Stigma is a mark of shame associated with mental illness, mainly due to misconceptions about what mental illness is. In our culture, the prevalent attitudes towards mental health problems encompass that mental illnesses are caused by personal weakness, character defects, black magic and supernatural influences. It is also often thought that people with mental illness are prone to violence and steeped in vices (particularly applicable to addiction). These misconceptions result in great prejudice against sufferers, with many being unable to get equal opportunities (such as housing or jobs) in society since no one wants to be associated with them.
In fact, in Pakistani society the stigma is so high that ‘nafsiyati’ (the Urdu word for ‘mental illnesses) is routinely used as an insult. If any member of a family is suspected of having mental health problems, the entire family gets ostracized, particularly in the context of marriage opportunities. This is why families actively try to hide the presence of mental health problems. In some cases, this even involves marrying the sufferers off before their illness is revealed, with the misguided hope that marriage will cure them.
As a result, the fear of being stigmatized prevents those who suffer from acknowledging that they have an illness and stops them from seeking the necessary help. This stigma is prevalent not only among the laymen but also among medical professionals trained in an era when there was little or no emphasis on psychiatry. In fact, it is routinely observed that some medical professionals in Pakistan, who consider psychiatry to be pseudoscience and ineffective, discourage patients from seeking mental health services. This is of particular concern since it is estimated that the majority of sufferers present themselves first to general practitioners or family physicians.
The phenomenon of stigma can be divided into two types: societal stigma and self-stigma.
Societal stigma consists of the bias prevalent in social attitudes towards mental illness. The prevalent image of mental illness in society is the individual who is completely dysfunctional, with depression and anxiety-related illnesses not perceived as mental health problems. Professional mental health services are frowned upon and it is thought that those diagnosed with mental health problems cannot recover. These social attitudes make it very difficult for sufferers to be honest about their condition and impedes their journey of recovery.
Societal stigma can be overcome by:
- Educating the public about the true nature of mental illness through systematic and sustained mass mental health awareness campaigns. This would enable society to understand mental illness and how to help others seek recovery.
- Survivors coming out and acknowledging their history of mental health problems in public, showing that recovery is possible and that people with mental illness can be functioning members adding value to society.
- Non-sufferers and caregivers to take a stand and perpetuate correct opinions and a positive image of people who suffer.
Self-stigma is less understood and often more severe than societal stigma. It involves the sufferer internalizing the societal misconceptions and prejudices about mental illness. This results in the sufferer feeling immense self-doubt and causes them to develop low self-esteem, guilt and even shame. This, in turn, decreases their motivation for seeking treatment and also results in their journey of recovery to be impeded.
Overcoming self-stigma is an important part of accepting one’s mental illness, which is crucial for starting the recovery journey. Self-stigma can be overcome by:
- The sufferer learning more about mental health and mental illness as a disease like any other which requires treatment. This will help them realize that their suffering isn’t due to personal weakness or character defects.
- Practicing self-compassion and learning to forgive themselves for any mistakes they may have made when not in control of their actions.
- Meeting and getting inspired by peer leaders who have recovered and are willing to share their stories (see our survivor stories section)
- Talking to those who they trust, which helps alleviate the shame and guilt.