Mental health stigma negatively influences those even with good intentions, research finds

LAWRENCE — In some respects, attitudes regarding mental health stigma have steadily improved. However, according to new research, even individuals with helpful motivations often harbor hurtful biases.

“There are those who are very explicit in their mistreatment of people with mental illness. But there are also those who have really good intentions about treating people with mental illness well and yet may still have some biases they don’t realize,” said Elizabeth Felix, assistant professor of sociology at the University of Kansas.

That contrast is explored in her latest paper titled “Unmasking the Aversive Stigmatizer: Integrating Deliberate and Automatic Cognition in the Study of Mental Health Stigma and Perceived Dangerousness.” It investigates the presence of a potentially unique actor in the stigma process: the aversive stigmatizer. These are individuals who deliberately reject negative cultural stereotypes but still hold implicit mental illness-related biases that may inadvertently influence discriminatory behaviors.

The article appears in Society and Mental Health.

“We live in a culture where we’re hearing all these messages about mental health like, for instance, linking mental illness with violence,” Felix said. “When you hear those messages so often — even if you don’t think of yourself as a biased person and presume you treat everyone equally — some of those messages can get embedded in people’s minds and influence behaviors.”

She characterizes public stigma as the attitudes and beliefs that motivate individuals to socially avoid, devalue or fear people with mental illness.

Aversive stigmatizers may embrace such attitudes … whether they know it or not.

“Let’s say I have a best friend who has a mental illness, and I often will say, ‘I would always be friends with them. I would always support them. We shouldn’t talk negatively about people with poor mental health,’” Felix said. “But if I was an aversive stigmatizer, some negative stereotypes might creep in, so that maybe next time I’m interacting with that person, I decide I don’t want to get quite as close to them.”

Another finding from the paper is that a surprising amount of people with mental illness themselves fall into this category of being an aversive stigmatizer. 

“This aligns with some of the theories we have in sociology around self-stigma. So even if they maybe say really positive things about mental health or would not endorse these negative beliefs about mental health out loud, they might still be applying them to themselves internally,” she explained.

Felix employed two methods to arrive at these conclusions. The first was traditional survey measures. The second was an implicit association test to examine the presence of aversive stigmatizers. She also surveyed the potential social patterning of aversive stigmatizers compared to nonstigmatizers and explicit stigmatizers.

Felix said she believes the greatest misunderstanding regarding how society views stigma is that people think it’s improved in recent years.

“Mental health literacy has gotten better in the last few decades. Like being able to recognize symptoms or a willingness to talk with a therapist,” she said.

“But attitudes toward certain types of mental illness have only remained stable or have actually gotten worse. So as an example, perceptions of schizophrenia — especially related to dangerousness — have statistically gotten worse in the last 15 to 20 years. Whereas perceptions toward a mental illness like depression has gotten a little bit better.”

Now in her third year at KU, Felix is an expert in the sociology of mental health and mental health stigma. Her published work has appeared in Social Science and Medicine and the Journal of Health and Social Behavior.

She hopes her research can help expand how people view mental health stigma and recognize how pervasive it remains.

“I would also like for sociologists to add more implicit measures into their work,” Felix said. “From a policy standpoint, it would be great if this framework of thinking about aversive stigmatizers could be taken into consideration when trying to figure out how we can reduce stigma.”