The Second Illness And How To Treat It


In 2005, Pinfold et. al. identified stigma as “the second illness”. We talk all the time about how to treat mental illness. But how do we treat the illness of stigma?

In order to treat stigma, it starts on the individual level. You must challenge your own perceived norms. Change on the individual, personal level is the only way to build acceptance and increase understanding of serious mental illness.

Eisenberg (2009) conducted a survey of 5,555 college students and concluded that an effective way to reduce stigma would be to address personally held beliefs as opposed to focusing on public stigma.

What is a perceived norm?

A "perceived norm" refers to what we think other people in our lives think we should or should not do. It can sometimes seem like a reflex response - a knee-jerk reaction. It can be powerfully influential in your life.

Perceived norm example:

You are in a crowded elevator and a disheveled man gets on. He is talking to himself. You automatically think "he's crazy" and "I should avoid him to protect myself". The other people in the elevator grow silent, tense, and pull away.

You associate mental illness with violence. That is a "perceived norm" that has less to do with reality and more with to do with social pressures and influence.

Facts to help you challenge this perceived norm:

  1. Phelan et. al. (2007) found that only a small subgroup of those with a serious mental illness (those not getting any treatment) tend to act violently; and yet, forty percent of US news articles connect mental illness and violence.

  2. Hiroeh et. al. (2001) conducted a population-based study, looking at data for 72,208 individuals listed in the Danish Psychiatric Case Register, and found that “People with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime”.

  3. In a review of the literature, Hiday (1999) found that “People with severe mental illnesses, schizophrenia, bipolar disorder or psychosis, are 2 ½ times more likely to be attacked, raped or mugged than the general population”.

Self-Evaluation: Where Am I On The Stigma Spectrum?

If you accept that stigma is an illness that you have, then bravo: that is the first step. Let's look at what comes next.

Treatment plan: self-evaluation, This is when you take a hard look at your own attitudes and beliefs.

Side effect: increased sense of personal agency due to increasing your sense of personal control.

Outcome: your belief that you do actually have the power to treat stigma in your own life.

According to Phelan & Basow (2007) the four core components of mental health stigma are:

1. Socially selected human difference is distinguished and labeled.

2. Association made between the socially assigned label and a stereotype (often negative).

3. The above two components lead to the separation of in-groups and out-groups (“us” and “them”).

4. Lastly, status loss, rejection and exclusion occur. This occurs when a group perpetuates the first three components with more power than the stigmatized group.

So where do you fall on the spectrum today?

Stage 1: I look at people and notice and label differences.

Stage 2: I make associations between that label and negative social stereotypes.

Stage 3: The first two phases have led me to identify as part of the in-group, helping to create an out-group and setting up an "us" and "them" dynamic.

Stage 4: the terminal phase. I am in the in-group and have been complicit in the status loss, rejection, and exclusion of a group or person with less power than me.

Pinfold (2005) et. al. found that stigma leads to dis-empowerment, diminished credibility, and avoidance by others - which in turn all lower one's self-esteem and increases emotional distress.

Ask yourself: In what ways am I complicit in the dis-empowerment of others? And in what ways have I dis-empowered and diminished myself with self-stigma?

Dinos et. al. (2004) found through qualitative interviews with forty-six individuals that feeling stigmatized can happen with or without overt discrimination and that long-term stigma challenges one's individual sense of humanity, causing social strife and isolation.

Increase Familiarity And Watch The “Them” And “Us” Divide Fall

When it comes to your mental wellness, there are no “us” or “them” groups. This is an area of life that is important to all of us.

“Mental health is more than the absence of illness” (Kobau).

Humans have a range of thoughts and emotions, positive and negative, and therefore mental health is important to everyone and includes much more than the negative connotations, such as illness.

In a study that surveyed 208 community college students on connections between familiarity, perception of dangerousness, fear, and social distance, Corrigan et. al. (2001) found that direct contact with a stigmatized group shifted the “them” and “us” divide. When the “in-group” and “out-group” distinctions between two groups falls, the negative impact of stigma begin to fall away as well.

If we increase our familiarity with mental illness, then social distance from those with a mental illness is lessened. Next time you feel yourself pulling away, do any of these things instead: pull up a seat, make eye contact, or strike up a conversation. Resist the urge to divide, to dis-empower, to lessen someones sense of their own humanity.

Kobau et. al. (2011) wrote that “Mental health promotion and positive psychology offer the public… additional ways to describe and value the full spectrum of mental health to lessen the stigma associated with mental illness and to initiate conversations about mental health…”.

#stigma #selfstigma

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Disclaimer: As therapeutic consultants, we advise, advocate, recommend, facilitate and empower, but we do not treat mental illness or addiction. We are not licensed mental health professionals, but will often refer you to professionals and programs for treatment. (Note: We have no financial relationship with any of these professionals or programs.)  Any consultation we give is for educational, informational and motivational purposes only and is not meant to replace professional psychiatric, psychological, programmatic, legal or financial advice you may need for yourself or your family member. 

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