How Much Do You Internalize Stigma?

Making Sense of Psychiatric Diagnosis : "A mental illness serves as an explanation for symptoms. It does not change who or what a diagnosed person is."

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.

 

book cover: Making Sense of Psychiatric Diagnosis by Ashley L Peterson

 

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.

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80 thoughts on “How Much Do You Internalize Stigma?

  1. kachaiweb says:

    I don’t care about the opinion of others on my mental state. I know I’m not visiting my old workplace because I know that they will not understand and see me as ‘weird’. My experience is that those working in mental health are distancing themselves from anything mental health related. I do care what people close to me think, that is important to me.
    What I don’t know – at this point – what is ‘me’ and what is the ‘depression’. Some thoughts are clearly not ‘mine’ but they come as they please. Or maybe I am just a ‘sad’ person in nature? That is also not true. I struggle with that and I believe that I sometimes accept some form of stigma from myself. (Who wants to be friends with such and such or I will not be able to handle that because of my mental state). I’m still on the journey…
    As for other people mental health, I have no problems at all, I’m curious about everything and I am accepting most of the time.

    • ashleyleia says:

      It’s unfortunate that so many people working in mental health see mental illness as something that only happens to other people.

      I think it can be hard sometimes to separate out what is self-stigma and what is realism that others have a hard time handling our illnesses.

    • kachaiweb says:

      I want to add something; while working, on some wards there was a great love for the ‘patient’ and that is a good thing, don’t get me wrong. But sometimes, as a care giver/the team also needed to admit that some people, although hearing voices and suffer tremendously, just have a sh*tty character/ ‘are’ out of line. It can be a relief to admit that too. That is maybe a possible other way of a stigma that still isn’t helpful when taken to extremes, to kill ‘them’ with kindness. Because the person is still held ‘hostage’ in his/hers diagnosis.
      I’ve spend meetings and meetings talking about that, where to help, where not to help a person, what is good and what is maybe not that good. It’s so difficult to change a perspective on someone once ‘set’ in a mind.
      I hope I make sense in some way …

  2. Mira - The Handy Journal says:

    Unfortunately we tend as human beings to judge others, especially if it’s sth we are clueless about ! Sorry to hear what you had to go through!!!
    Concerning “self-stigma” it’s even harder, sometimes we have no mercy on ourselves!
    Let’s hope that one day, this won’t be a problem anymore! we should start by teaching our kids and close relatives the truth and how to react in a proper way (so we don’t leave people with this feeling anymore)!
    Thanks for sharing your personal experience!

  3. marandarussell says:

    I think the stigma only really bothers me when people I know personally buy into it and I feel judged. I don’t really care what strangers think, but if those close to me (or those who should be close to me) use my conditions against me or to subtly put me down it hurts. My in-laws are really bad about being judgmental like that and while I don’t care as much since they aren’t my family, it still gets to me and I know it bothers my husband. His family is super conservative and listens to Fox News all the time, so they think everyone on disability is abusing the system. They are just as judgmental about my physical conditions as my mental.

      • marandarussell says:

        Yeah. It hurts him a lot though. They don’t treat him well either, especially since he left the church. He is definitely a black sheep now. Not long ago he was having a talk with his mom about her voting for Trump and she told him that she had to vote for Trump because liberals are evil. He actually told her “thanks Mom, I’m liberal so I guess you think I am evil too”. She didn’t argue with this thought or even try to reassure him she didn’t feel that way.

  4. Paula Light says:

    While not a mental illness, there is a stigma about migraines along with lots of stereotypes. Luckily, my bosses are free of those, but other people aren’t. That’s why I often say I have a headache instead. Even other migraine sufferers will scoff at me if they don’t think I’m sick enough ~ oh, I’m sorry the meds work on me. My bad. 🙄

  5. Meg says:

    Wow, yeah, I feel sad for you when reading your blog post, because it seems like the people judging you are small-minded and backward in their thinking. You went into healthcare with a compassionate view that people with mental illness are genuinely ill and need care, but then when it happened to you, you were deemed a troublemaker and a threat. It’s awful, and it makes me truly sad. 🙁

    Everything you’ve described I see as being small-minded. Like, people like that have no self-awareness, no outer awareness, no ability to think deep thoughts about nuance and the subtleties of reality, ya know? Like, their brains are tiny like dinosaur brains. It’s infinitely frustrating that we have to share the planet with such people, most especially in a professional context!! AARGH.

    Huh, stigma. A few years ago, our local hardware store was bought by new owners. I was walking up to the door of it when a city bus went past. As typical, since I hate the airbrakes, I plugged my ears and waited for it to pass. The wife of one of the new owners came out front and said, “What the heck are you doing?”

    I tried to explain to her about the airbrakes.

    She shook her head and said, “You’re standing in front of our store with your fingers plugged in your ears without coming in or going past.”

    I didn’t bother to explain that I couldn’t open the door to the store with my fingers in my ears.

    “It’s just weird,” she finished.

    Well, thank you for that insight, wife of the hardware store owner. Oddly enough, I’m friends with her husband on social media, and he and I have never had any problems. He’s always forwarding ways to prevent child abuse, and I’m always liking those posts, and thanking him for them annually on his birthday. (Like, “Keep up the great posts for preventing child abuse, and happy birthday!”) Am I friends with his wife on social media? Nope. [Snort.]

  6. Michelle says:

    I have been lucky to have people in my life that don’t treat me differently. I do experience at my job a little but that’s it. I do see it happen in terms of seeking help and self hate. I experience myself. I do hate myself some days for how I am because it keeps me from getting certain things I want. I don’t get accepted for any jobs or taken seriously as a candidate for my social anxiety. People often fail to see me as more than that

  7. lisa says:

    Hi Guys!! Wanted to commit on the stigma post. For me the stigma in my life has been hard. Ever since I was a little girl the image I had of myself has been very negative. I have struggled with my mental health since I was a youngster. I would hear bad things from people about my depression and take it on. I was so underestimated by people and overlooked because I didn’t stand up for myself. Now that I have taken the time to work me things don’t affect like they use to. Yes I feel there will always be stigma out there. Its all in how you react to it.

    • kbr0632 says:

      I know that this question wasn’t directed to me, but I will tell you that I got HR involved…and again, they just look at you differently and like they just have to follow the rules because it’s the law. They are careful as to what they say. I could’ve really gone after them for someone violating my HIPPA rights, but I played it down and didn’t do anything because of the reaction that I got from my boss when she thought I was going to file a complaint. They treat me differently. I stay in my office because I can’t trust any of them to really care. I am now receiving accommodations and I feel terrible about it. They don’t care. They just are careful with what they say and what they write…so not to get sued.

      • BeckiesMentalMess.wordpress.com says:

        I just find that to be truly harsh.
        When I was working, I was upfront and honest with the people I worked with. They all knew my anxiety was brutal.
        I was hospitalized for it several times. They never once gave me a hard time about it.
        Then again, I think they kept me on because no one knew how to do my job at all. LOL!
        Your company and you are all walking on egg shells, that can’t possibly be comfortable at all.
        I really for bad for your situation.

        • kbr0632 says:

          I am walking on eggshells. And I am not well enough to look for another job. I don’t want them to see me cry or shake or anything..because they will take it right to HR. They already did once. I have to fake it. To everyone.

          • BeckiesMentalMess.wordpress.com says:

            That was something I learned to do early on. Revamp the job to work more effectively and efficiently, I had always made it my own system.
            No one knew how to do it, and therefore I had job security.
            My one job in NY, I gave them over two months notice because my boss and co-workers hadn’t a clue how I did my job.
            Even after I moved back to NJ, they still called me with questions.
            To this day, I still miss that job.

  8. kbr0632 says:

    No one gets how I feel. They stay away. And instead of me getting mad, I take it on like it’s my fault and that I should be better. I would never do what has been done to me..to them. My brother said he would always be by my side..that he would never leave. When I was really sick a few months ago…he went to therapy with me..for a short time. It seemed like it did consume us. But instead of him weathering out the storm, he became aggravated because nothing was working so he decided not to go anymore. Maybe that helped me..I don’t know. but I know never to trust that anyone will stick around for the long haul. My sister in law went to therapy with me twice. She backed out too..and doesn’t talk about it. When i was sick, no one asked if they could bring me food or help with anything. They left me alone. So I internatlize the stigma for sure. I don’t even try to bother my daughter about it anymore.

  9. NooseGirl says:

    I am currently blogging about my experience living with accute paranoid psychosis for several years and am purposefully using a pseudoname because of my concerns with stigma.

    Don’t get me wrong . . I’m not a wallflower trying to hide my secrets of mental illness. In addition to my blog, I am a certified NAMI Connections group facilitator. I regularly speak to government, nonprofit, and corporate organizations as a participant of the NAMI in the “In Our Own Voice” program. And I’m in the process of working on my certification as a social and political lobbyist to advocate for mental illness awareness through the NAMI Smarts for Advocacy program. For all of the support and public speaking work, I use by real name and hide nothing about who I am.

    The reason I chose to blog under a pseudoname is 100% because of stigma. Unlike a small audience group or a small support meetup, the Internet is unforgiving. Having my real name associated with some of the crazy stories of psychosis I blog about could result in loss of job, housing discrimination, Internet bullying, etc.

    The decision to keep my identity secret did not come lightly. My therapist and I thought this was the best approach to getting my story out there without subjecting me to the realities of discrimination.

    As far as talking to others openly in a public setting like a cocktail party or family get together, I have found that those who know what happened to me sort of avoid it like the plaque. The don’t want to ask what it was like or how I am doing now . . .the only reason I can think of is because it is scary to them. They know nothing about it and are afraid they may say the wrong thing or hurt my feelings.

    I think the only way to break stigma is to talk about it. But who can I get to listen?

    You can follow my blog posts about living with psychosis at breathingwithanoose.com. Subscribe for email alerts!

    • ashleyleia says:

      I started off not using my full name for my blog, mostly because I didn’t think people who knew me in real life deserved to know my innermost thoughts and feelings. That only changed when I published my first book, since I didn’t want to do the book under a pseudonym.

      To break stigma we need to talk about it, but I think to avoid burnout we have to start with audiences that are at least somewhat receptive and work our way up.

  10. lisa says:

    Hi there!! Just to let you know I really enjoyed your post introducing yourself. I am new this month to blogging so I am still getting use to this. I live in Canada and I am really wanting to look at the Mental Health Image. I am wanting to do it all voluntary. I suffer from Bipolar.Anyt suggestions about where to start would be great.

  11. Alexithymia Alew says:

    Stigma! What a subject ey!

    I have BPD. The Cluster B spectrum, and as you mentioned most associate Borderline with difficult or crazy and suchlike.

    I swear people literally start walking away as soon as you mention this. To a certain extent I think I expect people to hate/dislike me and almost worry when they do like me now.

    Everyone has something it seems to say about the Cluster B’s and most of it is negative. Nuff said really. But I didn’t ask to have this illness. It is what it is. And it’s painful and exhausting to live with.

    The Internet is absolutely covered with stigma of all different types. One of the many reasons I came off Social Media.

    Whether I have internalised this, I am not sure. I guess to some extent, if enough mud is thrown, some will stick.

    Thank you for your support though Ashley with me and my now second blog. It’s very much appreciated. X

  12. mentalhealthfromtheotherside.wordpress.com says:

    Wow, some of you guys have it real bad with stigma in the workplace and elsewhere. Here in the UK, there’s a lot more awareness of mental health, lots of mandatory training going on and lots more acceptance. I can’t say there isn’t any stigma but at least the government are trying to do something.

    I grew up when anything ‘out of the ordinary’ was stigmatised and couldn’t admit to anyone that my mum had been in an asylum. But now that I’m grown and particularly since having spent 20 years working in mental health, I feel less stigmatised. Me and two of my siblings and my two sons experience mental ill health and we’ll discuss it openly if someone is disparaging about mental illness. It often surprises? people and they say things like “oh, wow! You don’t look like you’re mental.” So there is still some stigma lol.

  13. Alexithymia Alew says:

    I was swimming in a pool not long ago. I’m in UK. And me and my two friends were just making chit chat with some other people there. Although I prefer just to swim. And this guy asked what we all do, as in work. And I said: I was not working because I suffered with mental illness. He just said: “ok let me talk to somebody normal” and started talking to my friends, which was fine, as he seemed a bit stuck up anyway to me,….but it still felt horrible. So I just carried on swimming.

      • Alexithymia Alew says:

        I could have just made up something and he would have been none the wiser. But I am an honest person, and so just told the truth, of how it is. You can see though why people feel ashamed still to talk about it.

        I am considered having severe long-term mental illness, otherwise I would not have been able to get the benefits I get. And you have to go through a lot to get them. It’s not at all easy.
        I was questioned thoroughly for hours more than a few times. I had to go to many appointments, some being cancelled as I turned up, and also fill in many countless forms.
        It is absolutely horrendous! I could not handle it. I broke down in tears and had panic attacks, and was suicidal.
        The forms do not cover mental illness properly, they are all geared toward physical disabilities, and the government does not really know what to do with people like me.

        I think they like to pretend like we do not exist.

        • ashleyleia says:

          That’s so true. Disability benefits here are also totally geared towards people with physical problems. Right now I can get by without them, but it does worry me that I will need them at some point and be refused. It realy shouldn’t be this way.

        • Luftmentsch says:

          Hi, I just saw this. I am also in the UK and have struggled to get benefits because of the system being geared to physical illness, not mental. I am well enough that I am trying to find part-time work which in some ways is the worst of all worlds, because I think I will be considered well enough not to qualify for benefits, even though I am not well enough to work full time and earn anywhere near enough to support myself. I definitely agree that the government doesn’t know what to do with people like us.

          • Alexithymia Alew says:

            Whereabouts are you in UK? I’ve heard some areas are better than others.
            It’s like you have to be very mental to be in receipt of benefits. Like you have to show them what you are like at your worst times. They do not realise that mental illness has good and bad and worse days. Just because I wasn’t actually in therapy right now, it’s like I wasn’t mental enough. But I’ve had lots of therapy over the years and they took me off the system as I was more stable for time being (aka – not trying to kill myself). However, with mental illness, it is not like the flu, it is usually long term, and not something that goes away with plenty of rest and/or drugs.
            If you are well enough to work, even part-time, then that means to them you can support yourself financially.
            What they don’t realise is that work is not only hard to find, but the right kind of work being a problem, and if you have mental illness, you are going to have limitations on what you can deal with.
            They also do not make therapy easily available. Or there are simply not the therapists or therapy you need/want.
            The system is not equipped to deal with the amount of mentally unwell people there are. The same as it is not equipped enough to deal with the elderly also.
            It’s a growing problem.
            But then I see a much bigger picture. So to me, I recognise why any human type government cannot work and it doesn’t surprise me.
            It will get much worse before it gets better.

            • Luftmentsch says:

              I’m in London.

              Definitely agree about the right work. I’m probably on the autism spectrum as well as depressed (in the process of getting an official diagnosis) and I can’t handle many work environments because of that.

              I was fortunate that my parents were willing and able to pay for private therapy for me, and also fortunate to find a therapist who charged according to income rather than a flat rate, otherwise I would not have been seen by a therapist for as long as I needed.

              The silly thing is, I don’t like being on benefits. I hate feeling dependent on the state/society. I feel like other people are more deserving. I like to work IF I can find the right job. But the reality of my current situation is that I can’t work full-time at the moment and don’t know if I ever will be able to do so.

              • Alexithymia Alew says:

                Nobody likes being on benefits. There is shame associated with such. Nobody has a right to judge, because they are not suffering what you are going through.

                I know I can’t work. It’s not that I cannot do work per say, it’s everything that comes associated with work. The people, the stress, the hours, the having to be at places at certain times, the deadlines, the anxiety of everything. The separation anxiety, the social anxiety, and it goes on and on. And if it came to it, my husband would go back to work. Right now he is my carer. It is only because of him why I am relatively stable. I still struggle a lot with life, but I am trying to do self therapy, and heal from a life time of trauma.

  14. skinnyhobbit says:

    I’ve heard similar horror stories as yours from friends who work in healthcare. It’s appalling and I’m so sorry you experienced all this.

    You’ve read some of my own posts about experiencing mental health stigma, thank you always for your compassion. <3

  15. Alexithymia Alew says:

    Every time an actor/actress or singer dies because of mental illness, I think yeah, just because they excelled at something, that meant they couldn’t possibly be mentally ill. The truth is, often these make the best actors/actresses and singer/songwriters…

  16. wediditptsd says:

    We obviously behave in ways not expected or understood generally, due to our PTSD and DID. So we avoid people in general. We are worried about being judged, though it’s mostly the mental health community that judges now, since we don’t interact with many people! Professionals and institutions are divided (pun unintended) about whether or not they believe DID—part of the DSM—is real. We don’t care if it is or isn’t. Just give us a diagnosis so wet can try to heal!

    We have perfectionism OCD so we often feel we’re doing everything wrong.

    And we work hard to try to heal. There is fighting inside us. It is very painful. We really don’t “belong” many places. Our Spouse and Children are 100% long-term supporters and we’ve made some trauma friends at the hospitals and have some outstanding therapists… whom Medicare doesn’t cover.

    We don’t look to blame our judge back. We want to accept ourselves and try to regulate emotion, be grounded, act more effectively when possible. Not so we can rejoin society. Society is not for us. We don’t want money, success. We want peace, love, to live gently

  17. lavenderandlevity says:

    I’m pretty sure “internalized stigma” is a literal supporting character on my blog. But, I like to call him the Bully-in-my-Brain so I can plausibly claim all similarities to real life psychological phenomena ate purely coincidental to avoid copyright issues 😉

  18. NooseGirl says:

    Sometimes I think I am my own worst enemy when it comes to stigma,

    When I was first diagnosed with bipolar disorder, I was incredulous. “What??? . . you must be wrong . . ME??? . . I don’t have a mental illness . . I’m not crazy!”

    I didn’t realize that I had accepted stereotypical characterizations of mental illness. Still, there I was, doing all I could to fight against the damned assignment of a crazy person.

    I continued the brand of stigma into my later years. I never confided my illness to anyone, even my closest friends. I had clued in the diagnosis with a few of my family members, but their “mum’s the word” treatment of my condition further drove my secrecy into the closet.

    It wasn’t until my introduction to and involvement with NAMI that my embrace of stigma was not only losened but smashed. Now, instead of hiding, I proudly and willingly tell my story in hopes of helping those that suffer and the people supporting them.

    Great post! . . .stigma sucks!!!

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