“It is like having shame about who you are, it is as if you are suffering and you have to suffer, because you are not as good of a person.” – Anonymous

These are the words of someone who has experienced depression. Quite simply, it is an example of self-stigmathe negative beliefs that one attributes to oneself and the shame that one experiences as a result of being diagnosed as “mentally ill”.

Needless to say, many post-secondary students experience mental health problems. And with any diagnosis comes the risk of self-stigma.

Self-stigma entails: (1) awareness of the stereotype of a mental illness, (2) agreement with the stereotype, and (3) applying the stereotype to oneself [1]. Each step depends on the step that precedes it: Applying the stereotype to oneself cannot occur without the person agreeing, on some level, with the stereotype, which, in turn, would not occur without the person knowing that such a stereotype exists.

For example, if someone diagnosed with social anxiety disorder believes the stereotype that individuals with such diagnoses are not able to present well in front of an audience and appear on TV, they may apply the belief to themselves and shy away from such opportunities and, possibly, redirect their entire career path.

Such a belief is false. On TVOntario, a television show called “The Agenda” aired an episode titled “When Anxiety Attacks,” where a man diagnosed with an anxiety disorder appears to be very comfortable with public speaking.

Sadly, the power of such negative self-talk is not limited to simply disparaging oneself and prematurely changing one’s career path. It can go as far as barring one from seeking treatment or support from family and friends, as well as detrimentally shifting the dynamic of close relationships and society at large [1]. Accordingly, low rates of seeking help and negative attitudes towards mental health treatment are concerning when we are talking about university students, who find themselves in a high stress period with important life changes occurring in identity, personal relationships, and career objectives [2].

A recent report that examined the changes in help-seeking behaviours and attitudes among university students – over a 40 year period – suggests that current rates of seeking help for mental health issues are decreasing [3]. Specifically, although there is an increased use of psychiatric drugs in developed nations, such as Canada, there are more negative attitudes towards seeking help for mental health concerns. These negative attitudes exist despite the increasing prevalence of mental illnesses in such nations. Further, help-seeking rates for those belonging to racial or ethnic minorities are even lower [4; 5].

As previously mentioned, self-stigma can lead to possible career redirections, withdrawal from relationships, and possible decreased attempts to seek help [1]. However, it extends to aspects outside of the individual as well. Self-stigma is also affected by the family of the individual with mental illness. Siblings or parents may want to distance themselves from the individual with mental illness and may feel judged by outsiders. This, accordingly, can play a role in the family’s denial of the illness, or in their attempts to “save face” and make it clear that the illness is not their fault. And when the family is not actively present and involved in the life of the individual with mental illness, he or she may not turn to anyone else, including professional treatment, for help.

Not only is the family affected, but our society is affected as well. An example of the effect of self-stigma on society is given by Dr. Corey Keyes, a sociology professor from Emory College of Arts and Science, whose main areas of expertise include psychology and mental health. He comments that hiding one’s mental health problems from society results in a loss of opportunity to educate others about mental illness.

Although this tendency of self denial and hiding may be warranted in some cases, it may produce unnecessary suffering for the individual with mental illness. A similar case of self-stigma and subsequent attempt to hide one’s experience is found in members from the LGBTTQ (i.e., lesbian, gay, bisexual, transsexual, transgender, and queer) community. Sometimes, individuals from the LGBTTQ community find that loved ones don’t change the view they have of an individual, regardless of their orientation [6]. Likewise, Dr. Keyes comments that: “I think, many people love and care for people with mental illness, they just don’t know it right now. They would probably be much more accepting of the fact that those people have mental illness, because they already loved and cared for them.”

Though the consequences of self-stigma are undeniably negative, there seem to be some differing opinions as to whether self-stigma results in decreased treatment seeking.

According to Sireesha Bobbili, PhD student and co-investigator at the Centre for Addiction and Mental Health exploring mental health stigma, individuals “may not want to disclose that they have a mental illness, and if they don’t want to disclose, they won’t seek any mental health services. So, they may not want to disclose to family members. And so, your family won’t know about it, they can’t offer support or encouragement as well.”

On the other hand, Dr. Keyes is not convinced that self-stigma results in decreased seeking of mental health services:

“I do know that people with mental illness and self-stigma like to be very secretive about it, they keep it very private, but I don’t necessarily believe there is enough scientific evidence to this common notion that it prevents help-seeking. I do know that there is evidence in studies showing that for people who have self-stigma, the worse the self-stigma, the harder it is for them to recover, even if they are getting treatment.”

Supporting Dr. Keyes’ statement is also evidence that perceived need for mental health services increases the tendency to seek help [7]. Despite this, we still have a long way to go in terms of improving help-seeking. Indeed, in a Canadian community sample from 2009, 59% of those who made a suicide attempt and 76% of those with suicidal ideation did not perceive that they needed psychological treatment of any kind [7].

Though the consequences of self-stigma seem bleak, there are things that we can do to ameliorate these potential outcomes.

There is a relationship between self-stigma and stigma. According to both Dr. Keyes and Ms. Bobbili, without external stigma against mental illness, they believe that self-stigma would not exist.

Therefore, efforts to minimize external stigma will also affect self-stigma

Bobbili claims that such initiatives, including raising awareness about mental illness and substance use, may deter self-stigma and thus, encourage students with mental illness and substance use issues to apply to university, scholarships, and most importantly, seek treatment and support.

From an individual standpoint, Bobbili says that we should recognize our own biases and be aware that we may say or do things that stigmatize another individual suffering from mental illness. Simply listening, accepting, and trying to understand them – rather than trying to change them – can also play a huge role in deterring self-stigma.

Finally, it is worthwhile to acknowledge the suffering that someone with mental illness experiences; this acknowledgment can bring a much needed sense of understanding and acceptance.

 

This article originally ran in Issue I, Volume I: Post-Secondary Mental Health: http://mindsmattermagazine.com/issue-v1/

 

By: Ioana Arbone
Edited by: Veerpal Bambrah
Image by: Marian Sia

 

References:

[1] Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care. Psychological Science in the Public Interest, 37 –70.

[2] Cappelli, M., Davidson, S., & Vloet, M. (2011). We’ve Got Growing Up to Do: Policy and Practice in Youth Mental Health Transitions. Ottawa, ON, Canada: Ontario Centre of Excellence for Child and Youth Mental Health.

[3] Mackenzie, C. S., Erickson, J., Deane, F. P., & Wright, M. (2014). Changes in Attitudes Toward Seeking Mental Health Services: A 40-year Cross-Temporal Meta-Analysis. Clinical Psychology Review, 99-106.

[4] Steele, L., Glazier, R., & Lin, E. (2006). Inequity in Mental Health Care under Canadian Universal Health Coverage. Psychiatric Services, 317-324.

[5] Mojatabai, R., & Olfson, M. (2006). Treatment Seeking for Depression in Canada and the United States. Treatment Seeking for Depression in Canada and the United States, 631–639.

[6] Gonzalez, K. A., Rostoky, S. S., Odom, R. D., & Riggle, E. D. (2013). The Positive Aspects of Being the Parent of an LGBTQ Parent. Family Process, 325-337.

[7] Pagura, J., Fotti, S., Katz, L. Y., Sareen, J., & Team, t. S. (2009). Help Seeking and Perceived Need for Mental Health Care Among Individuals in Canada with Suicidal Behaviors. Psychiatric Services, 943-949.