Close to home: Intersectionality of familiarity, emotions, and stigma of mental disorders among rural residents

Persons with a mental disorder are often stigmatized, which results in reluctance to seek treatment and self-stigma. These consequences are exacerbated in rural communities due to the limited healthcare infrastructures. Familiarity and emotions may be promising avenues for decreasing stigmatization of persons with a mental disorder. However, findings are mixed, and studies' often fail to use measures that capture the complexities of familiarity (e.g., level of contact intimacy, quality of contact). To complicate familiarity, emotions may serve as the operating mechanism through which familiarity impacts stigma. Thus, qualitative interviews were conducted with 50 rural residents to examine gradients of familiarity with a mental disorder (intimacy and quality of contact), emotions (fear, anger, sympathy), stigma, and desire for social distance. A thematic analysis revealed that first, regardless of familiarity, rural residents’ desire for social distance was grounded in their fear of unpredictable, disruptive or dangerous (violent) behaviors. Specific disorders were frequently categorized as dangerous while others evoked sympathy, sadness, and a desire to help. Second, controllability and the rural landscape fueled stigma for some, but reduced stigma for others. We discuss how the results inform strategies to decrease stigma by discouraging residents (with varied familiarity) from assuming all persons with a mental disorder match the violent stereotype (e.g., dimensionality, evoking sympathy, sadness, or empathy). Further, we conclude by discussing how to correct the violent stereotype attributed to the majority while supporting those with high familiarity (family, providers) who recounted lived experiences with the minority who do indeed become unpredictably violent.