The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care

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From a public standpoint, stereotypes depicting people with mental illness as being dangerous, unpredictable, responsible for their illness, or generally incompetent can lead to active discrimination, such as excluding people with these conditions from employment and social or educational opportunities. In medical settings, negative stereotypes can make providers less likely to focus on the patient rather than the disease, endorse recovery as an outcome of care, or refer patients to needed consultations and follow-up services.

These displays of discrimination can become internalized, leading to the development of self-stigma: People with mental illness may begin to believe the negative thoughts expressed by others and, in turn, think of themselves as unable to recover, undeserving of care, dangerous, or responsible for their illnesses. This can lead them to feel shame, low self-esteem, and inability to accomplish their goals. Self-stigma can also lead to the development of the “why try” effect, whereby people believe that they are unable to recover and live normally so “why try?” To avoid being discriminated against, some people may also try to avoid being labeled as “mentally ill” by denying or hiding their problems and refusing to seek out care.

http://www.psychologicalscience.org/index.php/publications/mental-illness-stigma.html

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On the subject of stigma, I think pdocs have a lot of work to do still. My first pdoc that diagnosed me with psz was great, but the one after him has a lot of subtle stigmatic sentences she would be better not saying. Like “You look normal” and “Oh yeah, she has megalomania” in a prejorative tone. It certainly didn’t help me wanting to seek treatment, at at the time I only did it because I was court ordered. Then I changed pdocs and this one is cool, I have no complaints.

On the subject of self-stigma, I believe a lot of our issues come from it. We have an idea of what mental illness is, given mainly by the media, and we think we are like that, giving us some pretty weird and â– â– â– â– â– â–  up intrusive thoughts.

Best to know this, for future reference.

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I read an article that reports similar findings even more explicitly. The upshot is that for a significant subgroup of schizophrenics, lack of insight into the nature of their affliction is best accounted for by motivational factors relating to (self)stigma rather than by cognitive deficiency. It is not freely accessible to all, so here are a few quotes.

First, typically lack of insight is accounted for in terms of the latter deficits, however:

The study of neurocognitive function seem to be a promising approach, as significant associations with insight have been found (Lysaker and Bell, 1994, Young et al., 1998 and Smith et al., 2000). A meta-analytic integration of these findings, however, resulted in a statistically significant, but weak mean effect for the relation between insight and neurocognitive measures (Aleman et al., 2006). Accordingly, neurocognitive perspectives alone fail to explain the complexity of this phenomenon.

Hence, the article investigates a multi-factor account of lack of insight, one of the factors being motivational:

As persons affected by schizophrenia-spectrum disorders frequently experience stigmatization (Dickerson et al., 2002), which may threaten a person’s self-esteem (Corrigan and Ruesch, 2002 and Yanos et al., 2008), denial or deception in persons who are aware of the stigma may be one source of a motivated pathway to reduced insight (Link et al., 1989).

Such an alternative account, according to the authors, is particularly called for to explain the occurrence of a significant:

(…) group showing low insight values despite unimpaired cognitive functions.

It concludes that:

stigma, operationalized as stereotype agreement, was a significant predictor of insight over and above socio-demographic and clinical variables, symptoms, and neurocognition. Consistent with previous studies (Startup, 1996 and Cooke et al., 2007), we interpret these findings as supporting the theory that multiple factors influence insight. Of these, stigma may be a key determinant of
reduced insight.

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I can see that perfectely. I think my denial lasted for so long because of the stigma associated with the illness.

Thanks for sharing the article

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I have this article in my stack of articles to incorporate in my final write up of my thesis! It’s probably the authors best article this year, it encompasses lots of his more recent work and peers’ work as well.

He publishes things like mad and they’re all about stigma…interesting.

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I resisted taking meds for a long time because I thought it was unmanly and that real men should be able to grit their teeth and deal w/ life with no external help. And also the stigma of being a drug addict, even though they were legally prescribed drugs.

I finally changed because I realized how much harm I was doing to the people that I cared about.

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