I felt symptoms of depression in sixth grade, without knowing that’s what they were. I heard “depression” and thought of Vincent van Gogh cutting off his own ear in a fit of despair.
But I certainly didn’t connect Garfield, the cartoon cat hating Mondays, overeating, and being generally bored and sluggish to mental health problems. I didn’t understand that, sometimes, feeling tired and apathetic are signs of a larger issue.
It wasn’t till college—when I lost all motivation to finish a psychology project my senior year and cried in my professor’s office—that I finally dragged myself to therapy. And once there, I was adamant that I should be able to snap out of it: I hadn’t experienced trauma I had assumed was a prerequisite for depression.
I certainly didn’t think what I was feeling merited medication.
But it did.
The year after college, I consulted a psychiatrist about taking antidepressants. This decision prompted a tsunami of unsolicited advice from friends and family.
Some advice I received from well-meaning but misguided friends:
“Choose happiness every day.”
“Get off medication as quickly as possible, because you don’t want that stuff in your body.”
“Think of things you’re grateful for every morning.”
“Eat healthier and lay off caffeine.”
Of that advice, here’s what was helpful:
That’s not a typo. None of it helped.
In fact, these “tips” actually fed the prejudices I already had concerning medication—that what I had wasn’t a medical issue, that my problems were with willpower (or a lack thereof) and self-motivation. And because I couldn’t make myself happy on my own, I was convinced I was just weak.
Maybe I did need to exercise—the problem was that I couldn’t get out of bed to work out. Choosing happiness sounds so simple, but when I felt weighed down by depression, I didn’t have the energy to brush my teeth, let alone completely invert my emotional state.
Blaming myself for being weak did not exactly help my depressive symptoms of hopelessness and apathy. By internalizing external stigma about medication for mental illness, I dug deeper into the pit of my depression.
And the truth is, the stigma is still deeply ingrained in me, six years later—even after years of therapy, feeling the benefits of medication, and discussions with multiple psychiatrists. Every few months, I spend a restless night wondering if I’m using medication as a crutch, if it’s simply buttressing my weakness, wondering if I should wean myself off of it—or if I’ll ever even be able to.
What is self-stigma in mental health?
Stigma is a broad concept, but it can be broken down into more specific categories of public and self-stigma. Public stigma refers to all the discrimination, prejudice, and assumptions aimed at a particular group by the general population.
There is no weakness inherent in needing medication.
Public stigma around mental illness is evident in the way so-called “crazy” characters in movies are dangerous and violent, or the way men are often effeminate or flawed for seeking therapy.
Self-stigma happens when people absorb the discrimination, prejudice, and assumptions thrown at them by the general public—and agree with it. This can have some serious negative impacts, like crippling damage to self-esteem and reduced self-efficacy (the ability to succeed in any situation).
Self-stigma can create a nearly insurmountable barrier to achieving one’s life goals.
How does self-stigma affect mental health treatment?
Self-stigma doesn’t just make you hate yourself—it can also have an effect on how well you adhere to a mental health treatment plan and it can exacerbate underlying issues.
Studies have shown that people with high levels of self-stigma are more likely to quit taking their medication without the guidance of a psychiatrist, which can be seriously dangerous.
Take my story as anecdotal evidence that self-stigma can mess with psychiatric treatment.
Since I started taking medication after college, there have been two significant periods of time when I (with the help of my doctor) weaned myself off medication. I quit because I started feeling better, and thought I had found the “strength” inside me to muscle through depression without pharmaceutical intervention.
I really felt “strong” and happy for a month. But then I had a bad day, as we all do. And then I had a bad week. And a bad month.
And somehow I ended up back where I had been before I saw a doctor and started taking antidepressants. I felt exhausted and hopeless—had all the progress I made with my mental health been for nothing?
As I must continue to remind myself time and time again, that idea of “strength” is a fallacy. There is no weakness in needing medication.
My current psychiatrist put it bluntly—he told me that if I felt better on medication, it’s because the medication is working, and if I choose to stop, I will most likely start to feel worse again. It’s a matter of my condition and where psychiatric science currently stands.
His simple insight is something I return to every time I question my ongoing relationship with antidepressants. I close my eyes and find myself back in that tiny room in Manhattan, seated across from a 70-year-old Jewish man who tells me in the simplest terms that this medication is good for me, before asking about my plans for Passover.
And you know what? It helps.
How do you fight mental health stigma?
With public stigma, there’s a lot of work that needs to be done. We need better representation of mental illness across the board (I’d argue especially in television, movies, and books aimed at kids and young adults). But no one person can solve the public stigma in our society around mental health. It’s a massive, cross-cultural issue.
Self-stigma is also tough to overcome, but individuals have more control over it than they might have over their own depression. When it takes root, internalized stigma acts like an aggressive weed—even when you pull it out by doing research and talking to doctors about whether and why taking medication is the right decision for you, it can still pop back up.
You have to be more or less constantly aware of how you’re treating yourself and whether that insidious self-judgment is creeping back.
My current psychiatrist put it bluntly—he told me that if I start to feel better on medication, it’s because the medication is working, and if I choose to stop, I will most likely start to feel worse again.
If you suffer from self-stigma, it’s important to continue to seek treatment, keep returning to the research, and surround yourself with supportive people. Bolster yourself with as many reliable sources of information and understanding loved ones as you can.
Read firsthand accounts from people who have struggled with internalized stigma, as well.
My favorite is Furiously Happy by Jenny Lawson, who says, “I wish someone had told me this simple but confusing truth: Even when everything’s going your way, you can still be sad. Or anxious. Or uncomfortably numb. Because you can’t always control your brain or your emotions, even when things are perfect.”
But above all else: Listen to yourself. You’re stuck with you for a long time; you owe it to yourself to do what you can to feel better.
Corrigan, P. W., & Rao, D. (2012). On the self-stigma of mental illness: stages, disclosure, and strategies for change. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 57(8), 464–469. https://doi.org/10.1177/070674371205700804
Kamaradova, D., Latalova, K., Prasko, J., Kubinek, R., Vrbova, K., Krnacova, B., Tichackova, A. (2016). Connection between self-stigma, adherence to treatment, and discontinuation of medication. Patient Preference and Adherence, 10, 1289-1298. doi:10.2147/ppa.s99136
Mannarini, S., & Rossi, A. (2019). Assessing mental illness stigma: A complex issue. Frontiers in Psychology, 9, 2722. doi:10.3389/fpsyg.2018.02722
Mayo Clinic. (2017). Mental health: Overcoming the stigma of mental illness. Retrieved from: https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/mental-health/art-20046477