 1752, the Pennsylvania Hospital in Philadelphia housed mentally ill patients in the basement (where shackles were attached to the walls), and in 1792, the New York Hospital in New York City opened a ward for “curable insane patients.” 

More hospitals specifically dedicated to people with mental illness began popping up, and while some were humane, others had horrible conditions and brutal treatments. For the most part, many of these institutions were focused more on containing the mentally ill rather than actually helping them, thanks to widespread discrimination and an overall negative stereotype of people with mental illness.

Later, in the late 1930s and early 1940s, Nazis in Germany deemed people with physical and mental disabilities, including mental illnesses, to be “unworthy of life,” and they were targeted to be killed through what was called the T4 program. Estimates vary, but it’s thought that around 200,000 people with various disabilities, including mental illness, were killed. This tragic chapter in history further proves the deadly consequences of widespread mental illness stigma and dehumanization of people with mental illnesses.

Later, in the 1960s and 1970s, the concept of mental illness stigma began to be more publicly acknowledged, especially as psychiatric reforms gained momentum. Since then, public attitudes have shifted more meaningfully, and we’ve certainly made strides over the last couple of decades. Still, public stigma and institutional stigma are prominent, and we have a lot of work left to do. 

How does the stigma impact people getting treatment? 

“If someone with a mental illness feels they are going to be judged or treated badly because of their illness, they are less likely to seek help of any kind,” Couture says. “Mental health stigma can create a vicious cycle of people avoiding reaching out for help and talking about their concerns, creating more stigma, which can then lead to others not feeling comfortable sharing their own mental health concerns.” 

If you’re avoiding getting help when you know you need it, you’re doing yourself a disservice. Avoiding treatment can prolong your struggle and potentially cause your symptoms to worsen, ultimately delaying healing.

On top of the general mental health stigma, some people may face additional struggles related to culture or gender that make it even less likely for them to seek mental healthcare. “In some cultures or communities, seeking help is seen as a sign of failure,” Hinton says. For example, research shows this is common in Asian American, Black, and Latino communities. Additionally, Hinton says that boys and men may feel societal pressure to avoid showing vulnerability and seeking help. These layered experiences can make it even harder to reach out for mental healthcare.

The stigma surrounding more intensive mental health treatment

Although we have come a long way and there’s a difference in how we talk about therapy, the conversation often stops there. There’s still even more significant stigma around higher levels of care, such as intensive outpatient programs (IOPs), partial hospitalization programs (PHPs), and inpatient treatment.

Not to mention, the mental health concerns that often require this more intensive treatment, such as suicidal ideation or attempts, self-harm, and substance use, are particularly misunderstood, Couture says. “They can be especially uncomfortable to talk about, which — however unintentionally — creates a sense of secrecy and fear around them in families and communities.” This sense of secrecy can also be related to the lack of knowledge surrounding these more intensive treatment forms.

“Lack of education around what intensive mental health programs actually are and do can lead people to rely on stereotypes and misrepresentations found in popular media for information, creating further misunderstanding, judgment, and fear,” Couture says. “The negative and/or exaggerated portrayal of intensive treatment programs can also cause people with mental health concerns to diminish or dismiss their concerns and therefore not seek treatment for them, as they might think that what they experience is ‘not as bad’ as what they see in the media.”

The reality is that no two people’s experiences with mental health are exactly the same, and neither are their treatments. There is a wide spectrum of what symptoms for any given mental health condition look like and what its treatment looks like.

How to normalize needing more intensive treatment

Seeking help is a sign of strength, not weakness. It means you’re brave enough to confront your challenges head-on and dedicate yourself to making change, including if you’ve decided that you need more intensive treatment than a traditional once-weekly therapy model. 

“Reducing stigma around mental health and seeking more intensive treatment options is crucial to ensuring people feel safe and supported when reaching out for help,” says Hinton. “The key to stigma reduction is creating a culture where seeking help is viewed as a courageous, responsible, and proactive step toward health, rather than something to be ashamed of.”

It’s important to keep the dialogue open about mental health and its treatment (including intensive treatment) all year round, not just during Mental Health Awareness Month. Using our voice is a powerful way to fight stigma and normalize mental health disorders.

“When one person speaks up about what they’re going through, this gives others permission to do the same,” Couture says. “The more people who experience mental health problems talk about these issues, the more normalized these issues become, and therefore the less powerful stereotypes and misinformation become.” 

How Charlie Health can help

It’s okay to need more help. If you’re struggling with your mental health and once-weekly therapy isn’t getting you the results you want, Charlie Health is here to support you. Our virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health services for people dealing with serious mental health disorders, including anxiety disorders, bipolar disorder, eating disorders, personality disorders, and more. 

Our program incorporates trauma-informed and evidence-based therapies into individual counseling, family therapy, and group sessions. With this type of holistic treatment, managing your mental health is possible. Remember — it’s okay to need more support. You deserve to feel better. Fill out the form below or give us a call to start healing today.