Stigma in the purest sense of the word means ‘mark of shame’. Stigma occurs when a negative attitude, judgement of stereotype is held about a person simply because of their membership to a certain group. Stigma is an extremely dehumanising experience. People with mental illness face multiple different forms of stigma. We are often viewed as less reliable people who are weaker than the general population. We are sometimes seen as loose canons who cannot be trusted. We are stereotyped as lazy and crazy all in one. Jackpot.
Whilst there is a great deal of literature and discussion surrounding societal stigma, less attention is paid to self-stigmatisation. Self-stigmatisation is when a person begins to endorse the belief that there is something fundamentally wrong with them. The individual begins to believe the stereotypes held about the mentally ill. They may become shameful and embarrassed of their illness. Self-stigma also interferes with the therapeutic process as the individual tends to blame themselves and adopt a defeatist attitude. Self-efficacy and self-esteem become low as the individual questions; why bother? Self-stigma is a key reason many people don’t seek help.
I shall begin this post by saying that I generally have a ‘open book’ policy about my mental illness(es). In the case of my years with Anorexia, letting everyone know that I was sick meant I had contingencies in place. Anytime I tried to pretend I wasn’t hungry I had a support network telling me to munch down. Likewise, with my Bipolar I think it is very important to keep the people around me informed of my mood fluctuations, for my own safety and their own. However, there are exceptions to the rule where I feel I can not speak out. So despite being a person who is very open about my mental health for the most part I still feel the cool gaze of stigma. Despite being someone who studies Psychology, I still find a way to criticise my own unique psychology. It’s an all encompassing thing stigma. And even the toughest of skin is not immune.
My first real experience with stigma came when I was diagnosed with Anorexia. I was very underweight at the time, desperately sad and with the lowest self-esteem imaginable. I hated myself and thought the only way to fix myself was to keep losing weight. I had just gotten back from a trip with my family during which I spent the whole time deleting pictures where I thought I looked fat. During this trip my family saw me in a bikini and saw how unwell I really looked. I also couldn’t hide how little I was eating when we were having every meal together. Something had to give. So I went to the doctor for help. I poured out my heart and soul to this woman, describing my laxative use, binge eating and self-loathing. All I got from this woman was a diagnosis. She looked at me differently to she looked at the rest of the world. I was a problem to be fixed. She corrected my self-diagnosis of Bulimia with Anorexia (binge-purge subtype) and ignored everything human about me. To this day it is one of the most humiliating moments of my life. Once she knew my label I was nothing.
Now I’m fully recovered from that nastiness, no thanks to that Doctor, I have a different stigma to face. One of the first things I noticed when I was diagnosed with Bipolar is how scared of you people become. With Anorexia, I was met with sympathetic glances and understanding. However, there aren’t many people out there who want to understand those with Bipolar. But beyond the stereotypes of instability I face and the shock on peoples faces that I am a successful person with Bipolar Disorder is another more insidious stigma. I started to believe it. I spend a lot of my time educating friends and family about my condition and everytime I see them shiver away from me I want to do the same. To this day my boss still doesn’t know. Neither do my workmates or the majority of my clients. They think I work less now because of University commitments not because it was suggested by my Psychiatrist. I hate the idea of them thinking me unable to do my job because deep down, I sometimes don’t think I can/should do my job. I don’t think I deserve it. I tell myself that I am lying anytime I pretend to be a ‘normal human being’. This self-stigmatisation has hurt me far more that any from the big, bad world.
When people endorse stigma about themselves and their condition they often lose motivation to pursue their interests. Their is a general belief that the self is undeserving and liable to destroy any chance at success. Individuals who self-stigmatise lose belief in themselves as capable human beings who have value. They reduce themselves only to their condition. It is a dangerous, ugly process involving first being aware of the stereotype, agreeing with the stereotype, and applying the stereotype to one’s self. Thereby one of the ways we can reduce self-stigmatisation is by reducing stigma in society in order to prevent the initiation of this process. We reduce stigma by having open dialogues about mental health, such as this one, in order to normalise the presence of mental illness in society.
Another key way to reduce self-stigmatisation is by empowering individuals, the service users, the improve their own mental health. By focusing on increasing their value as individuals, this highlights to the person that they are unique and competent at exerting control in their own life. Positive Psychology approaches have been especially effective at helping the self-stigmatised recognise their own potential.