The Role of Disclosure in Beating Stigma
What role do identity and pride play?
Posted Jul 02, 2019
In a previous blog post, I asserted that contact between the public and people with mental illness is the best way to replace the stigma of mental illness with affirming attitudes of hope and empowerment. This means some advocates of people with mental illness need to share their past experiences with mental health challenges as well as recovery and accomplishment. This requires two steps. First, people need to identify themselves as individuals with mental illness. Second, they need to disclose this identity. These are complex processes indeed.
Social psychologists have shown that individuals who identify with their stigmatized group report less stress arising from prejudice and better self-esteem. This has been demonstrated for African Americans, women, and the LGBTQ community. The latter group is especially relevant for understanding the experiences of identity and mental illness because LGBTQ and mental illness are “conditions” that are not readily obvious to the public (compared, for example, to skin color for ethnicity). Hence, they can hide them. People might deny self-perceptions consistent with a stigmatized role to escape prejudice and discrimination. For example, people with minority sexual orientations that differ from the majority might distance themselves from thoughts and behaviors consistent with their orientation to control harmful self-statements (e.g., I am morally weak because I am attracted to people of the same gender). Conversely, LGBTQ persons who accept and hold close their sexual orientation experience not only have less self-stigma but greater self-esteem as well as health and wellness. In the latter case, embracing one’s “gay” identity can be essential for health and wellness.
Given this, one might think people with mental illness should identify with that illness. However, relationships between identity and stigma are complex and influenced by the perceived legitimacy of mental illness stigma. Those who identify with mental illness but also agree with the stigma of their disorder (“I guess that’s right; people with mental illness choose their illness cause they’re weak.”) report less hope and self-esteem.
Conversely, persons whose sense of self prominently included their mental illness, and who rejected the stigma of mental illness, showed not only more hope and better self-esteem but enhanced social functioning as well. Hence, identifying with mental illness does not automatically lead to more stress; it is the perceived legitimacy of the stigma that threatens the identity and harms emotional health. The evolution from patienthood to personhood is not necessarily a rejection of mental illness but rather an integration of its central experiences into a total self-image.
Self-identification is not a yes-no question. On some issues, people may identify with mental illness entirely (e.g., the haunting impact of depression, and/or dealing with the side effects of medication), while on other issues, they do not (e.g. anger with a restrictive mental health system). Moreover, ways in which people identify themselves with mental illness change over time. Mental illness may have different significance depending on whether psychiatric disabilities are still present, or whether a person has recently experienced the stigma of mental illness.
Pride and Identity
People who enjoy an identity have pride in it. Pride comes from a sense of accomplishment or rootedness. On one hand, people experience pride in achieving a standard recognized by their culture (e.g., a medal for the long-distance runner or a college degree for the person challenged by psychiatric disabilities) or set by themselves (e.g., a personal-best running time or meeting a course deadline while experiencing a recurrence of depression).
Hence overcoming the challenges of mental illness may lead to identity pride, an experience not to be minimized. This view may have a downside, however, because it echoes the medical view of recovery: pride is only achieved when symptoms abate and disabilities are resolved. An alternative perspective recognizes that a sense of agency and self-determination, in addition to the symptoms and disabilities of mental illness, fosters self-esteem and self-worth as part of an identity about which a person might be proud.
Pride also emerges from a sense of self. Ethnic pride is a clear example: the statement, “I am African American,” does not suggest any accomplishment per se, but rather satisfaction with heritage, an additional answer to the question, Who am I? This phenomenon explains mental illness as an identity in which a person might be proud. This kind of identity promotes authenticity and a recognition of internal conceptualizations in the face of an imposing world. Authentic people are proud of their authenticity.
Group identification, defined as feelings of strong ties to a socially defined collection of people, has been shown to diminish the effects of stigma on people with mental illness.
People with mental illness who identified more with the group of people labeled “mentally ill” were actually less likely to experience harm to self-esteem or self-efficacy as a result of internalized stigma. Strong group identification was associated both with viewing stigma as potentially more harmful and with more perceived resources to cope with this threat.
This means that identifying with the group of people with mental illness can both expose the individual to the risk of being discriminated against as a member of that group (the downside of disclosure) and offer sources of support to cope with discrimination.