Harmful Effects of Stigma

This model explains the four stages of the progression of self-stigma.

1. The stigmatized individual becomes aware of the stigma against their condition (Awareness). They may think “The public believes that people with mental illness are violent.”

2. The individual agrees with the public’s beliefs (Agreement) – “That’s right. People with mental illness are violent.” 

3. The individual may internalize these beliefs and apply it to themselves (Application). They may think “I am mentally ill, thus I am violent. I am dangerous, and I am afraid of myself. The individual may then discriminate against themselves, such as through self-isolation. 

4. This can result in Harm, such as low self-esteem, poor self-efficacy and self-worth, self-isolation, poor physical and mental health outcomes, and poor quality of life.

   
   

As a result of self-stigmatization, individuals’ low self-esteem and self-efficacy may interfere with their life goals in what is called the “why try” effect.

For example, the individual may  question the need to pursue opportunities when they are not worthy of it, or may shy away from independence because they do not believe they are capable. Overall, this results in decreased help-seeking and decreased quality of life.

The stigmatized individual experiences:

• Reduced hope

• Lowered self esteem

• Feelings of helplessness

• Increased psychiatric symptoms

• Difficulties with social relationships.

The stigmatized individual’s quality of life is also lowered as they experience systemic discrimination:

• A lack of understanding and support by friends and family

• Fewer opportunities

• Housing difficulties

• Bullying and harassment

• Physical violence

• Inadequate health insurance coverage

• Increased difficulties at work. 

Stigma from family and friends towards the individual can result in a lack of support, provision of unhelpful support, encouragement of non-disclosure, or opposition to formal help-seeking.

This is especially prevalent in Singapore, as mental illness is seen as a mark of shame among youths that leaves them open to stigmatization from peers.  

Examples of inappropriate support for stigmatized individuals by family and friends include:

• inappropriate comparisons of mental illness with other experiences,

• provision of unsolicited or unhelpful advice,

• attribution of depression to one’s character flaws,

• distrust of psychiatric practice,

• or even the inability to accept the illness. 

References

American Psychiatric Association. (n.d.). Stigma, prejudice and discrimination against people with mental illness. Stigma, Prejudice and Discrimination Against People with Mental Illness. https://www.psychiatry.org/patients-families/stigma-and-discrimination

Corrigan, P. W., & Rao, D. (2012). On the self-stigma of mental illness: Stages, disclosure, and strategies for change. The Canadian Journal of Psychiatry, 57(8), 464–469. https://doi.org/10.1177/070674371205700804

Samari, E., Teh, W. L., Roystonn, K., Devi, F., Cetty, L., Shahwan, S., & Subramaniam, M. (2022). Perceived mental illness stigma among family and friends of young people with depression and its role in help-seeking: A qualitative inquiry. BMC Psychiatry, 22(1). https://doi.org/10.1186/s12888-022-03754-0