Dealing with Stigma

This expertise is provided by Michael Trujillo, PhD; Elissa Epel, PhD; Margo Pumar, MD; Elena Fromer; and Stephen Hinshaw, PhD.

Stigma can be a powerful and toxic force affecting people’s lives and opportunities. There is unfortunately a lot of stigma present in our day-to-day lives — stigma of race, ethnicity, political beliefs, and illness. 

Stigma is an ancient and ugly term, originally signifying the marks or brands burned into the skin of social outcasts in ancient Greece and Rome. Today it signifies the devalued status placed on individuals including racial/ethnic, religious, or sexual minorities, as well as people with serious health challenges, mental disorders, or substance abuse. Some formerly stigmatized groups (for example, left-handers, adoptees, HIV-positive individuals) today experience less (or hardly any) stigma, signaling that as social norms change and as political action occurs, acceptance can carry the day. 

We hope to provide you information on stigma associated with mental health/substance use, experiences healthcare workers have gone through and tips on how to prevent and reduce stigma.

Despite far greater public knowledge of mental disorders than 50-60 years ago, public attitudes have been slow to budge. Depression continues to be a leading cause of disability worldwide. Still, a growing surge of openness, disclosure, and "parity" for mental health care coverage is combining to usher in a new era. We can no longer tolerate silence and discrimination. Given the sheer number of people experiencing mental disorders, everyone loses if fear, shame, and silence continue. UCSF and UC Berkeley professor Stephen Hinshaw, PhD, is an expert on stigma and mental health who has written extensively about the field of mental health stigma and strategies to overcome it.

Do we have stigma about mental health issues at UCSF? We do, and we need to fight that together. As an example, during the onset of COVID-19 the CDC reported that 40% of U.S adults reported struggling with mental health or substance use. These statistics included a rise in those who had considered suicide, most prominently among respondents who were ages 18-24 (25.5%) and essential health workers (21.7%), but people thought they were the only ones and were fearful or ashamed of sharing their struggles. This also led to barriers to seeking help.

The seriousness of this issue was brought to light by the tragic story of Lorna Breen, MD, head of the emergency department at New York-Presbyterian Allen Hospital, who died by suicide on April 26, 2020. After a few short weeks working around the clock treating incredibly sick COVID-19 patients, watching many die, and contracting the virus herself, this exemplary physician with no prior history of mental illness experienced a mental health crisis. Her sister wrote, “And when she became so overworked and despondent that she was unable to move, her biggest fear? Her job.”

Another example that was particularly magnified in 2020 was the xenophobia and violence toward people of Asian descent, because of some attaching a location and/or ethnicity to COVID-19. This act of prejudice led to hate crimes and other acts of discrimination against those perceived to be Asian. To help combat this phenomenon, UCSF's Thu T. Nguyen, ScD, MSPH, created a video detailing how being sensitive to the language we use can reduce prejudice and discrimination.

Today, many in health care worry that they will be seen as weak, ostracized or put their careers at stake if they break the silence. However, with the ongoing uncertainty and exhaustion associated with the residual of illnesses and currently social and political stress factors, the rise of mental illness and substance use disorders can no longer be a quiet epidemic, and we must learn to speak out for ourselves and others.

The Center for Disease Control (CDC) defines substance use as a chronic disease that can be treatable whether it includes alcohol, opioids, tobacco, etc. According to the National Institute on Drug Abuse, “there are many reasons as to why a person may be susceptible to substance use disorder, including genetic and social factors that may be beyond a person’s control.” There are also many emotions, such as anger and fear, that may arise when seeking help, helping an individual, and/or seeing an individual go through the disease.

Alisa Duran, MD, the chief of women’s health and associate chief of faculty affairs in primary care at the Minneapolis VA Health Care Center, shared her struggle with alcoholism while working in health care in a recent Washington Post article. Her story highlights how important speaking about addiction and mental health can be, and how shame can prevent us from seeking help. Understanding substance use disorder as chronic, using empowering language, and addressing forms of discrimination are ways to address stigma against people with substance use.

There are treatment and recovery services available via outpatient counseling, inpatient rehabilitation, behavioral health care and more. Get more information from the CDC.

In the midst of the pandemic, being exposed to COVID-19 led health care workers to be more isolated. In public, they may have been denied access to certain spaces for fear of higher risk of transmission. Friends and coworkers may have avoided them for fear of exposure. In their homes, they may not have been able to easily hug or show affection for their families or in some cases, even live with their loved ones. For many working with COVID-19 patients, it was a time of stress without the usual social support.

UCSF’s Robert Rodriguez, MD, documented the specific stressors, such as social isolation, in emergency room physicians nationally. Contracting COVID-19 led to stigma at work — where coworkers tend to avoid the person who recovered from COVID-19. Now that we have gained more resources to safeguard against contracting COVID-19, we also attend to reducing the burden associated with this stigma.

Before COVID-19, healthcare workers were already experiencing stigma related to stress and burnout. There is an apparent historical stigma related to healthcare workers seeking assistance, whether it is for mental health or substance use.  Working in healthcare it involves emotional stress while caring for sick patients, death, hazardous exposures, long unpredictable hours – causing to miss birthdays, family events, etc., and more.  In order to rise above the stigma, identifying workplace and community support can go a long way for those who feel alone. Receiving care for mental health or substance use is the first step to breaking the stigma.

Stigma is a worldwide phenomenon which affects everyone, and in that way, we can all play a part to reduce its impact. Below are some approaches we can do to reduce stigma, based on National Alliance on Mental Illness:

1. Educate Yourself: Do research, ask questions, listen actively without judgment. Share accurate information about the stigmatized issue, whether it’s mental health, disabilities, or other topics. Knowledge can eliminate myths and misconceptions.

2. Challenge Stereotypes: “See something, say something.” Call out stigma when you see it.

3. Use Inclusive Language: Choose words carefully. Avoid derogatory terms.

4. Support Open Conversations: Create safe spaces for dialogue. Highlight their strengths and contributions.

5. Practice Empathy: Cultivate compassion by trying to understand the challenges faced by those affected.

6. Be a Role Model: Demonstrate acceptance and understanding in your own behavior and language.

By combining these approaches, we can foster a more inclusive and understanding society.