Stigma and Bipolar Disorder

“Crazy! Psycho! Dangerous! Wacko! Scary!”

In the midst of severe bipolar disorder, members of my family called me “crazy”, and exhorted me to “just be positive and grateful for all your blessings, and your depression will go away. Snap out of it, you have so much to be thankful for.” My mother was of the Depression/WW2 generation that simply did not believe in mental illness and thought that it reflected weakness and lack of willpower. “Just suck it up and pull yourself up by your bootstraps and out of the depression. You don’t have anything to be depressed about!”

I had my first diagnosis of mental illness when I was 58 years old. I knew my brain was sick, and now I had a target with a face on it that I could do battle with. I hugged and thanked my doctor, and decided right then and there that I would OWN my diagnosis of bipolar disorder I with 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 (BD) every day – I’m in a forever war! And my oath as an American soldier has strengthened and guided me: “I will always place the mission first. I will never accept defeat. I will never quit.”

By mid-summer of 2014 I had rocketed to the apex of bipolar mania, a blissful heaven of psychotic delusion. At that time, I was president of the National Defense University in Washington DC, and a general officer in the most powerful army in the world. But I began to believe that I, like the Apostle Paul, had “become all things to all people” (1 Corinthians, 9:22). I didn’t feel it yet, but in truth I was the burning shell of the person I had been just months before: my soul had been stripped out by an invisible disease. My boss—General Martin Dempsey, the highest-ranking officer in the United States Military—fired me, retired me early, and ordered me to undergo a psychiatric evaluation. As decisively brutal as this was, it was necessary and the right thing to do; he may well have saved my life. He was not influenced by stigma – he focused on taking care of me and his university. I was later hospitalized. After I was fired there was a brief period of serene weightlessness. Shortly after that I entered free fall, beginning my descent into bipolar hell: a world of hopeless, crippling depression and terrifying psychosis. I still bear the scars.

A critical part of my mental health crisis was the problem of stigma, which is what I’m going to talk about today. First, I’ll give a little bit of background about the word stigma itself, as well as some definitions and perspectives on it. Then using my own lived experience, I’ll discuss stigma’s effects. Finally, I’ll talk about what we can—and must—do about stigma.

Professors Patrick Corrigan and Amy Watson of the Illinois Institute of Technology/University of Wisconsin wrote that many “people with mental illness are challenged doubly,”¹ both psychiatrically and socially. There is no clear line between these phenomena. But when I subtitled my book Bipolar General with “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 obvious enemy is the illness, in my case bipolar disorder (BD). But the much larger, more common, insidious foe is stigma. And stigma is everywhere. It’s a social disease, which is why I quote as many sociologists as I do psychologists and psychiatrists.

Photo of Gregg from the front cover of his book Bipolar General: My Forever War with Mental Illness

A Little About the Word “Stigma”: Its Origins, Connotations, Definitions

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.” Many of us might immediately think of the “stigmata,” possibly demonic possession, and Jesus Christ’s crucifixion and death. We can practically see his bloody hands, nailed down to the cross.

As Professor Stephen Hinshaw of University of California Berkeley says in his powerful memoir, Another Kind of Madness²: “The very term is noxious […] its sounds […] spit out from your throat and then lodges there. Its meanings are equally severe, as the individuals in the degraded group are branded as outcasts: shameful, offensive and less than fully human. Underneath the toxic cloud of stigma lie negation, repression, and banishment. For many stigmatized people, the accompanying isolation is tantamount to solitary confinement. There may be no sensation worse than being excluded from the mainstream, lacking any community or social support.”

In the 1960s Canadian sociologist Erving Goffman, who also taught at UC Berkeley, defined stigma as the “situation of the individual who is disqualified from full social acceptance.”³ He went on to add that stigma is an “attribute that is deeply discrediting.”⁴

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.”⁵

Gregg speaking at National Defense University, Wash DC, 2024

An example of stigma is when someone with a mental illness is called “dangerous”, “crazy” or “incompetent” rather than unwell. It’s also stigma when a person with mental illness is mocked or called weak for seeking help. Stigma often involves inaccurate stereotypes, which amounts to a cognitive distortion. According to the Department of Psychiatry, Washington University School of Medicine, (St. Louis, MO), most stigmatizers could use a course of Cognitive Behavioral Therapy.⁶ But that would involve a whole lot of people, because stigma isn’t just a product of a few bigots—tragically, it’s still widespread.

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.”⁷ I’m going to come back to this idea (of power) later.

Patrick Corrigan and Amy Watson break stigma down into two main groups: self-stigma and public stigma.⁸ “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.”⁹ Both kinds include stereotypes, prejudice and discrimination.

Perspectives on Stigma, Types and Effects

In their article Understanding the impact of stigma on people with mental illness, Patrick Corrigan and Amy Watson write:

Many people with serious mental illness are challenged doubly. On one hand, they struggle with the symptoms and disabilities that result from the disease. On the other, they are challenged by the stereotypes and prejudice that result from misconceptions about mental illness.¹⁰

The stereotypes and prejudice that Corrigan and Watson are talking about is stigma.

Goffman, whom I mentioned above, proposed three main types of stigma, the first of which was stigma associated with mental illness.¹¹

According to Licensed Independent Clinical Social Worker (LICSW) Gretchen Grappone, there are seven types of stigma¹². I’m going to run through all seven, and add examples from my lived experience.

Public Stigma

The first type is “Public Stigma” – when the public endorses negative stereotypes and prejudices, resulting in discrimination against people with mental health conditions. News coverage shapes discourse and attitudes: it’s negative and solidifies myths and stereotypes. Stigma leads others to avoid living, socializing, or working with, renting to, or employing people with mental disorders – especially severe disorders, such as BD and schizophrenia. It leads to low self-esteem, isolation, and hopelessness. It deters the public from seeking and wanting to pay for care. There is also the inaccurate conflation of mental illness and violence: the vast majority of people with mental illness are not violent; indeed, the mentally ill are far more likely to be victims than perpetrators. People with severe mental illness are several times more likely to be attacked, raped or mugged¹³; media portrayals exacerbate misconceptions.

At a church I attended, the pastor mentioned two people in the congregation who were living with mental illness. He said that all they needed was more prayer, stronger faith and that the Holy Spirit would heal them. He made no mention of the scientific fact that they were suffering from a serious physical disease of the brain. I confronted the pastor afterwards and told him that I lived with BD and that it is physiologically real and requires medication and therapy. He didn’t listen and would not talk with me. Even pastors and leaders are not immune from holding prejudicial stigmas. I left the church that day, for good.

Self-Stigma

Another form (Type 2) is “Self-Stigma” – when people internalize public stigma. Like Corrigan and Watson write, they turn 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 and often leads to death and destruction.

Gregg in Kuwait days prior to invading Iraq, March 2003

Fortunately, I never suffered from self-stigma. From onset of BD during the Iraq War in 2003 until diagnosis of BDI in November 2014, I voluntarily sought medical help six times, only to be told I was fine, and fit for duty. On the seventh try, my doctor got it right. Once diagnosed, I committed to going public and sharing my story, to help others. That was ten years ago. My friend and bipolar expert Sara Schley shared this profound quote: “Sharing our stories takes the wind out of the sails of stigma.”

Perceived Stigma

Grappone’s third type is “Perceived Stigma” – the belief that others have negative beliefs about people with mental illness. Right from the start I spoke publicly about my BD. But some family, friends and colleagues were concerned by this. They questioned me, “why are you going public and admitting to mental illness? You’d be better off keeping it private and working through it quietly.” I disagreed and argued that after undergoing such a horrendous experience, I owed it to the world to share my story to help others, passing on my experience, knowledge and hope.

Label avoidance

Type 4: “Label avoidance” – when a person chooses not to seek treatment to avoid being assigned a stigmatizing label. This is most harmful. Example: “I can’t go to the doctor because I don’t want people to think I’m crazy.” In fact, stigma is one of the most important factors in why treatment rates are so low. While disparities in service delivery and inadequate funding also impact treatment rates, the fact is that stigma also drives people away from the medical system. Stigma affects jobs by slamming the door shut on people with BD and other serious mental illnesses (SMI), making them hide their condition. This is a loss for everyone – workers and employers, who need the talent and diversity.

An example is that many members of the military who experience mental health conditions refuse to seek medical help out of fear that they will be perceived as weak, which is the opposite of the military culture and ethos, which is to always be strong and tough – physically, emotionally and mentally. The US Army typifies this in its slogan and philosophy of “Army Strong!”. This capitulation to stigma, and the resultant non-action often leads down the path of destruction: ruined marriages, families and careers; then homelessness, addictions and incarceration; followed by violence and suicide. The shame is that, with medical treatment, the chances of living a happy, healthy, purposeful life are high.

As Hinshaw has put it in many writings and talks: It’s a sign of strength, not weakness, to disclose mental illness and fight to get the best treatment for it.

Fortunately, I was not afraid of being labeled as weak, having gone to the doctor six times between onset and diagnosis, over eleven years. I wanted to know what was wrong with my brain, particularly when I was depressed and realized something was wrong. On the seventh try, after considering key collateral information from my wife, the doctors diagnosed me correctly, and after that, I began my public campaign of sharing my bipolar story to help stop stigma, promote recovery and save lives.

Gregg speaking at National Defense University, 2013

Stigma by Association

Type 5: “Stigma by Association” – 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.

After I was fired, I was assigned to a holding job for several months, prior to my retirement. My commander, Lt. Gen. Thomas Bostick, could not have been more compassionate or supportive, personally and publicly embracing me, even though he risked being tainted by the stigma of mental illness through his association with me. We need more leaders in the world who have the values and courage of Tom Bostick.

On the other hand, dozens of former friends, and colleagues have cut themselves off from me – completely. They refuse to speak or meet with me, and won’t even reply to emails or phone calls. This is hurtful and sad, but true.

The sixth variety of stigma is “Structural Stigma,” in which Grappone includes institutional policies and other social structures that decrease opportunities for people with mental health disorders. Society pays too, as stigma shapes policies and health care in ways that ignore the needs of those w BD. It costs us all, through higher healthcare costs, lost work, and the human cost of not providing the right care, or not treating people right.

The US Military’s long-time practice of separating all those with mental health conditions has evolved in a positive direction over recent years, but the powerful stigma still exists, instilling fear into service members who should be seeking help, but rather hide their condition in shame, fearing the perception of weakness, and the loss of their military careers. In fact, this is the case for people in a huge variety of careers.

Family photo at Gregg’s son Patrick’s graduation from West Point, 2008

Grappone’s last—and in this case definitely not least—kind of stigma is what she calls “Health Practitioner Stigma.” This is when a health professional allows stereotypes and prejudices about mental illness to negatively affect a patient’s care. Example: when I was finally diagnosed with BD, my doctor treated me with kid gloves and practiced “VIP Medicine,” which likely delayed my recovery by months, maybe years. After an informed discussion, he chose not to give me the strong medicine I needed – hospitalization and lithium – because of the perceived negative administrative and professional effects they would have on me. He believed the stress induced by a medical review board would outweigh the negative effects of my BD, so he kept my BD under the radar and only entered it in my official medical records the day before I retired from the Army. Unwittingly, his decision could have killed me.

This section isn’t completely comprehensive… and I could cite many counter examples of kind, caring, compassionate people – most notably my wife Maggie, sons Phillip, Patrick and Conor, and some close friends – who stuck with me and worked hard to get me the help I needed. The effects of stigma go on and on. Hinshaw wrote about this in his 2007 book as well: The Mark of Shame: Stigma of Mental Illness and an Agenda for Change. But now that we have identified so many manifestations of the enemy, let’s figure out how to fight them.

So…what to do?

Make a friend, be a friend, bring a friend to psychiatry. 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 a social disease, and just as Rosa Parks and Dr. Martin Luther King Jr. fought against the strains of racism, we too must stand against the stigma towards 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 stigma is a social action, a social fight. It means that leaders and organizers are needed. It also means we need boots on the ground, engaging the enemy, day after day, in this “forever war” against stigma.

We also need a radically different set of media images of people with mental illness, given that the usual depictions are of violence and/or incompetence.

Here are doctors Corrigan and Watson again: “Research has shown an inverse relationship between having contact with a person with mental illness and endorsing psychiatric stigma.”¹⁴ We need to train ourselves how to have hard conversations, how to deal with stress, and how to respectfully demonstrate why stigmatizing views are unreasonable. We won’t win every little firefight, but don’t lose hope.

Don’t allow yourself to be stigmatized, embarrassed, or ashamed. If you yourself have lived experience and are willing and healthy enough to have these conversations, then we need you to lead.

Educate, inform, and lead. Understand your condition; learn about it. Stand on medical research and its proof. Tell others; share verified, research-based information; share your stories and those of others who are okay with your sharing. Knocking down stigma means opening doors to better health, better jobs, and stronger communities.

What is this conference but a convening of leaders? Millions of us who suffer from BD and other SMI are not fortunate enough to even imagine showing up at a conference like this. It is not arrogant to suggest that, in the face of rampant, ancient stigma, leaders are necessary. Look at my story. After finally being properly diagnosed, I decided that I would OWN my condition and not be embarrassed, ashamed, or stigmatized. I chose to boldly go public, and the effect has been resoundingly positive!

For many of us, our health is in our hands. When you do have autonomy, don’t let a system or culture disempower you. Consider joining advocacy movements to help reduce the considerable stigma and discrimination other people with BD and SMI face around the world.

My mission is sharing my bipolar story to help stop the stigma, promote recovery, and save lives, and it’s making a difference with my website, talks, podcasts, interviews, articles, and now, my book, which is reaching people around the world, in different languages, and being used in diverse settings, including medical schools, businesses, the military, among veterans, and in the general population.

Gregg and friends at dance class at Cocoa Beach Health and Fitness in celebration of the army-navy football game, Christmas 2020

There is no room – anywhere – for stigma against mental conditions. Mental illness is physiologically real, like diabetes, cancer and heart disease, so any such stigma is based on fear and ignorance, not knowledge and truth. At the same time, negative social conditions can increase the risk for mental illness, just as they can for many physical conditions.

And now…A CALL TO ACTION!

Battling mental illness should be seen as a heroic cause, like women battling breast cancer, who, 50 years ago, were also stigmatized, ashamed and embarrassed. But thanks to a strong social movement, that stigma has given way to pride and admiration for all those battling that deadly disease. We need a similar social movement for mental illness, and it starts with each of us.

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.

Each of us must be a mental wellness warrior – strong, brave and committed – who sticks by and protects others, and never leaves a fallen comrade. This is the ethos I lived for 40 years as a soldier, and now it’s the ethos I live as a bipolar survivor, thriver and warrior. As a soldier, I swore to “always place the mission first… never accept defeat…and never quit.”

As the BIPOLAR GENERAL, my mission now is to share my bipolar story to help stop stigma, promote recovery and save lives. I will pursue my bipolar mission with the same drive as my Army mission, even more so.

Again, in the words of Stephen Hinshaw: “When shame and stigma are shed, hope can truly emerge.”

Let’s Stop Stigma Together!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/#B11
Hinshaw, S. P. (2017). Another kind of madness: A Journey through the stigma and hope of mental illness. New York: St. Martin’s Press.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2277138/#:~:text=According%20to%20the%20Canadian%20sociologist,of%20disgrace%20that%20arouse%20concern’.
Goffman, Erving. 1963. Stigma: Notes on the Management of Spoiled Identity. New York: Simon & Schuster.
https://www.nami.org/Blogs/NAMI-Blog/November-2016/I-Stop-Stigma-by%E2%80%A6#:~:text=Stigma%20is%20defined%20as%20a,a%20difficult%20thing%20to%20change.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9924160/
https://www.annualreviews.org/doi/abs/10.1146/annurev.soc.27.1.363
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/#B11
Ibid.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/#B60
Goffman, Erving. 1963. Stigma: Notes on the Management of Spoiled Identity. New York: Simon & Schuster.
https://spokane.wsu.edu/studentaffairs/counseling-services/end-the-stigma/stigma-types/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9415228/
https://pubmed.ncbi.nlm.nih.gov/10478780/

About the Authors

Gregg F. Martin, PhD is a retired U.S. Army major general, combat veteran and grateful bipolar survivor, thriver and warrior. He unknowingly lived on the bipolar spectrum his whole life, until diagnosis in 2014. His bipolar condition mostly helped him, until it went too far, and then nearly destroyed him. He is the author of BIPOLAR GENERAL: My Forever War with Mental Illness. For more, visit bipolargeneral.com

Phillip B. Martin is a writer, linguist, former staff sergeant, and combat veteran who served with Army Special Forces. He is the author of No Poetry Like War and the son of Major General (Retired) Gregg Martin. He is currently pursuing a master’s degree in rhetoric and composition at the University of Central Florida. He also lives with bipolar disorder.