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Self-stigma is a complex phenomenon, in which an individual endorses and internalises the stereotypes, prejudices and discrimination held and driven by the public. Using mental illness as a prime example, the onset of self-stigma upon an individual can lead to low self-efficacy, low self-esteem, decreased use of healthcare services and loss of opportunities which in turn reduces one’s overall quality of life. Although self-stigma provokes an array of negative impacts, such as the ones mentioned above, there have also been a range of strategical, preventative measures and interventions to alleviate the negative effects of self-stigma. These include, consumer operated services, like peer support and mentoring, and educational campaigns. Throughout this essay, the concept of self-stigma and its effects, as well as the strategies and methods to combat the negative effects, will be discussed in detail.
The concept of self-stigma can be explained through a thorough stage model presented by Corrigan and Rao (2012) as well as the ‘why try’ effect by Corrigan et al. (2009). To fully grasp the concept of self-stigma and its effects, it is important to note the role of public stigma in provoking individuals with mental illnesses to internalise the characteristics brought upon by the public. A blend of stereotypes and prejudices based off devalued characteristics can cause negative attitudes amongst the public, spawning discriminatory behaviour towards those with mental illnesses. The stage model of self-stigma presented by Corrigan and Rao (2012) illustrates the process in which an individual begins to endorse the public stigma intra-personally, within a series of stages. The first stage, awareness, is where the individual recognises and is aware of the public stigma surrounding their condition. When the individual begins to agree with the stereotypes in regard to their condition and subsequently starts to apply the stereotypes to themselves, they are in the agreement and application stage, respectively. Reaching the application stage of the self-stigma stage model, can cause harm to the individual, and contribute to a significant decrease in their self-esteem and self-efficacy, as well as poor health outcomes.
Corrigan et al. (2009) further explains self-stigmatisation through the ‘why try’ effect. Similar to Corrigan and Rao’s (2012) stage model, the ‘why try’ effect occurs when the individual applies the negative stereotypes and attitudes towards themselves, causing them to yield a ‘why try’ response. ‘Why try’ responses are ones that undermine the individual’s self-worth and are usually degrading towards themselves as a result of low self-esteem, consequently diminishing one’s self efficacy through the interference of life goals, achievements and opportunities. Corrigan and Rao (2012) provide an example of a ‘why try’ response in “Why should I attempt to live on my own? I am not able to do such independence. I do not have the skills to manage my own home”, which accentuate how it would affect an individual’s ability to achieve life goals, thus further implying the lack of self-efficacy. A ‘why try’ response elicits a ‘why try’ outcome, which is an undesirable outcome affecting an individual’s opportunities and life goals, as a result of the self-stigma and negative attitudes. As mentioned, self-stigma occurs when individuals with mental illnesses begin to internalise the discriminatory behaviour, stereotypes and negative attitudes directed towards their condition. Not only does this have a negative impact on their self- esteem and self-efficacy, but it also has a profoundly disadvantageous and almost cyclical effect on many other aspects of their life, including healthcare, employment, independence, social and leisurely activities.
First and foremost, self-stigma directly affects an individual’s ability to seek and/or adhere to treatments, counselling, and information about their condition. Lannin, Vogel, Brenner, Abraham and Heath (2016) argue that self-stigma elicits a negative attitude towards counselling, whether it be individual, group or careers based. Furthermore, Lannin et al. (2016) insist that the intention and willingness to seek counselling is significantly reduced because of self-stigma, as individuals begin to associate negatively connotated labels like ‘insecure, inadequate, inferior and weak’ towards seeking counselling. The study conducted by Lannin et al. (2016) further supported this notion, in which they found an association between both, self-stigma decreasing the chances of an individual seeking mental health information and self-stigma decreasing the chances of seeking counselling information. Therefore, Lannin et al. (2016) illustrates that self-stigma is indeed a contributing factor towards a reduced use of healthcare services, and poor health outcomes. Along with the study conducted by Lannin et al. (2016), Fung, Tsang and Cheung (2011) suggest that self-stigmatisation hinders an individual’s ability to adhere to treatment, which is another negative effect of self-stigma that contributes majorly to poor health outcomes and an overall quality of life.
Fung et al. (2011), through their trial of the self-stigma reduction program with schizophrenic patients, showed that individuals with lower self-stigma and greater self-efficacy were able to better adhere to their treatment programs. Subsequently, those with higher levels of self-stigma were found to have poorer treatment adherence. These factors are all contributors towards poor health outcomes and a lowered quality of life. There are multitudes of individual and societal level strategies that aim to alleviate the negative effects of self-stigma, to ensure individuals are able to access opportunities without the barriers associated with mental illness and self-stigma, collectively. A more societal level method of reducing stigma are educational interventions and campaigns, and although they don’t necessarily combat self-stigma, they aim to raise awareness and correct inaccurate and misleading information on mental illnesses. Despite being a strategy that combats public stigma, it was found that the education campaigns and interventions also reduced self-stigma and increased self-esteem in individuals. Consumer operated services, such as drop in centres and peer support services, are a more direct and individual strategy in reducing effects of self-stigma. These peer and mentoring services allow individuals to receive interventions and support for their condition in a non-discriminatory and less-hostile environment. These services initiate a sense of community and thus promote empowerment within the individual, further improving their self-esteem and self-efficacy.
The trial conducted by Fung et al. (2011) also introduces a program that aims to reduce self-stigma in individuals with schizophrenia. The program consisted of manualised strategies that would assist with the reduction of self-stigma, thus being able to alleviate its negative impacts. Such strategies included psychoeducation, cognitive behavioural therapy, motivational interviewing, social skills education as well as a goal attainment program. All these aspects of the program blend together to encourage the individual to change their negative behaviour, and positively adhere to the treatment program, which simultaneously allows for a decrease in self-stigmatisation, thus increasing the individual’s quality of life. Although significant improvements were shown through the self-stigma reduction program, the results were not long lasting and were difficult to maintain. Although there have been a large array of strategies in attempts to reduce self-stigma and its negative impacts, it can be agreed that there is still room for significant improvement and continuous developments are necessary to ensure that individuals are able to seek counselling and mental health information without intrusive and degrading labels.
To conclude, self-stigma is a societally formed, complex concept in which an individual with a mental illness internalises the public stigma around their condition, and applies it to themselves, bringing forth a number of undesirable effects that cause a hindrance to many aspects of their life. Self-stigma isn’t a ‘black and white’ concept. It has a cyclical effect in which lowered self-esteem, leads to reduced efficacy. As a result of reduced efficacy, an individual affected by self-stigma will experience poor health outcomes, a loss of opportunities regarding employment, a lack of independence as well as decreased use of healthcare services, subsequently leading to a lowered quality of life. Despite these negative impacts, a large range of individual and societal level methods have been developed to combat the effects of self-stigma. These include educational interventions, campaigns, condition specific programs and consumer operated services. These methods all contribute significantly to reducing self-stigma within individuals, as well as raising awareness to the public to provide a non-discriminatory and less hostile environment, to raise self-esteem and improve quality of life.
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