The stigma of mental illness remains a stubborn problem for those seeking recovery. Public stigma prevents people from achieving rightful life goals: for example, employers buying into the stereotypes choose not to hire people labeled “mentally ill;” landlords decide not to rent to them.
Self stigma — internalizing these stereotypes so people believe themselves unworthy or unable — leads to a “why try” effect. “Why try seek a job? Someone like me can’t handle it.”
Unfortunately, stigma does not seem to be improving despite evidence that the Western world is more educated about causes of mental illness than any time in history.
Contact is an effective approach to stigma change. “Contact” involves people with lived experience sharing their illness, recovery, and accomplishments to strategically-targeted groups including employers, landlords, police officers, health care providers, legislators, and faith-based community leaders. This means people need to disclose their experiences with mental illness and the health care system — come out, as it were — a courageous decision given the prejudice and discrimination it risks.
However, people who come out typically experience less self-stigma and a greater sense of personal empowerment. Hence, coming out has the potential of a double whammy: decreasing public stigma by helping the population appreciate the lives of people with mental illness while also diminishing self-stigma.
Coming out has value for the person struggling with mental illness. Would we say, however, that it is proud? And if yes, would we call the mental illness, or “surviving” the mental illness, the source of pride? Pride and identity have been understood by distinguishing accomplishment (“This is what I did”) from being (“This is who I am”).
On one hand, people experience pride in achieving a standard recognized by their culture (e.g., a medal for the long-distance runner or a college degree for the person challenged by psychiatric disabilities) or set by themselves (e.g., a personal best running time or meeting a course deadline when experiencing a recurrence of depression). In these examples, it seems to be overcoming the challenges of mental illness that lead to identity pride, an experience not to be minimized. There may be benefit as a person attains some sense of agency along with symptoms and disabilities; i.e., decision and self-determination in the ground of mental illness is an identity that yields self-esteem and self-worth about which a person might be proud.
Pride also emerges from a sense of “who” one is. Ethnic pride is a clear example: “I am Irish-American” does not suggest any accomplishment per se but rather satisfaction at the recognition of my heritage, an additional answer to the person’s search to understand, “Who am I?”
We would argue that this latter phenomenon explains mental illness as an identity in which a person might also be proud. For some people, “I am a person with mental illness” defines much of their daily lived experience. This kind of identity promotes authenticity, a recognition of one’s internal conceptualizations in the face of an imposing world. Authentic people have pride in their authenticity.
Toward this end, we have been working with colleagues from Australia, Canada, and Europe to develop a Coming out Proud program. Its goals can be discerned from the program’s three lessons and corresponding learning points:
- Considering the Pros and Cons of Disclosing:
- My identity and mental illness.
- Secrets are part of life.
- Weighing the costs and benefits of disclosing.
- Different Strategies for Disclosure:
- Five ways to come out.
- Testing a person for disclosure.
- How might others respond to my disclosure?
- Telling your Story:
- How to tell a personally meaningful story.
- Who are peers who might help me with coming out?
- Review how telling my story felt.
- Putting it all together to move forward.
Coming Out Proud entails three 2-hour sessions conducted by two trained facilitators with lived experience, typically for groups of five to ten peers. The program and workbook may be downloaded for free from the Resources page of the National Consortium on Stigma and Empowerment.
Coming Out Proud Manual (PDF)