Three Types of Stigma: Public, Internalized, and Stigma-by-Association

For the purpose of the following section we will focus specifically on stigma around mental health issues. However, as we identified above, stigma is experienced by many different people groups.

There are three ways stigma can show up: in the public, internally, and as a stigma-by-association. Let’s explore all three.

Public Stigma

When looking at how stigma shows up in public, we ask “how does the public (the majority, or a large part, of society) perceive this people group?” Potentially because of media coverage, there may be a tendency to see people with mental illnesses as dangerous, violent, weak, and unpredictable. Consider movies you’ve seen that portray villains as having a mental illness…(Joker, Psycho)

With this stigmatized worldview of mental illness, people who struggle can be considered scary, dependent, burdensome and unable to make competent decisions. Sometimes they are even blamed for their illnesses.

This stigma can make people with mental illness feel excluded from social groups. Because of this stigma, people may isolate and miss out on needed social opportunities. These factors lead to poor self-worth and even worsening mental health. People may begin to fear seeking treatment because they don’t want the label of being mentally ill

Public stigma can also cause discrimination and prejudice in housing, workplaces, and educational settings.

Can you think of ways the media has influenced this unhealthy worldview? Explain.

Internalized or Self-Stigma

Self-stigma occurs when individuals internalize the beliefs and opinions of their dominant culture. As you can imagine, these beliefs can profoundly affect a person’s self-image and feeling of worthiness. Self-stigma significantly impacts personal relationships, family, work and social life. Self-stigma can escalate depression, anxiety, suicidal thoughts, and feelings of shame.

People who are stuck in a self-stigma loop often internalize self-blame, believing they are responsible for their illness. They may doubt they are deserving of care or that they have any power to change their situation. They can get stuck in a state of learned helplessness, because the stigma they experience keeps them from moving forward in their life. They may believe they are incompetent and a burden to society rather than productive, contributing members. As a result, people who are struggling with self-stigma may feel immobilized and unable to pursue basic goals like housing, education and employment.

Stigma-By-Association (SBA)

Friends and family members of those with mental illness may also experience the detrimental effects of public stigma on their wellbeing. SBA can have psychological effects similar to those experienced by people who have a diagnosis, including a tendency to isolate and avoid social interaction. A coping mechanism for people dealing with SBA may be to distance themselves from the loved one dealing with mental illness as a way of distancing from the stigma. Or it could involve withdrawing from social situations so that they don’t have to answer difficult questions about their loved one. This distancing can lead to a breakdown in the family unit.

Family members are also often the caregivers. They may lack support themselves because they withhold information about their family member’s diagnosis out of the fear of stigma. SBA can overpower a person’s coping skills, especially when their concerns have not been taken seriously in the past.

How All of This Impacts Recovery

Stigma, prejudice and discrimination have a big impact on an individual’s ability to recover.

Stigma often leads to exclusion and isolation. Prejudice and discrimination can often lead to poorer economic and interpersonal outcomes relative to the rest of the population. All the above negatively impacts an individual’s sense of  self-worth.

Is it any wonder people often fear disclosing their illness or seeking treatment?

Unfortunately, this secrecy also significantly affects health outcomes.


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Post-Secondary Peer Support Training Curriculum Copyright © 2022 by Jenn Cusick is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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