Post No.: 0209
Stigma, when it relates to mental health, can be in the form of ‘social stigma’ (the stigmatising attitudes of society/other people) and it can be in the form of ‘self-stigma’ (an internalised or self-inflicted stigma, such as thinking that one is weak or an embarrassment for being defeated by depression, assuming that other people will avoid or be disappointed in oneself when these people won’t be, confidentiality concerns, or being afraid of being committed, sectioned or detained (such as under the Mental Health Act if one is in the UK)).
So sufferers of mental health disorders, disabilities or learning difficulties can often apply self-stigma towards themselves and their own conditions too, such as by assuming that other people in their particular community will treat them badly if their condition were to be publicly revealed. This will obviously increase the worry about speaking out.
People may hide their mental health problems because they fear being judged, which might be an actual or erroneously assumed outcome. Maybe they don’t want an official diagnosis and the label of a mental health condition themselves hence they avoid going to see their doctor, or they simply believe it’s pathetic of them to be feeling the things they are feeling and so they’re trying to tell themselves to ‘snap out of it’, to no avail. Maybe they don’t want to seek help for they’ll think of themselves as weak, lazy or as having given up or in to their problems.
Sufferers will often say what they think other people want to hear, so they just constantly reply with, “Yeah, I’m okay” even though they’re not. The people they’re particularly around might actually be compassionate and understanding; although there is a real risk that some under-educated people will deem them as ‘possessed by evil spirits’ or so forth, and discriminate them unfairly. The risk of social ostracism, of being sectioned (in some countries), ‘demon exorcism’ practices (in some cultures), or other such treatments, incentivise the sufferer to always say, “I’m fine” even when directly asked whether they’re feeling okay or not.
Stigma (whether the fears are real or imagined) will therefore affect whether or not a sufferer will seek help when needed, and this can be during the first signs of difficulty or up to many years later. So don’t dismiss or invalidate either a clear or timid call for help from someone, even when a stressor or pain appears small from the outside, because it can internally snowball, and this snowball can be kept hidden from public for many years simply because the initial reaction to it by others was dismissal or invalidation. If a person reacts negatively and unhelpfully towards a sufferer even when a problem is small then a sufferer may think that people will react even more negatively or unhelpfully if they find out they have a far bigger problem; and then it could become too late for the sufferer.
Those who self-stigmatise typically judge themselves to overly harsh, perfectionist and therefore unrealistic standards of ‘toughness’, ‘independence’ or ‘self-sufficiency’, and expect to have an infinite ability to cope without complaining or seeking help. Yet many of these very same people wouldn’t look down upon others who ask for help from them and would even, with heartfelt furry empathy borne from firsthand experiences, encourage other sufferers to ask for help. Well depression ordinarily manifests as a harsh criticism of the self – of beating oneself up – not as a criticism of other people. People generally consider it as a strength if other people admit to their vulnerabilities and shortcomings yet would consider it as a weakness if they admit to their own vulnerabilities and shortcomings.
So stigma can be external or social (e.g. family, community, institutional, structural) or internal (self-stigma). An illness label can negatively affect a sufferer’s self-concept, although this could arguably be broken down into those who empower themselves to seek help from knowing what their illness is, and those who internalise the stereotypes and succumb or resign to these stereotypes themselves and thus act with less empowerment. Self-stigma, just like external or social stigma, is a stressor, and so can exacerbate existing mental health problems. Self-stigma may not be the initial cause of a mental health condition like bipolar depression or anxiety but it can definitely worsen and needlessly prolong episodes.
It’s a self-stigma to be offended about personally getting tested or treated for a mental health problem but – analogous to a test for diabetes, for instance – being offered a test for a mental health problem doesn’t necessarily mean that one has a mental health problem; and even if one does become diagnosed with something, in most cases it’s something important to at least privately know. (Post No.: 0204 looked at whether receiving a diagnosis always helps.) Doctors will not share this confidential information (although health insurance companies will likely wish to find out, and health apps might infer diagnoses based on the data they collect from their users, in this world of ever-increasing ‘datafication’).
Some people do become extremely insecure and defensive about being labelled with a disorder, disability or learning difficulty, even though that is what they clinically have. They believe that other people are stigmatising them when these other people are just stating a fact of their diagnosis – hence they’re really stigmatising themselves when they react so emotionally defensively towards other people for just simply pointing out their disorders, disabilities or learning difficulties as a matter of fact without prejudice or discrimination. They arguably need to own their depression, Down syndrome, dyscalculia or whatever – to accept it and not be ashamed about it. They should take the attitude of ‘so everybody knows that I have a mental health condition – fine, because that’s what I have and it doesn’t make me overall any less good or capable as a person’. Woof!
Disorders, disabilities (mental or physical) or learning difficulties do present hindrances in one’s life and can limit one’s ability to work in certain areas or socialise, for instance – to deny this would be going too far. But absolutely no one is perfect and we will have other areas or careers we can shine in; and so stigmatising against those who suffer from OCD or autism would be equivalent to stigmatising against those who are rubbish at drawing or cannot cook, for instance.
There are cases of sufferers who want the reason for their behaviours or under-performances to stand – yet if people warn others about their limitations, they think it’s not fair for them to be labelled with the condition they have even when it’s relevant to the tasks they might be asked to do (e.g. even in the most liberal world, we wouldn’t want a person who easily suffers from panic attacks to control air traffic, like we wouldn’t allow a blind person to drive). So they want the empathy or sympathy when they get things wrong because of their condition, yet simultaneously want to deny they have any problems whatsoever. They apparently want the leniency without the label. For instance, a person writes addresses down incorrectly because of his/her dyslexia (which is recognised as a disability under the equality laws of many countries, including in the UK) but he/she refuses to be declared on application forms as being dyslexic and defensively shuts down anyone mentioning his/her dyslexia at all. This is self-stigma. They’re basically self-stigmatising their own condition as if it’s something to be ashamed of in public. And if even a dyslexic person isn’t happy to call him/herself dyslexic then how is the wider culture of stigmatising dyslexia going to diminish?
If even you think the label is unwelcome then so will others. If even you are ashamed about it then how are others supposed to feel about it?! There’s nothing to be ashamed of because no one is perfect, even though not everyone will have a name for their own imperfections (e.g. people who suffer from ‘boring-ism’ or ‘I-can’t-be-creative-at-all-ia’(!)) Some labels are, although useful from a clinical perspective, arbitrarily defined too because we all possess some level of anxiety or occasionally exhibit ‘strange’ thoughts, for instance (just like apart from some albinos, all of us possess levels of melanin in our skin, just to individually varying degrees, hence skin colour ‘boxes’ are arbitrarily defined). However it’s not a self-fulfilling label because in these cases the chronic symptoms come first then the clinical diagnosis.
Tackling self-stigma in mental health is like, as a loose analogy, not being ashamed of having red hair, of having a certain skin colour, sexuality or whatever, because why should you be? If people with red hair won’t accept being labelled as having red hair, and if they try to constantly hide it by dyeing their hair as another colour, then what are other people to think about those who naturally have red hair? Own it! There’s nothing to be embarrassed about it. It’s just a statement of fact. So you’re someone with schizophrenia, multiple personality disorder, bulimia or whatever, and that’s okay. It’s not like you’ve killed someone, stole something, cheated or done something else reasonably determinable as bad! No one’s saying go to the other extreme and gloat about it, but it’s okay. This also doesn’t necessarily mean that you don’t want to get better where possible – similar to accepting that you have a broken paw won’t mean that you don’t want your paw to get better.
It’s also worth looking at things from another perspective – it’s typically worse not being able to find a name or label for one’s own condition, as if you’re making up your own symptoms when you’re not. So a label helps other people to believe or understand your condition, as well as personally means that you’re not alone with your condition. There are also nasty and prejudicial slur words for sufferers of various conditions that are designed to stir emotional reactions, misapplied clinical terms for the wrong conditions, incorrect or no-longer-applicable labels, and these aren’t right – but using the correct clinical terms for those who have those conditions must be socially acceptable.
So own it, and include yourself and whatever you have as a part of a normal, diverse and enlightened society. This gets easier the more people open up about something so be a part of that movement. In a way, although social stigma does exist and is a worse and wider cultural problem, it won’t have a chance of disappearing until people firstly cut out their own self-stigma.