Stigma internalized
Trigger warning: this article discusses symptoms of mental illness & internalised stigma.
I sat on the couch and read aloud some notes I had prepared in the week before my appointment. Every now and then the woman would interrupt to ask one clarifying question or another. When I arrived at her office I was on the edge of a panic attack. I could not breath, my fingertips were on fire and my heart was racing. She was kind with her questions and thankfully my mind stayed with me.
I have struggled with my mental health for more than 14 years. In my life I have gone many rounds with bleak depressions. I’ve been house bound by anxiety. Other times my impulsiveness has ruled me. But, the woman I was talking with was less interested in these experiences than I expected.
She wanted to hear about how right now. How my nerves felt like they were on fire, and my muscles wouldn’t release. How I felt like I was wound up so tight that I could ‘jump out of my skin’. I couldn’t sleep or sit still, but getting out of bed to face the day felt like torture. She wanted to hear about how I couldn’t think straight. How overwhelming everything felt. How my mind was unraveling into insanity. She wanted to hear about the plan, that was on loop in my head, to end it all.
She wanted to hear about the other times I hardly slept because ‘I felt driven’ by something urgent. She wanted to hear about this metaphorical train, that sometimes pulls into the station inside my brain. Getting on the train always feels good. Great even — you are going someplace fun, seeing lots of people, and achieving lots of things. The problem is, this train doesn’t ever slow down. It only speeds up.
Sometimes that train goes so fast you're not even sure what your own thoughts are anymore. Distinct thoughts collide and mash up to form a weird hybrid, mutant thoughts. But the moment you have that thought, you can’t remember it. Your thoughts are moving too fast. All that fun you were having, suddenly isn’t fun anymore. It’s scary and it's overwhelming. It becomes a bit like the boat scene from Charlie & the Chocolate Factory. Except this hellish ride doesn’t end chocolate, and you can’t just choose to stop.
Worst of all, she wanted to hear about the extremely painful consequences of getting on that speeding train. After I told her what seemed like my life story, the woman, the psychiatrist, said ‘Type 1 Bipolar Disorder’.
At the time of my diagnosis everything I knew about Bipolar (or Manic Depressive Illness) was from the media. I didn’t ‘know’ much, but TV had taught me that if you have Bipolar, you are crazy. Like, legit crazy. My understanding of my diagnosis was rooted in stigma. My own internalized stigma, was going to be the first barrier I needed to overcome on the road to wellness.
In modern society, when we stigmatize others we indicate social disgrace, or lesser value. None of us want to fall victims of stigma, and thankfully more and more us agree that stigmatizing others is also not acceptable.
But here’s the interesting thing about stigma. Even when you think you have an open mind, free of stigmatizing and discriminatory biases, you don’t. Our brains are much better at hiding those biases than we realize.
I have been though many depressive episodes, yet when faced with my diagnosis I found I still held my own stigmatizing views. I learn’t that it was possible to label myself. I labeled myself with disgrace, rather than compassion.
Years of well meaning yet ignorant comments, has seen us internalize very negative messaging. Our friends, our families and our idols on TV all play a part in constructing this narrative. “Stop being a psycho” , “harden up” and “why can’t you just snap out of it”. The mentally ill are labeled as dangerous, incompetent and weak. Worst of all we are to blame for our illnesses.
Those of us struggling with mental illness expect to deal with societal stigma. What we don’t expect, is we can fall victim to the classification algorithm inside our brain. We label ourselves the same way society does. We fall silently to our own insidious stigmas.
After my diagnosis I felt the little self-esteem I had left disappear. This was a direct result of these internalized stereotypes. Thanks to this internalized stigma I managed to label myself as a ‘weak fuck up of a human being’. It happened almost the instant I heard the diagnosis. In the weeks following, more complex internal dialogs unfolded. It all centered around my internal struggle to balance my own stigmas which now contradicted the view I held of myself
After years of working against the tide of mental illness stigma, I still harbor my own toward myself. And it turns out, I’m not the only one either. There is a whole field of research which examines the effects of self stigma on the recovery and management of mental illness. Those of us who grew up around mental illness stigma are much less likely to reach out for help when ill. If we do reach out we suffer a large loss in our own self esteem for admitting that we belong to a stigmatized group — to admitting that we are less. Self stigma prevents us from getting well again. Self stigma may cause us to withdraw from the people we love, further give up on our goals, and even stop treatment altogether.
Bipolar disorder is a medical illness for which there is no cure. There are medications you can take that help manage the illness. Like many incurable illness, the path to wellness requires both commitment and acceptance. As I examined my own self talk after my diagnosis, I could see that much of it was rooted in stigma. I could also see, that this was going to be my first hurdle to overcome. How this is achieved is going to be different for each individual. For me, writing about my own biases forced me to confront my self stigma.
I have Bipolar Disorder. I’m not crazy, weak or a failure. I am not defined by my condition. I am still that same bubbly, clever, empathetic and driven woman I was. I can still do my job as well as I have done in the past. I still make a lot terribly lame jokes, and I still love my friends and family just the same. I haven’t changed.
That’s not to say nothing has changed though. For the rest of my life I will pay close attention to my routines — when I sleep, how much I exercise and what I eat. I’ve decided to try medication. Right now that is the best decision for me. I’ve felt drastic and indescribable relief too. For the rest of my life the medication conversation will be on going. Contrary to what my own self stigma would have me believe — I haven’t changed, aspects of my life have.
Bipolar describes a spectrum of neuro-divergent types. Each person on the spectrum will experience the illness differently. People with Bipolar have episodes (1 week or more) of either depressed, or elevated mood and energy. Elevated mood is called mania or hypomania. Mania is the defining characteristic of Bipolar. Episodes don’t always run back to back, though depression often follows mania. There can be (though not always) long periods of normal mood between. As a personal example, of the last 6 years, almost 4 of them have been symptom free.
After 14 years, I’m just at the beginning of my journey, I’m clearing out the closet so to speak. By facing my own stigma I’m making room to properly address my mental health. Mental illness stigma is so insidious that our own biases go unnoticed. Those biases then slowly devalue our friends, our families, and finally ourselves.
If you suffer from a mental illness, pay close attention to those hidden thoughts lurking in the back of your mind. The ones that make you subconsciously believe that you are less. Don’t let self stigma devalue your past experiences and achievements. Don’t let it cloud your present moments. And most of all, don’t let it be a road block on the road to wellness and recovery.
