Self-Stigma Narratives Among Adolescents Taking Psychiatric Medication

Introduction: The extant literature describes stigma in two forms, public stigma and self-stigma. Although both types have negative impacts on people with mental illness, they produce different effects. Self-stigma corresponds to the internalized effects and can reduce self-esteem and willingness to engage in life opportunities. Few adult stigma models represent self-stigma and no models exist that examine mental illness self-stigma among adolescents. When experiencing self-stigma, the adult literature contends the person with the mental illness accepts notions of stigmatizing images (stereotype), diminishes his/her self-esteem by agreeing with the stereotypes (prejudice) and reduces one's confidence in future opportunities by withdrawing (self-discriminating) (Corrigan, 1998). Adolescent experience may be unique because of developmental issues, especially as they are in the midst of transitioning to adulthood. Hinshaw (2005) states "there is an absence of research on the impact of stigma on children and adolescents who have experienced it themselves” (p. 723). This study investigated self-stigma among adolescents and developed a model for its representation. Methods: The qualitative study consisted of twenty-seven adolescents between the ages of 12-17 who took psychiatric medication for a mental illness diagnosis. The qualitative instrument employed in this study was the TeenSEMI, adapted from the AdultSEMI, which was designed to obtain narrative data about medication treatment from those diagnosed with schizophrenia (Jenkins, 1997). The TeenSEMI was produced by modifying questions for adults and developing age-relevant questions (e.g., questions that pertained to school, peer, and family interactions). The study applied a structural analysis (Riessman, 2008) to their narratives and identified the sequence of plot components that illustrated the self-stigma process for adolescents. Results: The findings revealed a self-stigma model composed of three narrative components: stereotype, differentiate, and protect. One ponders over the meaning of a stereotype and how it applies to them; differentiates sense of self and autonomy because of illness; protects vulnerable sense of self and reputation by censoring their need for psychiatric medication when engaging in social interaction. These adolescents were protecting themselves and their source of social capital, as exclusion from peers could limit rightful social and educational opportunities in the future. Discussion: This exploratory study portrayed a somewhat different, yet similar process of self-stigma among adolescents when compared with adults. This model featured characteristics unique to adolescent development. In particular, the adolescent self-stigma process incorporated developmental issues of autonomy (Brockman, 2003), peer perceptions (Karp, 2006) and integration of various aspects of identity (Erikson, 1968). These developmental tasks contributed to the variation in the model amongst adolescents as youth were consumed with a developing self-image. Clearly, the components are influenced by developmental issues appropriate to the stigmatized individual. Although this study provides exploratory data about youth and self-stigma, future work is needed. There is concern over the long term trajectory of youth who self-stigmatize because the process has implications for their future opportunities, particularly with respect to self-esteem and self-efficacy. A quantitative research design that correlates findings to developmental differences and follows respondents longitudinal would be the appropriate design for validating the proposed model.