Social experiences and stigma

Stigma refers to the negative attitudes and beliefs that motivate people to fear, reject, avoid, and discriminate against people with mental health conditions. Stigmatisation of mental health conditions remains extremely widespread and is experienced by many people with mental health problems. People we talked with felt that regardless of numerous public awareness campaigns in Australia in recent years, stigma related to depression and other mental health conditions is still commonly experienced. Stigma can lead people to avoid living, socialising, working with or employing people with mental health conditions – especially those towards the more severe end of the spectrum.

Artauds view was that mental health conditions should be disclosed at the workplace. However,…

Age at interview 43

Gender Male

Age at diagnosis 20

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Well, you know, mental illness you need, you know, I need to take days. Like there are times when I’m just not well enough to come to work. You need a work, you need to – I think you need to disclose. I think it’s fair on the place. But they have the responsibility then to take that knowledge and treat that knowledge with respect.

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Many people talked about the impact of stigma on their lives and how it contributed to their sense of low self-esteem, isolation and feelings of hopelessness. Responding to stigma, people with mental health conditions tend to internalise public attitudes. They often felt embarrassed to discuss their symptoms and sometimes avoided seeking treatment. People told us about hiding their depression from their employers and being ‘genuinely afraid of other people knowing’. They were concerned of being diminished in the eyes of others, being seen as professionally incompetent, and losing out on career advancement opportunities.

Jack talked about his experiences of stigma related to depression.

Age at interview 71

Gender Male

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Going back to the sixties, can you remember what you knew about depression or mental illness at the time?

Not a thing, not a thing. Except there was a stigma. That’s what I was talking about before, shame with older people. Ah, back then if anybody said you had a breakdown, oh, you were a mental case. You, you should be locked up.

But ah, it’s, the sixties, it was definitely – it was like getting pregnant, having a, a child, being a single mother. I can remember that my first wife had a friend who did this and she just braved right through it. And God, I admired her. And she brought up her child on her own, and any, without any help whatsoever. Oh, she one tough girl, really admired her. But the stigma of mental, mental disorder was worse than getting pregnant. I mean, my God, you’re, you’re, you’re mentally ill. And that stigma is like a big stain on your copybook, if you want to say.

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Some people decided not to discuss their mental health. They were hurt when those who knew about it did not consider it a serious health problem. A few professional men in high-status professional roles decided not to disclose it because they were concerned about being ‘ridiculed or pitied or pastored’. Some were reluctant to discuss it at all while others chose carefully whom they told. Most people decided to share their condition only with selected family members, partners or a few trusted friends, without disclosing it to others in their social circle.

Phil talked about his need to carefully select whom to tell about his depression.

Age at interview 52

Gender Male

Age at diagnosis 37

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And in (organisation name) they’re not really called – we don’t really classify them as, you know, as mental illnesses. We – we may call then, maladjustments or inadequacies.

You know, so, it just takes that, sort of that label and that tag off it, you know?

Have you ever experienced any, sort of stigma or discrimination from people because of your depression?

No, you’ve got to be careful with it, you know, you sort of – there’s a lot of people that don’t understand, so I wouldn’t be flashing it around in front of a potential employer.

It would be – it wouldn’t be – work in your best interest [laughs].
But yeah even friends and stuff like that, you know, they don’t really need to know some of them – a lot of people don’t understand, you know.

And then, you know sort of, when things start, you know, getting a bit, sort of – with friends maybe things start getting a bit, not so friendly that it could be used against you, you know.

So, it’s nice to be honest and it’s nice to be, you know sort of, yeah, but also, you know, you need to, sort of, look after yourself first.

And so, you know, for me I, sort of, am very, you know sort of, careful as to who I, sort of, give out that information to. You know, you do it, sort of, if I think it’s going to be helpful in a situation or, you know if it’s family.

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By contrast, some people found it helpful to talk openly about their depression. They believed that being open contributed to destigmatisation of depression and helped others with similar problems to acknowledge this and seek appropriate help. A few people perceived a positive change in social attitudes to mental health and increased awareness of depression. However, stigma associated with depression persisted, including with the word ‘depression’. Some suggested that renaming depression or normalising emotional distress, which is frequently experienced by new mothers for example, might help in destigmatising the condition.

Emma found receiving a diagnosis beneficial and talked openly about her perinatal depression.

Age at interview 33

Gender Female

Age at diagnosis 32

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Oh yeah, about my PND – I don’t know if everyone experiences it differently but I, from the day of diagnosis I’ve been extremely open to tell absolutely anyone. And I remember getting my legs waxed and I was, the lady said how are you? And I said, not so good, I’ve got postnatal depression. And I thought, I’m one of those nutters who tells way too much about their life and I know I was only doing it for myself because, you know, the trouble shared is trouble halved and I felt much better about it.

But I also thought at that time I felt like a real, I needed to get out and tell people that this happens to normal people who are generally very happy. Because I felt, gosh if it can happen to me it can happen to anybody out there. Because I’d never, ever – I hardly ever, ever cried, do you know? It was a total change of life for me. So I remember telling all the playgroup girls and, and since then in actually discussing it with a few people, quite a few people have gone forward and said, you know, I think I’ve actually had, I had postnatal depression when I had my children. And I found, and I also want to cry for them because they’ve suffered for, I know a friend she suffered for 13 months and she’s sure it sounds exactly the same postnatal depression and that was her third child. And I just don’t know how she went through it.

I, once I had the label and I got over the shock of it, it was a stepping stone to, to recovery. But I guess for some people to be told they’ve got it makes more reality for them and that can be quite scary, I guess. Because then you have to admit it. You can no longer deny that you’ve got it. And the stigma associated with mental health issues as well, eh, you feel like a basket case.

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Jane discussed treating perinatal emotional distress as a normal part of having children, as a…

Age at interview 39

Gender Female

Age at diagnosis 29

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I don’t think anything could have been done. I mean, I think this is one of the problems I think with postnatal depression, especially in women that have been successful. I don’t mean successful as in other people think you’re successful. You’ve been successful because you think you’re successful. So in highly competent strong women who’ve always done what they wanted to do, no matter what that is, and I wouldn’t think it would make any difference what walk of life you came from, to me this feels and sounds like an attitudinal thing. If that competence and control is being undermined I don’t know how you get them – I don’t, I don’t know that anyone could have got me to admit except after a very long period of really trying hard.

Because I then tried with – well, I mean, I have tried with people that I could see my – similarities with my experience, and they wouldn’t admit it, and they wouldn’t admit it til a very long time afterwards that there was even a problem. And yeah, so I mean, I think that’s an issue. And maybe the only thing that can be done is to normalise is, which is what’s happening is, for a lot of women. A normal part of being a mother is that you have some kind of postnatal experience and the more people talk about it the more normal it is.

Now it mightn’t – it’s not for everybody but if it’s just a normal part of, you know, this could happen to you the same way as you could get stretch marks or you could get tearing, or you – then it’s not such a big deal. So. But I think women won’t call it postnatal depression either, they’ll just call it something else. You know, it’ll be a normal part, a bit down and a bit whatever.

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Troy commented that societal attitudes towards depression were changing, but there was still…

Age at interview 22

Gender Male

Age at diagnosis 21

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Yeah, it’s interesting. I mean I had one of the, one of the girls in my course, she also had depression and I think actually there’s a few that have had it. I think there might be three at least, so me and another girl and another girl. There’s 11 of us in our class so, and I haven’t asked anyone, they’re the ones that have actually, it’s just come up. But I was talking to her how, you know, even still, even like even talking to her in that situation at – like it’s a couple of months ago so I don’t know her that well yet. But, you know, even actually saying the word depression – for me it still does hold a lot of stigma and, and that surprises me when, you know, in general I’ve try, I try to be quite open about it.

But and I do, like I do actually tell people quite a lot still, but there’s still a feeling inside me, I wonder how people will react? So there’s an awareness of it, even if it’s not going to stop me talking about it.

So why is that? What do you think?

Yeah. I mean, I think mental health has that image – fully, and it’s, they’re changing. I think the image is trying to be changed, there’s, but it still certainly does have it, doesn’t it? Ah. I think for me though, I mean the interesting thing is that I always describe something like depression, well at least not necessarily when I describe it. But when I say that word it has the connotations of what I feel are, you know, are biological mechanisms for it. But maybe people in the wider community don’t have that perception so then that it’s, you know, it’s all in their head or, you know, that kind of cliché.

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A few people talked about the importance of attitudes towards depression at their workplace. Colleagues’ reactions were a major factor shaping whether or not people felt stigmatised. Some people experienced positive and supportive attitudes, while others felt judged.

Belinda talked about the benefits of her work colleagues generous support.

Age at interview 35

Gender Female

Age at diagnosis 25

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So there was a lot of very unhelpful sort of behaviour then, and, but when I started work at a in a you know (place of employment) out in the (location) where I worked, my managers, I had two really great ones, and I was just so sort of upset I think about what was going on for me. It was a little bit of a shock for me as well to be told you have depression. You know I did think it was stigmatising at that time when I was first time, and I told them you know, and they, and they said to me and this is probably why I don’t think it any more, they said to me that’s cool, so do I, you know. That’s fine. So, it’s not a big deal. it’s okay. so you have it. Okay. This is what I do, you know, and they told me some good things and some bad things, but (laughs) you know but they were really great about it.

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Chloe compared two workplaces, one unsupportive and homophobic and the other supportive and how these opposite attitudes made a difference to the way she felt about herself.

Age at interview 25

Gender Female

Age at diagnosis 19

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There’s a lot [laughs] I could add to my story. I wouldn’t mind mentioning mental health in the workplace. That’s. In my, when I got my first full time job, it was in like a big kind of corporate office. And I had really bad anxiety and depression but and I came out to my workplace as being gay, like because I had a partner and obviously they’d just find out. And then there was a bit of homophobia afterwards unfortunately and then I was already anxious and that made me extr like even more anxious.

And I brought it up with, one of my managers and they responded in a really bad way, which was really unfortunate. And that made me realise that mental health in the workplace is probably – like needs to be addressed.

They were just kind of like, – almost like you shouldn’t bring that to work kind of, you know – we pay you to look happy [laughs] and greet our clients and you know yeah, it was more like that.

So your work environment is clearly markedly different now?

So you feel comfortable talking about yourself and your situation and who you are in this new environment?

Oh definitely yeah. Well I work in a youth homelessness agency. I actually run a support group every week for same sex attracted young people and we always talk about mental health issues, and just. It’s a really great space for them especially considering the majority of them are homeless or like at risk of homelessness. So it’s just a great space for them to connect with other people because they’re, they’re quite isolated. And we always talk about mental health and yeah, mental health in our workplace is just – because our, most of our clients have mental health issues, it’s just, it’s common; it’s day to day basis. It’s yeah, [nods] a really, really great environment to work in.

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Paul had positive experiences following his disclosure of his depression. He thinks that public…

Age at interview 39

Gender Male

Age at diagnosis 29

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I guess I underestimated a lot of people. No one ever, in my whole journey, no one has ever, have I ever heard, oh you know, Paul oh, you know, careful with him, he’s a bit dodgy. Not even in the slightest. it’s only ever been encouraging. You know I think when I finally told some mates, one time I remember a really, really good mate, very, very hard man. You know ah man’s man, loves a beer and then bites the top off the stubby at the end, you know. And the bloke you want when you’re in the police force and in a bit of, in a bit of trouble.

And he came to hospital to see me and he walked in the room and he was already crying before he got in the room. And put his arms around me and just hugged me so tight. And he’s probably one of the people that I feared judgement the most and oh he just yeah, it just broke me up. And was, you know, has always been very supportive

So yeah look, it, it’s all right. My life’s moving forward. I think, as I said just somewhere recently, I said you know, I’m certainly not where I would have pictured myself or I wanted myself to be. You know I can’t even get a home loan. They won’t give me a home loan. They don’t recognise the pension as an income. Yeah and, and the pension is quite a bit higher than the average wage but they won’t give me a home loan so ah yeah, a bit frustrating. There’s, you know, I know that a lot of things in the community are changing and a lot of them the awareness is getting better. But it hurts that.

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A few people compared their experiences with reactions to physical illness and to depression. There was a general view that people were more sympathetic to physical illness than to depression. Comodor commented that physical illness was obvious, but ‘depression’s different, that’s mental. I don’t think that’s something you spread around’.

Artaud described his experiences of being stigmatised for his mental health condition during his…

Age at interview 43

Gender Male

Age at diagnosis 20

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I was teased very badly, very badly to the point where when I got to 18 I actually tried to overdose. So the teasing was, it was really bad and I and I’m still, it’s only since I just got into a new relationship with my new partner that I’ve been able to actually let that go. You know it was terrible. They used to call me the mongoloid that got escaped, escaped from the abortion bucket so it was pretty awful stuff. And looking back on it now like I’d go, Well who gives a shit?’ But at the time it was, at the time it was really quite traumatic.

I mean I, one of the great things I found out about university was if people didn’t like you they just left you alone. So you know, at school people didn’t like you they, they sort of suggested quite strongly that they didn’t like you.

But so at university they weren’t very good on mental health but again I was a bit immature and I pushed them and really, you know. I actually took them to the internal Equal Opportunity because they weren’t, you know, they were letting people in classes who were meant to be social workers talk about psychos. And they – I remember one woman saying I want to be honest, I’m scared of the mentally ill and you know. Even though, you know, looking back on it now I think, oh it doesn’t matter, but at the time I was very upset by that kind of stigma.

You know I was talking to my partner and she’s got terribly bad wrists and she was talking about the stigma of disability. And I said, look [partner’s name] I know you’ve got disability because your wrists are all smashed but there’s no stigma with that disability.

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Sara talked about her depression and about her experience of working with young people with…

Age at interview 55

Gender Female

Age at diagnosis 43

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Oh I think there’s an enormous amount of stigma. I work with predominantly young people. There is a huge amount of stigma with having any sort of depression or any sort of mental illness or any sort of psychological stress still, for all the talking, for all the understanding, all the things we have, you know, it’s still, I think, in lots of people’s backgrounds, that sense of some sort of personal failing, that they should be able to get over in terms of managing their, their illness.

Interestingly, I think with a lot of young people it’s also, they also have that approach to their physical health. So if you get diagnosed with a juvenile diabetes, often it’s not dissimilar. But it’s even more complicated with mental health.

I think there’s a real stigma in health care professionals about mental health. And that might just be, and that’s not something I’ve experienced but it is still a concern that I have. And I would be far quicker to tell people about my, about cancer than I would about the depression. Because I don’t know that there is – and that’s even amongst people who are health care professionals. [Laughs] You know, I think there is still attitudes associated with mental health that, that aren’t necessarily that helpful.

I think complex depression and treatment-resistant depression is a nightmare to treat. it’s a nightmare to try and live with. it’s a nightmare to sustain your level of hope if you have somebody, you know, a friend or a colleague who has it, that things will be different and things will change. I think it’s so difficult.

It asks enormous amounts of us as human beings and a capacity of, of understanding and empathy that I don’t think most of us have most of the time. It takes too long and we now live in a world where we need quick fixes and we need it done neatly and quickly and all the rest of it. And it’s quite fascinating ’cause we don’t get that in physical disease either. But somehow we feel a bit more tolerant of that.

Perhaps we can see it. I think there’s still that perception underpinning a lot of this stuff, that if people really, with depression, if they really wanted to get better they could. For all the education, you know, perhaps it needs more, more statements like that from people who’ve had depression.

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Debra linked perceived stigma in relation to depression to her decision to marry her ex-partner, as well as her sense of being seen as a failed mother. Speaking about her ex-husband, she explained that: ‘because I’d gone through the panic attack stages with him, I felt that nobody else would ever ask me to marry them again as a person with a mental illness’. After they divorced, Debra’s distress became more severe and she had to give up custody of her children and let them live with their father. Despite this being in her children’s best interest and despite her staying in contact with them and supporting them financially, Debra felt that social norms associated with motherhood meant she was seen as a failure by some members of her social circle.

Debra felt judged because of her depression and that she was seen as a bad mother.

Age at interview 43

Gender Female

Age at diagnosis 34

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The main thing was the fact that the kids went to their father that was the, the big, big factor and people judging me for that as well, you know. And when I did the rehabilitation course back into the workforce for people with mental illnesses I even had people judging me doing that. Why is she doing that? You know, she’s, why is she doing that? She gave her kids up, you know, her kids went to their father. Why is she doing that?

And it was like, well hang on a minute. Okay, maybe I had to do that but I’ve done it for the kids’ own good. It hasn’t been an easy decision and I live with it every day of my life and it hurts me every day of my life. But I’ve kept in contact with them, I support them financially. I support them as a mother, even though he moved them three and a half hours away. So there’s another nasty little thing there. But I’ve been in their lives, you know, since that’s happened. But people didn’t think I deserved to have a life because I’ve done that.

Because I, my kids had to go and, and, you know, live with their dad. So a lot of judgement there as well with mental illness. A lot of judgement around the depression. A lot of people can identify with anxiety and high anxiety and stress I guess. But a lot of people can’t identify with you’re that depressed that you feel like you’re sinking to the bottom of a black pit and you will not find your way back up again, you know. But it’s, that’s, yeah.

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A few immigrant women we talked to from African and Asian countries observed that there was no word for ‘depression’ in their first languages. They explained that depression was not a commonly acknowledged mental health condition in their countries of origin, however, there was a clear understanding of severe mental health conditions and these were highly stigmatised. Akello who is from an African background and who was treated for depression in Australia talked about hiding the fact that she was taking antidepressants. She said she had felt stigmatised by some members of her community after she revealed this information. A few other people also told us about concealing taking medication, as they felt ‘there was a great stigma in taking antidepressants’. Safra spoke about social norms of sharing with others only one’s successes in life, and not talking about problems, including mental health conditions.

Akello could not translate ‘depression’ into her own language. She described how people in her African country of origin hide mental health conditions because of fear of stigma, and talked about her friends’ attitudes towards antidepressants.

Age at interview 45

Gender Female

Age at diagnosis 44

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I still don’t know it in my own language. Because depression is a mental illness and when they talk about mental illness nobody wants to identify themselves with mental illness, because mental illness means someone is crazy and of course the crazy people are seen as people who run in the street, they’re half dressed or they’re doing things that are not nice or they’re throwing stones.

There was one particular one who used to walk from one – round the city. He walked – they say he walked day and night – and one day he just collapsed and died.

So those are the sorts of people – they’re dirty, they’re, you know, that’s what – that’s – it’s stigmatised. Mental health is so stigmatised that people who are mad and crazy – and even the mental institutions, no one wants to identify with them because people who are mentally sick and mentally sick is crazy. Yeah, so, it’s not a good thing.

So where did you get – where is all this information – information were coming from?

From my friends. From my friends – mostly my Christian friends. One particular one said to me depression is from the devil and you should reject it, you should refuse it. You know, it’s – don’t take those antidepressants, they’re not good. You know, and I didn’t – I chose not to listen to them. And others who understood said to me one particular one said to me did they put you on antidepressants? I said yes. She said, continue with them and just don’t talk about it with anybody.

So I’ve stopped, I haven’t, I don’t tell many people that I’m on antidepressants and I’m happy with that.

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Safra felt that in Malaysia, her home country, people were expected only to share good things…

Age at interview 56

Gender Female

Age at diagnosis 52

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No. You’re not allowed to. You’re allowed to talk about your success. You’re allowed to talk about how good your children have come out, how many degrees they have got and who has done what. You can talk about all the good things that you as a mother has achieved. And you can talk about how many countries you and your husband have visited, but you do not talk about your problems (laughs).

Why is that?

Because it shows you are a failure. You’ve got to talk about the jewellery you bought. You’ve got to talk about the life you have, but you don’t talk about how lost you are in life.

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In general people were concerned about stigma attached to mental health conditions in Australia. They took great care in choosing whom to disclose their depression to and often tried to hide it from colleagues and particularly superiors in the workplace. They would usually talk to their family members and close friends first, these being the people who would notice behaviour changes and be affected by these changes. However, a few commented that they had noticed some increase in public awareness of depression and expressed hope that this would further reduce stigma related to depression and other mental health conditions.

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