One of the greatest ways to improve self-confidence when living with a chronic illness is with education. Learning what causes depression and the treatments available out there are great starting points. However, there's one aspect of education that gets overlooked -- and is the basis for this article. I'm talking about stigma and its many forms.
Derived from the ancient Greeks, stigma was the primitive practice of burning or cutting a part of the body of an objectionable person as a means to identify them to others. The bearer of this "mark" was to be avoided, shunned, and spurned in public. Those who were stigmatized were assigned the most undesirable category in community because the community feared their "difference" or "illness". Though modern use of the word stigma no longer involves physical markings, a person with a mental illness often carries an indelible mark of shame nonetheless (1). This happens because society views mental illness as menacing, deviant, and unpredictable, and as such, categorizes people with mental illness as undesirable. Despite research showing that depression is neurobiological in origin, stigmatizing beliefs cause a person living with depression to have a diminished sense of self, feel socially disconnected from others, and, as such, have fewer support systems (2).
Stigma is addressed frequently in mental health advocacy, but did you know there are many different kinds of stigma? Knowing the about the different categories of stigma will help you better understand this social phenomenon, and what to do to combat such experiences.
There are five levels of stigma that can affect your daily living experiences if you have depression. Stigmatizing beliefs occur on a personal level, in the general public, within professions, via labels and by associative connections.
1. Self Stigma is the self-blame you attach to your identity as being someone who has depression. Whether it's your personal or professional identity, you attach negative self-beliefs about your abilities or worthiness. These pessimistic beliefs can become such a part of your thinking style that you become passive and accepting of their power (3). In truth, the self-stigma you've assigned yourself is not based in reality. To combat this experience, you need to educate yourself about what depression really is. It is a neurobiological issue, not a result of laziness or weak character. Living with depression may be something that affects you greatly, but it does not singularly define you. Changing negative self-talk styles to positive ones will help increase your self-esteem and self-confidence -- which will lessen self-stigma and shame. Try using these more positive affirmations:
2. Public stigma is the experience where myths and misinformation keep the general public fearful about mental illness. Commercials that make fun of someone with depression might sell a product, but we'd all agree it perpetuates stigma. Movies, television shows, newscasts and jokes that use depression as a tool for ridicule worsens public stigma. Just like self-stigma, educating the public is the key here. Be it writing a letter, firing off an email, or talking to someone directly, taking on a public stigmatizing experience can become a teachable moment.
3. Professional Stigma occurs when stigmatizing views of mental illness go beyond the general public to the so-called educated levels of professionals. Studies have shown that well-trained professionals from an array of health fields stereotype psychological disorders (4). To combat professional stigma, don't be afraid to educate. Take your personal knowledge of depression and help others learn what it's really about. Just because a person is a professional, does not necessarily mean they are truly educated.
4. Label Stigma occurs with the use of diagnostic labels. It's important to note that diagnosis is a meaningful way to identify illness. However, the language of diagnosis can make having a mental illness stigmatizing. For example, "He's a depressive" feels more negative as a descriptor than "He is a person who has depression". Again, put yourself out there and correct the misuses of labels or language that dehumanize.
5. Stigma by Association is the experience of being stigmatized because you know someone who has a mental illness. If you are a family member, friend, coworker, or neighbor of someone who has mental illness, you have the potential for finding yourself socially disqualified from others. Sometimes called courtesy stigma or associative stigma, stigma by association devalues your status because you share an affiliation with a child or adult who has mental illness (5). If you are someone who has depression, talk to your family and friends and teach them about the stigma by association. Give them permission to address stigma should they feel the need to do so. For example, if your spouse can educate a misinformed person about depression, three things happen. First, your loved one confirms your importance and value. Second, your loved one minimizes stigma by teaching about the realities of mental illness, and third, the stigmatizing person learns a valuable lesson.
Now that you understand how the psychosocial cycle of stigma presses on you, it's time to shift the focus of shame off of your shoulders. As you continue to educate yourself, make the leap to teaching others so that the myths of depression can be addressed. You will be creating a new reality, one that shows how living with depression is not something to be afraid of or shameful about. As you gain more self-confidence, you'll find that you've transformed from a person identified with an "illness" to a person who is respected as an "advocate".
1. Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. New Jersey: Prentice-Hall.
2. Martina, J. K., Pescosolido, B. A., & Tuch, S. A. (2000). Of fear and loathing: The role of disturbing behavior, labels and causal attributions in shaping public attitudes toward people with mental illness. Social Behavior, 41, 208-223.
4. Heflinger, C. A. & Hinshaw, S. P. (2010). Stigma in child and adolescent mental health services research: Understanding professional and institutional stigmatization of youth with mental health problems and their families. Administration Policies in Mental Health, 37(1/2), 61-70.
5. Mehta, S. & Farina, A. (1988). Associative stigma: Perceptions of the difficulties of college-aged children of stigmatized fathers. Journal of Social Clinical Psychology, 7, 192-202.
Editorial Note: Dr. Deborah Serani is the author of Living with Depression" by The Rowman and Littlefield Publishing Group.