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What is ‘self-stigma’, why is it a problem, and what can help solve it?
Mental illness and its stigma have long been a phenomenon that are directed through external
means such as prejudice and discrimination. However, the internalisation of this stigma,
called self-stigma, alludes to the self-judgment pertaining to stereotypes of mental illness and
its subsequent negative effects and processes. The subsequent effects to self-stigma have
immense impacts on the self, in particular a reduction on their esteem and efficacy.
Following these effects, surges the inaction in pursuing professional help or evidence-based
practices as treatment for their illness, becoming detrimental to an individual’s mental
wellbeing. Although, prescribing a bleak outlook on the pursuit for treatment, it allowed for
the development of strategies in order to combat this phenomenon. As such, self-stigma, an
internalised judgement prescribing to ready-made stereotypes of mental illness may have
negative effects on the self’s action for improvement, however, evidence-based practices
have been developed and are developing in order to combat self-stigma.
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Self-stigma although stems from the individual perception, public stigma and its
corresponding stereotypes against mental illness form the underlying principle of self-stigma.
Stigma then is categorised as either public or self, even if there may be linkage between the
two. In categorising these two, public stigma represents the prejudice and discrimination
directed at a group, mentally ill patients, by the general population (Corrigan & E. Larson &
Rusch, 2009). This consists of stereotypes that are endorsed, prejudice, in which it results in
negative behavioural attitudes observed as discrimination. When the stereotypes pertaining
from public stigma is processed and internalised by an individual, there may be the result of
self-stigma. In order for self-stigma to be developed, it needs to include three stages;
awareness, agreement and application (Corrigan & E. Larson & Rusch, 2009). When self-
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stigma includes these three stages or “three A’s” does an individual completely experience
self-stigma. The first “A”, awareness, describes the knowledge or ‘awareness’ of stereotypes
about mental illness, and this awareness can then be agreed to, the second “A”. Upon the
actualisation of these two “A’s”, self-stigma can only be experienced if there was the third
stage, the application, that is, applying those stereotypes to one self. The “three A’s”, can be
observed in the example of mentally ill individuals being aware of the stigma announcing,
“those who are mentally ill are scary”, in which then they prescribe to themselves as “I am
scary”. Self-stigma is then present when the awareness and acceptance are practiced, such as
isolation. The awareness, agreement and hence the application correlating to public
stereotypes and attitudes, produces negative consequences, such as self-discrimination, in
which then is self-stigma defined and developed.
Understanding self-stigma and its problems, will the strategies formed to combat the
phenomenon be effective. Having defined self-stigma and how it develops produces
questions on what the consequences are of this phenomenon. This can be observed in the
“why try” model. The model consists of three components; self-stigma, mediators, and extent
of life goal achievement (Corrigan & E. Larson & Rusch, 2009). Self-stigma can also be
perceived as a modified version of the labelling theory. The modified labelling theory, the
“three A’s”, and thus self-stigma, form the first component of the “why try” model. The
second component, mediators, comprises the process of self-esteem and self-efficacy. These
two processes significantly correlate with the individual’s emotional reactions towards self-
imposed stigma. As such the processes become mediators of the extent of the application or
discrimination the individual insists upon themselves. Four studies have shown that the
threshold to having self-stigma is associated with low levels of self-esteem (Livingston ;
Boyd, 2010). This is further reinforced in the analysis of 127 studies by Livingston and Boyd
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(2010) which demonstrated self-stigma correlates to variables including; low levels of hope,
self-esteem and self-efficacy, quality of life, social support, and empowerment. Thus, the
self-efficacy and self-esteem, mediates the consequences of an individual’s self-
discrimination and hence, their application. In the third stage, an individual’s lack of or
pursuit of life goals is then directly proportional to the mediators of the second stage.
Therefore, lower levels of self-esteem and self-efficacy can demonstrate a problem in the
achievement of life goals, and also whether an individual chooses to seek professional help in
order to assist in that goal. This is explained in studies that presented variables of low levels
of esteem and efficacy to be combined with the level of social support of an individual
(Livingston ; Boyd, 2010). Furthermore, it is emphasised by reports by MacInes and Lewis
(2008) which in the implementation of group-based therapies, there was an observable
reduction of self-stigma. This reflects how in seeking professional help can be beneficial in
reducing self-stigma, and illuminating self-stigma as correlated to the pursuit of professional
help. However, this may not completely support how self-stigma may influence an inaction in
pursuing evidence-based practices, although, it does leave powerful suggestion that self-
stigma does indeed lead to the problem reduced treatment seeking due to the third A,
application, and how studies demonstrated that these practices or treatment such as therapies
become evident in the alleviation of the problems of self-stigma.
Self-stigma and its diminishing effects in self-esteem and self-efficacy are concerning as it
can be detrimental to an individual’s well-being. Furthermore, the significant linkage
between self-stigma and the reduction in seeking treatment and evidence-based practices,
also have growing awareness and concerns. In conjunction with the negative effects of self-
stigma and the growing awareness of its relationship with treatment seeking behaviour,
interest in developing strategies to combat this phenomenon also grows. Since, there’s
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acknowledgment of interventions in alleviating the self-stigma of its negative effects by
improving help-seeking and empowerment in attaining life goals (Buchter ; Messer, 2017).
Potential strategies are henceforth, effective in combating the phenomenon. Strategies
developed are based on the idea of empowerment. Empowerment becomes effective in
reducing the diminishing effects of self-stigma by encouraging people in realising their life
goals and thus, prevent any further negative consequences (Corrignan ; Rao, 2012). This
understanding of empowerment is implemented in the introduction of consumer-operated
programs where services are provided to allow a supportive social environment, offsetting the
discriminating window of public-stigma by a population. In doing this, these consumer-
operated programs rely on peer support as the fundamental therapy to empower the
individual. Buchter ; Messer (2017) discussed the randomised controlled trials (RCT’s) of
people who’ve been diagnosed with mental illness according to the DSM or ICD, and the
interventions that were implemented. Results of the trial were collated and compared to show
that narrative enhancement and cognitive therapy (NECT) to be the most effective. NECT
involves the disclosure or “coming out” of an individual with mental illness and from the
support of peers, it enables an offsetting of consequences and thus empowerment. In NECT,
there are a total of 20 sessions which are separated into 5 stages (Yanos ; Lucksted ;
Drapeski ; Roe ; Lysaker, 2015). In this evidence-based intervention, participants are at
first encouraged to talk about their experience and reflect on their illness. However, in the
second stage, it becomes more structured to present self-stigma to be a derivative of public-
stigma which in the third stage participants are to reconstruct stigmatising ideas of
themselves. Having reconstructed their ideas, the fourth stage consists of an oral or narrative
of the participants, thus the disclosure. The therapy then ends with a description of their
experience, circulating back to the first stage of the program. Therefore, in Yanos et al
(2015), NECT is explored as an effective treatment method in allowing participants in
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vocalising their experience, giving opportunities for empowerment. Making it an effective
evidence-based practice in combating self-stigma.
Self-stigma a phenomenon that describes the internalisation of public discriminating ideas
and the application of it, brings in negative effects that become detrimental to a person. Part
of self-stigma is the inaction in seeking treatment which can be attributed to the lack of
attaining life goals. This then negatively impacts an individual’s wellbeing. However, in
understanding these effects and the models of the phenomenon, strategies have been
implemented to combat it. NECT, an evidence-based practice, shows effectiveness in
influencing the phenomenon by empowering individuals through disclosure and reflection of
their experience as mentally ill. In combating the phenomenon by this strategy, inaction of
seeking treatment is reversed and thus the wellbeing of an individual improves as they
reconstruct their internalisation of stigmatising ideas.
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References
Buchter R., Messer M. (2017). Interventions for reducing self-stigma in people with
mental illnesses: a systematic review of randomised controlled trials. GMS German Medical
Science Vol. 15, 1-12.
Corrignan P., Larson J., Rusch N. (2009). Self-stigma and the “why try” effect:
impact on life goals and evidence-based practices. World Psychiatry, 8(2), 75-81.
Corrignan P., Rao D. (2012). On the Self-Stigma of Mental Illness: Stages,
Disclosure, and Strategies for Change. Can J Psychiatry, 57(8), 464-469.
MacInnes L., Lewis M. (2008). The evaluation of a short group programme to reduce
self-stigma in people with serious and enduring mental health problems. Journal of
Psychiatric and Mental Health Nursing, 15(1), 59-65.
Livingston J., Boyd J. (2010). Correlates and consequences of internalised stigma for
people living with mental illness: A systematic review and meta-analysis. Social Science &
Medicine 71, 2150-2161.
Yanos, P., Lucksted, A., Drapalski, A., Roe, D. and Lysaker, P. (2015). Interventions
targeting mental health self-stigma: A review and comparison. Psychiatric Rehabilitation
Journal, 38(2), 171-178.
