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.
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-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 (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 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 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.