Why is that the case?

Even in the developed world, people with psychiatric disorders are still occasionally called psychos while people with type 2 diabetes don't get called "pancreatos".

Even in successful cases of stigma reduction like epilepsy, stigma did not disappear fully and the reduction that did happen was mostly normalization through prolonged contact and normal generational replacement. Intellectual arguments like "it's just a disorder, like hypertension" barely changed anyone's mind.

43 minutes ago, Otto Kretschmer said:

Why is that the case?

Even in the developed world, people with psychiatric disorders are still occasionally called psychos while people with type 2 diabetes don't get called "pancreatos".

Even in successful cases of stigma reduction like epilepsy, stigma did not disappear fully and the reduction that did happen was mostly normalization through prolonged contact and normal generational replacement. Intellectual arguments like "it's just a disorder, like hypertension" barely changed anyone's mind.

I think people are often fearful of those with mental illness because some varieties of it can make their responses to communication unpredictable and hard to react to in a constructive way. The term "psycho" refers to a psychotic individual, that is, one who has lost contact with reality and reason to a significant degree, perhaps with delusions or hallucinations and so forth. This is quite upsetting to encounter and deal with. How are you supposed to respond if a person tells you there are voices in his head, telling him men in black are out to get him? Whereas with a physically ill person one can at least carry on a normal conversation, because they retain their reason.

There are plenty of mental afflictions that don't lead to psychotic behaviour of course, but I suspect one reason for the stigma is that people who don't know details of a person's condition may fear this is what they may encounter.

What Ex said. I had a job for a while that involved helping people with behavioral problems connect with their community so I was aware of the stigmatization. Humans tend to think of the mind as the soul, the body as the container - so physical disabilities or ailments aren't seen as reflecting on the inner person. If the perception is that someone's mind is clouded or unhinged, then this ancient programming kicks in and can lead to fearing and devaluing the person. People are more aware now, fortunately, that many mental conditions are a result of physical trauma or pathology snd there is a person much like themselves still in there trying to cope and get past some neurological damage. And this is much easier if more people are made aware, and not shunning people with mental problems.

And there are people, a small minority, who seem to be psychopathic from an early age, and the stigma will remain because they are truly different and are capable of great harm to others. In my work, I met one such person, and it was quite difficult - I would feel a chill of fear in their presence, some deep instinct to get away ASAP. I recall meeting a friend a short time later and she asked me why my hands were cold. I am unsure if medicine can ever heal someone who is so broken in that way, but I would like to think it's possible.

@exchemist @TheVat:

Thanks for answers. I am myself of the opinion that this stigma will only disappear when psychiatry gets advanced enough that all or nearly all cases - including severe ones - get caught in childhood or adolescence and treated so successfully that the people in question never experience symptoms after that.

But that will not happen probably for the next 15-20 or even 25 years, neuroscience simply isn't advanced enough yet.

Edited Monday at 05:27 PM2 days by Otto Kretschmer

12 minutes ago, Otto Kretschmer said:

@exchemist @TheVat:

Thanks for answers. I am myself of the opinion that this stigma will only disappear when psychiatry gets advanced enough that all or nearly all cases - including severe ones - get caught in childhood or early adolescence and treated so successfully that the people in question never experience symptoms after that.

But that will not happen probably for the next 15-20 or even 25 years, neuroscience simply isn't advanced enough yet.

Well it may never actually disappear completely, but there are plenty of signs already that mental illness is far better understood by the public than it was 30 years ago. For example what used to be called "manic depressives" are now known as bipolar and a person with a bipolar diagnosis is no longer someone most people are frightened of, as it's not uncommon, not threatening and doesn't involve significant loss of reason by the sufferer. Same with clinical depression, which is very common indeed, and with people on the autism spectrum. And then there are things like ADHD and OCD which are common talking points in normal conversation about people in one's social circle. Again, 30 years ago it was not like this. People are getting slowly educated about the range of conditions and that fact that most are not threatening or unduly disturbing.

As with all things mental, people mistakenly believe that you can simply stop thinking and acting that way, whereas with physical ailments you have no choice but to be disabled.
Nobody expects a cripple to stand up and walk, but a lot of people do expect mentally distressed people to think and act 'normally'.
Maybe, one of these days, we'll realize that their 'computer', which controls their body, is malfunctioning, and it is also a physical ailment over which they have no control.

I guess on a simple level a physical illness is visible to others in many cases, whereas a mental illness can be hidden and can manifest itself in different ways.

But as @MigL said, we will hopefully realise that mental illness is due to the brain and is therefore also physical.

Paul

I don't think that the assumption in OP is universally true. Ignoring the divide between mental and physical for now, there are a lot of conditions that stigmatized. Infectious diseases are one, where certain types, especially STIs carry a huge stigma.

And likewise, there mental disorders of varying degrees and some have been very much normalized, sometimes to very weird degrees.

8 hours ago, CharonY said:

I don't think that the assumption in OP is universally true. Ignoring the divide between mental and physical for now, there are a lot of conditions that stigmatized. Infectious diseases are one, where certain types, especially STIs carry a huge stigma.

And likewise, there mental disorders of varying degrees and some have been very much normalized, sometimes to very weird degrees.

It's not universally true but it's true to a significant degree. There is normalization of mental health problems in US/Europe but IIRC it's mostly present among urban, educated populations and applies mostly to depression/anxiety - mental health issues involving aggression, unpredictability and/or odd behavior are still heavily stigmatized. Outside of the west it's even worse.

7 hours ago, Otto Kretschmer said:

There is normalization of mental health problems in US/Europe

I asked my wife about this. She's currently working with a number of patients diagnosed with Borderline Personality Disorder:

Onset of symptoms can be triggered by events others perceive as normal,^[14] with the disorder typically manifesting in early adulthood and persisting across diverse contexts.^[7] BPD is often comorbid with substance use disorders,^[19][20] depressive disorders, and eating disorders.^[14] Studies estimate up to 10 percent of people with BPD die by suicide, a rate approximately 730 times greater than the general population in the United States.^[21][22] BPD faces significant stigmatization in media portrayals and the psychiatric field, leading to underdiagnosis and insufficient treatment.^[23][24]

Clearly, Wikipedia isn't the last word in this field, but by all accounts, this is an extraordinarily difficult condition to manage.

The stigmatization of BPD is likely to be a result of several characteristics of the BPD syndrome. [... Pejorative] terms such as "difficult," "treatment resistant," "manipulative," "demanding," and "attention seeking" [are used to describe such individuals. This] can have an impact upon the treater's a priori expectations. [... Such] stigmatization is likely to be a result of several [behaviour characteristics of individuals with BPD, and the fact that] psychotherapy with [them] may involve disturbing and frightening behavior, including intense anger, chronic suicidal ideation, self-injury, and suicide attempts. [... Clinicians, under the stigma, may] see lower levels of [their patient's] functioning as deliberate and within [ones] control, or as manipulation, or as a rejection of help, [and may therefore respond] in unintentially damaging ways, [possibly by withdrawing] physically and emotionally. [...] It has been found that when one person has negative expectations of another, the former changes his or her behavior toward the latter. These interpersonal situations have been described as self-fulfilling prophecies.

Physical ailments are often more obvious; you can e.g. see that someone has a broken arm. It’s obvious that it’s being treated (cast and sling) and it’s common enough we know there’s a timetable to recovery to near normal. We also have common experience with that kind of injury, or something less serious like a sprain, or can at least imagine what it would be like to spend time without use of an arm, or be hobbled in some way.

I think mental issues are much more opaque. We’re less likely to have the experience in common, harder to imagine what it’s like, and the path to getting better is much less clear.

We also have the social conditioning of “toughing things out” which we do for minor physical issue (no pain, no gain) so I think less-than-optimal mental health is seen as a character flaw, i.e. weakness, rather than something being broken. You wouldn’t make that same association with a physical injury.

24 minutes ago, swansont said:

Physical ailments are often more obvious; you can e.g. see that someone has a broken arm. It’s obvious that it’s being treated (cast and sling) and it’s common enough we know there’s a timetable to recovery to near normal. We also have common experience with that kind of injury, or something less serious like a sprain, or can at least imagine what it would be like to spend time without use of an arm, or be hobbled in some way.

I will note that in cases where it is clear that the ailment does not heal (e.g. visible lesions, damages that impact physical movement, e.g. cerebral palsy) also carries social stigma. Obesity is also an interesting condition in that regard. It is considered lifestyle-associated and can be associated with moral judgement. At the same time, it has become so common in many societies that to some degree it is also normalized in part. Substance use disorders are similar, they are behavioral conditions, and have a heavy stigma (and as bonus, they can also exacerbate mental health conditions).

Perhaps it is neither here nor there, but one definition of stigma is a visible indicator of disease, though perhaps not what OP has in mind.

On the other side of the spectrum there are invisible conditions, like chronic pain, or autoimmune diseases. While the condition itself might not be stigmatized, individuals are frequently suffering from disbelief, i.e. folks think that their condition is not that bad, or they are just making things up to get out of work.

And when it come to all of these conditions, there are degrees and on the extreme end I am fairly sure most have some sort of stigma or something similar to it. I suspect one can quibble about the precise definition of stigma, but, say, having a deadly infectious disease gets you isolated from any direct human contact quite literally.

51 minutes ago, CharonY said:

I will note that in cases where it is clear that the ailment does not heal (e.g. visible lesions, damages that impact physical movement, e.g. cerebral palsy) also carries social stigma. Obesity is also an interesting condition in that regard. It is considered lifestyle-associated and can be associated with moral judgement. At the same time, it has become so common in many societies that to some degree it is also normalized in part. Substance use disorders are similar, they are behavioral conditions, and have a heavy stigma (and as bonus, they can also exacerbate mental health conditions).

In addition to addictive behavior, some will look at some ailments as being deserved (e.g. lung cancer for smokers, or injury after reckless behavior) and garner less sympathy than for other physical problems

On the other side of the spectrum there are invisible conditions, like chronic pain, or autoimmune diseases. While the condition itself might not be stigmatized, individuals are frequently suffering from disbelief, i.e. folks think that their condition is not that bad, or they are just making things up to get out of work.

There’s also a history of gender and race biases associated with this. But overall there’s a lack of empathy.

35 minutes ago, swansont said:

There’s also a history of gender and race biases associated with this. But overall there’s a lack of empathy.

That for sure. Plus moral judgement.

11 hours ago, swansont said:

But overall there’s a lack of empathy.

This response sums it up nicely. +1

When we see someone with a physical disability, we see the problem and feel sympathy for the victim of this accident of nature or luck. But when we meet a person with a mental disability, we do not see the problem, we do not feel sympathy -- we feel fear. We see someone who is not responding to people, or the situation, as they should; and we have no idea of how they will act, what they will say, or what they will do. This unpredictability frightens us, so fear is the predominant reaction (as has also been mentioned by some of the other members above). Then, of course, we have movies like, Psycho, and news headlines that exaggerate the danger this person may impose on us. The truth is that mentally disabled people are more dangerous to themselves, than they are to us. We are much more likely to be attacked by a perfectly rational mean person, who is pissed off, than we are in danger from a psychotic person -- as they usually hurt themselves.

Many years ago, I stopped at the bank on my way home from work, and as I entered the lobby, I saw a man, who was obviously upset, and he was shouting about a bus. The bank employees that surrounded him were telling him that he had to leave. After I finished my business with the teller, I was walking back through the lobby and realized the situation had escalated. Now the bank employees were threatening to call the police, the man was close to hysterics and still complaining about the bus, and I realized a few things. 1. There was a bus stop right in front of the bank. 2. This man had mental disabilities. 3. If the bus did not come on schedule, this man had no ability to adjust and find an alternate way home. 4. The bank employees demands were useless, because this man had no idea of where to go to get home -- and the bank employees could see this, but didn't care. When I asked, the bank employees told me that I was putting myself in danger and should wait for the police. I ignored them.

I walked up to the man and asked how far he lived. He told me where home was (about a mile) but he gets lost if he tries to walk it. I told him that I had a car and could take him home. He was so relieved, and thanked me profusely. He even tried to pay me, but I told him it was on my way so there was no cost and I would enjoy the company. When I got him home, he smiled like it was Christmas morning and thanked me again.

I wonder how many people have criminal arrest records for things like disturbing the peace, simply because other people are afraid of them. If you meet someone like this, try to remember that he may not be able to respond well to you, but you can listen and respond to him. Tell him to look around, there are no men in black, zombies, etc., in the room. He is safe. Always let him know that he is safe.

Gee

Add to this that the last 40 years have not exactly been a glorious march forward for psychiatry.

SSRIs, the 1st line treatment for depression/anxiety were introduced in 1987 - literally the year Amiga 500 was introduced. Then there were 15 years of nothing but me-too SSRIs and SNRIs that weren't any more effective than the original fluoxetine.

The approval of esketamine in 2023 was the 1st approval of a psychiatric drug with a novel mechanism of action in 19 years, the previous one had been buspirone in 2004. Bupropion has been around since the 1970s, benzos since the 1960s, dopamine d2 receptor blocking schizophrenia drugs - since the 1950s (an 18 y.o treated for schizophrenia today receives a drug almost identical to what their great grandparent would have received).

It occurs to me that while we (as a society) often stigmatize chronic mental issues, we tend to understand acute ones, the ones we have experience with or can imagine, such as a break-up in a relationship, being cheated on, loss of a loved one, etc. We know such things have a cause and generally fade in time. But everybody reacts to such things in their own way, and I think people have a harder time anticipating/understanding some reactions since it’s not how they would cope.

4 hours ago, Otto Kretschmer said:

Add to this that the last 40 years have not exactly been a glorious march forward for psychiatry.

SSRIs, the 1st line treatment for depression/anxiety were introduced in 1987 - literally the year Amiga 500 was introduced. Then there were 15 years of nothing but me-too SSRIs and SNRIs that weren't any more effective than the original fluoxetine.

The approval of esketamine in 2023 was the 1st approval of a psychiatric drug with a novel mechanism of action in 19 years, the previous one had been buspirone in 2004. Bupropion has been around since the 1970s, benzos since the 1960s, dopamine d2 receptor blocking schizophrenia drugs - since the 1950s (an 18 y.o treated for schizophrenia today receives a drug almost identical to what their great grandparent would have received).

The fundamental problem is, the conflation of excuse and reason; we can see a reason for the excuse (a broken leg/spine etc) but we can't see the reason for the, so called, excuse bc it's not fair, I work hard so why can't they???

There was a recent article in The Telegraph headlined “How having a disability became cool” with the subheadline “Young women, nicknamed 'sickfluencers', are turning chronic illness into a lifestyle trend and entrenching a culture of economic inactivity”

It required an account to read so I didn’t get past that point, but “entrenching a culture of economic inactivity” paints a position of treating a chronic condition as laziness, though I’m not sure if economic inactivity points to not working or not doing our “duty” as consumers

29 minutes ago, swansont said:

There was a recent article in The Telegraph headlined “How having a disability became cool” with the subheadline “Young women, nicknamed 'sickfluencers', are turning chronic illness into a lifestyle trend and entrenching a culture of economic inactivity”

It required an account to read so I didn’t get past that point,

https://archive.ph/2026.09.06-034031/https://www.telegraph.co.uk/news/2026/09/05/disability-became-cool/

Perhaps you’ve seen it on a news segment on television about a transgender rights march, where every other attendee appears to be supported by a walking stick. Or perhaps you’ve heard about it in your family WhatsApp group, when your sister tells you about your seemingly healthy niece’s new condition. If you still haven’t noticed it, your daughter surely can’t have escaped the bravely smiling young women on Instagram, their profiles decked out in acronyms.

POTS. ME. CF. ADHD. MDD. GAD. PMDD. EDS. FND. For a steadily growing group of British young women, these acronyms – and the conditions they represent – are fundamental to their lives. The country is sicker than it’s ever been before, and it’s not afraid of shouting about it. Disability is changing. To many, it is no longer an adversity to overcome, but a social identity akin to one’s sexuality, gender, or race; an immutable reality to be celebrated by the subject and accommodated by the rest of us.

One in four British people is now disabled, according to the Department for Work and Pensions’ Family Resources Survey. To put this figure in context, this is a higher rate of disability than witnessed in the immediate aftermath of the Second World War. The growth in those identifying as disabled does not reflect a sudden, shocking increase in the number of paraplegics. The twin driving factors are, instead: mental health disorders and chronic conditions. They can be hard to “prove” and harder to effectively treat, and are more likely to be experienced by young women.

A cohort of young people – somewhat cruelly dubbed “sickfluencers” – want to tell you about their conditions and convince you they are real. Like the rest of my generation, they broadcast their struggles to an online community of like-minded individuals. But, were they not decked out in the accessories of their disease, it would be impossible to perceive the conditions they consider to be so central to their interaction with the world....

3 hours ago, TheVat said:

https://archive.ph/2026.09.06-034031/https://www.telegraph.co.uk/news/2026/09/05/disability-became-cool/

Perhaps you’ve seen it on a news segment on television about a transgender rights march, where every other attendee appears to be supported by a walking stick. Or perhaps you’ve heard about it in your family WhatsApp group, when your sister tells you about your seemingly healthy niece’s new condition. If you still haven’t noticed it, your daughter surely can’t have escaped the bravely smiling young women on Instagram, their profiles decked out in acronyms.

POTS. ME. CF. ADHD. MDD. GAD. PMDD. EDS. FND. For a steadily growing group of British young women, these acronyms – and the conditions they represent – are fundamental to their lives. The country is sicker than it’s ever been before, and it’s not afraid of shouting about it. Disability is changing. To many, it is no longer an adversity to overcome, but a social identity akin to one’s sexuality, gender, or race; an immutable reality to be celebrated by the subject and accommodated by the rest of us.

One in four British people is now disabled, according to the Department for Work and Pensions’ Family Resources Survey. To put this figure in context, this is a higher rate of disability than witnessed in the immediate aftermath of the Second World War. The growth in those identifying as disabled does not reflect a sudden, shocking increase in the number of paraplegics. The twin driving factors are, instead: mental health disorders and chronic conditions. They can be hard to “prove” and harder to effectively treat, and are more likely to be experienced by young women.

A cohort of young people – somewhat cruelly dubbed “sickfluencers” – want to tell you about their conditions and convince you they are real. Like the rest of my generation, they broadcast their struggles to an online community of like-minded individuals. But, were they not decked out in the accessories of their disease, it would be impossible to perceive the conditions they consider to be so central to their interaction with the world....

Thanks.

“an immutable reality to be celebrated by the subject and accommodated by the rest of us” seems a tad condescending, and reflects a common attitude, complaining about these people not being invisible, and forcing everyone else to treat them with dignity and respect their rights, because that’s such a burden.

1 hour ago, swansont said:

Thanks.

“an immutable reality to be celebrated by the subject and accommodated by the rest of us” seems a tad condescending, and reflects a common attitude, complaining about these people not being invisible, and forcing everyone else to treat them with dignity and respect their rights, because that’s such a burden.

Unfortunately the writer turns to a rather sneering tone as the article continues. The section on Pots, postural orthostatic tachycardia syndrome, seems determined to paint sufferers as potential dupes of the "sickfluencers," and contented to take to their chic sickbeds for life with (it is implied) possibly psychosomatic symptoms arising from undue focus on the ordinary sensations of being sedentary and out of shape. The whole article seems relevant to the thread topic in terms of stigma being applied to newly defined ailments and the writer seeking experts who lean towards interpretations like "hyper-awareness of physical symptoms like fatigue and a racing heart” rather than genuine pathology. That expert goes on to say that patients are determined to find a diagnosis that validates a syndrome...

Often though, she says, it is more likely that factors such as “a lack of sleep and exercise and a poor diet” are causing the patient’s symptoms, and these can be resolved with minimal medical intervention.

Some women, however, do not accept such a verdict. Invariably, these individuals have already decided they have a certain condition before they see a doctor, and if the GP refuses to validate their beliefs, they “seek out a private specialist and get a diagnosis of an unusual condition,” says Musgrave.

I mean, there could be patients who are hypochondriacs shopping around for an illness, but I feel the writer is pretty one-sided on the verdict we should be reaching about various conditions.

Edited 2 hours ago2 hr by TheVat
Fat thumbs that don't type for shit