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A Pandemic of Tortured Silence

I remember sobbing at the dinner table as a kid, listening to the ugly roar of family

arguments as they consumed the family peace I had once known in flames. My earliest memories

all contain my older brother as we played games together, swam, or I simply shadowed him.

However, around the time he reached high school, the kind and warm brother I had always

looked up to had seemingly completely disappeared, replaced by anger, manipulation, mania,

and depression incarnate. His relationships with friends and family were all strained or

completely cut off by his anger and all-consuming moods. The chasm in my family only widened

as his experimentation with drugs and alcohol became real problems that put him in danger with

his reckless actions. This family turmoil, his uncontrollable moods and emotions, and his

dangerous relationship with substances were all symptoms of oppositional defiant disorder,

bipolar disorder, and addiction which he was later diagnosed with. I know now that my brother

never “disappeared” and instead was suffering the effects of the mental illness he now lives with.

He still struggles at times, however with determination and support he has been able to succeed

and live happily and comfortably. I am proud to be his younger brother.

Growing up with mental illness and a psychologist in the family, I learned a lot about the

devastating impacts that ignoring mental health can have. I try to use what I learned to monitor

my own well-being as well the mental health of my friends. Problems like anxiety, low

self-esteem, negative self-image, unhealthy levels of stress, and even depression are not as rare

as we would believe or hope them to be. I am glad to have been able to not only open up to those

close to me about the tough times I have personally gone through, but to also have been able to

support my friends through their own problems.

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Seeing the effects mental illness and untreated mental health have had on my family and

friends has shown me how important it is to talk about and support those suffering from these

afflictions. Yet, instead of supporting those suffering, our society instead places taboos on talking

about mental illness and ignores mental health issues. Some issues like toxic masculinity and the

need to “man up” have reached the public eye and are slowly being addressed, but many others

like dismissive vernacular or the negative treatment of addiction have not. I can not help but

think: “How might things have been different for my brother if his mental illness was recognized

earlier? If he had support and treatment earlier? If he never had to resort to drugs and alcohol?

Or, what if he never received any support?” More generally, my experiences with mental health

and illness and society’s treatment of them has led me to the question: How does societal

stigmatization and dismissal of mental health and illness impact those who suffer from them,

especially adolescents?

The stigma surrounding mental health and illness is a complex amalgamation of many

different prejudices and misconceptions which places shame upon, and fear of, individuals

suffering with mental conditions or struggles. Stacy Overton, a licensed professional counseling

and addiction counselor, and Sondra Medina quote Crawford and Browns, who say that “ …

stigma arises when an actual social identity falls short of a societally defined ideal identity.”

Overton and Medina also reference Corrigan, who, “described self-stigma as a private shame that

diminishes self-esteem and causes self doubt regarding whether one can live independently, hold

a job, earn a livelihood, and find a life mate” (qtd. in Overton and Medina 144). Stigma can be

broken into two parts; the prejudice and judgment which society puts upon an individual who

diverges from the social paradigm, and internalized shame and mistrust in one’s own abilities due

to self-applied judgment.

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Society tends to paint a negative and erroneous picture of the character and behavior of

those who suffer from mental health and illness, creating fear, distance, and misunderstandings.

Bruce Link, Distinguished Professor of Sociology and Public Policy at University of California

Riverside, and several other researchers investigated public perceptions of different forms of

mental illness. Their research showed the public believed that those with depression or

schizophrenia were respectively 2 and 3.5 times more likely to be violent than a “troubled

person,” who represented an average person with mild conditions and struggles. In reality,

“empirical studies show that only a minority of people with mental illnesses are violent,” clearly

indicating the large public misconception on the behavior of individuals with mental illness

(1332). These prejudiced beliefs cause discriminatory behavior which harms those who live with

mental illness: “ … we found a strong desire for social distance across several domains of social

interaction… It is not just that the symptoms are undesirable but that they induce fear… And, as

our results also show, there is an appreciable correlation between this fear and willingness to

interact” (Link et al. 1332). Struggles with mental health and illness already pose a great burden,

so this social distance and fear only further taxes these individuals. Mental health issues in

general are met with less empathy and understanding than physical ailments due to their

perceived controllability: “ … individuals with psychological problems were seen as more

responsible for their difficulties than those with physical problems and that attributions of

controllability were related to decreased pity and increased anger toward the individual

possessing the problem” (Greene-Shortridge et al. 158). However, psychological problems are

not simply controlled and managed as the public may believe. The misconceptions surrounding

mental health and illness create stigmas which make living with these conditions even harder.

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Stigma threatens the livelihood and well-being of those living with psychological

conditions through discrimination, prejudice, and other effects. According to Overton and

Medina, the stigma surrounding mental illness can create difficulties obtaining a job, getting

treatment, acquiring proper shelter, and even create negative views in mental health counselors

and professionals. Mental illness makes potential employees seem less predictable, dangerous,

and less valuable to employers (145). Overton and Medina go so far as to say that the stigmas

surrounding mental illness, “ … may be as harmful as the disease itself” (143). These prejudicial

views make all aspects of life harder for those with mental illness. Unfortunately, stigma can also

make managing the mental illness itself harder as well: “ … 50 to 60% of individuals who could

seek help for a psychological problem do not… individuals with a mental illness are less likely to

seek treatment if they view themselves as being responsible for their disorder(s)”

(Greene-Shortridge et al. 158). At least half of those who suffer from a psychological problem do

not seek any kind of help, in part due to the shame and responsibility that those with these

problems have internalized. The effects of not seeking help can vary from unheard struggles to

harming oneself and possibly even suicide. Stigma is more than just judgment and shame which

is cast upon those struggling with mental health and illness, it is discrimination and real damage

to one’s well-being.

The effects of mental health and illness are especially important to note in youths who are

still developing and establishing their futures, but who are also in the age where many mental

illnesses first present themselves. Vikram Patel, a psychiatrist who co-founded the Centre for

Global Mental Health and serves on four committees in the Indian government, and several other

researchers found that, about 20-25% of young people aged 12-24 will endure one or more

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mental disorders every year (1303). Patel also notes that the effects of mental disorders in youth

are magnified due to youth being a critical time in the development of the individual:

75% of people with a mental disorder had an age of onset younger than 24 years.

Furthermore, the ages of onset for most disorders likely to persist into adult life… [fell in

the] 12–24 year age range. Since youth is the period of life when most people complete

their academic career, establish themselves in the job market, and establish friendships

and romantic relationships, and since mental disorders might reduce the likelihood of

these tasks being completed successfully, mental disorders in young people have a

substantial effect on economic and social outcomes that extend into adulthood (1306).

Mental illness and health problems tend to develop during a key time of growth and development

in an individual’s life, obstructing their ability to achieve their potential. To ensure the success of

youth and future generations, mental well-being must be supported. Yet, youth has increasingly

become a time where suicide poses a major risk, and in India and China it is the leading cause of

death for young people (Patel 1303). Improving the mental health and wellness of youth could

not only help improve the social and economic well being of future generations, but also save the

lives of many youths in need.

In just the same way the effects of mental disorders are magnified in youth, so are the

effects of stigma. In a phone interview with Nuria Levin, MFT, a licensed marriage and family

therapist, Levin stated that “Youth feel more pressure to be a certain way… Stigma may stunt

this time of development and learning, negatively impact their sense of self and identity, strain

connections… create a sense of helplessness or even hopelessness, and in some cases lead to

suicide.” Youth is an important time during which individuals solidify their self identities and

form deep relationships, so damage to their self-esteem and connections have extensive and long

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lasting effects. In the worst case scenario, the shame and helplessness in addition to the struggles

of mental health and illness may push the individual to suicide. Even in cases where stigma does

not push youth to suicide, it still has a major effect on the life of these developing individuals. “I

so wish I’d met them earlier. We could talk about things while they were still in the process of

understanding who they are and the story they tell about themselves.” notes Jon Parker, MFT,

who works as a counselor for high school students, recalling several students he’s talked with.

“A few years later that story is a little more ingrained and they believe sometimes unhealthy or

negative things about themselves that aren’t true that could have been a little bit easier to dispel

if we had that discussion at an earlier time.” Parker compares mental health and illness to a

wound, noting that treatment and support can heal it, but, if ignored, it can become “infected”

and worsen. “They can get stuck and not develop fully into their potential by minimizing their

circumstance and saying ‘I don’t need any help’” he comments, indicating the detrimental effects

of untreated and suppressed mental health struggles. Pain and strife fester when left untreated

and disregarded, so it is essential that the means to treat wounds, both internal and external, are

not stigmatized as a sign of weakness.

The stigmas surrounding mental health and illness stem from various aspects of society

and Western culture and cripples the abilities of society as a whole. One major source of the

misconceptions and prejudice which form this stigma is mass media. According to Yiyi Yang, an

assistant professor in communications at the University of North Carolina Wilmington, and other

researchers, mass media plays a major role in the public’s view and knowledge of mental illness,

creating many misconceptions and stereotypes which play a part in the formation of stigmas.

“People with mental illnesses are often represented as nuts, psycho, and crazy” (794). In addition

to misinformation and negative preconceptions, mass media also feeds the belief that people with

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mental illness are violent and dangerous. TV, movies, and even medical journal advertisements

have all portrayed mental illnesses such as schizophrenia as causing violent behaviors. In

addition, news tends to selectively and discriminatorily depict violence by schizophrenic

individuals, enforcing the public belief that mental illnesses cause violence and are to be feared

(Yang et al. 794). It is possible that the public’s belief that individuals with mental illness are

more violent, which Link found in his research, is due largely due to the depiction of these

individuals in mass media. Finally, Yang also found that magazines contribute to perceived

controllability and responsibility that individuals with mental illness have over their condition:

“Both men's and women's magazines were more likely to attribute mental health issues to

individual causes rather than social causes… individual causes implies individual responsibilities

for mental health, which could trigger stigmatizing attitudes and decrease helping behavior”

(Yang et al. 804-805). Mass media has immense influence over the public’s beliefs and behaviors

and has been used to normalize judgement rather than acceptance.

Another major source of stigma is toxic masculinity and the pressure it puts on men to

hide any kind of emotional vulnerability and mental struggles. Toxic masculinity—the

destructive beliefs, behaviors, and attitudes which are associated with male gender roles—is

detrimental to society in many ways such as misogyny and violence. However, one effect that is

not often talked about is its relationship to the mental health and well-being of men. Sophia

Ceniza notes that “ … toxic masculinity underpins a system where vulnerability is seen as a sign

of weakness rather than strength, and asking for help is insidiously stigmatized.” The societal

and cultural pressure to “man up” teaches men that emotions are signs of weakness, so they must

be hidden and bottled. Ceniza cites data from the National Institute of Mental Health to show

that fewer men pursue counseling to identify mental illness, seek help, talk about receiving

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treatment, or acknowledge their mental illness. “According to the NIMH, women are more likely

to attempt suicide then men, but men are more likely to die by suicide,” states Ceniza, who

follows up with the observation that men choose much more fatal suicide methods, “such as

firearms, as men represented 86% of firearm suicide victims in the U.S. from 2012 to 2016.” The

overwhelming use of aggressive and lethal suicide methods by men is likely due in part to toxic

masculinity’s demand for men to appear strong and dominant, even in their choice of suicide

method. Toxic masculinity is a major problem for all members of society in different ways and

must cease for the good of humanity.

Those who suffer from mental illness and health problems are the members of society

who need the most support from their communities, so shifting away from ostracization and

towards supportive beliefs and behaviors could have massive effects. The stigma surrounding

mental health and illness is a complicated and deeply embedded aspect of Western society and

culture, however multiple approaches may be able to untangle and undo this knot of judgment

and shame. In an interview conducted by Jenara Nerenberg, Roy Grinker, author of Nobody’s

Normal and professor at George Washington University, claims that adjusting the focus of mental

illness towards personal experiences and complex factors, instead of blaming personality and

upbringing, would decrease stigma. Grinker says, “there is much more empathy and openness to

the idea that no one is immune from distress. We all experience trauma and difficulties in our

lives. We all get depressed and anxious.” By shifting away from blame and focusing more on the

tough experiences an individual may have had, society will naturally become less prejudiced and

more empathetic towards those living with mental illness and health problems. Grinker also

advocates “social support groups” for individuals living with mental illness as opposed to

isolated, autonomous living which Western individualist culture expects. These kinds of groups

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make it, “more likely to have your symptoms identified and… to have others to support you to

get treatment.” It is natural to struggle at times, but having a supportive group makes those

difficult times easier and could create a domino effect within the community that reduces the

stigma and increases supportive behaviors.

Another area in which mental health and illness stigma exists is with mental health

practitioners who may not realize they hold stigmatizing attitudes and beliefs. Overton and

Medina argue that practitioner’s behaviors and responses may “contribute to stigma or make

clients’ symptoms worse.” they recommend practitioners learn more about stigma and the effects

it has on their clients (148). Levin recommends a “strength based approach” in counselling

which identifies and builds upon strengths that the individual already has rather than negatively

judging them. Personalized, positive feedback and avoiding language that discriminates,

generalizes, or focuses on negative attributes brings out the strengths and empowers Levin’s

clients. “The language we use can turn into what we believe,” she remarks, so the use of positive

statements rather than negative ones is vital.

Stigmatization and dismissal of mental health and illness creates many negative effects

for those who suffer from them, especially adolescents. Society pressures its members to become

a certain ideal citizen, and when individuals deviate from this model, they are harshly judged and

discriminated against. Those with mental illness are viewed by the public eye as violent,

unreliable, weak, and irresponsible individuals who are to be avoided. These prejudiced beliefs

lead to difficulties obtaining employment and treatment. The internalization of these harmful

beliefs can damage the individual’s self-esteem, create self-doubt, decrease help-seeking

behaviors, and worsen the isolation and depression these individuals feel. The effect of mental

disorders and stigma are especially important to note in youth who are in a critical time in their

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self, academic, and career development, and during which period most mental illnesses first

develop. The risk of suicide in youth is increasingly becoming a leading cause of death, but

supporting the mental well-being of youths could stop this trend and benefit society. If those with

mental illness are supported and have the resources necessary to be successful, it could lead to a

more productive, happier, and safer society for all individuals.

It will be difficult to get rid of this deeply ingrained stigma, however there are multiple

options available to slowly reduce it. Sources of this stigma such as mass media and toxic

masculinity can be controlled to prevent the continuation of stigma to future generations.

Additionally, shifting the focus away from blame and towards experiences and complex factors

will help reduce the judgement society imposes. Finally, teaching mental health practitioners

about the effects stigma has and endorsing a strength based approach, which positively reinforces

the strength of clients, will help create an environment of growth rather than tortured silence. A

little bit of kindness and openness goes a long way at reducing the suffering of those closest to

the individual.

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Works Cited

Ceniza, Sophia. "Green Juice Skeptic: Toxic Masculinity Underpins our system’s Flawed

Understanding of men’s Mental Health." University Wire, 29 Sep 2020. eLibrary,

https://explore.proquest.com/elibrary/document/2446957787?accountid=193803.

Accessed 13 Mar. 2021.

Greene-Shortridge, Tiffany, Thomas W. Britt, and Carl A. Castro. "The Stigma of Mental Health

Problems in the Military." Military Medicine, vol. 172, no. 2, 2007, pp. 157-61. eLibrary,

https://explore.proquest.com/elibrary/document/217062455?accountid=193803. Accessed

13 Mar. 2021.

Levin, Nuria. Personal interview. 23 Mar. 2021

Link, Bruce G., et al. "Public Conceptions of Mental Illness: Labels, Causes, Dangerousness, and

Social Distance." American Journal of Public Health, vol. 89, no. 9, 1999, pp. 1328-33.

eLibrary, https://explore.proquest.com/elibrary/document/215090813?accountid=193803.

Accessed 13 Mar. 2021.

Nerenberg, Jenara, and Roy Grinker. “How to Dismantle the Stigma of Mental Illness.” Greater

Good Magazine, Greater Good Science Center, 17 Mar. 2021,

https://greatergood.berkeley.edu/article/item/how_to_dismantle_the_stigma_of_mental_il

lness. Accessed 18 Mar. 2021.

Overton, Stacy L., and Sondra L. Medina. "The Stigma of Mental Illness." Journal of Counseling

and Development : JCD, vol. 86, no. 2, 2008, pp. 143-151. eLibrary,

https://explore.proquest.com/elibrary/document/219029734?accountid=193803,

doi:http://dx.doi.org/10.1002/j.1556-6678.2008.tb00491.x. Accessed 13 Mar. 2021.

Parker, Jon. Email interview. 29 Mar. 2021

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Patel, Vikram, et al. "Mental Health of Young People: A Global Public-Health Challenge." The

Lancet, vol. 369, no. 9569, 2007, pp. 1302-1313. eLibrary,

https://explore.proquest.com/elibrary/document/2067753220?accountid=193803,

doi:http://dx.doi.org/10.1016/S0140-6736(07)60368-7. Accessed 13 March 2021.

Yang, Yiyi, Lu Tang, and Bijie Bie. "Portrayals of Mental Illnesses in Women's and Men's

Magazines in the United States." Journalism and Mass Communication Quarterly, vol.

94, no. 3, 2017, pp. 793-811. eLibrary,

https://explore.proquest.com/elibrary/document/1934458009?accountid=193803,

doi:http://dx.doi.org/10.1177/1077699016644559. Accessed 13 Mar. 2021.

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