The discussion around stigma is multi-faceted and is best understood when broken down on different levels. One angle is to examine how mental health struggles are perceived culturally and how treatment is understood. We then must look at the stigma we impose on ourselves, and how these perceptions are internalized at the individual level. In many cultures those who struggle with mental health issues are viewed as broken, damaged, defected and are encountered with disapproval, disrespect, and rejection. The societal objection can result in the person internalizing those belief systems and feeling ashamed of their symptoms. This then makes it less likely for them to reach out to their loved ones, to look for community resources or seek professional help.
While the spectrum of mental health and substance use issues are fairly indiscriminate, impacting people regardless of race, gender, or ethnicity, we do know that men, in general are less likely to reach out for help. They are less likely to talk about their troubles, and even less likely to reach out for support or seek mental health care. The intergenerational and pancultural stigma around these issues often leads to discrimination and rejection, leaving people who are suffering in loneliness and social isolation. This further perpetuates the downward cycle with an exacerbation of the stressors and distancing the person from valuable resources that promote healing.
When we talk about the stigma of men being open about their mental health concerns and their propensity towards seeking out professional help, we must understand the notion of ‘manhood,’ and the masculinity standards and social expectations associated with this concept. In many cultures, men are expected to be strong, powerful, and dominant. It is socially acceptable for them to express disinhibited impulsivity, aggression, or violence, normalized by the notion that ‘boys will be boys.’ This is often contrasted with an implicit expectation that their need to express emotions will be limited, and any outward display would be considered as a sign of weakness.
Even in the 21st century, we continue to witness children being raised with the notion that ‘boys don’t cry.’ The fact that men die from suicide three to five times more than females, yet females have over double the rates of depression comparatively, speaks volumes to the untreated, and preventable harms of the stigmatization and barriers for males to access mental health care. Substance use rates, along with other unhealthy, risk taking, self-destructive behaviors occur at an increased prevalence in men as well.
These antiquated norms further lead to the worsening of mental health symptoms, increase in substance use, gender stereotyping roles, homophobia, issues with interpersonal relationships, poor self-esteem, increase in stress, increase in psychosomatic symptoms, worsening of physical health conditions, and intimate partner violence.
Redefining manhood in the context of stigma reduction is an extremely important and timely step towards an inclusive and healthier society. As we work towards improving education, promoting stigma reduction campaigns, and shifting cultural norms and belief systems, we must work to reduce barriers to care as well. Educating physicians, mental health providers, teachers, school faculty, and communities as to the damaging consequences of stigma is critical.
Cultural competency is understood at the ethnicity, language, and religious level, and can be expanded to ensure additional marginalized, disadvantaged groups have equal access to judgment free care. Tailored mental health treatment begins with understanding the family system and upbringing the person was raised in, their attachment patterns, and the strength of their social connections.
In addition to elevating the core competencies of current mental health providers, we discuss the clear value in investing in an increasingly diverse range of clinicians, who have lived experience, and come from similar cultural and ethnic backgrounds. The evidence is clear that a sense of familiarity, and genuine empathy significantly improve outcomes of care, adherence rates and patient satisfaction.
Individual, family as well as group therapy for those experiencing similar challenges are also effective in diminishing the power of stigma, while building community. Other initiatives that have shown to improve rates of reaching out for care include own voice campaigns in social media, and podcasts that give platform to important conversations around mental health, cultural norms, and stigma. Including representation of mental health struggles and the healing journey in novels, television shows, and movies is an inspiring and powerful way of normalizing these issues. Public figures, actors, or athletes who openly speak about their struggles and see taking care of one’s self and family as a sign of strength, has also been impactful. Specifically, engaging men in their own advocacy and raising awareness for others like them, can also lead to an increase in funding and support for community level services.
In order to break these stigmas, we have to understand the role of our cultural norms and value systems as they relate to mental well-being. It is important to establish strategies and provide resources to make mental health treatment more accessible for everyone.
About Duygu Balan:
Author and psychotherapist specializing in intergenerational trauma, Duygu Balan, LPCC developed her expertise in intergenerational trauma while working as a clinical counselor in New York City treating patients on society’s margins. A licensed psychotherapist, she is the co-author of Re-Write: A Trauma Workbook of Creative Writing and Recovery in Our New Normal and a contributor to the best-selling medical textbook, Big Book of Emergency Department Psychiatry: A Guide to Patient Centered Operational Improvement. Born in Germany and raised in Istanbul, Duygu’s upbringing provides her with a fresh perspective on how to navigate tension between cultures; adverse childhood experiences; and attachment wounding through hope and resilience. She is based in the San Francisco Bay Area.
Connect with Duygu Balan, LPCC:
Official site: DuyguBalan.com
Instagram: @duygubalan
LinkedIn: www.linkedin.com/in/duygubalan
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This Post is republished on Medium.
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