How Self-Stigma Happens

A look at how mental illness stigma can get internalized

Maddiebunday / CC BY-SA

Public stigma, involving prejudice and discrimination from outsiders towards people with mental illness, is damaging enough as it is. But sometimes that stigma gets internalized into self-stigma, an unpleasant gift that keeps on giving.

How self-stigma develops

Researchers Patrick Corrigan and Amy Watson described three broad types of reactions by people who are impacted by stigma: righteous anger, apparent indifference, and self-stigma.

A paper by Corrigan and Rao described a 4-stage model for how self-stigma develops in someone with a mental illness:

1. There is an awareness of public attitudes and the stereotypes that go along with them — aka “I know what they think”
2. There is an agreement with those public views and stereotypes — aka “I think they’re right”
3. Those beliefs are applied to the self, and stereotypes are incorporated into the self — aka “I think they’re right about me”
4. Behaviours are impacted in a harmful way; often, this takes the form: because of [stigmatized belief], I am not [worthy, able], so what’s the point even trying — aka “I’m fucked”

There are multiple factors that determine how a given individual reacts to stigma. The combination of low self-esteem and high perceived legitimacy of stigma makes people more likely to develop self-stigma.

On the other hand, people who have low perceived legitimacy of stigma, intact self-esteem, and strong identification with their social in-group (i.e. others with mental illness) tend to respond to stigma with righteous anger. However, if that combination is changed up and group identification is low, then there’s an increased likelihood of an indifferent response to stigma.

Other factors that come into play include:

• the belief that stigma arises from unjust social pressures
• cultural stereotypes
• individualist vs. collectivist ideologies
• attribution of positive and negative events to internal or external factors

Negative effects of self-stigma

Self-stigma tends to decrease self-esteem and self-efficacy. Quality of life and health outcomes tend to be worse. The why-try effect mentioned earlier acts as a barrier to achieving goals. Increased self-stigma has even been linked to increased psychiatric hospitalizations in a study by Rüsch and colleagues.

There can also be disruptions in identity and sense of self that arise from perceiving oneself as part of a stigmatized group. This can lead to increased anxiety and vigilance. It’s an interesting counterpoint to the benefits of strong group identification in preventing self-stigma from developing in the first place.

Ways to decrease self-stigma

Empowerment decreases self-stigma, and peer support can boost empowerment. Peer connections in some form can also promote stronger group identification, which in turn has protective effects against self-stigma and tends to promote a righteous anger response.

“Coming out of the closet” can decrease impact of self-stigma on quality of life. An analogy Patrick Corrigan often makes is to coming out proud in the LGBTQ+ community. While it’s something that can be challenging on an individual level, on a broader social level, it can have a significant effect.

My own experience

When it comes to righteous anger vs. self-stigma vs. indifference, I fall squarely into the righteous anger camp. I rate stigmatized beliefs as having very low legitimacy (aka a steaming load of BS), and at least in part, this came from working in mental health care and having a reasonably good understanding of the reality of mental illness. I’m also inclined to be pro-medical intervention because of my health professional background. I tend to view the world through a social justice lens, which I think also lowers the perceived legitimacy of stigma.

It probably also makes a difference that I first got sick as an adult, when I already had a strong sense of identity and self-esteem. I chose to “come out” early on; in part, that was because I had no control over certain people knowing, and I figured the best way to regain control would be radical openness.

I’ve heard from quite a few people that have internalized stigma but didn’t realize it was an actual phenomenon rather than just something they felt as an individual. I think being able to recognize self-stigma for what it is could be very helpful for toning down some of the self-blame and shame that might be brewing in the darkness.

References

• Corrigan, P.W., Kosyluk, K.A., & Rüsch, N. (2013). Reducing self-stigma by coming out proud. American Journal of Public Health, 103(5), 794–800.
• Corrigan, P.W., & Rao, D. (2012). On the self-stigma of mental illness: Stages, disclosure, andstrategies for change. Canadian Journal of Psychiatry, 57(8), 464–469.
• Corrigan, P,W., & Watson, A.C. (2002). The paradox of self-stigma and mental illness. Clinical Psychology: Science and Practice, 9(1), 35–53.
• Rüsch, N., Corrigan, P.W., Wassel, A., Michaels, P., & Larson, J.E. (2009). Self-stigma, group identification, perceived legitimacy of discrimination, and mental health service use. The British Journal of Psychiatry, 195(6), 551–552.

Originally published at https://mentalhealthathome.org on August 11, 2020.