A new analysis in medical research has illuminated a crucial aspect of the battle against mental health stigma: there are two very different—and deeply misunderstood—types of stigma affecting people with mental illnesses, each requiring distinct approaches to overcome. The findings, published this week in STAT News, call for nuanced strategies in advocacy and policy to ensure that the global response to mental health challenges is both effective and compassionate.
For Thailand, where mental health issues have traditionally been shrouded in silence and misconceptions, these insights could be game-changing for healthcare providers, educators, and policymakers striving for a more inclusive and supportive society.
Globally, mental health stigma acts as a powerful force keeping people from seeking care, with repercussions ranging from untreated illnesses to social and occupational isolation. In Thailand, mental illness is often considered “เรื่องในบ้าน” (a family matter), sometimes met with silence or denial rather than support and treatment. The new research offers a rationale for why anti-stigma efforts must target separate but equally damaging beliefs about psychotic disorders, such as schizophrenia, and more common mental illnesses like depression and anxiety.
The analysis begins with a physician’s recollection of his struggle with depression while practicing in a rural community, underscoring how internalized stigma—fear of being judged as weak or incapable—can drive even educated individuals to avoid seeking help close to home. The author, a senior scientist at the Johns Hopkins University Bloomberg School of Public Health, emphasizes that this is not a unique experience: “Globally, we know of no culture that does not severely stigmatize mental illness,” he writes. The narrative reflects a reality echoed in Thailand, with Ministry of Public Health surveys revealing that up to 80% of people with mental illness do not receive treatment due to shame or fear of social consequences (Ministry of Public Health, Thailand).
The research distinguishes between two primary forms of stigma. The first targets those with psychotic disorders such as schizophrenia, which are often associated with hallucinations and delusions. This form of stigma centers on fear and mistrust: people with these conditions are wrongly perceived as unpredictable or dangerous. Statistically, such fear is unwarranted; the research cites studies showing that people with psychosis are less likely than average to be violent, and more likely to be victims rather than perpetrators of violence. Yet, in the United States, more than 60% of the public considers individuals with schizophrenia dangerous, a perception likely mirrored in Thailand, where media reports frequently conflate psychosis with criminality (Bangkok Post), compounding fears and further isolating sufferers.
The second form of stigma is just as severe but affects many more people and is centered on common mental conditions such as depression and anxiety. Instead of being feared, individuals with these disorders are often viewed as weak or lacking in willpower. The new research highlights how a linguistic overlap between temporary negative feelings—“feeling depressed” after a loss, for example—and clinical depression, leads to a perception that sufferers are merely insufficiently resilient. In Singapore, a survey found that over half regarded depression as a sign of personal weakness. Data from Thailand reflects similar attitudes: a 2023 National Statistical Office report found that 38% of Thais surveyed believed depression was the result of “ใจไม่แข็งแรง” (not having a strong heart or mind), not a medical condition (NSO Thailand).
Drilling down into why these stigmas persist, the researchers argue that the rarity and “invisibility” of psychotic episodes—affecting only about 3% of people, with many living stable lives—can paradoxically magnify fear and alienation. On the other hand, nearly half of the global population will experience a mental illness at some point, with major depression and anxiety among the world’s leading causes of disability (WHO). Despite this, depression and anxiety are often dismissed as character flaws, making it harder for advocates to rally support and resources. In Thailand, access to mental health care remains highly centralized, with only 882 psychiatrists nationwide as of 2023—just one per 80,000 residents (Royal College of Psychiatrists of Thailand).
The research outlines practical solutions. Anti-stigma campaigns must accommodate the different roots of prejudice: for psychotic disorders, myths about violence and unpredictability must be countered through evidence-based education and more accurate portrayals in media. For common disorders like depression, campaigns must emphasize that these are not personal failings and that treatment is both possible and effective. Social exposure—interacting with people living successfully with mental illness—can powerfully challenge stereotypes for both types of stigma.
Public figures who share their mental health journeys can also dismantle myths by demonstrating that mental health challenges affect people from all walks of life, including those perceived as strong and successful. The article singles out Olympic champion Michael Phelps, who has spoken openly about his depression, as a powerful advocate. In Thailand, such disclosures by actors and musicians have spurred important conversations, but barriers remain, especially outside Bangkok and urban areas.
The Thai context is particularly complex. Although Buddhism emphasizes compassion and non-judgment, traditional beliefs can sometimes reinforce stigma—for example, attributing mental illness to “กรรมเก่า” (bad karma from past lives). These beliefs may either discourage help-seeking or steer families toward traditional healers and religious rituals rather than modern treatments. At the same time, the growing influence of social media and popular culture has introduced new frameworks for discussing mental health, with younger generations in particular showing greater willingness to discuss these issues openly (UNICEF Thailand).
Looking ahead, the report underscores the need for Thailand to broaden and tailor its mental health anti-stigma campaigns. For psychotic disorders, this could mean involving community leaders, Buddhist monks, and health volunteers in educational outreach that corrects misconceptions about safety and unpredictability. For depression and anxiety, workplace wellness programs and school-based initiatives could reframe these conditions as treatable health issues, not personal weaknesses. Policy support is also critical: mental health must be integrated into universal health coverage and public health investment proportional to its steep social burden. As the article highlights, in 2023, suicide claimed 740,000 lives globally—more than HIV and malaria combined—an alarming statistic with urgent implications for Thailand, which has one of the highest suicide rates in the ASEAN region (WHO Thailand).
For Thai readers, the practical takeaway is twofold. First, challenge your own assumptions about mental illness: ask whether your views are rooted in fact or stereotype, and seek reputable information from health bodies like the Department of Mental Health or international organizations such as WHO and UNICEF. Second, foster openness and empathy within your families, workplaces, and communities. Support those seeking help, recognize that recovery is achievable, and remember that silence only deepens stigma’s harm. As Thailand navigates growing mental health challenges amid rapid social change, this research reminds us that compassion, education, and action must take priority in public and private life alike.
Source citations: STAT News, Ministry of Public Health, Thailand, Bangkok Post, NSO Thailand, WHO, Royal College of Psychiatrists of Thailand, UNICEF Thailand, WHO Thailand