When we think of stigma and mental health, we tend to think of hurtful societal reactions and prejudice based on negative stereotypes. But this is only the tip of the iceberg. Those with mental health problems also frequently suffer from self-stigma. This is where a person takes on wider social prejudices about mental illness, internalizes them, starts to believe and incorporate them into their self-image.
I have suffered from devastating, life-changing anxiety and panic since my late teens, mixed in with periods of relative stability. As I got older I increasingly started to integrate societal attitudes towards anxiety and label myself. I felt weak, pathetic, dependent, and incapable of being by, or looking after, myself. In short I was suffering from self-stigma, which is characterised by feelings of low self-esteem and self-efficacy, self-discrimination and self-isolation.
During my early 30s, when my anxiety was at its worst, I used the tactic of avoidance. I actively avoided making new social connections, as I thought nobody would like me once they discovered my problems. I cut myself off from all but my oldest friends, as I didn't want to have to explain why I couldn't do things that I used to do, like going out for a meal or a drink, the cinema, or a gig.
After finishing my PhD, rather than feeling elated and proud about my achievement, I questioned why I'd bothered to do it in the first place. Because who would ever employ an academic whose anxiety precluded them from teaching, going to conferences, or giving presentations when they could hire someone 'normal'?
This is an example of the ‘why try?’ effect, where self-stigma acts as a barrier to achieving your goals in life. Ultimately it becomes a vicious circle. The more you stigmatize and berate yourself for your mental health problems, the worse your self-esteem and self-worth become. This can then lead to an exacerbation of the original problem or bring on others, such as depression, as it did in my case.
The burden of keeping a secret can have further negative effects on your mental health, as you are constantly worrying about hiding your condition and trying to maintain a façade of normality.
I used to drive to the park two streets away to walk my dog Mavis because I needed my car near me as a security blanket to be used as a means of quick escape. When people questioned me about it, I said that I needed to keep my walking to a minimum due to my (albeit genuine) love of high heels.
If I was in a situation where there might be alcohol I would say I was driving or on antibiotics, rather than admit to being on anti-anxiety medication.
Research has found that one of the key tools in challenging self-stigma is through self-empowerment. And, in turn, one of the best ways of empowering yourself is through disclosure: talking about your mental health condition and your recovery journey.
This can be done selectively - for years I had a small number of friends and family who knew about my problems but who were forbidden to talk to other people about them due to my intense feelings of shame.
However, I still couldn’t bring myself to engage in what is known as ‘indiscriminate disclosure’, where no effort is made to conceal your condition. Indeed, the opposite is true: you decide to be completely open about your experiences to anyone and everyone.
Not quite ready to take this step, I started on some new medication and got a dog, and my anxiety began to improve and with it my confidence and self-esteem.
It turned out that I did, and do, get work as a researcher. My colleagues understand that, for example, I need to do meetings by conference call or Skype rather than face-to-face. They value me for the work I’m good at, rather than concentrating on what I can’t do.
And I discovered that people do like me, after all, despite – perhaps sometimes even because of – my mental health problems. I may not be a great friend to ask to go on a holiday, to a festival, or even on a train ride, but I think my struggles have made me a kinder, softer, more empathetic person.
Even the very act of sharing, being honest and open, allowing yourself to be vulnerable with others, fosters a kind of warmth, understanding and closeness. As a consequence I now feel incredibly lucky to have a wonderfully supportive network of friends who accept me unconditionally.
Emboldened, I started to talk about my mental health to a slightly wider circle of people. This included the odd social media post where I tested the water. For example, on my dog Mavis’s birthday, I wrote a post about how he had been instrumental in helping to get me over the worst of my agoraphobia. After posting it on Facebook I felt anxious, exposed and vulnerable. What if nobody responded? What if people thought less of me? But the comments were supportive and validating; others even shared their own experience of how their dogs had helped them.
Feeling further empowered, I then wrote a couple of blogs for mental health charities and, after long deliberation, I disclosed my struggles in the introduction of a book that I co-authored about mental health.
This article is another step in my journey of self-empowerment as a tool against self-stigma. So please people, be kind; I've metaphorically beaten myself up enough.