Stigma Within and Without

Definitions of Stigma

Stigma is best defined as prejudice and discrimination. People may have negative feelings and beliefs about people who have a mental illness. Usually, this is based on ignorance, people lacking knowledge about mental illness and recovery. Discrimination, based on ignorance and prejudice, may deny people with mental illness some of the same basic rights that everybody in our society has including getting jobs, housing, and being included in the community in other ways.

Internal Stigma

Sometimes, people who have a mental illnesses internalize stigma. This can lead to feelings of shame, worthlessness or that somehow they are to blame for having the symptoms of a mental illness. The two most powerful ways to combat internalized stigma are:

• Learning more about the causes of mental illness
• Learning about recovery.

External Stigma

There are powerful ways to decrease stigma about mental illness in the community:

• Contact: Having a personal relationship with somebody with a mental illness helps decrease ignorance and prejudice.
• Education about mental illness and recovery: This can include public information campaigns such as commercials on TV and informational shows.
• Protest: Confronting stigmatizing practices and language on the spot as they occur can decrease discrimination.

Stigma exists within the mental health system itself.

Unfortunately, even people who work in mental health centers can promote stigma. For example, they may use terms that are insulting or make people feel deficient, such as referring to a person as a "manic" or a "borderline." Many consumers report that they experience discrimination in mental health centers.

Since mental health centers are where healing and recovery occur for many people, it is important to work on decreasing stigma in these places.

Ways to decrease stigma in mental health centers:

• Hiring peer counselors as staff. Peer counselors not only show real proof that recovery happens, but they also expose mental health staff to people with severe mental illness as co-workers rather than consumers. This relationship allows mental health workers to develop a different view about the strengths of people with mental illness.
• Involve consumers in training staff. Consumers can help staff learn about recovery, staff language and behavior that may be offensive, and the strengths of the consumer self-help approach.

Strategies for responding to stigma

Possible strategies include:

Educate yourself about mental disorders

• Sometimes people who experience psychiatric symptoms do not know the facts themselves. They may blame themselves for their symptoms or think they cannot take care of themselves or that they can't be part of the community. You may have had these negative thoughts or feelings. This is called "self-stigma."
• It is important to fight self-stigma, because it can make you feel discouraged and cause you to lose hope in your recovery. One way to fight self-stigma is to educate yourself about psychiatric symptoms and mental disorders, and to be able to separate myths from facts. For example, knowing that you did not cause your depression can help you to stop blaming yourself.  See "Learning about your Illness".
• Another way to fight self-stigma is to belong to a support group or another group where you get to know different people who have experienced psychiatric symptoms. 

Correct misinformation in others without disclosing anything about your own experience
A co-worker might say, "People with mental illness are all dangerous." You might decide to reply, "Actually, I read a long article in the paper that said that the majority of people with mental illness are not violent. The media just sensationalizes certain cases."

Selectively disclose your experience with psychiatric symptoms
Disclosing information about your own experience with psychiatric symptoms is a personal decision. It's important to think about how the other person might respond. It's also important to weigh the risks and benefits to yourself, both in the short term and in the long term. Talking this over with someone in your support system might be helpful.

People vary widely in whether they choose to disclose information about themselves, and if so, how much. You may decide to disclose personal information only to family members or close friends. Or you may disclose information to people only when it becomes necessary. For example, you might need a specific accommodation in order to perform your job.

You may feel comfortable disclosing information in a wide variety of settings. You may even be willing to speak publicly about mental illness for educational or advocacy purposes.

Become aware of your legal rights
It's important to educate yourself about the laws against discrimination. Two major laws that protect against unfair treatment are the Americans with Disabilities Act (ADA) and the Fair Housing Act (FHA).

The Americans with Disabilities Act makes it illegal to discriminate against people with physical or psychiatric disabilities in employment, transportation, communication, or recreation. The Fair Housing Act prohibits housing discrimination because of race, color, national origin, religion, sex, family status, or disability (physical or psychiatric).

It is worthwhile to take some time to understand the basic principles of these laws and how they might apply to you. If you feel that your legal rights have been violated, there is a range of possible actions you might take, depending on the situation.

Sometimes it is most effective to speak directly to the person involved. For example, it is usually preferable to approach your employer about the need to provide a reasonable accommodation on the job. An example of a reasonable accommodation would be asking to move your desk to a more quiet area in the office to improve your concentration.

Sometimes it may be more effective to talk to an expert to get advice, support, advocacy, mediation, and even legal help. For example, if a landlord refused to rent you an apartment because of psychiatric symptoms you may need to contact the Office of Fair Housing and Equal Opportunity (FHEO) in the Department of Housing and Urban Development (HUD) for advice and assistance. If an employer was unresponsive to your request for accommodation on the job, you might want to contact the Equal Employment Opportunity Commission (EEOC).

Resources

Anti-Stigma organizations and websites:

Chicago Consortium for Stigma Research
7230 arbor Drive
Tinley Park, IL 60477
Phone: 708-614-2490

National Stigma Clearinghouse
245 Eighth Avenue
Suite 213
New York, NY 10011
Phone: 212-255-4411

Resource Center to Address Discrimination and Stigma
1-800-540-0320

Federal agencies:

Substance Abuse Mental Health Services Administration's Resource Center to Promote Acceptance,
Dignity and Social Inclusion Associated with
Mental Health (ADS Center)

Equal Employment Opportunity Commission (EEOC)
1801 L Street, NW
Washington, D.C. 20507
Phone: 202-663-4900
To locate the nearest office: 1-800-669-4000