Updated: Nov 19, 2020
I did my thesis manuscript on the stigmatization of individuals with narcissistic personality disorder, and I learned so much! I'll share the knowledge.
What is stigma:
Good ol' Google defines stigma as being: "a mark of disgrace associated with a particular circumstance, quality, or person" (Oxford Languages, 2020). For those of you unfamiliar with stigma, it is when something is societally seen in a negative light. Things like racism, stereotyping, and judgements are all under the stigma umbrella. The most mind-blowing experience with stigma is the moment when you realize that something is stigmatized; it feels as if society has incepted it's judgmental opinion into your mind without you even noticing. Once familiar with stigma, you begin to see the way that our society unfairly judges each other. In Canada, so many things are stigmatized!! Individuals that are typically stigmatized are those with mental disorders, health disorders, families that are "different" (single parent families, for example), homes that are "different" (multigenerational homes, for example), people that are "different" (immigrants, or LGBT2Q+ individuals, for example). Typically, things that are different than the way that society has defined "normal" are susceptible to being stigmatized.
Internalization of stigma:
The internalization of stigma is the process where an individual begins to see themselves with the same mark of disgrace as they believe society views them. This is where stigma has the potential to be extremely dangerous. Well, stigma in general is dangerous in the way that it threatens individuals safety, but internalized stigma is destructive from within. It deteriorates individuals sense of self-worth, esteem, and increase one's sense of shame. When working with individuals who have mental disorders, it is known as a "second illness" as the destruction that internalized stigma creates is so extremely severe (Finzen, 1996, as cited by Huggett et al., 2018, p.381).
So, hopefully by this point you're like "Lauren, we need to do something. We can't let stigma hurt all these people.... People are allowed to be different, we should celebrate their differences!! We can't let this continue to happen." To which I'll reply "HECK YES, READER. I COMPLETELY AGREE. However...... keep reading"
Stigma and the human perception (education = harmful):
The worst part about stigma is that there is a paradoxical issue with increasing education about stigma. Evidence has found that increasing an individuals education on the reasons that they could be experiencing stigma (for example, educating individuals with a mental disorder about the injustices they face due to stigmatization), increases an individuals sense of shame (Hasson-Ohayon et al., 2012)! This is problematic because it escalates the negative self-perception that stigma already heightens within an individual!!
Stigma and Getting Help:
Okay, so you're sitting over there reading this probably being like "okay, stigma isn't great!". JUST YOU WAIT.
Get this horseshit. Arguably the most detrimental negative effects of stigma are that it is considered the most major deterrent to successful treatment (!!!!!!!!!!!!!!!!!!!). How infuriating is that. The individuals who are already different, already facing challenges (likely both externally and internally), are statistically going to be less successful in treatment due to the effects of stigma (Lannin et al., 2015; Livingston & Boyd, 2010; Tsang et al., 2016).
How to coexist with stigma:
So, Reader, as you can see we are in a bit of a bind. Increasing someone's education about stigma actually puts them at risk. So, how do we make them aware, in order to protect against the stigma, but support them through the potential dangers of being vulnerable to the negative effects of education? Well, honestly there really isn't much - yet! There is a lot of research that demonstrates that narrative enhancement cognitive therapy (NECT) is successful in reducing self-stigmatization, however it is still being researched. The process used in NECT that is proving to be quite successful is by utilizing narrative therapy as a way of monitoring the internalized views of self (Buchman-Wildbaum et al., 2020; Hansson et al., 2017; Roe et al., 2014; Yanoes et al., 2011), and ensuring that they are positive and not negatively influenced by stigma.
SO - we're finally getting to the end here. What can you do???
1. Be stigma aware - challenge judgement, challenge racism, challenge stereotypes. Question why you view something negatively.
For example, regarding homeless people: Why do you look down on homeless people? Have you ever personally met one? What have your personal experiences been like with homeless people? Do your experiences deem them to be categorized so generally in such a negative light?
For example, with ethnic food restaurants: Why do you think that the food would be of lower quality? Have you ever personally had an experience where you have identified the food to be of lower quality or of a lower hygienic standard? Why have you decided in your brain, before having had the experience yourself, that it would be unenjoyable?
2. Understand that "with great power comes great responsibility" (credit: Peter Parker).
Due to the paradoxical effects of education, ensure that maintenance and monitoring of self-esteem and shame due to self-stigma are highly prioritized.
Okay - that's all I'm going to write - GOOD LUCK out there, and don't let that stigma get you down. Do not be afraid to be different, do not be afraid to be yourself.
Buchman-Wildbaum, T., Váradi, E., Schmelowszky, Á., Griffiths, M. D., Demetrovics, Z., & Urbán, R. (2020). The paradoxical role of insight in mental illness: The experience of stigma and shame in schizophrenia, mood disorders, and anxiety disorders. Archives of Psychiatric Nursing. https://doi.org/10.1016/j.apnu.2020.07.009
Hasson-Ohayon, I., Ehrlich-Ben Or, S., Vahab, K., Amiaz, R., Weiser, M., & Roe, D. (2012). Insight into mental illness and self-stigma: The mediating role of shame proneness. Psychiatry Research, 200(2–3), 802–806. https://doi.org/10.1016/j.psychres.2012.07.038
Huggett, C., Birtel, M. D., Awenat, Y. F., Fleming, P., Wilkes, S., Williams, S., & Haddock, G. (2018). A qualitative study: Experiences of stigma by people with mental health problems. Psychology and Psychotherapy: Theory, Research and Practice, 91(3), 380–397. https://doi.org/10.1111/papt.12167
Lannin, D. G., Vogel, D. L., Brenner, R. E., & Tucker, J. R. (2015). Predicting self-esteem and intentions to seek counseling: The internalized stigma model. The Counseling Psychologist, 43(1), 64–93. https://doi.org/10.1177/0011000014541550
Livingston, J. D., & Boyd, J. E. (2010). Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis. Social Science & Medicine, 71(12), 2150–2161. https://doi.org/10.1016/j.socscimed.2010.09.030
Roe, D., Hasson-Ohayon, I., Mashiach-Eizenberg, M., Derhy, O., Lysaker, P. H., & Yanos, P. T. (2014). Narrative enhancement and cognitive therapy (NECT) effectiveness: A quasi-experimental study. Journal of Clinical Psychology, 70(4), 303–312. https://doi.org/10.1002/jclp.22050
Tsang, H. W. H., Ching, S. C., Tang, K. H., Lam, H. T., Law, P. Y. Y., & Wan, C. N. (2016). Therapeutic intervention for internalized stigma of severe mental illness: A systematic review and meta-analysis. Schizophrenia Research, 173(1–2), 45–53. https://doi.org/10.1016/j.schres.2016.02.013
Yanos, P. T., Roe, D., & Lysaker, P. H. (2011). Narrative enhancement and cognitive therapy: A new group-based treatment for internalized stigma among persons with severe mental illness. International Journal of Group Psychotherapy, 61(4), 576–595. https://doi.org/10.1521/ijgp.2011.61.4.576