Andrew Devendorf applied to psychology graduate school to advance society’s understanding of depression. From his personal and familial experiences, Devendorf was all too familiar with the crippling nature of the condition and its associated stigma. But his psychology mentors warned him that sharing his experience in his application’s personal statement would increase his risk of rejection, so he left it out.
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Unfortunately, a tragedy struck that made it impossible to avoid talking about the topic. The same week Devendorf was admitted into his graduate program at the University of South Florida, his brother Matt went missing. The search for his brother was extensively covered in the media, leaving Devendorf and his family with much unwanted public exposure. After 6 weeks, Matt was found, and reports confirmed that he had died by suicide.
When Devendorf entered his program 5 months later, he was dealing with grief, depression, and posttraumatic stress disorder. But he masked those difficulties after hearing about the dangers of sharing them. “I didn’t feel comfortable talking about how I was doing,” he said. His fears were later confirmed when he was not awarded a scholarship to study depression and suicide after noting in the application that his brother’s suicide motivated his interest in helping others with these challenges. Behind the scenes, a trusted mentor told him that the committee had rejected his application because they thought his motivation to study these topics was too personal and would somehow bias his research.
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These incidents got him thinking about why this stigma exists and what he could do about it.
“I know a lot of psychologists and trainees who have experienced mental health difficulties, so why aren’t people talking about it?” said Devendorf, now an intern at the VA Puget Sound Health Care System in Seattle. “And if psychologists hold these stigmatizing attitudes, how does that affect the care that we’re providing for our patients and who we’re recruiting and supporting in our field?”
Serious impacts
Devendorf is one of a cadre of psychologists and trainees who are working to address mental health stigma in the field. In academia, this bias manifests in an unwritten code that if you have personal mental health struggles, it can color your work and make you unable to properly carry out your duties or conduct objective research. In turn, psychologists and students with what are sometimes colloquially referred to as “lived experiences” of mental illness may encounter barriers to success without necessarily understanding why: Examples include being turned down for scholarships, awards, promotions, research funding, tenure, or from being admitted to graduate school itself.
This same stigma pervades clinical practice, as well, said Maya Nauphal, a graduate student at Boston University who studies mental health stigma and is doing her internship at Montefiore Medical Center in the Bronx. She notes that clinicians may intentionally or unknowingly use judgmental language such as “treatment-seeking,” “frequent flyers,” “attention-seeking,” or “manipulative,” when discussing patients. Others may express a preference not to work with certain patients, particularly those with personality disorders or serious mental illness.
For psychologists and trainees who have mental health issues or conditions, this generalized stigma means that many simply don’t reveal this aspect of their identity. But concealing it can have harmful effects: Not only can burying key parts of one’s identity result in social isolation, depression, and anxiety (Berkley, R. A., et al., Human Resource Management Review, Vol. 29, No. 3, 2019), but it can lead people to avoid seeking help and support. In turn, failing to practice self-care can spill over into work, creating a vicious cycle, said Stephen P. Hinshaw, PhD, distinguished professor of psychology at the University of California, Berkeley, and author of Mark of Shame: Stigma of Mental Illness and an Agenda for Change (Oxford Academic, 2011) and Another Kind of Madness: A Journey Through the Stigma and Hope of Mental Illness (St. Martin’s Press, 2017). “How do you get the support and treatment you need when doing so might risk your very livelihood?” Hinshaw said.
Why the bias?
On the face of it, it seems ironic that people who enter a field devoted to improving people’s mental health would potentially stigmatize those they work with, treat, and study. Sarah E. Victor, PhD, an assistant professor at Texas Tech University who studies stigma, nonsuicidal self-injury (NSSI), and suicide, believes one reason may be the field’s emphasis on the fact that psychology is a science with an emphasis on quantitative research—a laudable aim for many reasons, but one that may not leave enough room for patients’ or providers’ subjective experiences.
“Clinical psychologists in particular have spent a lot of time trying to emphasize that we’re not just sitting around asking people to talk about their feelings—that we have evidence to back our treatments,” Victor said. “Because of that, there’s a feeling that we have to be objective, and in order to be objective, we have to be at a distance from what we study.”
But research shows that humans are not terribly objective: For example, not only do we all have biases, but we are often unaware of them (Pronin, E., et al., Personality and Social Psychology Bulletin, Vol. 28, No. 3, 2002). “ So, let’s not pretend that some people are not objective because of their experiences [with mental health conditions], while others are,” Victor said.
In addition, people in general don’t like to be judged, and psychologists aren’t immune from that, others commented. A psychological rub-off effect may be operating, too, Hinshaw speculated: If you see that your colleagues are vulnerable, it may make you more aware of your own vulnerability. To avoid acknowledging that, you may project perceived weaknesses and defects onto others. “It’s that kind of dehumanization that I think is at the core of stigma,” he said. In addition, if a colleague shows vulnerability and is judged for it, this may deter others from acknowledging their own vulnerabilities.
There is a further irony at play, as well. According to research headed by Victor, Devendorf, and colleagues, mental health problems are common among psychologists. In an anonymous survey of 1,692 faculty and trainees in clinical, counseling, and school psychology, more than 80% said they had experienced a mental health difficulty at some point in their lives, and nearly half said they’d been diagnosed with a mental health condition, said Victor. What is more, most who said they had experienced mental health difficulties said the difficulties had started before beginning their graduate training, and, for the majority of those diagnosed, the issues were ongoing. In addition, graduate students were more likely to report mental health struggles than faculty were (Perspectives on Psychological Science, Vol. 17, No. 6, 2022).
“I often get asked, how do we increase representation of people with these lived experiences?” said Victor. “Well, we’re already represented!” she said with a chuckle.
Facing the elephant in the field
Given the complexity of the issue and the difficulty in changing paradigms, how can the field increase transparency and inclusion of those with these lived experiences while maintaining scientific, clinical, and ethical integrity? Leaders in the area share these thoughts.
Take steps in your setting. Because there is so much at stake, dealing with stigma on your professional turf is probably more difficult than in any other setting. However, there are effective ways to start facilitating more open communication and eventually more supportive policies, these psychologists said.
In graduate programs, simply talking with colleagues informally is an important first step, Devendorf said. It needs to be ongoing, though: “It’s going to take concerted efforts of talking to students, talking to faculty, and integrating people with their own lived experiences into these efforts,” he said. “Otherwise, we’re just relying on behind-the-scenes mentoring and advice.”
If you’re in a position of authority at your institution, consider adopting strategies and policies that encourage transparency, Victor added. On the first day of her introduction to psychopathology class, for example, she starts by telling students that some in the room will have undoubtedly experienced some of the conditions and difficulties described. “So, when we talk about these conditions,” she tells them, “let’s make sure we think about our language in ways that wouldn’t make us feel embarrassed if we found out our classmate had that condition.”
She also encourages faculty to be transparent in their requirements for personal essays from graduate school applicants. On her website, for example, she spells out that it’s OK for applicants to share or not share, and they won’t be penalized either way.
Seek support. While it remains difficult for many psychologists and trainees to find support for disclosure in their institutions, it’s important to know that such places do exist. Cassie Boness, PhD, a research assistant professor and substance use stigma researcher at the University of New Mexico (UNM) Center on Alcohol, Substance Use, and Addictions, for example, praises the progressive atmosphere at UNM, where faculty welcome research that incorporates lived experience. Similarly, Michaela B. Swee, PhD, a staff psychologist and director of clinical training in the Trauma Continuum of Care at McLean Hospital in Belmont, Massachusetts, said she has appreciated professional spaces where self-disclosure and personal sharing are accepted and encouraged to the extent that individuals feel it is helpful and pertinent to their work. This includes settings like supervision for trainees and consultation meetings for professional peers.
“I have experienced a collection of these settings where self-disclosure feels welcome and safe,” she said. “When colleagues feel safe enough to open up with each other, it can really shift the tone. You start to hear other voices saying, ‘I can relate,’ or, ‘I’ve experienced a similar kind of struggle.’ That can enrich the relationships and trust colleagues have with one another, as well as deepen the work we do with our clients.”
If you can’t find support in your institution, seek it elsewhere, Hinshaw advised. “When you form solidarity with and get support from psychologists in the same situation as you, it’s an antidote to self-stigma,” he said.
Mind your language. In terms of clinical practice, as mentioned, it’s important to discuss patients respectfully with colleagues—not only because it is professional and ethical to do so, but because patients can sense it if you look down on them. Talking in pejorative ways about patients can also build and perpetuate stigma among colleagues, especially if the symptoms you’re maligning are some that your colleagues are hiding. Instead of using judgmental terms when talking about patients, work to use language “that is objective, descriptive, and based in a more compassionate understanding of why people act the way they do,” Nauphal advised.
Address stigma directly with patients. On a related note, think about ways to directly address the issue of stigma with patients, Nauphal suggested. One way could be to judiciously and deliberately use self-disclosure to communicate a sense of shared humanity. For example, you could say that you, too, have struggled with difficult emotions and have found the same therapy skills that you are sharing with them helpful. Another powerful strategy is having open conversations with them about stigma, including assessing their own experience of stigma and working to reduce self-stigma as one of the treatment goals, for example.
Expand your research lens. On the research front, psychologists may be discouraged from conducting so-called “me-search”—research that focuses on a topic they have a personal connection to, such as mental health conditions, race, gender, or sexual orientation. Again, the field appears to hold a double standard in this regard: While the practice is ostensibly frowned upon, 55% of Devendorf’s and Victor’s representative sample of psychologists and trainees said they have conducted such research.
What’s more is there’s no reason such research can’t be rigorous, these psychologists maintained. After all, mental illness is a main topic of study for many psychologists, and any study worth its salt requires many more participants than an N of 1. Moreover, personal experiences with mental health conditions can add a richness and depth to the work and raise research questions that might not otherwise be considered, they said. To name just one example, in the past, the field has held that NSSI is the sole province of women with borderline personality disorder who have serious histories of childhood trauma, said Victor. “But a lot of my friends in high school and a lot of people struggling with self-injury do not fit that description,” she said.
Participatory action research—which includes people with lived experiences as cocreators and not just as participants—is another potential way to help destigmatize mental illness and empower those with different conditions, said Stephen P. Lewis, PhD, a professor of psychology at the University of Guelph in Ontario, Canada, who studies NSSI and is open about his own experiences with the behavior and his own mental health difficulties. Lewis is facilitating a filmmaking project based on participants’ personal experiences with NSSI. The participants are creating the videos themselves and will eventually screen the films with target audiences, hosting question-and-answer sessions at the end to gauge audience reactions. “We see it as a potentially formidable way to address stigma.”
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