At least two out of five people in Bulgaria have encountered mental disorders such as depression, eating disorders, and others in one way or another. The society is successful in intuiting what is a mental problem and what is just an emotion. For the most part, the answers of people in our country are tolerant regarding mental problems. But beneath these responses presenting tolerance, there are layers of latent rejection. For example, as many as 45%, or almost half of the respondents, say that if someone in our country admits a mental problem, others will start avoiding them.
There is an underestimation of the different types of addictions as a real social problem. For 37% of the people in our country, after all, addictions are simply a lack of willpower.
Between 10 and 25% - i.e. at least nearly a million and a half adult Bulgarians (with no more than 5.5 million residing in the country) – is the share of conservative and even retrograde views. For example, 12-13% do not hesitate to share that going to a psychologist or a psychiatrist is a whim or a shame. Probably, the share of such perceptions is much higher - because of hidden opinions.
For 25% it is not normal for men to cry. For men in general, mental health issues seem to be more of a topic taboo.
About two-thirds of Bulgarians say that, in case of a problem, it is best to look for a specialist in psychological or psychiatric care, but a number of other indicators show that looking for specialists is not the first choice.
It is clear that attitudes towards mental health depend on the quality of life: groups with a higher life status can afford to pay more attention to the subject. The modern way of life makes stress and anxiety to be increasingly perceived as a systemic problem, not just an emotion.
On the eve of the World Mental Health Day, these are some of the findings of a short experimental study by Gallup International Balkan, initiated by "SKIN - a mental health platform" foundation, which focuses on milder forms of mental disorders, addictions, and so on. The survey was conducted "face to face" among 807 people in the period 3-11 September.*
Mental disorders - encounters with the issue
41% of the respondents say that they know people who suffer from mental disorders, such as depression, eating disorders, and others. Of course, one should take into account the different degrees of genuine answers, the subjectivity of the assessment of what exactly can be defined as a mental disorder, stigma, and many other factors. Despite all the stipulations, it can be concluded that two-fifths of the country's adult population believe that they have encountered the problem in one way or another.
Asking such a question also helps for a more relaxed answer from people who suffer (or think they suffer) from mental disorders. The higher your standard of living and education, the more likely you are to have encountered a mild mental disorder. This outcome may be a matter of different latitudes of the personal horizon, resp. varying degrees of awareness and naming of the problem.
It is also possible that there is a higher degree of exposure to the problem in people with more active status - due to the dynamics of life, alienation, etc. But still, the role of the "big city" and the "modern lifestyle" should not be generalised. For example, the people in villages also to a large extent indicate that they know people with so-called “more frequently encountered” mental disorders - probably due to the smaller size of the communities.
Curiously, women are the ones who are more likely to declare that they know people suffering from mental disorders. Nearly half of them choose the answer "Yes, I know", while among men the share is a little over a third. Demographic factors may also play a role. It is more likely, however, that there is a different attitude to the topic among men and women – throughout the survey results, it is clear that men are more reserved regarding the explored topics.
In an experimental question, the respondents were asked to choose between two options - if a person admits to having a mental disorder, would others avoid them or would they help him? 55% still believe in mutual aid, but a significant proportion of 45% appeared as sceptical. Responding to this question, it appears that the respondents categorise their society, but in fact, they are indirectly answering for themselves. These almost levelled percentages are a sign of concern. Bulgarians obviously have doubts about the place of people with mental health problems in society.
61% of the respondents believe that if a person takes antidepressants, for example, it is good to share with colleagues so they can help. Here again, however, a significant share - 39% - believe that this is a personal problem and should not be shared. And here, it is clear that men are more likely to consider mental health problems entirely a matter of privacy.
Recognising the problem within the wider society
Subjected to a test of public opinion, various mental disorders and emotional states are generally recognised and distinguished, i.e. the society has developed intuitive markers. The respondents were offered a list and asked for each option to judge whether this is a mental disorder or not. Schizophrenia (93% of "yes, it's a mental problem"), self-harm (79%), and depression (76%) seem to be the easiest to recognise as a mental health disorder.
Conditions such as eating disorders, post-traumatic stress disorder, obsessive-compulsive disorder, and others follow. Of course, partly the terminology, in fact, suggests the "right" answers.
At the other "pole" are sadness, nostalgia, and falling in love - which are rather not perceived as mental health problems. Only about a tenth of people tend to define those as a mental health problem, and this is probably a curio rather than a systematic social problem of perceptions.
However, society is not very sure about stress and anxiety - more than half believe that these are not mental health problems, but there is a significant proportion, about and over a third, who is of the opposite opinion. It is possible that the increasingly active lifestyle that modernity requires, resp. stress and anxiety, are also thought of as one of the systemic problems of our times.
It is clear that education has an impact on the respondents' responses, with the impression that people with lower education are more likely not to identify a problem as a mental health disorder. On the one hand, this can be attributed to less familiarity with the concept, and on the other hand – this may be due to different views based on a different way of living.
Addictions and degrees of optimism
In a provocative question, 63% answered that people with various addictions (alcohol, drugs, etc.) actually suffer from a form of illness, whereas 37% choose another option - they think such people simply do not have a strong enough will. This indicator is rather "lab-sociological” and demonstrates possible extremes in the interpretations. The fact that 37% choose the " lack of will" response is an important societal symptom for possible neglect of the addictions as a real mental health issue.
The groups at risk of marginalisation are also those who are more likely to say "they just don't have the will." This type of response represents also the "more masculine" point of view.
In general, there is a belief that different dependencies can be overcome. Of course, inertia and social desirability should also be taken into account when interpreting the answers. For example, 77% find that addiction to food can be overcome, to cigarettes - 76%, to alcohol - 61%, to gambling - 48%.
However, when it comes to drug addiction, the share of optimists is lower than that of pessimists: 42% vs. 47%. Obviously, it is drugs that are perceived by society as a "genuine addiction". As can be seen, however, as for the other possible forms of dependency, they are clearly misjudged.
Among those who point out that various addictions can be overcome, there are people with more favourable status - income, education, etc. Probably, a number of factors are intertwined in the answers, but the main ones are the quality of life and the lifestyle - the higher they are, the more optimism there is.
65% of the respondents agree that in case of a mental or emotional problem it is best to seek help from a specialist. Naturally, a large dose of declarativeness is relied upon in these answers.
However, the share of those who prefer support among relatives and friends (21%) or other options, is not neglectable. There are visible differences in the answers of the groups representing different educational and income levels - the reference to relatives and friends is more typical for people with poorer life prospects.
Put in a conditional situation - if, for example, their child exhibits a developmental problem - nearly half of the respondents choose the "specialist" option. The others would either look for relatives or would hesitate about the right approach. The question is primarily experimental and reveals social instincts rather than a detailed picture.
There are no structural differences between the general picture of opinions and the picture of parents’opinions, but it seems that parents are more inclined to trust specialists. Older respondents would be more likely than other groups to wait for the child to outgrow the problems. Of course, among representatives of this group the answers are also dominated by "I will consult a specialist" responses.
In a provocative question, 12% is the share of those who consider "going to a psychologist is a whim." The remaining 88% realise that going to a psychologist may be a necessity. 13% accept the final opinion that going to a psychiatrist is embarrassing. 87% are of the opposite opinion. The 12-13% in question should be considered possibly as a minimum - because of the expected degree of sincerity. In summary: at the declarative level there is trust in the specialists, but the share of those for whom this is not the first option is not to be neglected.
Degrees of tolerance
For the most part, respondents give answers that can be defined as tolerance to mental health problems. But there are also not negligible groups who have a different opinion - especially the groups with less favourable life prospects. The question here, of course, is one of a latent intolerance - which lies need the otherwise “correct” answers.
Here, too, respondents were faced with test questions that challenge them to force a choice between different statements - sometimes seeming equally true or even equally extreme. A the end of the day, there is a share in the range of 10 - 25% of the respondents, in which the reaction to the various indicators is rather conservative. For example, 25% would agree with the statement “people who suffer from depression just need to pull themselves together”. The other 75%, of course, is of the opposite opinion and accept that people with depression really need help. But the presence of a quarter of dismissive responses is evidence of certain levels of a lack of understanding.
18% would say that people with mental health disorders such as depression and anxiety are better off being isolated from society. 18% take seriously the otherwise joking statement that any mental health problems are solved with a shot of brandy and a little more sleep. Also, 18% define suicide attempts as a sin (while the rest still consider it a sign of a problem, not a sin). 18% is actually equal to nearly a million adult Bulgarians - out of a total of about five and a half million adults permanently residing in the country. Moreover, one million is the minimum estimate, given the possible degree of genuine answers.
16% of respondents agree that a psychological problem should be solved on one's own, while the rest still say that they prefer sharing with other people. 25% say that it is not normal for men to cry, while the rest say they do not think so.
The main factor for more intolerant and stigmatising responses seems to be to some extent the age, but overall the education stands out as a factor. The latter, of course, should not be taken for granted, but as might be expected, people with more favourable life outcomes are also more "open" according to their responses to the provocative questions used here. Conversely, groups at risk of marginalisation are also those who remain with a patriarchal disposition. In the context of the latter, here as well, the "more closed" answers are those of men.
*The survey was conducted between 3rd and 11th September 2020 among 807 people using a face-to-face method. The sample is representative of the adult population of the country. The maximum standard deviation is ± 3.5% for the 50 per cent share. 1% of the sample is equal to about 55 thousand people.