Stigma can manifest in multiple ways, with examples including public stigma and self-stigma. While stigma can occur for many groups of individuals (such as minority groups including the LGTBQ+ community, ethnic minorities and racial minorities, etc.), here we focus on stigma in relation to mental illness.
What is Stigma?
Erving Goffman (1963) emphasised the importance of defining and understanding stigma. He suggested that stigma occurs when someone has an attribute that is viewed as undesirable by others. They see an individual as this attribute, often defining and labelling them based on a diagnosis. In doing so they fail to see them as a whole person.
Stereotypes, prejudice and discrimination
There are three key components to stigma including: stereotypes, prejudice and discrimination.
Stereotypes are a set of ideas and beliefs about a group of people. It is argued that stereotypes are useful, as they allow us to quickly place people within a group and form assumptions about them based on these stereotypes. However, often these stereotypes are negative and inaccurate. Image 1 shows some common misconceptions about people with mental illness.
We can be aware of stereotypes without necessarily agreeing with them or believing they are accurate. However, those who do agree with stereotypes show prejudice.
Prejudice is thought of as the cognitive and emotional response to stereotypes. Here individuals support the negative stereotypes and demonstrate a negative emotional response, such as fear of individuals with mental illness.
Discrimination is thought of as the behavioural response to prejudice. Here we often see individuals treating someone differently because they have a mental illness and may include, for example, avoiding anyone with a mental illness.
In Image 2 you can see how these key concepts (stereotypes, prejudice and discrimination) all link together.
Remember, stigma may take different forms, including public stigma, and self-stigma. Public stigma, as discussed so far, is a response or reaction from the general population about a group of people. So, what is self-stigma?
What is Self-Stigma?
People living with mental illness often internalise the negative stereotypes and stigmatising attitudes which are held and expressed by the general public. This is referred to as self-stigma, or internalised stigma.
Being aware of stereotypes does not necessarily mean that you will endorse them; that you will show prejudice or discrimination. Similarly, not everyone who is aware of the stereotypes will experience self-stigma.
So how exactly does self-stigma occur?
Corrigan and Colleagues developed a 'four stage model' describing the formation of self-stigma (awareness, agreement and application), followed by the consequences (harm) which follow (Corrigan & Rao, 2012; Corrigan & Watson, 2002). These stages are shown below using depression as an example.
The Consequences of Self-Stigma: Self-Esteem, Self-Efficacy and the 'Why Try' Effect
The ‘harm’ that occurs as a result of self-stigma can be in the form of emotional or behavioural consequences.
Self-esteem is having confidence in your worth; while self-efficacy is the belief we have in our capabilities. Self-stigma can lead to diminished self-esteem and self-efficacy, both of which are thought of as emotional consequences. Low self-esteem, for example, can leave us feeling unworthy. Meanwhile decreased self-efficacy can make us feel incapable of achieving life goals.
Diminished self-esteem and self-efficacy may lead to the “why try” phenomenon, which can be thought of as a behavioural consequence to self-stigma. If we hold the belief that we are not capable or that we are unworthy of achieving life goals, this is often followed by a sense of futility that there is no point trying. For example, “why should I try living on my own”; or “why even try getting a job”. Ultimetly, self-stigma and the consequences that follow can lead to decreased help seeking, lack of healthcare use, and poor health outcomes.
Mental Illness Self-Stigma in Young People
Children and young people are vulnerable to developing mental illnesses and are therefore likely to experience self-stigma and its harmful consequences. These consequences may be even more pronounced given the unique challenges faced by young people: peer relationships, different transitions, and becoming ever more familiar with the world around them.
Self-stigma is likely to affect young people when thinking about their education, wellbeing, help-seeking behaviours, and overall quality of life. Thinking about the why try effect, many young people may have thoughts such as "why should I try seeking help? I'm not worthy".
Unfortunately, mental illness self-stigma in children and young people is poorly understood, and research in this area needs to be promoted in order improve understanding and to make a difference for children and young people.
Take Home Message
Stigma occurs where someone has a characteristic considered undesirable by others. Public stigma refers to the prejudice and discrimination faced by someone from other people. When someone with a mental illness is aware of the stereotypes, prejudice and discrimination faced by others with that same mental illness, they may agree with this and apply it to themselves. This is known as self-stigma. The consequence of this is often low self-esteem, diminished self-efficacy, and the “why-try effect”.
If you would like to learn more about self-stigma, the references below may be of interest. We would love to hear your thoughts on the topic of self-stigma. What are your experiences of self-stigma?
References
Corrigan, P. W., Bink, A. B., Schmidt, A., Jones, N., & Rüsch, N. (2016). What is the impact of self-stigma? Loss of self-respect and the “why try” effect. Journal of Mental Health, 25(1), 10-15. https://doi.org/10.3109/09638237.2015.1021902
Corrigan, P., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness. World Psychiatry, 1(1), 16-20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/
Corrigan, P. W., & Watson, A. C. (2002). The paradox of self-stigma and mental illness. Clinical Psychology: Science and Practice, 9(1), 35–53. https://doi.org/10.1093/clipsy.9.1.35
Corrigan, P., & Rao, D (2013). On the Self-Stigma of Mental Illness: Stages, Disclosure, and Strategies for Change. Canadian Journal of Psychiatry, 57(8), 464-469. https://doi.org/10.1177/070674371205700804
Rüsch, N., Angermeyer, M. C., & Corrigan, P. W. (2005). Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. European Psychiatry, 20(1), 529-539. https://doi.org/10.1016/j.eurpsy.2005.04.004
Watson, A. C., Corrigan, P., Larson, J. E., & Sells, M. (2007). Self-Stigma in people With Mental Illness. Schizophrenia Bulletin, 33(6), 1312-1318. https://doi.org/10.1093/schbul/sb1076
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