Recently I posted the above image on Twitter. I got a response from someone who felt that their diagnosis had changed who they were as a result of the stigmatized ways that other people viewed them, and the internalized stigma limited who they were able to be.
That saddened me, and it got me thinking about how we handle the stigma that will almost inevitably come our way at some point or another.
One of the reasons that self-stigma develops is by growing up in the same culture that promotes stigmatized beliefs in other people. That stigma can then be turned inwards after developing a mental illness.
Another major contributor to self-stigma was what the person on Twitter mentioned; being exposed to stigma directly through the prejudiced beliefs and discriminatory actions of others.
I can’t say that I grew up exposed to all that much stigma. I grew up in a small town, and there were never any overtly crazy people that I was exposed to. When I was in high school the younger sister of one of my classmates died by suicide. It was generally known that was how she died, and from what I recall there was a tone of sadness but no judgment.
The first real exposure I had to mental illness was once I started nursing school. I didn’t get sick myself until I’d already been a nurse for over 2 years. By that point I had a pretty positive view of mental illness; not positive in the sense that it was a good thing, but in the sense that I viewed it as a legitimate form of illness that was not brought on by personal weakness, bad choices, etc.
I think my first exposure to stigma was during my first hospitalization. I was not happy about being there and I was not cooperative, which earned me a label of borderline personality traits, a reflection of the stigmatized view held by the psychiatrist that “difficult” = borderline.
During my time in hospital, I also learned that the hospital had reported me to the nursing regulatory college, because it’s enshrined in stigmatized legislation that any time a health professional is hospitalized for illness it must be reported to their professional college and treated as a complaint about the person’s fitness to practice. It took two years and plenty of lying to my mental health team before that went away.
When I returned to work, my dingbat of a manager used my illness as an excuse to treat me as untrustworthy and unreliable. Luckily, though, my coworkers were supportive.
So, that was a fair bit of stigma right from the get-go, but I didn’t turn any of it inward. Instead, I got angry at the onslaught of idiots all with head inserted very far up arse. Much of it I didn’t have any power to change, but it was very clear in my mind that they were the f***-ups, not me.
As time has gone on, I’ve faced more stigma in a professional sense and in terms of some of the craptastic “care” that I have received, but the pattern has continued that I get angry and judge the a**holes that are judging me. Sometimes that anger has been directed in a constructive way and other times not so much, but it’s been something that’s served as a very effective barrier to internalized stigma.
It’s hard to say what would or would not have been different if I’d gotten sick either before nursing school or if I hadn’t become a nurse at all. Certainly my professional knowledge about mental illness has given me more confidence in deciding it was other people that were wrong, not me.
While external stigma is in many ways inevitable, I think we do have some degree of control over the extent of internalized stigma. That will be harder for some people than others given that we’ve all been exposed to different circumstances, but I think at least the potential exists for us to take charge of our own identities.
The world can judge us, but maybe that says more about them than it does about us.
My book Making Sense of Psychiatric Diagnosis breaks down the different categories of DSM-5 diagnoses, explaining the diagnostic criteria and providing first-hand stories of the various illnesses. It’s available on the MH@H Store, as well as Amazon and other major retailers.