Self-Stigma

Self-stigma in the context of mental health occurs when individuals with mental health conditions assume the negative stereotypes and beliefs associated with mental illness. This assumption can lead to thoughts of indignity and reluctance to seek help due to a fear of being judged by others. 

Prejudices against people with mental conditions span cultures, religions, ages, races, and beyond— therefore, people from all walks of life can experience self-stigma. However, regardless of an individual's life circumstances, researchers have noted there appears to be a progressive model of self-stigma with four stages:

1. The individual has an awareness of public stereotypes applying to mental illness.
2. The individual concurs with these stereotypes and labels them as accurate.
3. The individual identifies with the stereotypes and internalizes their negative aspects.
4. The individual experiences emotional and psychological distress³ because of this internalization.

People experiencing self-stigmatization may fear sharing their mental health condition with others in anticipation of adverse reactions and social repercussions. This fear can prevent them from seeking support and treatment, potentially creating further mental health challenges. 

Modified labeling theory posits that individuals who identify with stigmatized labels may internalize perceived stigma, and societal prejudices, leading to self-stigmatization and diminished self-esteem. Research papers, such as those found through Google Scholar or university press publications, underscore the influence of modified labeling theory in understanding the relationship between self-stigma and mental disorders. Many of these papers emphasize the importance of stigma reduction efforts by mental health care providers and alliances like the National Alliance on Mental Illness to combat prejudice and discrimination and enhance self-efficacy.

Self-stigma can manifest in various forms, creating barriers to seeking help and support. However, other types of stigmas can also impact people with mental health challenges, including the following types. 

Public stigma

When a general population holds negative attitudes and beliefs toward people with mental illness, they are showcasing public stigma, which can create discrimination, social exclusion, and judgment of personal character. For example, when people carry the misconception that individuals with mental illnesses are lazy, weak, or unpredictable, they are participating in public stigma. 

Structural stigma

Structural stigma, sometimes called systemic stigma, involves institutional or systemic barriers preventing individuals with mental health conditions from accessing proper care and opportunities. This type can include discriminatory policies, inadequate insurance coverage for mental health treatments, and limited resources for mental health services.

Affiliation stigma

Family members, friends, and caregivers may sometimes experience discrimination on behalf of an individual with a mental disorder. Affiliation stigma can create relationship difficulties and feelings of social isolation and ostracization.

The impacts of self-stigma are often multi-faceted, affecting individuals, families, and communities on different levels. Some examples include the following. 

Self-isolation 

People experiencing self-stigmatization may isolate themselves or attempt to conceal their mental health difficulties from others for fear of discrimination or rejection, creating potential complications for families and caregivers. 

Difficulty seeking support 

Self-stigma can deter individuals from seeking help, support, or treatment for their condition because they might believe that they don't deserve assistance or that seeking help would confirm negative stereotypes about themselves. Without treatment, some people experience increased severity of symptoms and, in some cases, increased rates of suicidality.

Avoidance

Internalizing negative beliefs may lead to avoidance of social interactions, limited opportunities in the workplace, and a reduced quality of life. These challenges can potentially contribute to societal challenges like poverty and homelessness.

Maladaptive coping mechanisms 

People with mental illnesses who are experiencing perceived stigma and self-stigma may develop maladaptive coping mechanisms⁴ to manage the associated distress. These mechanisms may include denial, avoidance, and withdrawal. In addition, individuals may develop other mental health conditions like substance use disorders.

Experiences with self-stigma and its impact on self-esteem often differ between individuals. Some people may experience severe self-stigma with suicidal ideation and extreme isolation, while others experience mild self-doubt and negative thoughts. Others may believe that they are inferior or flawed in some way because of their condition or identity. Regardless of its severity, self-stigma creates various challenges, including those that specifically impact self-esteem.

Some people with self-stigma engage in "self-sabotage" because they assume they cannot achieve their goals. Researchers have coined the "why try" effect to describe such beliefs. There are many examples of how the "why try" effect can surface. For example, individuals may forego trying if they believe they cannot live independently or establish a career because of self-stigma. The "why try" effect can also impact the efficacy of mental health treatment. Some with self-stigma may refuse help or stop adhering to a treatment plan because they don't believe they will succeed. 

Individuals with low self-esteem due to stigma may also intentionally sabotage their relationships. They might believe they are unworthy of having relationships or that people want a relationship with them for reasons other than the enjoyment of their company. Self-sabotage and the "why try" effect may be a form of self-protection. Sabotaging the activity or relationship may seem easier than facing the pain if an individual expects failure due to negative self-esteem. Engaging in self-sabotage for fear of failure due to low self-esteem driven by self-stigma may reinforce their negative beliefs and perpetuate the cycle.

Overcoming self-stigma can be a valuable step toward improved self-esteem and well-being, as well as promoting mental health awareness and acceptance. Individuals and societies can combat stigma in several ways, including the following:

Education 

Cultivating education and awareness about mental health conditions and their causes can serve to challenge misconceptions, replace stigmatizing beliefs with accurate information, and encourage empathy and understanding.

Open conversations about mental health 

Sharing personal stories and experiences may break down barriers and reduce isolation. Self-stigma may lessen when people realize they are not alone in their experiences. Having open conversations about mental health may also encourage others to reach out for help if they know that someone they care about is also seeking support. 

Mindful language 

Be mindful of language when discussing mental health. Using person-first language (e.g., "a person with bipolar disorder" rather than "a bipolar person") emphasizes that the individual is not defined solely by their condition. However, note that some people may prefer identity-first language, such as “Autistic person,” as they may find that their condition or disability is an integral part of their identity. Ask each person what they prefer to be referred to as. 

Self-compassion 

Treating yourself with the same kindness and understanding you would offer to a friend may counter feelings of shame and self-criticism often associated with self-stigma.

Mindfulness 

A mindfulness practice such as yoga or meditation can help individuals stay present and non-judgmental, reducing the impact of self-stigma on their overall well-being.

Self-empowerment 

It can be helpful for individuals to define themselves beyond their condition and identify their strengths, achievements, and passions. For example, journaling prompts, writing poetry, and other self-care strategies may cause a sense of empowerment and well-being. 

Support networks 

Engaging with friends, family, and peer support groups can help individuals combat self-stigma.

Critical thinking 

Portrayals of mental health conditions in media are often inaccurate or stigmatizing. Being able to discern fact from fiction can reduce the influence of negative stereotypes.

Fighting stigma on a broader level 

Participate in mental health advocacy efforts to help fight stigma on a broader scale. Promoting policy changes, supporting anti-stigma campaigns, and sharing personal experiences may create positive change.