Health economists have their own ways of assessing quality of life, but if we ever find a reliable way to measure mental burden, that may be a more accurate way to express the morbidity of health conditions.

As an example, I have a chronic pain condition. According to some measures, my quality of life is lower than someone with, say, an incontinence condition. But as much as I have to worry about how my condition restricts my activities, I don’t have to worry about:

  • keeping a mental map of all public washrooms,
  • taking a change of clothes, or
  • facing the embarrassment or stigma of a public accident.

To me, that is a higher level of mental burden compared with my pain condition, and that burden may translate to a lower quality of life.

The physical pain I experience is arguably not the source of my mental distress about my condition. Rather, the burden comes from having to consider how that pain will affect what I do in my daily life.

Stigma adds another layer of mental burden to a health condition (and so should lead to a lower score on quality-of-life measures). I’m old enough to remember when cancer was stigmatized, and certainly when HIV/AIDS was far more stigmatized than it is today.

People with stigmatized conditions—including psoriasis, sexually transmitted infections, mental illness, problematic drug use, and so on—have to worry about their symptoms and other peoples’ reaction to them. Structural stigma can make people reluctant to seek treatment, and they suffer more, for longer.

There’s some argument that certain stigmas—against smoking, for example, or against drunk driving—can be positive because they prevent harmful behaviours. The point here is that stigma itself adds to mental burden. How that mental burden then affects behaviour will depend on the person and their context.