By Gregg F. Martin, Major General, US Army (Ret.)
I was first diagnosed with mental illness when I was 58 years old — and I decided to own my diagnosis of Bipolar Disorder I (BD) — and its psychotic features — and not succumb to stigma, embarrassment, or shame. I reasoned that if I didn’t own it, then it would own me. I’m still battling my bipolar disorder every day, but my oath as an American soldier strengthened and guided me: “I will always place the mission first. I will never accept defeat. I will never quit.”
Although the U.S. Military’s long-time practice of separating all those with mental health conditions has evolved over recent years, a powerful stigma still exists. It instills fear into servicemembers who should be seeking help, but who end up hiding their condition in shame for fear of being perceived as weak — and of losing their military career.
Doctors Patrick Corrigan and Amy Watson of the University of Chicago write that many “people with mental illness are challenged doubly,” both psychiatrically and socially. When I wrote my book, Bipolar General: My Forever War with Mental Illness, I don’t think I was consciously aware of the fact that this "forever war” actually has two fronts against two distinct enemies. The first enemy is the illness. And the second, much more insidious, foe is stigma.
My Mental Illness Diagnosis
By mid-summer of 2014, I had rocketed to the apex of bipolar mania, a blissful heaven of psychotic delusion. At the time, I was president of the National Defense University in Washington, DC, and a general officer in the most powerful army in the world. My boss — General Martin Dempsey, the highest-ranking officer in the U.S. Military — fired me, retired me early, and ordered me to undergo a psychiatric evaluation. Shortly after that I entered free fall, beginning my descent into bipolar hell: a world of hopeless, crippling depression and terrifying psychosis. I was later hospitalized.
As decisively brutal as my firing was, it was the necessary and right thing to do. General Dempsey may well have saved my life. He was not influenced by stigma, instead he focused on taking care of me and the university.
How Is “Stigma” Defined?
The first recorded use of “stigma” in the English language was in 1590. It meant “a scar left by a hot iron” (Merriam-Webster). The Oxford Languages Dictionary calls one of stigma’s early meanings “a mark of disgrace associated with a particular circumstance, quality or person.”
In the 1960s, Canadian sociologist Erving Goffman defined stigma as the “situation of the individual who is disqualified from full social acceptance.” He went on to add that stigma is an “attribute that is deeply discrediting.”
Luna Greenstein, writing for NAMI (National Alliance on Mental Illness), defines stigma as “a set of negative and often unfair beliefs that a society or group of people have about something.”
Columbia University’s Bruce Link and Jo Phelan, addressing the fact that stigma is “a very persistent problem,” define it as “the co-occurrence of its components: labeling, stereotyping, separation, status loss, and discrimination,” and further indicate that “for stigmatization to occur, power must be exercised.”
Patrick Corrigan and Amy Watson of the University of Chicago break stigma down into two main groups: self-stigma and public stigma. “Public stigma,” they argue, “is the reaction that the general population has to people with mental illness,” while “self-stigma is the prejudice which people with mental illness turn against themselves.”
7 Types of Stigma
According to Gretchen Grappone, Licensed Independent Clinical Social Worker (LICSW), there are seven types of stigma:
- Public: This happens when the public endorses negative stereotypes and prejudices, resulting in discrimination against people with mental health conditions. It leads to low self-esteem, isolation, and hopelessness — and it deters the public from seeking and wanting to pay for care.
- Self-Stigma: This is when people internalize public stigma, turning the prejudice against themselves. Responding to stigma, people with mental health problems internalize public attitudes and become so embarrassed or ashamed that they often conceal symptoms and fail to seek treatment. Self-stigma deters the suffering from seeking help.
- Perceived: This is the belief that others have negative beliefs about people with mental illness, whether or not it’s true.
- Label Avoidance: This may be the most harmful type of stigma, which happens when a person chooses not to seek treatment to avoid being assigned a stigmatizing label. Example: “I can’t go to the doctor because I don’t want people to think I’m crazy.”
- Stigma by Association: This occurs when the effects of stigma are extended to someone linked to a person with mental health challenges. Example: “If they see me with him they’ll think I’m crazy, too.” Stigma spills over into families and communities — resulting in embarrassment, weaker community ties, isolation, less support, and understanding.
- Structural: This is when institutional policies and other social structures decrease opportunities for people with mental health disorders.
- Health Practitioner: This is when a health professional allows stereotypes and prejudices about mental illness to negatively affect a patient’s care.
The Effects of Stigma
Negative perceptions are the most important factor in why treatment rates for mental illness are so low. While disparities in service delivery and inadequate funding may impact treatment rates, stigma can drive people away from the medical system.
Stigma also affects jobs by slamming the door shut on people battling mental illness and making them hide their condition to remain employed.
Many members of the military who experience mental health conditions do not seek medical help out of fear that they will be perceived as weak. Being weak is the opposite of the military culture and ethos, which is to always be strong and tough — physically, emotionally, and mentally. The U.S. Army typifies this attitude with its “Army Strong!” slogan and philosophy.
By capitulating to stigma and the resultant non-action, people battling mental illness are often going down the path of destruction, resulting in ruined marriages, broken families, and careers cut short. It could lead to homelessness, addiction, and incarceration; and even result in violence and suicide.
It’s unfortunate that’s the case, because with medical treatment, the chances of living a happy, healthy, purposeful life are high.
Combatting the Threat of Stigma
Mental illness is just as physiologically real as diabetes, cancer, or heart disease. There is no room for stigma against it. Battling mental illness should be seen as a heroic cause, similar to how women are now battling breast cancer, when 50 years ago, they were also stigmatized, ashamed and embarrassed.
Bruce Link and Jo Phelan state that “for stigmatization to occur, power must be exercised.” This suggests that combating stigma requires active engagement. As any civil rights movement demonstrates, ending stigma is not easy — we need to change how we think and act, from the personal level up to the whole society.
Stigma is its own social disease, and just as Rosa Parks and Dr. Martin Luther King Jr. fought against racism, we too must stand against the negative narrative that frames mental illness. Just as we can overcome ignorance with learning and fear with bravery, we can overcome stigma with knowledge and courage. The fight against it is a social action, a social fight. It means that leaders and organizers are needed to rally the troops around it.
Combatting stigma also requires education, information, and leadership. If you suffer from mental illness, it’s your duty to learn about and understand your condition. Then, you can face it, seek appropriate treatment, and share verified, research-based information.
My mission is sharing my mental illness story to help stop the stigma, promote recovery, and save lives in the military, among Veterans, and in the general population. We must normalize the conversation around mental illness, help educate people on the facts and science, and speak out, using every venue and opportunity. It is critical to share our stories of experiencing and dealing with mental illness. We must be compassionate, interested in, and supportive of all those grappling with mental health conditions.
Hear General Martin describe his mental health experience in his own words. Listen to his discussion with AAFMAA Director of Partnership and Member Engagement, Sarah Bumgardner.
AAFMAA Is Here to Help
AAFMAA is proud to provide services that give military members past and present the support they deserve. Though we do not offer mental health counseling, our services and benefits can help provide peace of mind. Reach out to AAFMAA today to learn how we can help you live your best military life.