This week I’m traveling with my son to Tokyo on vacation after a hectic start to May. I was asked by my work to speak company-wide for Mental Health Awareness Month and prepping for presenting to the entire company was occupying a lot of my attention. And I was freaking out. Just a little. Maybe a touch more than a little.
The topic of the presentation was stigma and, specifically, self-stigma. Since I had worked out the majority of the information in the slides, I thought I would provide some of that information to all of you for my May edition.
I think I have one or two subscribers that don’t work with me (ha ha)!
Stigma is a well-known phenomenon but was first defined in 1963 by Erving Goffman as any characteristic or attribute by which a person was devalued, tainted, considered shameful or discredited.
Four types of mental health stigma have been recognized:
Public stigma: negative attitudes towards those with mental illness by held by the general public. Most often this is the type of stigma we think of when the topic comes up. These are messages and opinions that come to us from family and friends, social media, the news and even via workplace discrimination.
Professional stigma: when healthcare professionals hold stigmatizing attitudes toward their patients or psychiatric professionals. Patients may experience this type of stigma when symptoms are dismissed by doctors or the patient is not taken seriously. Interestingly, psychiatric professionals also feel this type of discrimination when they are not considered to be “real” doctors. Look at some of the names we call psychiatrists – shrink, witch doctor, head shrinker. Such name calling doesn’t happen often to cardiologists and oncologists.
Institutional stigma: refers to an organization’s policies or culture of negative attitudes and beliefs toward stigmatized individuals. I like to give the example of health insurance policies here. You can visit a primary care physician or a specialist as often as you can get an appointment and no questions are asked, but this is not the case with behavioral health. Patients are often restricted to the number of times per year they can see a psychologist – maybe once per month or seven times a year for a given issue. I’ve never understood why there is a limit if it is suggested by a doctor or considered essential treatment.
Self-stigma: negative attitudes of an individual to his/her/their own mental illness.
Those who have internalized stigma hear the information from the public, professional and institutional realms; agree with it; and then apply it to themselves. There are many types of feelings and reactions that can come with self-stigma. We may disconnect from others because of feeling inferior or that we are a disappointment or embarrassment. Self-stigma can also cause social withdrawal, resulting in giving up social interaction completely, severing ties with family and refusing treatment. Internalizing stigma can also make you feel people are always discriminating against you. This can especially be felt in the workplace. If you hear about or experience discrimination in the workplace, you may internalize the discrimination and believe your career will be in jeopardy.
You may have picked up on a couple of themes as you read about the different origins of stigma and the impact it has on an individual when it is internalized. Mental health stigma can send a message that we are no longer on par with or considered equals with the rest of the population. Some common stereotypes about people with mental illness are that they lack credibility; they are dangerous, lazy or trying to game the system; they suffer from brain damage; are crazy; or are broken. But self-stigma adds another layer to this so that not only do we believe this is how the world perceives us, we believe this about ourselves.
The alternative to self-stigma would be to actively fight against these stigmatizing beliefs. But let’s consider the mental and physical condition of someone experiencing an episode of mental illness. When feeling strong symptoms, it is not uncommon to have emotional outbursts, frequently cry, be anxious, nauseous, unable to sleep, have racing thoughts, and be impatient with self and others. When in such an overwhelming state of mind, experiencing these feelings in unrelenting waves, it’s understandable we would come to believe that WE ARE those stigmas.
There has been additional attention from employers and insurance companies to provide more services for mental health since the pandemic, but this hasn’t done much to eliminate stigma. The world could relate to COVID; we understood it well because we were all in the midst of it. But understanding the loneliness that came from lockdown is not on par with those incapacitated by major depressive disorder, severe anxiety, and psychosis – to name a few. Also, I believe there is an assumption that mental illness related to COVID has abated with the removal of lockdown orders, masking, and social distancing. In other words, it came to an end. This is not the case with other mental illnesses. As those of us living with mental illness know, it’s more about managing symptoms than being cured. We’re in it for the long haul. There very well may not be an end.
With mental health stigma still prevalent, and no real signs of mass improvement on the horizon, we must work to reduce stigma on an individual level and educate others on methods to counteract self-stigma. Based on my own experience, there were some things I needed to address to overcome the stigma I held about myself and my condition:
• Counteract isolation
• Build self-esteem
• Develop coping measures
To counteract isolation, I wholeheartedly recommend group therapy. Group therapy is a great option for reducing self-stigma as it puts you with people facing the same issues. This helps with any belief that no one can understand what you are going through. For me, this was social exposure in a very controlled and safe format. It also gave me the opportunity to see these issues from the outside, as an observer. There is something very powerful about hearing someone share their frustrations and struggles when you possess them as well. And, for those that are in a positive place, they can share tips and techniques for what has worked for them. In group, I felt for the first time that I wasn’t alone.
When it comes to building self-esteem, I recommend that people both focus on themselves and others:
YOU tips for building self-esteem:
- Pick one or two priorities to focus on where a success will bring you joy. The rest can wait for now.
- Make a plan for action by thinking of a single task that will reinforce your priorities. If needed, break large actions down into individual tasks.
- Commit to performing those small actions in your plan. Set dates and time limits if needed. Ask a friend or family member for help getting started or keeping you accountable. Recognize that less than 100% success is NOT failure.
- After a few weeks, celebrate your success and pick a new priority to focus on
THEM tips for building self-esteem:
Commit a daily random act of kindness:
- Hold the door for someone entering a store with you
- Return someone’s grocery cart
- Compliment someone
- Buy a coffee for the person behind you
Volunteer for a favorite cause
Buy a special treat for your pet and record their reaction
Why do this? A couple of reasons. For one, focusing on someone else for a time can break us out of our current train of thought. I needed this often because I would become stuck in self-destructive cycles. It was refreshing to focus on something other than myself. And by doing something nice for someone else, it provided validation that I was a good person that does good things and deserves to feel joy. I needed this reminder.
Have a toolbox of coping strategies. Some of my favorites are:
The Buddy System (or the 911 text)
Have a 911 agreement with a friend to meet for drinks, coffee, movie date, etc. During the COVID pandemic, my son would have virtual dates with his friends where they would watch horribly-rated movies online together and try to make each other laugh. I keep meaning to try this myself!
Laugh it Out
Find something guaranteed to make you smile or laugh (unashamedly) – cat videos, cartoons… whatever makes you smile. If you have streaming services on your TV, a lot of comedians have recorded specials that also work well.
Best. Listener. EVER.
Make a date with your pet to talk about everything bothering you. I’ve always felt that if you have a pet, you have a live-in therapist. I talk to my pets (and, yes, FOR my pets) all the time. There’s something cathartic about just getting the words out that helps relieve my burden.
A Literal Box
Fill a box with items you love and save for these occasions. One of the boxes I have is full of baby momentos and photographs. Another is full of random strange and artistic things I’ve picked up over the years. It takes me over an hour to go through it because I’m reliving all the memories.
I hope reading this has given you some ideas for how to counteract the stigmas we often apply to ourselves. There was more to my presentation that I’d like to share, so when I’m back in June, I’m going to share ideas for how to support those in your life that are dealing with mental health issues. Thanks so much for reading.
As always, please keep in mind I’m still very much a student of my own condition. I’m happy to share what has worked for me and the journey that got me there. Please reach out to your own support team as you start or continue your journey as well.
If you are in need of mental health resources, please consider reaching out to the National Alliance on Mental Illness (NAMI.org). On the website, you can find local resources and groups. You can also dial 988 in the United States for the Suicide and Crisis Lifeline. Lastly, you can reach the Crisis Text Line by texting HOME to 741741.
See you all next month!