Self Stigma and Mental Health

Stigma related to mental illness is regarded as a barrier for people to seek help from a specialist or even GP. This can come at a high personal cost and lead to reduced functioning or disability. The nature of the stigma has been well researched and can be divided into different types. Two broad categories are the public stigma and self-stigma. There have been a number of campaigns against the public stigma and others that encourage help seeking. Self-stigma on another hand is an issue that doesn't get much spotlight but should be at the fore front of a clinicians' mind when seeing patients. Self-stigma (also called internalised or anticipated stigma) occurs when an individual affected by a mental illness endorses stereotypes about mental illness, anticipates social rejection, considers stereotypes to be self-relevant and believes himself or herself to be a devalued member of the society (Schnyder, 2017).

In clinical practice, I have seen patients who present with a varying degrees of help seeking behaviours. In one situation, despite seeking professional help and accepting the diagnosis of personality disorder, the person struggled to accept the situation, a not too uncommon outcome in mental health practice. In an another scenario help seeking was encouraged by family, facilitated by the GP in timely manner and medication deemed effective by the patient. However, the advice to continue on medication endorsed a negative stereotype. In these cases, the negative stereotype was formed during childhood when their parents did not seek help for their mental health issues. The possibility of experiencing the same mental illness as your parent could be perceived as a failure by many who have made an effort to improve their life despite adversity during childhood. Experience of embarrassment or trauma related to hospital admissions, especially under the Mental Health Act, also contributes to this.

Patients disengage from treatment for a variety of reasons and self-stigma could be one of them. It is likely to re-enforce negative feelings about one self in the individual and act as a barrier to help seeking in future. It is important to explore and understand this dimension when one is assessing a patient who has been either brought to the clinic by the family or strongly encouraged by another professional to seek help. It is vital to acknowledge person’s perspective and support them. In some cases, they could be better engaged by their GP who could get access to support from specialist, if required. Peer support in clinical settings could also help normalise the challenge of hospitalisation and instil hope.

References:

Schnyder, N., Panczak, R., Groth, N., & Schultze-Lutter, F. (2017). Association between mental health-related stigma and active help-seeking: Systematic review and meta-analysis. British Journal of Psychiatry, 210(4), 261-268. doi:10.1192/bjp.bp.116.189464

Corrigan PW, Kerr A, Knudsen L. The stigma of mental illness: explanatory models and methods for change. Appl Prev Psychol 2005; 11: 179–90. 

Link BG, Yang LH, Phelan JC, Collins PY. Measuring mental illness stigma. Schizophr Bull 2004; 30: 511–41.