Stigmatization of Mental Health: A Cross-Cultural Analysis of Austria and Poland

Marie Morningstar

Introduction and Background:

Mental illness is one of the most common health concerns in today’s world. In the United States, 1 in 5 adults suffers from a mental disorder. However, less than half even receive treatment. According to the American Psychiatric Association, mental illness is defined as “health conditions involving changes in emotion, thinking or behavior, or a combination of these” (Parekh, 2018). Mental health is often a topic that is overlooked, but it still pertains to many people. This is due to its social stigma. Stigma comes from viewing “characteristics or behaviors… as different or inferior to societal norms” (Holder, 2018, p. 370). Almost always, the negative stigmatization of mental illness plays a part in patients being willing to admit they have a problem, which is the first step in getting help. Kevin Breel used a good example of the stigma behind mental illness in his TED talk “Confessions of a depressed comic” when he asked “Would you rather make your next Facebook status say you’re having a tough time getting out of bed because you hurt your back or you’re having a tough time getting out of bed every morning because you’re depressed? That’s the stigma” (Breel, 2013). It is clear that there is a negative stigma present when no one wants to admit that they are struggling with a disorder. The stigmatization of mental illnesses has an important historical context, is very intertwined with the likelihood of patients to start on the road to wellness, and is impacted differently by professions and cultures.

The negative stigma around mental illness starts with the denial of the problem or lack of education. Since the early 1700’s when the term “psychology” or the study of the mind, was coined by Christian Wolff, there were skeptics. Some believed that mental content was based off events, so it could not be studied like a science. There has been a rich and interesting history of how the mentally ill have been treated, both clinically and generally in society. In the 1700’s, some philosophers thought that mental disturbance arose because of a corrupt culture (Freedheim, 2003). The idea of treating mental illness with good morals, like kindness and respect, was also a common belief of the time. Throughout history, there have been many false ideas about what mental illness is and the correct way to go about treating it. These all feed into the social stigma, or ways that a culture views differences of those struggling with mental illness.

As briefly mentioned earlier, studies show that people suffering from mental illness are unlikely to admit to their condition because of the negative stigma. Therefore, there is an even smaller chance that the individual in question will then seek treatment. However, it is interesting to note the changes that occur when several mentally ill citizens form a group. In one study, the odds of someone starting to use medication and seeing a psychiatrist increased by 80% when included in a “mental illness group” (Klik, 2018). When the mentally ill are in a group or environment where they feel comfortable speaking about their struggles and aren’t afraid of being judged based on a stigma, it is easier to receive help. The stigma almost disappears in a way because there are no longer strong differences between these people and their society. The group becomes the “culture” and everyone in the group has a mental illness. In this example, having a mental illness is thought of as more “normal” and acceptable (Schlier, 2019). This is a great example of the social identity perspective. Personal identity is created through the comparison of self to others in the group. Even though mental illness might not necessarily be “normal”, it can be talked about in a normal way. In cultures and societies where the conversation around mental health is open, the citizens are more likely to accept their conditions and seek help.

It is interesting to look at cultural and professional differences concerning the acceptance and stigma of mental illness. Studies find that mental illness and the likelihood of suicide is much more prevelant in high-stress workplaces. The amount of stress on the job varies from culture to culture. The United States is a more task-oriented society than most European countries that are relationship-oriented. Being so motivated by tasks can create unneeded pressure and an unhealthy work environment. According to Financial Times, construction workers are six times more likely to die from suicide than an on-the-job accident. Other professions where mental illness flourishes include the fields of finance and law. In England, jobs in the banking industry are 44% more likely to lead to a stress-related illness than other jobs (Evans, 2016). Along with these statistics is the fact that employees in these competitive workplaces don’t want to admit any weaknesses. As is the case with most stigmas, opening up the conversation is the first step to addressing the problem. Some organizations have realized the importance of the connection between supporting mental wellness and productivity on the job. The City Mental Health Alliance in London, Building Site to Boardroom, and several international banks like Goldman Sachs, Citi, and Morgan Stanley, have worked towards taking care of their employee’s health, including the mental aspect. Having psychologists and counseling on-site is just one way that some places have worked towards ending the negative stigma surrounding mental illness and showing that it is valid to ask for help.

The stigmatization of mental illness has a rich history, has a strong impact on the help-seeking process, and changes between both professions and cultures. A stigma arises from recognizable differences between a certain group and societal norms. Humans are constantly looking for inclusion and therefore, are not likely to talk about struggles, weaknesses, or otherness. This is why stigma plays such a large role in programs of treatment. Those struggling with mental illness may not even realize they need help because their lack of information or inability to talk through problems. Without acceptance, there is no chance of successful medication, therapy, or counseling. People are more likely to admit their conditions and seek help when the conversation topic is not taboo, and there are cultures and professions that do a better job of opening up this conversation. Mental illness is especially prevalent in high-stress workplaces. The combination of an increase of pressure from the job and aversion of any weakness in these jobs is quite dangerous. There have been opportunities and efforts made to end the stigma but there is still much progress to be made.

Culture A: Austria

Austria was a very interesting culture to research, especially for my topic. The long duration of our stay gave me the opportunity for plenty of observation, and it was interesting to be in the same place where psychologist Sigmund Freud lived. The first artifact I found was in the Freud Museum, which I thought would show the importance of psychology and psychotherapy in Austria.

Sigmund Freud’s own work at the museum dedicated to his life

However, the museum was very small and included quite a bit of information about Freud’s family and life, but not so much about his ideas or theories. This is interesting especially considering the interview I conducted with my German professor. She said that many people probably don’t know anything or much about Sigmund Freud because there isn’t a lot of education on mental health. In the academic sphere, psychology is studied on a broad level, but there is not discussed as much on a personal level.

Psychology Institute in Vienna, Austria

I was also surprised to hear that mental health is still a taboo topic in Austria. My professor and my Austrian roommate told me that people just don’t talk about it openly because it is viewed as a weakness. She even went so far to say that Austrians don’t talk about their own mental health because of the fear of losing their jobs. Even the most common mental illnesses like depression and anxiety are thought of as laziness or unreliability in the work place. This negative stigma isn’t just present in adulthood, however. Other newspaper articles and blogs that I found said that less than half of adolescents suffering from mental illness in Austria seek help. Once the critical first step is taken, though, there are options to healing.

A clinical psychologist and therapist’s office near our dorms in Vienna.

However, my professor said that this type of medical attention is not covered by Austrian federal health care. This means that although treatment might be available, there are still many barriers for mentally ill Austrians to live a healthy life. Also close to our dorms was the University of Vienna Psychology Institute, shown in the picture above. It is clear that Austria, and especially Vienna, have a rich history of the study of the brain. However, the general public does not seem to show the same interest. My Austrian roommate said that she just doesn’t see what the big deal is. She admitted that mental health isn’t a discussion topic but also doesn’t see a problem with that. In her opinion, there are definitely clinical mental illnesses like schizophrenia and bipolar disorder, but the average person doesn’t have to deal with these. She said it’s important to take care of yourself, but people might be taking the “whole mental health thing” too far. I wondered if my roommate felt this way because people in Austria really are healthier mentally, but the data does not show that. About 25% of Austrian adolescents and even more adults suffer from a mental illness. These numbers are large enough that the discussion on mental health should be more present than it is and more should be done to help those suffering and combat the clear negative stigma.

Culture B: Poland

It was interesting to find that the climate around mental illness in Poland was both similar and different to my findings from Austria. Mental illness is still highly stigmatised in Poland, like many other European countries. I would conclude that the conversation is even less open than what I observed in Austria. This was fairly obvious by a few of the conversations I had with Polish people. The first Pole I attempted to talk with about mental health was a youth leader at the Josiah Ventures English Camp. He was hesitant to start the dialogue with me. A lot can be said about the way someone reacts to the question, “Can I ask you some questions about how mental illness is viewed in your country?” He didn’t think he would have much to say about the topic, but agreed to answer some questions the best he could. Essentially, I learned that it is not common to learn about mental health in school or to talk about it with friends. He said that he would probably would not know if his closest friends or family were struggling with mental illness; it is not something most Poles personally discuss with family. Not only did this young man’s actual answers give me insight into Polish views on mental health, but so did the length of his answers. He did not expand much on what he was thinking and seemed a bit uncomfortable. This behavior seemed rather normal for Polish culture considering what I learned from a practicing therapist who talked to our group. Billy spoke about Polish culture in general, but had quite a bit to say about mental health in the country too. It was interesting to hear that Billy saw many different types of clients with problems ranging from marriage and family to depression and anxiety to bipolar disorder. The breadth of his field of work as opposed to specialization could provide insight into the under-development of Polish mental healthcare as a whole.

The graph above shows the small number of Poles who receive specialized treatment.

He also said that people usually find it difficult to admit they need help and feel ashamed to need the help of a counselor or therapist. In a study, 75% of the general Polish population believed that mental illness is considered a health problem that is “concealed and treated as embarrassing” (Kochański & Cechnicki, 2017). I think that all this information shows how strong the stigma surrounding mental illness is in Poland. Also, there is clearly a lack of development of the Polish mental healthcare system. This is a historical issue that goes back to World War II. During the war and the Holocaust, more than half of Polish psychiatrists died. Also, most of the patients in psychiatric wards were killed or taken as subjects of Nazi experiments during this time (Bomba, 2008).

This photo shows buildings in Auschwitz where some experiments occurred.

Mental institutions in countries under Nazi control were told to “neglect” patients by refusing food and medication (Berenbaum, n.d.). It is no wonder that mental health is a tricky topic in Poland. Not only is there surely fear of admitting weakness and mistrust of those in authority due to the messy history, the Second World War also depleted many of the Polish resources for mental healthcare. In Poland’s case, the stigmatization likely comes from a mixture of historical fear and a lack of education.

Comparative Analysis

There are basically two schools of thought when comparing two European countries, such as Austria and Poland. On one hand, it is easy to view the two different cultures as very similar compared to all other countries in the world. After all, they are in close geographical proximity, have similar histories, and are affected by many of the same neighboring countries. Then on the other hand, you can see how any two countries are completely different because none of these factors are exactly the same between two places. When analyzing just one aspect of each of these cultures, the same rules apply. There are definite similarities and differences, and each can be attributed to the respective country’s cultural values. The stigmatization of mental health in Austria and Poland may seem quite alike on the surface. However, upon further inspection, there are intriguing reasons that the climates surrounding mental illness in each country are actually not the same at all.

There were a few ways that I saw similarities between Austria and Poland’s view and approach to mental illness. Citizens I interviewed of both countries were not the most willing to talk about what mental illness is. I found it interesting that Austrians and Poles alike said that mental health as a conversation topic was a bit taboo, but that it is moving away from this. This would normally make sense to me, but the younger people I talked to from both countries were the ones that seemed the most uncomfortable. Usually social change comes from the younger generations who are tired of the way things are. Many people are tired of hiding their mental illness and not being able to get the help they need. Those struggling with their mental health cannot receive treatment in the first place if they are not willing to accept this struggle. Addressing mental health is not part of the curriculum in either Austrian or Polish schools. Because of this, students do not. receive encouraging messages that it is okay to have and talk about your depression or anxiety or any other illness. Then, even if an individual realizes his or her struggles, there also has to be a realization that help is necessary. Many of the. mentally ill in Austria and Poland live in fear of what others will think if their affliction is discovered. This was evident in my conversation with an Austrian who said there would be fear of unemployment because of mental illness and the Polish study that showed 75% of the country’s population viewed mental illness as “embarrassing”. In both countries, it is clear what the answer to Kevin Breel’s question would be: “Would you rather make your next Facebook status say you’re having a tough time getting out of bed because you hurt your back or you’re having a tough time getting out of bed every morning because you’re depressed?”. There are very few cultures in today’s climate that it would be normal to talk about mental health in this way and neither Austria or Poland are examples. Even though the stigma behind mental illness is fairly negative in both countries, there are much deeper aspects to dive into with this topic. Reasons for the stigmatization and the history of psychology are some of the main differences between Austria and Poland, and important to consider here.

While the mental illness climate seems the same between Austria and Poland at first glance, this is not necessarily the case. The two countries have had very different pasts and function based on different underlying cultural values. An example of this would be the development of the mental healthcare system in each county. Austria actually has many resources available for the mentally ill, whether or not they are utilized. Psychology is widely studied and talked about, if only in the academic sphere. There was evidence of therapy clinics in Vienna, which shows the opportunity for people to receive psychiatrist help. However, if the conversation isn’t open, then citizens won’t even take advantage of the help available. There is a seemingly strong presence of Sigmund Freud in Austria, specifically Vienna. His museum is in Vienna, and there is also a large psychology institute at the University. Psychology has strong roots in Austria, especially when you consider Freud the father of the modern study of the mind. However, the deep history does not have as large of an effect as one might imagine. The Freud Museum was mostly dedicated to the life and family of the psychologist instead of his theories, methods, or ideas. There is something to be said about how this sort of history has less of an effect on the country’s view of mental health than it should. It raises questions about the importance of this field of study in modern-day Austria. Despite the advanced mental healthcare system, the reasons for Austria’s stigmatization of mental health are likely due to deep cultural patterns. Poland, on the other hand, does not have this kind of famous figure to shape it’s mental health climate. The country’s history in World War II has an interesting impact. A majority of psychiatrists in Poland died in the Holocaust and many of the patients’ fates were not much better. They were either tragically used in experiments, killed, or neglected. This messy history leads to an under-developed mental healthcare systems and makes the topics regarding mental illness, psychology, mental hospitals, and psychiatric treatment all the more taboo. While Austria was also affected by the Second World War, the country’s history is still different than Poland. Underlying cultural values also explain differences between countries.

Looking at Hofstede’s cultural values can show some interesting insights into both Poland and Austria’s society. For example, it was stated earlier that Austria has a history familiar with psychology but also still has a negative stigma surrounding mental illness. How could a country with such an advanced system and understanding of mental healthcare make the help-getting process difficult for the very people struggling with this topic? Part of the answer lies in Austria’s individualism and uncertainty avoidance. Austria scores high in both of these areas, as does Poland. This shows that Austrians and Poles tend to value safety and certainty, things they know. Mental illness is scary because it’s unpredictable. Mental disorders that go untreated, especially severe conditions like bipolar or schizophrenia, make conditions especially unstable. It might make sense to combat this with treatment, therapy, or medication; however, it seems that these cultures approach the issue differently. It might seem like a better option to ignore the uncertainty that comes with mental illness and not discuss it. Poland’s score in this dimension is even higher, at 93. This could explain the slow changes toward innovation. One of my Polish interviews revealed again that there are gains being made to open up the conversation surrounding mental illness. However, the progress is slow in any culture that values security more than societal change. Also, both countries are highly individualistic. According to Hofstede, this means that “individuals are expected to take care of themselves”, and these types of societies often “cause guilt and a loss of self-esteem”. Poland’s higher individuality is another explanation of the less willingness of Poles to talk about mental illness. It is viewed as a personal problem, not something to be discussed with friends or family. This puts a lot of pressure on the individual, which is what can cause the guilt and low self-esteem. Mental illness is obviously already unhealthy, but it becomes even more so when the person thinks they are going through it alone. The combinations of high uncertainty avoidance, high individualism, and history with psychology may be some of the reasons for the negative stigmatization of mental health in both Poland and Austria.

Personal Reflection

Despite all the details provided, there are still places this analysis falls short. Unfortunately, the information and data found for this project are not completely accurate. Firstly, the interviews I conducted cannot speak for the entirety of each of the countries. Also, my observations were made after only being in Poland and Austria for about three weeks each. However, one of the biggest areas that creates a bias is the personal beliefs I bring into the project. Almost everything I researched and tried to understand was being compared to my experiences of my own culture in the United States. While I don’t see myself as an ethnocentric person, I know that our own cultures shape the way we see think and see the world. It can be easy to view the ways other countries operate and believe that our own culture does it in a better way. For example, when learning that many Austrians and Poles don’t feel comfortable discussing their mental well-being with family or friends, I felt pity for them. If only they could become more open-minded societies. However, the United States is far from perfect too. Kevin Breel’s Ted Talk about the stigma surrounding mental health was given in America and mostly addressing the need for change in the U.S. My experiences go past just being an American, however. The ways I was brought up within my family and in the church play a part, too. There is a history of mental illness within my family, so I think that helps to open up the conversation. Also, my mother has training in the medical field so she seems to be more understanding than most other Americans might be. These factors have formed me into what I think of as a fairly open-minded person. I think my faith also contributes. Sometimes churches tend to have high uncertainty avoidance similar to what we saw in Poland and Austria. However, the way that I was brought up allows me to view Christianity in open-minded way too. I think scripture talks about mental illness in a variety of ways and some specific verses stick out to me. Psalm 40:1–3 says “I waited patiently for the Lord, and he turned to me and heard my cry for help. He brought me up from a desolate pit, out of the muddy clay, and set my feet on a rock, making my steps secure.

He put a new song in my mouth, a hymn of praise to our God. Many will see and fear, and they will trust in the Lord”. This passage was written by someone at a dark, low time in their life. God was there to pull them out of that depression and help them through. And 1 Peter 5:6–7 addresses anxiety when it says “Humble yourselves, therefore, under the mighty hand of God so that at the proper time he may exalt you, casting all your anxieties on him, because he cares for you.” This verse shows how God deals with our anxious hearts. The Bible doesn’t just say to not have anxiety, but suggests to give it up to the Lord. There are also examples of Jesus caring for and encouraging us as Christian to care for the weak, either physically, mentally, or spiritually. I think examples like this have shaped the lens through which I view the world, including mental illness.

The reason I chose this topic was because it is something that I am passionate about. I was very interested to look at how mental illness is viewed in other countries considering the stigmatization is such a large part of the definition. Even in the United States, people don’t talk about their problems because they are viewed as weaknesses. In my opinion, it is so sad that the only reason someone’s life cannot be better is because of fear of asking for help. Because the healthcare system is well-developed in both the U.S. and Austria, it made me disappointed that there is still such a negative stigma surrounding mental illness. I think part of these feelings come from my Enneagram 2 personality of wanting to be able to help those around me and wanting them to accept my help. In this way, it is frustrating for me to see or learn about people who are having problems with their mental health but find it difficult to receive treatment. But I also have to be aware of how my own attitudes and beliefs contribute to the problem. It can be difficult to find a balance between empathy and pity. Sometimes a helpful spirit turns into a self-righteous spirit. I had to be careful about this when researching mental illness in several different countries. Questions have to be formed in a respectful way to preserve esteem, especially in individualistic cultures like Poland, Austria, and even the United States. Finally, I have not had formal education in psychology so I cannot exactly come at this issue from a strictly academic perspective. There were many issues I had to be aware of while conducting interviews and research for this project, but I am happy with what I learned about myself and the stigmatization of mental illness in Austria and Poland.

References

Almost a quarter of adolescents in Austria are currently suffering from a mental health problem. (2017, June 1). Retrieved from https://www.sciencedaily.com/releases/2017/06/170601095007.htm.

Berenbaum, M. (2018, September 10). T4 Program. Retrieved from https://www.britannica.com/event/T4-Program.

Bomba, J. (2008). Mental healthcare in Poland. International Psychiatry, 5(1), 10 — 12. doi: 10.1192/s1749367600005403

Breel, Kevin. (2013, May). Confessions of a Depressed Comic. TED. www.ted.com/talks/kevin_breel_confessions_of_a_depressed_comic?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare.

Evans, J., Agnew, H., & Jacobs, E. (2016, September 14). Mental illness flourishes in high-pressure workplace. Retrieved from https://www.ft.com/content/d4168a70-4533-11e6-9b66-0712b3873ae1

Freedheim, D. K., & Weiner, I. B. (2003). Handbook of Psychology, History of Psychology. New York: Wiley.

Gesundheitspsychologe — Gesundheitspsychologin. (n.d.). Retrieved from https://www.gesundheit.gv.at/gesundheitsleistungen/berufe/therapie-beratung/gesundheitspsychologe.

Holder, S. M., Peterson, E. R., Stephens, R., & Crandall, L. A. (2018). Stigma in Mental Health at the Macro and Micro Levels: Implications for Mental Health Consumers and Professionals. Community Mental Health Journal, 55(3), 369 — 374. doi: 10.1007/s10597–018–0308-y

Klik, K., Williams, S., & Reynolds, K. (2018, March 23). Toward understanding mental illness stigma and help-seeking: A social identity perspective. Social Science & Medicine, 222 (2019) 35 — 43.

Kochański, A., & Cechnicki, A. (2017). The attitudes of psychiatrists toward people suffering from mental illnesses. Psychiatria Polska, 51(1), 29 — 44. doi: 10.12740/pp/62400

Parekh, R. (2018, August). What is Mental Illness? Retrieved October 27, 2019, from https://www.psychiatry.org/patients-families/what-is-mental-illness.

Schlier, B., & Lincoln, T. (2019, November 9).The stigma of mental illness: Testing for the implicit bias in diagnostic labels. Psychiatry Research, 275 (2019) 221 — 227.