Approaches to Reducing Stigmas in Serious Mental Illness Through Multidisciplinary Intersectional Patient Narratives and Digital Platforms

When co-author Gregg Martin, PhD was diagnosed with Bipolar I disorder with psychotic features, he felt the impact of stigma with rippling effect. Those close to him labeled him "crazy," or alternatively, dismissed his condition. His disorder went unrecognized in the military where serious mental illness (SMI) is viewed as a career threat or weakness (the opposite of the "Army Strong" military ethos), preventing members from seeking help. After he publicly disclosed his bipolar disorder, many former friends and colleagues distanced themselves from him. Even his pastor disregarded his condition, instead recommending "more prayer and stronger faith," which ultimately led him to leave his church. For Martin (retired Army Major General combat veteran, who has since become a mental health advocate) these responses from his support systems worsened his isolation, prolonging recovery. Over the next 2 years from diagnosis to gradual recovery, Martin refused to succumb to stigma, reasoning, "if I didn't own my mental illness, it would own me." Indeed, stigma surrounding psychiatric disorders remains a significant barrier to societal understanding, effective treatment, and quality of life. NAMI (National Alliance on Mental Illness) article "Overcoming Stigma" by Gretchen Grappone, licensed clinical social worker, expands on prior research to outline the seven subtypes of stigma: (1) public stigma, negative societal stereotypes of SMI; (2) self-stigma, internalization of these negative attitudes toward oneself; (3) perceived stigma, beliefs that others hold these negative views; (4) label avoidance, shunning proper diagnosis and treatment to escape negative labels; (5) stigma by association, discriminating against those connected to someone with SMI; (6) structural stigma, institutional policies that hinder care and opportunities for someone with SMI; and (7) provider stigma, biased attitudes among healthcare professionals that undermine patient care [1]. These subtypes of stigma, which collectively increase barriers for those with SMI, can be challenged by patient stories such as Martin's. Stigma thrives in silence, whereas open dialog reduces fear and ignorance. Patient narratives such as Martin's (outlined in his 2023 book Bipolar General), are crucial for raising public awareness [2]. To challenge the various types of stigma, we build upon prior research endorsing the use of patient-centered narratives [3]. Specifically, we present Martin's story as a foundational example of how patient narratives can help humanize and de-stigmatize mental illness, further explore this approach to uniquely leverage technology and social media, and suggest actionable strategies to integrate these insights into psychiatric training and practice. We also discuss expanding patient narratives in further directions that incorporate multidisciplinary and intersectional dimensions. Specifically, the multidisciplinary lens examines a patient's experience across various mental health disciplines, providing a more comprehensive clinical understanding, while an intersectional approach considers the patient as a "whole" person with overlapping identities that shape their experience. Digital media provides a platform for these dimensions to illustrate the lived realities of SMI patients, extending their reach to broader audiences. Firsthand patient accounts help bridge the empathy gap between providers, patients, and the public, empowering patients to have agency over their experiences. Building on prior research discussions emphasizing the importance of patient narratives, we assert that these accounts confront misconceptions about SMI [4]. They challenge the preconceived Public Stigmas of trainees entering the field, and recognize the diversity of patient experiences versus homogenizing people with certain psychiatric conditions into a monolithic group (e.g., overgeneralizing treatment approaches, dismissing physical symptoms as attributed solely to SMI, or following negative assumptions about prognosis). For example, societal biases can dehumanize individuals with SMI by imposing harmful stereotypes, such as assumptions of violence or unpredictability. The narrative approach emphasizes the ethical importance of viewing patients as "knowers," whose voices enrich psychiatric understanding. These stories normalize mental health challenges, fostering inclusive perspectives instead of "othering" those with SMI [5]. Patient stories supplant stigma with knowledge and accessibility, presenting a counterbalance to the sensationalized portrayals in film and television. In traditional approaches to healthcare, communication can resemble a one-way street, where providers drive the discussion, oftentimes with little input from the patient (reinforcing self-stigma and label avoidance), such that patients feel deprived of control over their own healthcare decisions. Patient-centered narratives prioritize patient voices to ideally encourage a "two-way street" model, in which communication flows bidirectionally—providers solicit and value patient perspectives, and patients reciprocally feel empowered to share their thoughts, preferences, and concerns, resulting in cooperative decision-making. This shift to a two-way street model challenges provider stigma by enhancing mutual respect and understanding, reducing power imbalances inherent to the one-way model, and cultivating a sense of patient ownership and control. When practitioners prioritize the voices of those with lived experience, they are more likely to practice in a truly patient-centered manner, promoting better rapport, adherence, follow-up, and overall care outcomes. Publicly accessible information via social media platforms like YouTube, TikTok, Instagram, and self-forming communities on Reddit currently outpaces traditional medical curricula in de-stigmatizing mental health issues [6]. Much of this content is created by individuals with firsthand SMI experience. However, while impactful, these accounts often lack scientific scrutiny and can perpetuate misinformation [7]. In recent years, mental health awareness has been increasingly spread through social media, where firsthand SMI accounts allow conditions and treatments to be demystified, normalized, and even celebrated (e.g., a 2018 APA survey shows that Generation Z and millennials are more likely to seek therapy than older generations) [7, 8]. We propose that the field of psychiatry use digital technology to contextualize firsthand accounts within a scientifically informed framework, thereby closing the gap between accuracy and accessibility. Collaboration between mental health professionals and advocates with lived experience is essential to ensure public information is both meaningful and accurate. Professionals can provide the scientific context necessary to prevent the spread of misinformation, while digital creators can share personal stories in ways that resonate with the public. For example, an inspiring YouTube channel and organization entitled "Special Books by Special Kids" features patient interviews on myriad psychiatric disorders, humanizing these conditions and allowing the patient to control the narrative [9]. Similar media could be further developed to include scientific backing for incorporation into Grand Rounds or case presentations. Furthermore, our approach allows patients with SMI to share valuable insights surrounding healthcare preferences, including practices that are counterproductive, damage rapport, or deter them from seeking help. This type of peer-driven support offers social validation and collective empowerment, promoting accessibility and inclusivity in mental health discussions [7]. Formalizing digital media uniquely leverages the existing cultural shift to adapt psychiatric education to modern and diverse contexts, making it timely and practical for today's mental health landscape. To implement the aforementioned viewpoints, we suggest several actionable approaches: (A) designating plenary slots for patient narratives in research conferences; (B) requiring trainee participation in patient advocacy programs for curriculum credit, and/or collaboration with patients on case studies and research; (C) establishing peer mentorship programs, where individuals with firsthand SMI experience can mentor trainees, providing insight beyond the clinical lens; and (D) partnering with SMI patients to co-create educational digital media that is both publicly accessible and scientifically validated. Including those with lived experience in developing these materials is imperative for ensuring that anti-stigma efforts remain authentic, effective, and relevant to those directly impacted by SMI [3, 4]. Storytelling should emphasize patient recovery and resilience, illustrating not only the obstacles individuals face, but also the ways in which they can lead fulfilling lives with appropriate support. Additionally, exposure to positive role models (e.g., healthcare professionals and other high-achieving individuals with SMI themselves to serve as guest lecturers) can also help unify the "us" versus "them" divide, reshaping the perception of mental health for the better. Stephen Hinshaw's book Breaking the Silence offers a powerful example, sharing accounts of mental health professionals and their family members with bipolar disorder and other SMI. Involving real stories highlighting patients' strength and success not only helps address provider stigma, but also supports providers in building their own resilience to burnout, particularly when working with "difficult" patients and diagnoses. SMI narratives can be further strengthened by integrating multidisciplinary angles. The combined input from patients and their families, psychiatrists, therapists, patient advocates, and social workers constructs a more comprehensive picture to synthesize the clinical and personal aspects of mental health. Each discipline may observe unique facets of the patient's experience, as patients often build different types of rapport with various members of their care team. This collaborative approach creates a holistic, multidimensional view of SMI that transcends single-discipline perspectives, helping team members identify how stigma impacts patients both within healthcare settings and society at large. By addressing the dual suffering of patients—psychiatric and social—this approach can reduce patient isolation and enhance patient-provider relationships. The collective insights gained can motivate mental health professionals to counteract stigma in their practices and advocate for their patients' rights and dignity. Such narratives can illuminate the complexities of mental health conditions and critical support networks that aid in recovery. Of course, Dr. Martin's story is only one powerful example of the impactfulness of patient stories. However, to ensure narratives are more reflective of diverse patient populations, it is essential to include and highlight intersectional perspectives. The factors that make up a patient's lived reality are complex. A patient's background–including culture, race, religion, class, gender, and other intersecting identities–interact to shape one's experience with SMI and influence health outcomes, such that diagnosis and treatment do not follow a one-size-fits-all approach. Intersectional perspectives can illustrate how patients may face compounded stigma and systemic barriers, deepening our understanding of their experiences and care requirements. Appreciating how cultural difference and societal factors can influence behavior, rather than viewing challenges as individual failings, promotes a more systems-based, personalized, and equitable treatment approach. Psychiatric education should emphasize patient-centered narratives to amplify patient voices, deconstruct stigmas, and help dismantle the inequitable hierarchies that silence those with SMI. We believe that these accounts, aided by digital platforms, would foster patient-provider collaboration and scientifically informed public awareness. Incorporating multidisciplinary and intersectional perspectives adds dimension to patient stories to foster an inclusive mental healthcare system–and society–that is more compassionate, informed, and community-driven. As Martin states, "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. Knocking down stigma means opening doors to better health, better jobs, and stronger communities." Data sharing is not applicable to this article as no new data were created or analyzed in this study.