Applied Psychology OPUS

Stigma: A Different Kind of Bully

by Brit Lizabeth Lippman

         Most college students can attest to the challenges of adolescence: the tiring effort put into appearance, the hypersensitivity to peer criticism, and the prevalence of bullying in middle and high school. However, for those suffering from mental disorders, preoccupation with the opinion of others may take on a new meaning. These individuals face a different kind of bullying that may erode their mental health and willingness to persist in treatment: stigma.

         In recent years, the breadth of literature on the connection between stigma and adolescent mental illness has expanded as scholars have sought to understand how stigma affects the lives of young people. Researchers have also begun to explore how stigma manifests itself in peer groups, school environments, and family life. Through a variety of methods, they have painted what is sure to be an ever-expanding mural of what stigma looks like for adolescents with psychiatric disorders. In learning about the experience of stigma as it relates to psychological well-being, psychologists have opened doors to effective methods for combating stigma.

         The literature distinguishes between two types of stigma: public stigma and self-stigma. Public stigma is one’s perception of others’ reactions to his or her illness. Meanwhile, self-stigma involves the internalization of public stigma typically marked by feelings of shame, embarrassment, and low self-esteem directed toward oneself (Corrigan, 2004). Despite this differentiation, it is best to conceptualize the two constructs together since they are so closely related—public stigma instills self-stigma.

         Most of the recent research on stigma reports that adolescents with mental disorders are personally affected by stigma in at least one area of their lives. For example, Moses (2010) found that adolescents who perceive stigma in one domain of their lives are likely to feel stigmatized in other domains as well. A study of stigma among adolescents taking psychiatric medication discovered through qualitative interviews that 90% of participants demonstrated at least one of three measured stigma themes: secrecy, shame, and limiting social interaction (Kranke, Floersch, Townsend, & Munson, 2010). Many of these adolescents endorsed feeling some stigma from their friends or peers (Moses, 2010). Others expressed fear of being bullied by peers in school environments, consequently leading to secrecy, shame, and social withdrawal (Kranke et al., 2010).

         Not only does stigmatization from family and peers negatively affect an adolescent’s psyche, but it can lead adolescents to actually define themselves by their illnesses, a phenomenon known as         self-labeling. The majority of adolescents do not seem to be self-labelers, but it is important to note that self-labeling positively correlates with self-stigma, depression, and a lower sense of mastery (Moses, 2008). That being said, self-labelers seem to have an overall poorer self-image, with a greater susceptibility to depression. Moses (2008) found that adolescents who self-label “refer to their illness as an organic part of themselves,” merging their own identity with that of their psychiatric disorder (p. 575). These findings suggest that individuals who cannot separate who they are from their diagnoses might experience poorer psychological well-being that likely seeps into their academic performance, as well as other dimensions of their daily lives.

         The negative effects of stigma are best avoided by contact with supportive family and peer groups who either suffer from the same condition or can empathize with the affected adolescent. Kranke et al. (2010) found that adolescents who did not endorse any stigma themes had such a support system, and thus were able to normalize their illness so that they “no longer felt that anything was wrong with them” (p. 504). In another study, an adolescent spoke highly of her father because he showed understanding by treating her “like a kid that doesn’t have any problems” (Moses, 2010). On the other hand, having family members who also struggle with some form of mental illness can actually serve as a positive factor for adolescents, since parents and relatives who empathize may be less likely to exclude their children or act condescendingly toward them (Moses, 2010).

         We know that adolescents with psychiatric disorders fare better when they have parents and peers who can relate to them, but this begs the question: what about those who do not? What can we as peers, educators, and parents do to combat the shame and negative experiences of individuals who bear the burden of a DSM-IV diagnosis? Explicitly enforcing and expressing acceptance of these adolescents is crucial since feelings of shame might eventually lead to treatment avoidance and unwillingness to seek care down the line. Research reveals that family shame in particular significantly predicts treatment avoidance (Corrigan, 2004). Vogel, Wade, & Hackler (2007) found that high levels of self- stigma are associated with negative attitudes toward counseling and seeking help. Similarly, a study on adolescent depression also noted that teenagers who felt more stigmatized, particularly within the family, were less likely to seek treatment (Meredith et al., 2009).

         Since much of the literature currently published is qualitative and correlational in nature, research has yet to determine whether stigma actually causes poorer psychological well-being (e.g., in the forms of shame, low self-esteem, and withdrawal) or whether the correlation is contextual and extraneous factors are the bigger culprit. As several studies have wisely acknowledged, future research must include longitudinal or experimental studies in order to get a clearer sense of how damaging stigma may be for adolescents over time, especially in terms of continuing with treatment (Kranke et al., 2010; Moses, 2008). Research on adolescent mental health stigma is especially valuable, since adolescence is a critical time period for identity development and solidification (Moses, 2008). Longitudinal work is necessary to comprehend the nature of the more permanent developmental trends this bullying may produce.

            As research in this area progresses, school administrators and teachers should continue to discuss how to appropriately address stigma experienced in the classroom. Recent evaluations of anti-stigma interventions in Germany (Conrad et al., 2009), Britain (Pinfold et al., 2003), and the United States (Mann & Himelein, 2009) have discovered that using first-person narratives from students who have personally dealt with mental illness is helpful in reducing stigma within schools. Such studies suggest that schools in which students can share their own experiences with illness might be most helpful in fighting stigma. It is harder to change parents’ relationships with adolescents or the social dynamic within peer groups, but educators may serve as a stepping stone in advocating for a population that is so often misunderstood.

References

Conrad, I., Dietrich, S., Heider, D., Blume, A., Angermeyer, M., & Riedel-Heller, S. (2009). “Crazy? So What!”: A school programme to promote mental health and reduce stigma—Results of a pilot study.Health Education, 109(4), 314-328.

Corrigan, P. W. (2004). How stigma interferes with mental health care. American Psychologist, 59(7), 614-625.

Kranke, D., Floersch, J., Townsend, L., & Munson, M. (2010). Stigma experience among adolescents taking psychiatric medication. Children and Youth Services Review, 32, 496-505.

Mann, C. E., & Himelein, M. J. (2008). Putting the person back into psychopathology: An intervention to reduce mental illness stigma in the classroom. Social Psychiatry and Psychiatric Epidemiology, 43, 545-551.

Meredith, L. S., Stein, B. D., Paddock, S. M., Jaycox, L. H., Quinn, V. P., Chandra, A., & Burnam, A. (2009). Perceived barriers to treatment of adolescent depression. Medical Care, 47(6), 677-685.

Moses, T. (2008). Self-labeling and its effects among adolescents diagnosed with mental disorders.Social Science & Medicine, 68, 570-578.

Moses, T. (2010). Being treated differently: Stigma experiences with family, peers, and school staff among adolescents with mental health disorders. Social Science & Medicine,70, 985-993.

Pinfold, V., Toulmin, H., Thornicroft, G., Huxley, P., Farmer, P., & Graham, T. (2003). Reducing psychiatric stigma and discrimination: Evaluation of educational interventions in UK secondary schools. The British Journal of Psychiatry, 182, 342-346.

Vogel, D., Wade, N. G. & Hackler, A. H. (2007). Perceived public stigma and the willingness to seek counseling: the mediating roles of self-stigma and attitudes toward counseling. Journal of Counseling Psychology, 54(1), 40-50.