Internalized Stigma of Mental Illness: More than a scale.

Abstract

I am a mental illness and help-seeking stigma researcher and yet, somehow, I have severe internalized stigma of mental illness as measured by the 9-item short form of the Internalized Stigma of Mental Illness Scale (ISMI-9). I began studying mental illness and help-seeking stigma because I witnessed it. I continued studying it, more passionately, because I experienced it. But nothing could have prepared me to learn that I had internalized the stigma of mental illness to that degree. It led me to contemplate the process by which I had done so, and I concluded that it was not by believing some disembodied stereotypes about people with mental illness, it was a result of instance after instance of negative treatment due to my severe mental illness. In this first-person narrative, I describe several significant examples of such in my life, tying them back to the process of developing severe internalized stigma of mental illness. I offer this first-person narrative not out of some grandiose notion that I am special, but rather for the specific reason that I doubt I am the only one. In this work, I hope to give ear to an underrepresented voice in stigma research-the voice of those who are suffering.

A heavier burden of stigma? Comparing outpatient and inpatient help-seeking stigma.

“…Participants reported greater public and self-stigma for inpatient treatment than outpatient treatment and more negative attitudes for inpatient treatment than outpatient treatment. These results for inpatient treatment are consistent with a heightened awareness of public stigma and discrimination experiences reported by those receiving inpatient care (Dinos et al, 2004; Mathison, 2019; Sibitz et al, 2011). However, this is one of the first studies to establish empirically that stigma and negative attitudes toward inpatient treatment are more severe compared to outpatient treatment.…”

“…Although inpatient treatment stigma received significant attention in early years, recent literature has increasingly focused on the stigma of outpatient psychological services (see Schnyder et al, 2017, for a comprehensive review and meta-analysis). As a result, remarkably little recent research on inpatient stigma exists (e.g., Mathison, 2019; Moses, 2014), and even less comparing the two treatment modalities. The goal of this study is to address this omission by examining the help-seeking stigma associated with both inpatient and outpatient services.…”

“…Compared to outpatient settings, inpatient treatment is typically associated with more serious psychopathology (Szmukler & Appelbaum, 2008) and greater restrictions on personal freedoms (Mathison, 2019). As a result, certain parameters of outpatient care may not apply to the context of inpatient services.…”

“…Individuals in an inpatient facility are likely to be experiencing acute psychiatric distress and a marked decrease in the ability to function (Bowers et al, 2005; Chai et al, 2013; Saba et al, 2008). There are additional dynamics related to psychiatric hospitalization, as patients are physically isolated from the outside community (Lilja & Hellzén, 2008), held behind locked doors (Mathison, 2019; van der Merwe et al, 2009), can be committed against their will and/or held for longer than intended, and may be forced to take medication, all of which reduces patient autonomy (Katsakou & Priebe, 2007; Rüsch et al, 2014). Once in an inpatient setting, Lilja and Hellzén (2008) suggest that patients undergo a “psychiatric socialization” which impairs identity formation and freedom by pairing the individual with the disease.…”

“…That said, inpatient treatment usage may be more “visible” than that of outpatient, as individuals may suddenly miss a significant amount of work or other commitments. Therefore, with increased likelihood of others finding out, these populations may be more vulnerable to social rejection (Verhaeghe & Bracke, 2007; Verhaeghe et al, 2008; Wright et al, 2000) and discrimination (Mathison, 2019; Sibitz et al, 2011; Stengler-Wenzke et al, 2000).…”