When Mental Illness Stigma Turns Inward

By Margarita Tartakovsky, M.S.
Associate Editor

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.

We see it with our families or friends, who might say versions of “just snap out of it” or “get over it already” or offer “advice” like sleep more, eat less, look on the bright side and try harder.
There’s also just pure ignorance, especially when it comes to serious mental illness such as bipolar disorder and schizophrenia. As E. Fuller Torrey, M.D., wrote in Surviving Schizophrenia: A Manual for Families, Patients, and Providers, “Schizophrenia is the modern-day equivalent of leprosy, and in the general population the level of ignorance is appalling.”
But what happens when that stigma comes from within — when people with mental illness internalize these negative public perceptions?
An excellent article in Esperanza magazine — whose tagline is “hope to cope with anxiety and depression” — explored the issue of self-stigma. Not surprisingly, internalized stigma can worsen a mental health condition. How?
According to the article, self-stigma makes people less likely to seek treatment. (Other studies have confirmed these findings as well.) From the article:

“For example, a 2009 study from Leipzig University in Germany identified internalized stigma as ‘an important mechanism decreasing the willingness to seek psychiatric help’—and of far more influence than ‘anticipated discrimination.’ Likewise, a U.S. study of college students, published in Medical Care Research and Review in May 2009, found that personal stigma (as opposed to perceived stigma) was ‘significantly’ associated with unwillingness to seek help.”

Even medical students — who suffer from depression at high rates — report concerns about stigma. In a recent study published in the Journal of the American Medical Association, 53.3 percent who reported high levels of depressive symptoms worried that disclosing their diagnosis would be risky.
Also, 34.1 percent of first- and second-year students and 22.9 percent of third- and fourth-year students reported that they’d feel less intelligent if they sought help. And these are the individuals who’d presumably be more comfortable than the average person in seeing a professional.
Self-stigma also can lead to isolation, lower self-esteem and a distorted self-image. “People with a mental illness with elevated self-stigma report low self-esteem and low self-image, and as a result they refrain from taking an active role in various areas of life, such as employment, housing and social life,” according to David Roe, professor and chair of the department of community mental health at the University of Haifa. He and other researchers are exploring the efficacy of a new intervention to minimize self-stigma.
So what can you do? The Esperanza article suggested these tips to combat self- and social stigma:

“Explore therapy to help you reframe your life experience, improve your self-image and replace negative self-talk with more positive language.

Use the Internet for peer support. Twitter with others who have depression, trade recovery stories with Facebook friends, or join an online mental health forum (such as those at psychcentral.com or Esperanza’s new peer-to-peer forum at hopetocope.com or hopetocope.ca).
Practice strategic disclosure. Tell your story to a peer or person with a realistic view of depression.
Get involved in outreach. Join advocacy groups. Participate in or help organize a walkathon or mental health fair. Write protest letters to media outlets or companies that spread negative stereotypes.”

Whether you have a mental illness or not, push past the misperceptions, and educate yourself with the facts.
Realize, for instance, that someone with depression isn’t able to just snap out of it. (Trust me, if they could, they would!) Realize, too, that eating disorders are serious illnesses; the person can’t just eat to fix it. (Anorexia nervosa has the highest mortality rate of any mental illness.)
Such is the same with all mental illnesses.
Educating yourself about what mental illness is and what it isn’t can help tremendously. So can spreading the word to others and getting involved in advocacy.
And, importantly, remember that you are not alone! Mental illness is common, and it touches everyone’s lives in one way or another. Consider checking out support groups or online forums to connect with others who are in similar spots.
Have you experienced stigma? Have public perceptions of mental illness affected you or your seeking treatment?
* – Research has shown no causal link; risk for violence increases with drugs and alcohol, which is true for people without mental illness, and with the presence of past violent behavior.Go To Psych Central to learn more.