Self-Stigma Regarding Mental Illness

In the early 1900s Cooley’s concept of the “looking glass self” (Cooley, 1902, 1909) articulated that ideas about ourselves are profoundly shaped by how we believe others see us—that one’s self concept is socially constructed. As a result, negative judgments from others are often incorporated into one’s self concept (Allport, 1954; Crocker & Major, 1989; Link, Cullen, Struening, et al., 1989; Mead, 1934), resulting in ‘shame’ (Allport, 1954; Crocker & Major, 1989; Goffman, 1961; Scheyett, 2005). Later, Allport (1954); Goffman (1961, 1963) and others expanded this by highlighting the inherently social aspect of stigmatization, defining stigma as negative judgments we levy against each other based on devalued group identities (e.g., “the mentally ill”; Scheyett, 2005). These concepts have been applied to the social-distancing and discrimination often faced by people experiencing or labeled with mental illnesses (Link, Cullen, Struening, et al., 1989; Scheff, 1966; Wahl, 1999), drawing in part on theory regarding other marginalized identities (e.g., Meyer, 2003). One result has been the idea of “internalized stigma” or “self-stigma” (shortened from ‘stigmatization’), the incorporation of others’ prejudices and stereotypes about people with mental illnesses into beliefs about oneself. Previous research has documented internalized stigma’s many harms, while also clarifying that stigmatized individuals are often resilient and paths between societal stigmatization and individual impacts are diverse (Corrigan & Watson, 2002; Crocker & Major, 1989; Watson, Corrigan, Larson, & Sells, 2007). Resistance to internalizing stigmatization is also persistent, if too rarely documented (Beers, 1908; Grobe, 1995; Jefferson, 1947). Nonetheless, that many people with mental health problems experience significant negative effects from internalized stigma is now well documented in research (Ritsher & Phelan, 2004; West et al., 2011) and first person accounts (Deegan, 1993; Gallo, 1994; Shimrat, 1997). These include reduced self-esteem, empowerment, hope, and sense of recovery, as well as exacerbated psychiatric symptoms and a greater reluctance to engage in treatment and other supports (Livingston & Boyd, 2010; Ritsher & Phelan, 2004). Such proximal effects, in turn, have potential distal consequences, such as impeding pursuit of life goals, reducing community participation and hindering social relationships and support (Lysaker, Roe, & Yanos, 2007; Yanos, Roe, Markus, & Lysaker, 2008). Much like breathing in polluted air, it is very hard to not take in at least pieces of societal prejudices like racism, sexism, classism, homophobia, and mental illness stigmatization (e.g., Bearman, Korobov, & Thorne, 2009; Meyer, 2003; Williams & Williams-Morris, 2000). When one then also belongs to the stigmatized group, internalizing the messages is often impossible to entirely avoid (Conde & Gorman, 2009; David, 2013) Thus, people who find themselves experiencing self-stigma are not at fault— but are left with the effects. In October 2013, we brought together 30 researchers in the area of mental illness self-stigma to discuss the current state of the field and to identify future priorities (“Reducing Internalized Stigma of Mental Illness: Mapping Future Directions,” Baltimore Maryland). These included the differences between and relationships among self-stigma and related constructs; exploring models or theories of the development, maintenance, and amelioration of self-stigma; validating new and existing measures of self-stigma with a variety of populations; and advancing strategies and programs designed to prevent, reduce, or eliminate self-stigma. That small working meeting was the impetus for this special issue. A call for papers was circulated widely, and final authors include both conference attendees and others. The resulting articles push forward our knowledge about and inquiry into the effects and dynamics of internalized stigma associated with mental illness as well as potential avenues and strategies for intervening to reduce it. Several seek to clarify our understanding of the concept of self-stigma and the interrelationships between it and other constructs (e.g., public stigma, anticipated stigma). For example, Quinn, Williams, and Weisz (2015) explore the relationship between discrimination experiences, anticipated stigma, and selfstigma in an effort to understand how self-stigma might develop. Their findings suggest that because of prior experiences of discrimination, individuals with mental illness may come to expect and anticipate that they will be stigmatized, which, in turn, may contribute to believing that the stereotypes involved are true. Further, Jennings et al. (2015) examine the role of perceived need Alicia Lucksted, Department of Psychiatry, University of Maryland School of Medicine; Amy L. Drapalski, VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, Maryland. Correspondence concerning this article should be addressed to Alicia Lucksted, Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, 737 West Lombard Street, Room 528, Baltimore MD 21201. E-mail: aluckste@psych .umaryland.edu Psychiatric Rehabilitation Journal © 2015 American Psychological Association 2015, Vol. 38, No. 2, 99–102 1095-158X/15/$12.00 http://dx.doi.org/10.1037/prj0000152