I’d wonder such things as whether the environment – a small ward, barred up windows, very little stimulatory activities, zero fresh air – was appropriate for good mental health. I’d often consider the more obviously ill men in my ward and wonder too if some of their problems weren’t brought about by over-prescribed medication.
Days ebbed and flowed around the dispensation of medicine. There was a brief window of time every evening when certain patients’ eyes sharpened and their tongues seemed to deflate. This window was quickly shut by a trip to the medicine dispensary. A tell-tale amphibious film went up over their eyes again shortly before bedtime. Of course, many of these people needed drugs for their respective illnesses, but one or two incidents made me wonder, such as the night an elderly man got caught short on his way to the ward toilet. He ended up sitting on the floor in his own excrement, sobbing in a tiny voice with a look of vulnerability so unusual to his typically taciturn countenance that I could only look at him for a brief moment. The first nurse to tend to him offered him something to calm him down. I couldn’t help but wonder if kindly and carefully deployed words alone might have been just as effective. I found out the next day that it wasn’t the first time this happened to him; it was a unfortunate side-effect of his medicine, treated by more medicine.
Stigma is a burden on many people with mental illness. […]
Stigmatized individuals face public discrimination, and are targets of negative stereotypes; moreover, they often agree with these stereotypes and apply them to themselves, resulting in low self-esteem.
This process is referred to as self-stigma […].
Self-stigma comprises both a negative attitude toward mental illness and low self-esteem, such that a person who explicitly self-stigmatizes might say “People with mental illness are bad and therefore I am bad, too.” Self-stigma is typically associated with noteworthy negative outcomes such a low quality of life. (Rüsch et al., 2010)
Rüsch et al., ’Implicit Self-Stigma in People With Mental Illness’ (2010), examined the hypothesis that implicit self-stigma predicts low quality of life. They found that:
[…] implicit self-stigma can be measured in people with mental illness as the product of a negative implicit attitude toward mental illness and low implicit self-esteem. Implicit self-stigma predicted poor quality of life independently of explicit self-stigma, even after controlling for depressive symptoms. Because including diagnoses and demographic variables as predictors did not change our results, the findings seem to apply to people with mental illness in general, independent of their individual diagnosis and demographic characteristics. (p.152)