Research shows that the stigma surrounding anxiety may be just as challenging to manage as the symptoms themselves. The National Consortium on Stigma and Empowerment (NCSE), a National Institute of Mental Health (NIMH) funded center comprised of more than 12 research institution partners, has been grappling with this issue and the broader subject of mental illness stigma for the past 15 years. NCSE researchers see stigma as an umbrella term that includes stereotypes, prejudice and discrimination.
Negative stereotypes associated with people who experience anxiety come from society’s over-generalizations that often paint everyone with an anxiety disorder as weak or damaged. Further, prejudice occurs when these stereotypes are recognized, accepted, and expressed through emotional reactions to a stigmatized individual (e.g. “that poor Sharon—she has anxiety and you know, those people with anxiety are damaged goods”). Discrimination, the last link in the stigma chain, ensues when individuals are treated differently because of membership in the stigmatized group. For people with anxiety, this can result in social exclusion or denial of opportunity (e.g. “Sharon can’t handle the pressure of a promotion—I’ll go with the other candidate”). Two prominent and particularly damaging aspects of anxiety stigma are the misguided notions that a) people are to blame for their own anxiety symptoms and b) recovery from anxiety is improbable. When members of her community believe that Sharon brought her worries upon herself, or that she should just try harder to recover, this may further justify the discriminatory behavior and social exclusion in the minds of the public. Likewise, when Sharon is seen as having a condition that can’t be cured, this can lead to large-scale systematic discrimination, such as reduced funding of mental health programs.
Self-Stigma and the Why-Try Effect
Stigma is not only imposed upon the stigmatized group by members of the public; stigma can also creep into the identity of the person diagnosed with a mental illness. Once the stigmatized individual becomes aware of the public stigma, agrees with that stigma, and applies the stigma to themselves, this is referred to as self-stigma. Those who experience self-stigma may see themselves as weak or damaged because of their anxiety. Much as public stigma leads to discrimination, self-stigma leads to the “why try” effect—Why should I try to go back to work when a person like me just can’t hack it?
Awareness of public stigma also leads to label avoidance, wherein an individual prevents being identified as a member of the stigmatized group. Although this has advantages for eluding prejudice and discrimination, label avoidance may limit access to treatment and support. Jeff may decline therapy because he does not want to be seen walking into the therapy practice. If Jeff decides not to tell his boss about his panic attacks for fear of being labeled, he also forgoes the opportunity for accommodations such as a more flexible work schedule or time off to attend doctor appointments.
How to Beat the Stigma
So, what can we do about stigma? In regards to public stigma, research has looked at how education and contact-based programs can change stereotypes, prejudice and discrimination towards people with mental illness. Education-based programs challenge the stereotypes and myths about mental illness and provide more accurate information. Public service announcements, flyers, workshops and videos are commonly used methods to provide educational anti-stigma messages. While there is some research support for the educational approach, contact-based programs are considerably more powerful in promoting stigma change. In contact interventions, people with mental illness tell their stories and interact with those who might stigmatize them. This process familiarizes the public with mental health issues and personalizes the experience of mental illness.
Self-disclosure of mental illness is also a route towards reducing self-stigma. When people “come out” about their illness, they are challenging the shame and stigma. For many, talking about their experiences of anxiety with a trusted person relieves the burden of secrecy and brings feelings of personal empowerment. Revealing an anxiety diagnosis can also result in much needed social support from family, friends and coworkers.
Don’t Hide Your Identity
Although the best ways to reduce stigma involve people with mental illness sharing their personal stories, disclosing details of mental illness makes those same individuals vulnerable to being labeled, judged, and discriminated against. How can individuals with anxiety and other mental health diagnoses make the difficult decision to be open about these experiences? Our program, Coming Out Proud (COPp), is designed to help people in navigating the decision to disclose. Using trained leaders with mental health experience, the program engages participants in examining the risks and benefits of disclosure, while recognizing that this is a personal decision that is made continuously in many life domains (work, school, romantic relationships, etc.).
Whereas some anti-stigma campaigns may focus on normalcy (“people with anxiety are just like you and me”), that strategy may have unintended consequences; namely, that people with mental illness are encouraged to pass as normal and deny their identity. We promote the perspective that anxiety may be a unique aspect of your identity; hiding this identity leads to shame and fails to challenge the stigma. Solidarity campaigns such as COPp support and celebrate those who share—warts and all—their mental health journey.