The Concept Of ‘Self-Stigma’, Its Risks And Ways To Solve

People with mental illnesses and other mental health problems are among the most devalued and degraded individuals in society. As a result, they are frequently burdened by experiences of prejudice and discrimination. Researchers have come to understand this phenomenon as stigma. There are two types of processes related to the stigmatisation of mental illness: public stigma and self-stigma. Public stigma is the negative perception held by society and manifests itself though stereotypes, prejudice, and discrimination. Self-stigma is experienced by those with a mental illness and occurs when they internalise these negative public attitudes. The consequences of self-stigma are abundant. Research shows that self-stigma can lead to a decrease in self-esteem and self-efficacy, as well as reduce the level of treatment-seeking and hinder the efficacy of health services. Considering this, the purpose of this essay is to explore the concept of self-stigma and examine the risk it poses to individuals seeking mental health services. Furthermore, I will also discuss potential methods of combatting self-stigma and analyse its overall effectiveness.

People suffering from issues of mental health are very commonly burdened by stigma. To fully comprehend this phenomenon, researchers have identified two principal levels upon which it operates: public stigma and self-stigma. Public stigma (or social stigma) is defined as a “social construction whereby a distinguishing mark of social disgrace is attached to others in order to identify and to devalue them”. In most cultures, mental illness is considered a ‘distinguishing mark of social disgrace’ because, as Crawford and Brown (2002) theorise, it does not align with the social norm and therefore, emanates a sense of fear and uneasiness. Social psychologists have distinguished the ways in which public stigma can manifest: stereotypes, a socially-shared cognitive representation used to identify a group of people; prejudice, a positive affective reaction towards negative stereotypes; and discrimination, the negative behaviour and actions taken as a result of prejudice. Typically, mentally ill people are associated with negative stereotypes, but the way they are characterised varies, ranging from dangerous and offensive to incompetent and weak. These are often driven by the idea that mental illness is a threat or a character flaw that the individual cannot or refuses to control. These stereotypes can elicit prejudiced reactions, such as fear, anger, or disgust and consequently, lead to discrimination, which can take on a multiplicity of forms. Self-stigma occurs as a consequence of public stigma. Self-stigma is an internal evaluation process whereby “people internalise these public attitudes and suffer negative consequences as a result”.

Self-stigma is understood as a three-part process of awareness (knowing how they are stereotypically perceived), agreement (accepting these perceptions), and application (integrating these stereotypes within one’s self). Self-stigma can lead negative emotional reactions such as decreased self-esteem, where the individual feels inferior and inadequate. This is embodied through the ‘Why Try’ Effect, a “modified labelling theory that suggests avoidance as a behavioural consequence of devaluation”. When these concepts manifest within the individual, it can hinder care seeking actions. This is because, when one seeks treatment, the decision to participate is ultimately determined by their perception of whether or not the benefits outweigh the costs. Individuals who, as a consequence of self-stigma, embody the “Why Try” effect may believe that treatment will not benefit them because “Why try to seek care when I do not deserve it, or know it will fail?”. This is reflected in the statistic that found that 54% of Australians diagnosed a serious mental illness failed to seek treatment (Australian Institute of Health and Welfare, 2014).

Self-efficacy, defined as the belief in one’s success and accomplishments, is also adversely affected by self-stigma and this too can become a barrier for treatment engagement. With poor self-efficacy, individuals who do utilise mental health services oftentimes drop out, with over 20% discontinuing prematurely, because they do not believe in its effectiveness. Internalised ideas of low efficacy in both one’s self and the treatment has also shown to produce a self-fulfilling prophecy and consequently, reduced the treatment’s level of effectiveness.

Broadly speaking, empowerment is one potential strategy for mitigating the negative impact of self-stigma and improving treatment-seeking behaviour amongst people with mental illnesses. Empowerment, in the context of mental health, is defined as “the level of choice, influence, and control that users of mental health services can exercise over events in their lives”. In this sense, empowerment has the ability to transform self-stigmatised peoples from being passive and avoiding negative outcomes to being active and creating positive outcomes. The process of empowerment begins with disclosure. Secrecy surrounding one’s mental health history can imply that it is something to be ashamed or embarrassed about. Through indiscriminate disclosure – that is, no longer making an active effort to conceal its existence – the individual has taken away any possibility of consequence that could come from others finding out, exercising power over their lives, and thus has developed a sense of autonomy and independence. In cases where indiscriminate disclosure poses threat, the alternative is selective disclosure, where only people who are trustworthy are informed. This openness could also draw people of similar situations in and lead to the formation of a group identity. Research has found that individuals who interact with members of their stigmatised group are likely to find comfort in their shared identity and experiences, which can diminish the negative effects of self-stigma such as low-self-esteem and self-efficacy. As a result, they are more likely to engage in mental health treatments.

Furthermore, ‘coming out of the closet’ could also empower individuals through the broadening and strengthening of support networks. Research shows that the more experience and personal proximity one has with mental illness, the less likely one is to hold stigmatising beliefs. From this, we can infer that, despite one’s condition, there is a strong possibility that they will have the support of friends and family who will encourage treatment seeking behaviours. This is supported by the following statistic: 95% of people with schizophrenia are cared for by family members, which demonstrates the effectiveness of loved ones when promoting the use of services, as they are most likely the resources of care.

Overall, stigmatised individuals are found to have positive life changes due to empowerment, one of which includes the promotion of care seeking engagement. Mental health conditions and the issues related to it are pervasive all over the world. People who suffer from this are only further burdened with self-stigma and the consequences it can reap. Lower self-esteem and self-efficacy, manifested through the internalisation of the ‘Why Try’ Effect, combine to form a barrier between stigmatised individuals and effective mental health services. Indeed, the rate of access and efficacy for psychiatric treatment accessed by individuals with a diagnosed mental illness is very low. The strategy proposed by Corrigan & Rao (2012), empowerment, has found to be effective in stimulating treatment-seeking behaviours. As the binary opposite of stigma, empowerment reduces its negative effects and encourages individual power, control, independence, and autonomy. Ultimately, in understanding the phenomenon of self-stigma and the potential strategies that could be used in combatting its difficulties, perhaps we can get closer to eradicating the stigma of mental illness all together.