SOCW 6090 WK1 Assgn Assignment: Diagnosis: The Burden of Stigma in Help Seeking The threat of public stigma, as well as self-stigma, can prevent individual

SOCW 6090 WK1 Assgn Assignment: Diagnosis: The Burden of Stigma in Help Seeking
The threat of public stigma, as well as self-stigma, can prevent individuals from receiving the mental health treatment they need. In this Assignment, you analyze the influence of stigma on experiences with and treatment of mental illness.
To prepare: Watch the TED Talk by Sangu Delle and then review the readings for this week.  
Focus on Delle’s examples illustrating Corrigan’s model about the stages of stigma and the hierarchy of disclosure. Consider Delle’s experience against that model.
By Day 7
Submit 3 pages that addresses the following:

Briefly explain Corrigan’s model of the stages of stigma and his recommendations and hierarchy about recovery.
Explain whether Delle’s experience follows that model. Use specific examples to argue your perspective. If you agree, identify which stage of recovery Delle is in.
Analyze Delle’s reports about his own experiences with both types of stigma. Provide specific examples, and in your analysis consider the following questions:

Does one type of stigma predominate in his talk?
Which of Delle’s personal values or beliefs were challenged by his internalizations about his own illness and help-seeking?
What strengths does he exhibit?
What was the primary benefit of his diagnosis?
Do you think his experience would be different if his culture was different? Explain why or why not? www.LaRCP.ca464 W La Revue canadienne de psychiatrie, vol 57, no 8, août 2012

CanJPsychiatry 2012;57(8):464–469

Key Words: self-stigma,
stigma reduction, mental
illness, empowerment

Manuscript received and
accepted January 2012.

In Review

On the Self-Stigma of Mental Illness: Stages, Disclosure, and
Strategies for Change

Patrick W Corrigan, PsyD1; Deepa Rao, PhD, MA2
1 Distinguished Professor and Associate Dean for Research, College of Psychology, Illinois Institute of Technology, Chicago, Illinois.
Correspondence: Illinois Institute of Technology, 3424 South State Street, Chicago, IL 60616;

2 Research Assistant Professor, Department of Global Health, University of Washington, Seattle, Washington.

People with mental illness have long experienced prejudice and discrimination.
Researchers have been able to study this phenomenon as stigma and have begun to
examine ways of reducing this stigma. Public stigma is the most prominent form observed
and studied, as it represents the prejudice and discrimination directed at a group by the
larger population. Self-stigma occurs when people internalize these public attitudes and
suffer numerous negative consequences as a result. In our article, we more fully define the
concept of self-stigma and describe the negative consequences of self-stigma for people
with mental illness. We also examine the advantages and disadvantages of disclosure in
reducing the impact of stigma. In addition, we argue that a key to challenging self-stigma
is to promote personal empowerment. Lastly, we discuss individual- and societal-level
methods for reducing self-stigma, programs led by peers as well as those led by social
service providers.


Les personnes souffrant de maladie mentale font depuis longtemps l’objet de préjugés
et de discrimination. Les chercheurs ont pu étudier ce phénomène comme étant celui
des stigmates, et ont commencé à examiner des façons de réduire ces stigmates. Les
stigmates du public sont la forme prédominante qui a été observée et étudiée, car elle
représente les préjugés et la discrimination dirigés vers un groupe par l’ensemble de la
population. L’auto-stigmatisation se produit lorsque les gens internalisent ces attitudes
du public et par la suite, souffrent de nombreuses conséquences négatives. Dans notre
article, nous définissons plus complètement le concept de l’auto-stigmatisation et décrivons
les conséquences négatives que l’auto-stigmatisation provoque chez les personnes
souffrant de maladie mentale. Nous examinons aussi les avantages et désavantages de
la divulgation pour réduire l’effet des stigmates. En outre, nous alléguons qu’un moyen
de défier l’auto-stigmatisation consiste à promouvoir l’habilitation personnelle. Enfin, nous
présentons des méthodes au niveau individuel et sociétal de réduire l’auto-stigmatisation,
des programmes menés par les pairs ainsi que ceux menés par des prestataires de
services sociaux.

In making sense of the prejudice and discrimination experienced by people with mental illnesses, researchers
have come to distinguish public stigma from self-stigma.1
Public stigma is what commonly comes to mind when
discussing the phenomenon, and represents the prejudice and
discrimination directed at a group by the population. Public
stigma refers to the negative attitudes held by members
of the public about people with devalued characteristics.
Self-stigma occurs when people internalize these public
attitudes and suffer numerous negative consequences as
a result.2 In our article, we seek to more fully define self-
stigma, doing so in terms of a stage model. We will argue
that a key to challenging self-stigma is to promote personal
empowerment. One way to do this is through disclosure, the

strategic decision to let others know about one’s struggle
toward recovery. Then, we will discuss individual and
societal level methods for reducing self-stigma.

Defining Self-Stigma
While acknowledging the role of societal and interpersonal
processes involved in stigma creation, social psychologists
study stigma as it relates to internal and subsequent
behavioural processes that can lead to social isolation
and ostracism.3 Stereotypes are the way in which
humans categorize information about groups of people.
Negative stereotypes, such as notions of dangerousness or
incompetence, often associated with mental illness, can be
harmful to people living with mental illnesses. Most people The Canadian Journal of Psychiatry, Vol 57, No 8, August 2012 W 465

On the Self-Stigma of Mental Illness: Stages, Disclosure, and Strategies for Change

Clinical Implications
• Self-stigma can significantly impact overall health


• Techniques and interventions have been developed to
help a person reduce self-stigma.

• Although interventions have been developed to help

a person reduce self-stigma, there are limited studies
on the validation of these interventions and their
adaptations for specific populations.

• Future research needs to continue to evaluate
programs that promote empowerment to reduce

people have knowledge of particular stereotypes
because they develop from, and are defined by, societal
characterizations of people with certain conditions. Although
broader society has defined these stereotypes, people may
not necessarily agree with them. People who agree with
the negative stereotypes develop negative feelings and
emotional reactions; this is prejudice. For example, a
person who believes that people with schizophrenia are
dangerous may ultimately describe feeling fearful of those
with serious mental illness (SMI). From this emotional
reaction comes discrimination, or the behavioural response
to having negative thoughts and feelings about a person in a
stigmatized outgroup. A member of the general public may
choose to remain distant from a person with mental illness
because of their fear (prejudice) and belief (stereotype) that
the person with mental illness is dangerous.

People who live with conditions such as schizophrenia are
also vulnerable to endorsing stereotypes about themselves,
which is self-stigma. It is comprised of endorsement of these
stereotypes of the self (for example, “I am dangerous”),
prejudice (for example, “I am afraid of myself”), and the
resulting self-discrimination (for example, self-imposed
isolation). Once a person internalizes negative stereotypes,
they may have negative emotional reactions. Low self-
esteem and poor self-efficacy are primary examples of
these negative emotional reactions.4 Self-discrimination,
particularly in the form of self-isolation, has many
pernicious effects leading to decreased health care service
use, poor health outcomes, and poor quality of life.5,6 Poor
self-efficacy and low self-esteem have also been associated
with not taking advantage of opportunities that promote
employment and independent living.7 Link et al8 called this
modified labelling theory; contrasting classic notions of
the label (see Gove9,10), Link et al noted that people who
internalize the stigma of mental illness worsen the course
of their illness because of the harm of the internalized
experience, per se. Self-stigmatization diminishes feelings
of self-worth, such that the hope in achieving goals is
undermined. Thus the harm of self-stigma manifests itself
through an intrapersonal process, and ultimately, through
poor health outcomes and quality of life.2,4

A Stage Model of Self-Stigma
Self-stigma has often been equated with perceived stigma;
for example, a person’s recognition that the public holds
prejudice and will discriminate against them because of their
mental illness label.7 In particular, perceived devaluation
and discrimination is thought to lead to diminished self-
esteem and -efficacy. We believe this to actually be the first
stage of a progressive model of self-stigma (Figure 1). As
such, we see the process of internalizing public stigmas as
occurring through a series of stages that successively follow
one another.2,4,10,11 In the general model, a person with an
undesired condition is aware of public stigma about their
condition (Awareness). This person may then agree that
these negative public stereotypes are true about the group
(Agreement). Subsequently, the person concurs that these

stereotypes apply to him- or herself (Application). This may
lead to harm and to significant decreases in self-esteem and
-efficacy (Harm). Unlike other research on self-stigma,12,13
the stage model shows that pernicious effects of stigma on
the self do not occur until later stages. Not until the person
applies the stigma, does harm to self-esteem or -efficacy

One of the challenges of a stage model of self-stigma
is sorting out the effects of later stages from those of
depression, which is frequently experienced among people
with SMI.14 Other staged models of behaviour suggest
that any individual stage is most strongly influenced by
the immediately preceding one.15 Thus to fully understand
stigma’s contribution to poor health outcomes, research
must crosswalk specific stages with common antecedents
of poor outcomes, such as depressive symptoms. In this
way, the effects of internalized stigma on self-esteem can
be partialled out from other causes of depression.

The Why Try Effect
A related consequence of self-stigmatization is what has
been called the why try effect, in which self-stigmatization
interferes with life goal achievement.11 Self-stigma
functions as a barrier to achieving life goals. However, self-
esteem and -efficacy can reduce the harmful results of self-
stigma. Diminished self-esteem leads to a sense of being
less worthy of opportunities, which undermines efforts at
independence, such as obtaining a competitive job.

Why should I seek a job as an accountant? I am
not deserving of such an important position. My
flaws should not allow me to take this kind of a
job from someone who is more commendable.

Alternatively, decrements to self-efficacy can lead to a why
try outcome based on a person’s belief that he or she is
incapable of achieving a life goal.

Why should I attempt to live on my own? I am not
able to be independent. I do not have the skills to
manage my own home.

Why try is a variant of modified labelling theory,8 in which
the social rejection linked to stigmatization contributes to

www.LaRCP.ca466 W La Revue canadienne de psychiatrie, vol 57, no 8, août 2012

In Review

low self-esteem. Modified labelling theory also suggests
avoidance as a behavioural consequence of devaluation.
When people perceive devaluation, they may avoid
situations where public disrespect is anticipated.

Challenging Self-Stigma
There is a paradox to self-stigma.16 Some people with
mental illness internalize it and suffer the harm to self-
esteem, self-efficacy, and lost goals. However, many
others seem oblivious to its effects and report no pain. Yet
another group is especially interesting: people who seem
to report righteous indignation at the injustice of stigma.
It is this third group that may suggest an antidote to self-
stigma: personal empowerment. Empowering people seems
to be an effective way of reducing self-stigmatization,
encourage people to believe they can achieve their life
goals, and circumvent further negative consequences that
result from self-stigmatizations. In a sense, empowerment
is the flip side of stigma, involving power, control, activism,
righteous indignation, and optimism. Investigations have
shown empowerment to be associated with high self-
esteem, better quality of life, increased social support,
and increased satisfaction with mutual-help programs.17–19
Thus empowerment is the broad manner by which we can
reduce stigma. In the remainder of our article, we describe

the specific mechanisms that are involved with empowering
people as ways to decrease self-stigma.

Disclosure: The First Step
Many people deal with self-stigma by staying in the closet;
they are able to shelter their shame by not letting other
people know about their mental illness. One way for a
person to promote antistigma and counter the shame is to
come out, to let other people know about their psychiatric
history. Research has interestingly shown that coming out
of the closet with mental illness is associated with decreased
negative effects of self-stigmatization on quality of life,
thereby encouraging people to move toward achieving their
life goals.20 When people are open about their condition,
worry and concern over secrecy is reduced; they may soon
find peers or family members who will support them, even
after knowing their condition, and they may find that their
openness promotes a sense of power and control over
their lives.21 Still, being open about one’s condition can
have negative implications. Openness may bring about
discrimination by members of the public, any relapses
may be more widely known than preferred, and therefore
more stressful, and in some cases, disclosure may be more
isolating. For example, in India, documentation of mental
illness is grounds for divorce, a situation that some would
consider a form of institutionalized stigma.22,23 A person
with mental illness in India may feel doubly stressed by
the threat of divorce and further public discrimination.
Deciding to disclose is ultimately a very personal decision,
closely tied to the cultural context, and requires thorough
consideration of the potential benefits and consequences.

Coming out is not a black-and-white decision. There are
strategies that vary in risk for handling disclosure, which
are summarized in Figure 2.24,25 At the most extreme, people
may stay in the closet through social avoidance. This means
keeping away from situations where people may find out
about one’s mental illness. Instead, they only associate with
other people who have mental illness. It is protective (no one
will find out the shame) but obviously also very restrictive.
Others may choose not to avoid social situations but instead
to keep their experiences a secret. An alternative version
of this is selective disclosure. Selective disclosure means
there is a group of people with whom private information is
disclosed and a group from whom this information is kept
secret. While there may be benefits of selective disclosure,
such as an increase in supportive peers, there is still a
secret that could represent a source of shame. People who
choose indiscriminant disclosure abandon the secrecy. They
make no active efforts to try to conceal their mental health
history and experiences. Hence they opt to disregard any
of the negative consequences of people finding out about
their mental illness. Broadcasting one’s experience means
educating people about mental illness. The goal here is to
seek out people to share past history and current experiences
with mental illness. Broadcasting has additional benefits,
compared with indiscriminant disclosure. Namely, it fosters

Figure 1 The stage model of self-stigma

Figure 1: The Stage Model of Self Stigma

The public believes
people with mental

illness are weak.

Because I am weak, I

am not worthy or

That’s right. People
with mental illness

are weak.

I am mentally ill so I

must be weak.

Why try…
To pursue a job; I am not worthy.
To live on my own; I am not able. The Canadian Journal of Psychiatry, Vol 57, No 8, August 2012 W 467

On the Self-Stigma of Mental Illness: Stages, Disclosure, and Strategies for Change

their sense of power over the experience of mental illness
and stigma.

Methods of Reducing Stigma
There are other strategies that people living with mental
illness can use to cope with the negative consequences of
self-stigmatization. A caution needs to be sounded first.
In trying to help people learn to overcome self-stigma,
advocates need to make sure they do not suggest that the
stigmatization is the person’s fault, that having self-stigma
is some kind of flaw like other psychiatric symptoms that
the person needs to correct. Stigma is a social injustice and
an error of society. Hence eradicating it is the responsibility,
and should be the priority, of that society. In the meantime,
people with mental illness may wish to learn ways to live
with, or compartmentalize, that stigma. However, curing it
lies with the community in which one lives. Hence erasing
public stigma may be a broad-based fix of the stigma
problem. What we broach here are more narrowly focused
efforts to help people who are bothered by internalized

Manualized approaches to self-stigma reduction for people
with mental illnesses are in development. One promising
approach is the Ending Self-Stigma intervention,26 which
uses a group approach to reduce self-stigmatization. The
intervention meets as a group for 9 sessions, with materials
covering education about mental health, cognitive-
behavioural strategies to impact the internalization of public
stigmas, methods to strengthen family and community ties,
and techniques for responding to public discrimination.
The cognitive-behavioural strategies rest on insights from
cognitive therapy27 that frame self-stigma as irrational self-
statements (for example, “I must be a stupid person because
I get depressed”) that the person seeks to challenge (for
example, “Most other people do not think depressed people
are stupid”). These kinds of challenges lead to counters—
pithy statements people may use the next time they catch
themselves self-stigmatizing.

There I go again. Just because I got depressed last
fall does not mean I am stupid and incapable of
handling a job. I have struggles just like everyone

A pilot study of the intervention showed that internalized
stigma was reduced and perceived social support increased
after participation in the weekly intervention.26

A good example of a societal-level approach that may also
benefit a person is the In Our Own Voice program, developed
by the National Alliance on Mental Illness in the United
States. This intervention involves a manualized group
approach for targeted groups of the general population.
Testimonials by people with mental illness are the key
to stigma reduction in this program. Participants of the
intervention can be, for example, health care professionals,
church congregations, and students. Research has shown
the program’s effectiveness in reducing negative attitudes
toward people with mental illness, in its long and short

versions.11 If programs such as these help to reduce public
stigmas around mental illness, possible prejudices that
a person with mental illness perceives and internalizes
would be reduced, thus indirectly impacting self-stigma. In
addition, the people providing testimonials as part of the
intervention feel empowered by the activist role they play
in advocating for themselves, thereby reducing self-stigma
as the program is implemented.

Peer Support
Consumer-operated programs offer another way for people
with SMI to enhance their sense of empowerment.28 Groups
such as these provide a range of services, including support
for people who are just coming out, recreation and shared
experiences that foster a sense of community within a
larger hostile culture, and advocacy and (or) political
efforts to further promote group pride.28 Several forces
have converged during the past century to foster consumer-
operated services for people with psychiatric disabilities.
Some reflect dissatisfaction with mental health services
that disempower people by providing services in restrictive
settings. Others represent a natural tendency of people to
seek support from others with similar problems. Recently,
various consumer-operated service programs have
developed, including: drop-in centres, housing programs,
homeless services, case management, crisis response,

Figure 2 A hierarchy of disclosure strategies

Figure 2. A hierarchy of disclosure strategies

Social avoidance:
Stay away from others so they do
not have a chance to stigmatize me!

Go out into the world—work and go
to church—but tell no one about my

Selective disclosure:
Tell people about my illness who
seem like they will understand.

Indiscriminant disclosure:
Hide it from no one.

Be proud. Let people know.

www.LaRCP.ca468 W La Revue canadienne de psychiatrie, vol 57, no 8, août 2012

In Review

benefit acquisition, antistigma services, advocacy, research,
technical assistance, and employment programs.28,29 Results
of a qualitative evaluation of consumer-operated programs
showed that participants in these programs reported
improvements in self-reliance and independence; coping
skills and knowledge; and feelings of empowerment.29
Future research needs to isolate the active ingredients of
consumer-operated services that lead to positive change.

Stigma is a societal creation—what social psychologists
have come to describe as prejudice and discrimination.
Unfortunately, some people with SMI internalize the stigma
and suffer significant blows to self-esteem and -efficacy.
However, self-stigma is not an inevitable curse. People
in a stigmatized group do not necessarily turn that stigma
onto themselves. Consider research about racism affecting
the African-American community. Classic psychological
models believed African Americans to have lower
self-esteem than White Americans because the former
internalized the biases and prejudices about them that
dominated in the culture of the latter.30,31 Research
consistently fails to show this, and, in fact, may suggest
the obverse; African Americans may have higher self-
esteem than White Americans.32–37 How can this be?
African Americans will report they are aware of White
Americans prejudice but do not believe it actually applies to
themselves. In fact, many African Americans report White
Americans ignorance can be a personal rallying cry for
their personal sense of empowerment and a wake-up call
for their community.

The lesson seems to apply to self-stigma for mental illness,
too. Internalizing prejudice and discrimination is not a
necessary consequence of stigma. Many people recognize
stigma as unjust and, rather than being swept away by it,
take it on as a personal goal to change. Many others are
unaware or unmotivated by the phenomenon altogether.
However, there are people who seem to apply the prejudice
to themselves and suffer lessened self-esteem and -efficacy.
These people may benefit from structured programs to
learn to challenge the irrational statements that plague
their self-identity. They may benefit from joining groups of
peers who have successfully tackled the stigma. They may
benefit from a strategic program to come out about their
stigma. Research needs to continue to identify and evaluate
programs that promote empowerment at the expense of

This work was supported, in part, by US National Institutes
of Mental Health grant 08598–01. Dr Rao is supported by a
US National Institutes of Health career development award,
K23 MH 084551.

The Canadian Psychiatric Association proudly supports the
In Review series by providing an honorarium to the authors.

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