In this following piece, I will be sharing with you how most of us learn and internalize stereotypes about mental health stigma and the effects that such stereotypes have on individuals should they end up suffering from mental health issues.
First up. What exactly is stigma? Stigma is first coined by sociologist Erving Goffman. Effectively speaking, stigma refers to any forms of discrediting stereotypes (generalized ideas) that are attached to individuals, by virtue of the fact that they belong to a particular social category. In other words, when it comes to mental health stigma, it refers to the negative stereotypes that are tagged to individuals with mental health conditions, ideas such as them being “weak”, “crazy”, “violent”, “incapable” etc., just to mention a few.
Why is stigma bad? Stigma is bad because such stereotypes are harmful as they lead to very real impact on the life of individuals, such as causing social distance between persons with mental health conditions and the members of public. It also hinders help-seeking, thereby leading to aggravation of condition, just to mention two of the many key consequences.
Stigma comes in many forms. In this article, I will mention two types, public stigma and self-stigma. First of all, public stigma. Public stigma is about how people from the general public are prejudiced (unfair ideas) and often discriminate (unfair treatment) against persons with mental health conditions. Public stigma is what we commonly know of. Self-stigma is not as commonly talked about since it is a private matter within the individual. Essentially, self-stigma is about individuals holding prejudiced ideas about mental health conditions and in turn themselves. My sense is that perhaps self-stigma could be more common than public stigma.
I am certain most of us hold stereotypical ideas about mental health and ideas against persons with mental health conditions. Yet, have you ever stop and wonder where did you get those ideas from? Today I offer some possible explanations with insights from Modified Labeling Theory (Link et al., 1989). The following diagram is a summary of the Modified Labeling Theory which highlights some key idea of how stigma perpetuates itself.
This theory explains how the negative messages about mental health conditions at a societal level influences the way individuals respond to mental health conditions should they ever get diagnosed (labeled) with one. The original theory talks about the relevance of a diagnosis in effecting negative responses to the diagnosis (label), And self-stigma starts to occur. Consequences of self-stigma could come in forms of secrecy in concealing condition, withdrawing from people, as well as educating the public which may expose them to further discrimination. Such responses may in turn result in low-self-esteem of individuals, reduce their earning power and social ties with people, all of which increases their vulnerability to new disorder, hinder their recovery or lead to relapses of conditions. In short, this theory talks about how public stigma leads to self-stigma in shaping individuals’ perceptions of having mental health conditions and their response in face of a mental health condition, resulting in dire consequences on their mental well-being.
While the original theory addresses cases of formal diagnoses, the same logic applies to how persons in distress but do not have a formal would diagnosis might respond, should they ever respond to mental distress. Even without the diagnosis, all of us have been exposed to negative stereotypes about persons with mental health conditions and myths and legends about how persons with mental health conditions will be (mis)treated. Such negative ideas prevent people from seeking help, because we all fear judgment and we all shun possible negative consequences from public. Some common ideas that has been passed down are things like “If I have a mental health condition, I may get sacked from work”, “People will look down on me if I have a condition”, “It would affect if I will ever be able to find a job”, People would reject me” etc.
However, have you ever stopped and wondered, where did you even get all these ideas from? Where did these ideas originate? These are questions that I have been thinking much of late. I have been asking around. Most of the time, individuals would pause, and they do not even know where they got all these ideas from. As of now, one of the key sources of origins of such ideas is from the media portrayal of how persons with mental health conditions are like and how they are treated. It could be messages passed down from generations to generations, yet, nobody quite knew who started such “folk-tales”.
Besides taking a step back to assess where we got these stereotypical ideas about mental health from, it is just as important to think about whether if all these negative stereotypes about how people would react to persons with mental health conditions are really true in reality. I do not doubt that perhaps there could be some truth in such statements of how individuals are mistreated. Yet, would bosses really sack people if they find out that their employees have mental health conditions? Fact is that I have heard very encouraging stories about how bosses are protective of individuals with mental health, and colleagues are just as supportive and are very willing to help. Even for myself, my boss was truly supportive during that phase when my mum had cancer and I had to see a therapist to journey with me through that period when I had episodic depression. When I told my kids in school about my own journey with episodic depression, I think they were more impressed than they thought I was weak. I thought they respected me even more that I was brave enough to share openly than anything. Each time I decided to be opened about my own vulnerable moments on Instagram, I received a lot of warm comments and likes more than any other posts. Hence, could it be self-stigma at work, preventing us from venturing out to talk to people and have honest discussions about mental health due to the “folk-tales” that have been passed down and we so naturally internalized without questioning?
The journey to fight against mental health stigma requires a two-pronged approach. Firstly, public education on mental health conditions and its symptoms presentation for various conditions and how persons with mental health conditions truly are and not how they are stereotyped to be. Secondly, it also requires a ground-up approach, with individuals like you and I making the effort to contest such forms of automatic thoughts and stereotypes that have been passed down from where we do not even know.
Your voice matters in this whole battle against mental health stigma. People need to hear your personal stories on your journey with mental health, stories that are important and which I believe would change the climate towards mental health. Be that teacher to teach the public about what you have gone through. It will be largely through your sharing that the lay public will finally understand what persons with mental health goes through, learn about what you are capable of and would then be able to learn better how to treat you with more respect. How about we put these stereotypes of how people would react to persons with mental health to the test from today on, starting with sharing with our safest people?
In closing, I would like to share with you an excerpt of one of my favourite poems, entitled "Our Deepest Fears" by Marianne Williamson which I hope will encourage you today:
“Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darkness that most frightens us. We ask ourselves, Who am I to be brilliant, gorgeous, talented, fabulous? Actually, who are you not to be? ...Your playing small does not serve the world. There is nothing enlightened about shrinking so that other people won't feel insecure around you. We are all meant to shine, as children do... It's not just in some of us; it's in everyone. And as we let our own light shine, we unconsciously give other people permission to do the same. As we are liberated from our own fear, our presence automatically liberates others.”
And I close with these words: You matter. Your story matters. And the world needs to hear your story.