It’s said that people with mental illness face a double-edged sword.
Not only do they have to contend with serious, disruptive symptoms, they still have to deal with rampant stigma. Sadly, mental illness is still largely shrouded in stereotypes and misunderstanding.
Stigma also can lead to discrimination. Yes, even in this enlightened day and age, it doesn’t appear as though prejudice and discrimination against individuals with mental illness are decreasing. (This study shows in some cases, it might even be increasing.)
We see stigma everywhere. Every time violence is automatically connected to mental illness in an article or news report, we see it.*
We see it in movies and other forms of media. We see it at work where stereotypes might be perpetuated, where employees are afraid to “come out” with their diagnosis.
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This is a very interesting way to look at stigma – I hadn’t thought of this. Yes, the anticipation of the stigma is probably equally as bad – and actually certainly worse in my case – as the stigma itself. In my particular circumstance I have been very selective about who I confide in, which I’m sure has reduced my exposure to any risk of stigma. But even having said that I was sure that even my friends would abandon me if they knew. I remember telling one friend by email – and when she responded that she was ‘there for me’, I burst into tears I was so stunned.
Reaching out to my friends and family has been such a powerful force in assisting my recovery – but it could have started such a long time ago if only I hadn’t been so worried…
I found your comment interesting. I too was nervous to tell people about my diagnosis of depression. I found that once I started it wasn’t nearly as bad as I thought. In fact I now write a blog about my experience and share it with many people I know. Much of my depression was caused by hiding my real self and in an effort to learn to live with depression I decided that I needed to stop hiding, this diagnosis included. It was hard, but you are right that the anticipation of stigma is often harder than the actual reaction we get.
Brilliant article. Thanks.
Stigma is a difficult thing to struggle with, and internalising it makes it so much worse. I wish I could do more to fight it but some of the reactions I’ve had from friends when “coming out” were devestating.
One day when I’m well, and when I’ve developed enough self confidence, I hope I’ll be able to stand up for myself and others to fight stigma.
Social Stigma and Self Stigma – Thank you for this excellent piece on social and self stigma in mental health issues. Hopefully raising awareness and the difficulties experienced when seeking help, especially if this is through the NHS. I have had problems for over 9years, have avoidance issues because I was so well known in my community and a bit beyond, ie worried about ‘press’ – unfortunately cannot seek private help which would offer more privacy. Very low at the moment and searching for help but where to start?
This was right on time for me! Today was one of the most streesfulmdays I’ve had in a long time! My teenage son suffers from depression and anxiety, my husband, from bipolar. This day started out with my husband being in a weird mood and disagreeable and it went from bad to worse on a two and a half hour trip to a soccer match. I realized during the course of the day, his opinion of himself and diagnosis is his biggest enemy. He accepts the diagnosis but doesn’t want therapy only medication and is always defensive saying he’s not stupid, just crazy but not stupid. So with him in his mood today, the entire car was stressed, my son started the game late and stressed and when the team lost the game, the ride home was just as fun as it was to get there. The only difference on the way home was, I had mr irritable and defensive in the front and mr irritable and let’s blame mom for everything. Subsequently, I fought off my own panic attack and by the time we got home we all three went our separate ways. At least reading this article I feel better knowing this is more common than I realized.
BTW, I also fight my battles of depression, GAD, OCD and ADHD so I am very sensitive to the difficulties and stigma but I get frustrated at the avoidance of therapy, not self educating about the diagnosis, and the self depricating remarks along with the extreme defensiveness. I hope that my husband will come to truly accept the diagnosis, and see himself the way we (me and the kids) do, as a smart, wonderful person, and great father!
Great article. Self stigma is really destructive. I work for a consumer run mental health provider, so there are many days when I deal with my own low self image as I see it reflected back in the folks that I serve. It can be a huge struggle to keep a positive focus and good self image when you are dealing with your own symptoms as well as helping others to deal with theirs. Most days it isn’t about avoiding therapy, or things like that, because we do self disclose to those we work with, but the issue is who do we as providers of services turn to when we are a small non-profit agency that can’t afford mental health coverage. I know this isn’t the forum for this, but just wondering. Stigma hurts in many, many ways, all different.
Here’s the rub. Is internalized stigma a “symptom” of depression, an overawareness and subsequent reaction to cultural oppression which others, (with more chemical and social resources) might meet instead with surprising resiliency?
I am constantly reminded by my 12 step group that I am not alone in my struggles but that my brain convinces me I am. I don’t believe in miracles but I do believe that when I see my internalized stigma for what it really is, my own voice turned against me, trying to lead me away from the light, then I may still be depressed but I am less confused.
This article really hits a home run for me. I began reading everything I could get my hands on about Mental Illness and the stigma that comes with it. Having MI myself,the negitive stigma around MI was the reason it took so long for me to seek help. ( What would people think of me! ) But with the aid in Treatment I will be able to share my experence with others so they would not suffer as long as I did. Thank you so much Psych Central for the Positive impact you create.
While I appreciate the intent of the article, “stigma” means “mark of shame or disgrace”. I do not believe that mental illness is “mark of shame or disgrace”. As you allude, the real issues is discrimination and prejudice. There is no stigma. (I don’t think links are allowed here, but if you google “There is no stigma to mental illness jaffe” you will come up with my Huffington Post article on this. ) Thanks again.
I disagree with why the author assumes part of the reason people avoid treatment is stigma. I was diagnoised as a rapid cycling bi-polar individual at the tender age of eight. From then till I was sixteen, I spent most of my time in a medication haze, unable to relate to any of the people around me. It was like being at a play, where you have to act your part, but you’re the only one without a mask. At sixteen I tried to kill myself again. While on the medication. It didn’t work as well as the last time.
Pity.
At eighteen I stopped taking medication at all. Since then, it’s been nine years, and I’ve observed a very solemn oath on my birthday each year. I’ll die before I allow the doctors to rape away my mind again and, preferably, I’ll take the one who tries with me.
Only my brother and handful of my very closest friends know I’m a recovering alcoholic (20 years) and suffer from depression. It’s simply no one’s business and I believe that if I put it out there, I’m only inviting comments from people. In terms of self-stigma, no. I’ve been dealing with mental illness for decades, I’m used to it. I have a lot of experience in deciding whether to tell someone else about my problems.
Besides, I am so much more than my diseases, I don’t want to be defined by them.
For 2 years I have been living with moderate depression. I am an Occupational Therapist, trained in healthy, balanced lifestyles! I went through the embarrassment stage of not coping with life, and then became proud that I was stepping into my client’s shoes and seeking professional help and being open and honest with what I was finding difficult and recognising my own needs- which real friends totally accepted, but I did experience some people backing away.
My employer has not been so understanding (I work for a mental health NHS trust, unbelievably) and I’ve been off for 18months. The source of my depression being chronic work stress. But what I have found so difficult, after accepting that I was mentally unwell, was to then advocate that I am unwell and in need of recovery time, to people who are set on trying to normalise how you feel, to try to help you to ‘gain perspective’, ‘that every one feels down sometimes’. It keeps you questioning- am I being lazy? have I become self indulgent? and that is part of the struggle too- knowing where you stand with yourself, and trusting your knowledge of yourself.
There are also days when I feel I am unreliable, unmotivated and lack energy- not a model employee-so I sometimes believe I’ve earned that stigma too.
I never went into MH as an OT, because of my own fears-knowing the darkness can happen to any one-I had a fear of being sucked of my energy from people with MH problems. In some ways I still am, as that has been me, drawing on other people on the dark days. To me this has led to my isolation for fear of sucking other people’s energy. I believe self stigma exists, but based on facts or feelings?
Hmmmm…..
BMcS: I, too, am an occupational therapist trying to cope with major depression. Because I had a similar negative experience with my (now former) employer, I have some thoughts, suggestions and feelings I’d like to share with you personally — does this site provide a way we could email one another privately?
I’m struggling with internalized stigma as it relates to my job. I no longer view myself as capable of adequately counseling my employees. I know that in management circles I’ve beein in that this is a career killer. I confided my chronic depression to my boss and she could only relate to her post-partum depression, so she doesn’t understand life-long depression. I confided in my parents and they were totally shocked and admitted they couldn’t provide me with any support because they didn’t understand it or my suicidal thoughts. I think they got defensive and I ended the conversation instead of further upsetting them.
Every living person has some form of disability. Including and especially the employer (boss). Now dosen’t that statment make the world a little bit more connected. I believe that when a person becomes aware of this statment then they can empower themselves and know that they are not alone.Immagine saying at work “this is my disability whats yours”
Good article. Another form of internalization of stigma which I have been struggling with is the reaction to what people say when they already know you have mental health issues.
My friend who supported me through so much has moved on in life and decided he wants nothing more to do with me. He refuses to speak to me but occasionally replies to texts. However all the things he says imply that it was all my decision to part company – that I hated him, that I never want to get better, etc. No matter how much I try to regain his friendship or understand why I’ve lost him he blames it all on me and says it was my decision.
What I’m really struggling with is whether he is twisting things to cover his guilt or whether I’ve actually done all that and have been misunderstanding absolutely everything. After all, I’m the one with the mental illness.
I have ‘emotionally unstable personality disorder’ – I may get stressed and out of control but my brain generally knows what is going on, I don’t hear voices or have hallucinations so I think I’m fairly lucid.
I didn’t mean this post to be all about my personal problems, I just wonder if it is a problem for people with mental illnesses – that it’s too easy to label that person as the one in the wrong or causing any problems because they’re ‘not right in the mind’. In which case they end up internalizing it and believing it.
Right now I don’t know quite how ‘mad’ I am, and no doctor/therapist can tell me because they only have my side of the story.
Thank you THANK YOU. I have bipolar disorder and just can’t stand it when people say I “don’t understand”. THEY don’t spend each day thinking of ways to kill themselves, tearing into their own skin, wishing they were dead, or feeling nonexistant drops of water falling onto them each day. I have told some of my friends about my disorder and felt my stomach drop or anger cloud my vision when they replied with stuff like, “That explains it”.
It sickens me when people put crude labels on people. That “fat kid” in the hall may very well have an eating disorder, while the “emo kid” possible suffered child abuse or depression.
I’m beginning to understand why it took 38 years for me to face my illness and ask for help. Trying to appear normal all my life. Yet knowing inside that I am very sick. I never realized how much I was hurting myself. I’m now in therapy and on medication. Each day is a struggle. My hope is to one day feel okay with with myself, my life and my illness. I have missed out on so much of my life. I pray others don’t wait so long. Thank you for sharing this information, it’s been very helpful.
I know what stigma can do to a person, in Kona Hawaii it’s professionals who are the worse to stigmatize me, treat me as damaged good, not good enough not capable of step outside that role or image they have. I did step outside that rat trap and doing a workshop for professionals and my peers on stigma want to change how we are all treated. how they look at us, the myths and misconceptions.. i could get mad but i will equip them with facts instead..
This for sure hits home hardest for those with Borderline Personality Disorder, as it is the most stigmatized disorder in the medical community by far. Telling psychiatrists can feel like telling a doctor I have the plague. The stigma I’ve encountered, despite being a treated, mature individual and informed patient, has been extreme. This all reinforces the interior shame and self-hatred, which is exceptionally strong in the disorder already. I feel for everyone else who experiences the shame and stigma of diagnosis, because treatment- specifically Dialectical Behavior Therapy- is so important. Being judged by those you seek to help you feels like a slap in the face. Stigma is very real, prevalent, and is going to require a huge tide of change similar to what depression, anxiety, and bipolar have seen. Borderline is much more common than bipolar, we need education, and social stigma is the biggest block on this path forward.
Thank you! These things need to be said more often and more loudly.
As a person with autism and depression, I can understand where I internalized stigma. There was a time which I questioned every feeling, every action and every single thought as “Is this normal?” Every time, I thought it was weird. Seeing my mother, with Bipolar Disorder, lose many friends because of her diagnosis, I have been very closed up about my feelings…even to the point of thinking that even an appropriate feeling was weird and unacceptable – even to the point of not knowing what I was feeling.
Now, not only do I see the fallacy in that way of thinking, I am slowly learning to do the opposite. I am tired of the ignorant and immature ruling my life. Besides, what is normal anyway, except a dryer setting? According to the DSM everyone talks about, EVERYBODY can get an abnormal diagnosis.