Public attitudes toward mental illness: An examination across countries and over-time
- Sigrún Ólafsdóttir
- Jun 1
- 9 min read
Updated: 3 days ago
Ever since Goffman published his work on stigma in 1963, sociologists and other social scientists have been interested in understanding stigma. Goffman defined stigma as “an attribute that is deeply discrediting” and argues that the stigmatized person is reduced “from a whole and usual person to a tainted, discounted one” (Goffman 1963:3). Around the same time, sociologists and psychiatrists influenced by social constructionist perspectives challenged the biomedical conceptualization of mental illness. Thinkers such as R. D. Laing (1967) argued that schizophrenia could be understood as a meaningful response to a deeply troubled social world, while Thomas Szasz (1960) questioned whether mental illness simply represented a myth. A widely known study by Rosenhan (1973), On being Sane in Insane Places, is classical within this perspective showing that eight people (including himself and his graduate students) were successfully admitted to a psychiatric hospital by describing symptoms associated with schizophrenia. Upon admission, they resumed “normal” behavior, yet their mental state was never questioned by any health professional, and all were released with schizophrenia in remission. The study questioned the ability of the psychiatric profession to distinguish between the sane and the insane.
Sigrún Ólafsdóttir
Professor of Sociology at the University of Iceland. She received her PhD in sociology from Indiana University in 2007. Her research is at the intersection of medical, political and cultural sociology. In her work, she focuses on how broader institutional arrangements shape individual outcomes. Her work has appeared in journals including Journal of the American Academy of Child & Adolescent Psychiatry, American Journal of Sociology, European Journal of Public Health and Social Science & Medicine. She leads Iceland’s participation in several international social surveys, including the European Social Survey and the International Social Survey Programme.
Since the 1990s there has been a resurgence of research on the causes and correlates of mental health stigma, frequently led by sociologists and social psychologists. A part of this larger development was a proposal by a research team to include a special stigma module on the 1996 General Social Survey (GSS) (Pescosolido et al. 2013). This survey showed considerable stigma in the U.S., especially toward individuals with schizophrenia and addiction. It found that a large proportion of the public associated mental illness with dangerousness. A surprising finding was, contrary to expectation of labeling theory, that neither the characteristics of the respondent nor of the person that was being evaluated mattered (Martin et al. 2000). Similar findings were found elsewhere, most notably in Germany (Angermeyer 1995). However, there was a lack of comparative data on stigma that were methodologically, substantively and culturally coordinated.
Stigma in Global Context – Mental Health Study (SGC-MHS)
Inspired by the finding from the WHO International Study of schizophrenia that recovery was more likely in low- or middle-income countries as compared to high-income countries, the Stigma in Global Context – Mental Health Survey (SGC-MHS) was fielded in 2006-2012 in 16 countries on all continents. The overarching puzzle was the surprise of better chance of recovery in low- and middle-income countries, with some stating that they would rather want to be diagnosed with schizophrenia in India than in the United States. A mechanism that was suggested, but not tested, was level of stigma. The argument was that people in the Global South were simply kinder than their counterparts in the Global North. A key contribution from the SGC-MHS was to show that this is not true. Levels of stigma were largely unrelated to levels of development, and in the few cases when they were, the relationship was the opposite, stigma was lower in countries with higher levels of development, irrespective of what measure was used to capture development (Martin et al. 2015). In fact, lowest levels of stigma were found in countries like Iceland and Germany regardless of whether it was toward depression and schizophrenia and whether the outcome was social distance, exclusionary statements or negative affect (Pescosolido et al. 2013).
To provide a deeper look on stigma in high-income countries, Manago, Pescosolido and Olafsdottir (2019) compared stigma and social distance toward individuals experiencing schizophrenia or depression. One of the advantages of comparing fewer countries is the possibility to understand the cultural context in which mental health problems exist. Combining the data from SGC-MHS, with a content analysis of media in the U.S., Iceland and Germany, the authors relate variations in stigma to the cultural context. Specifically, they show that while all three countries display relatively low levels of stigma, important cultural differences remain. Americans were substantially more likely to associate mental illness with dangerousness and violence, especially toward others, while Icelanders expressed the lowest levels of exclusionary attitudes and were more supportive of social inclusion. Germans generally showed more moderate and cautious responses across stigma dimensions.
The findings suggest that public attitudes toward mental illness are closely connected to broader cultural narratives and media representations. Icelandic discourse emphasized solidarity and collective responsibility, American discourse focused more on danger and criminality, and German reporting tended to avoid extreme judgments (Olafsdottir 2007). Although patterns of social distance were relatively similar across countries, the differences that emerged indicated that anti-stigma interventions should not assume that Western societies are culturally uniform. Instead, stigma-reduction efforts must be tailored to the specific concerns and cultural contexts of each society (Manago et al. 2019).
How do we reduce stigma?
One of the main reasons for why scholars and policymakers alike are interested in stigma is the potential of stigma reduction. A belief promoted in the U.S. in the 1990s was that if it was only possible to convince the public that mental illness was “diseases like any other,” stigma would disappear. The replication of the 1996 GSS in the US in 2006 allowed for a test of whether this was correct. Major stigma campaigns during this period highlighted the biological foundation of mental illness and the notion of “disease like any other” was highly promoted. Yet, what research examining public attitudes found was that the American public had bought into the notion that mental illnesses, such as schizophrenia and depression, had a biological basis, endorsing causes such as chemical imbalance in the brain and genetics. Yet, there was no reduction in stigma over the same period (Schnittker 2008).
During the last few decades, the voice of users has become louder and is generally taken more seriously. Ideas of recovery and empowerment that met resistance earlier are now generally accepted, albeit not always really practices, within mental health systems (Pilgrim and McCranie 2013). This raises the question of whether an emphasis on recovery and hope may be a solution to reducing stigma. To address this, the 2025 Icelandic stigma study that builds on the SGC-MHS, included vignettes that described both schizophrenia in the original conceptualization and another one that added a description of recovery. The same approach was taken in vignettes describing alcohol and heroin addiction. The findings showed that the description of recovery significantly reduced stigma of schizophrenia and especially addiction, regardless of whether it was from heroin or alcohol (Olafsdottir et al. 2026). To illustrate this, Figure 1 shows that the mean for preferred social distance from heroin addiction was 3,49, from alcohol addiction was 3,3 and schizophrenia 2,91 (on a scale from 1-5). When a description of recovery was added, the mean for heroin addiction was reduced to 2,83, for alcohol addiction to 2,48 and for schizophrenia to 2,68. All reductions were statistically significant, and the reduction was significantly greater for addiction than for schizophrenia.
Figure 1. Preferred social distance from a character described with addictions and schizophrenia, with and without a description of recovery.
To conclude
The history of public attitudes toward mental illness reflects broader shifts in how societies understand deviance, responsibility, illness and social inclusion. While early sociological and social constructionist perspectives emphasized labeling and social reaction, later biomedical approaches focused on symptoms and treatment. Research over the past decades suggests that neither perspective alone explains stigma. Instead, stigma emerges through the interaction of cultural beliefs, institutional structures, media representations and everyday social encounters (Pescosolido et al. 2008).
Comparative research has further demonstrated that stigma is not simply lower in low- and mid-income countries, challenging assumptions that modernization inevitably increases social distance and exclusion (Pescosolido et al. 2015). Rather, cultural narratives surrounding danger, recovery, responsibility and solidarity shape how mental illness is perceived across societies. The Icelandic case, alongside findings from other countries, illustrates that relatively inclusive public attitudes are possible, even toward the most severe mental illnesses (Manago et al. 2019).
At the same time, the persistence of stigma despite increased public acceptance of biological explanations suggests important limitations of anti-stigma campaigns built solely around biomedical models. Recent findings from Iceland point toward a different possibility: emphasizing recovery, hope and social participation may be a key to reduce stigma. This aligns with contemporary recovery-oriented approaches that center on the lived experiences and agency of people with mental health problems themselves (Olafsdottir et al. 2026). Future research should continue to examine how stigma changes over time, how it differs across cultural contexts, and which interventions are most effective in promoting social inclusion. As mental health becomes an increasingly central public issue globally, understanding stigma remains crucial not only for research and policymaking, but most importantly for the lived experiences of people. □
The 2006 Stigma in Global Context – Mental Health Study was funded by the Fogarty International Center, the National Institute of Mental Health, and the Office of Behavioral and Social Science Research of the U.S. National Institutes of Health (grants 5 R01 TW006374, R01MH082871). The Icelandic part of the SGC-MHS was funded by Rannís: The Icelandic Centre for Research. The 2025 Icelandic Stigma Study was Funded by Geðhjálp.
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