Mortification of the Self: The Impact of Stigma on Identity

Vladimir Musicki, PhD
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Characterizing people who struggle with mental problems as “psychiatric patients,” “mental patients” or “mentally unstable” can make them feel particularly unhappy. After they have been hospitalized for the first time they typically face drastically different social expectations. This new life may bring new social roles to the individual, where the self before the first psychiatric diagnosis and the self after the diagnosis differ greatly.

During the stay in the psychiatric institution, the patient would experience something that sociologist Erving Goffman called “the mortification of the self.”1 Goffman analyzed asylums as “total institutions,” whereby there is no clear line of division between work and free time. The purpose of institutionalized pressure in asylums is to constitute a new kind of identity which is “normalized” so that patients can go back to the “real world” from which they had previously been expelled. Further, the individual is stripped of social support and meaningful human relationships, so her previous identity is being erased during the time spent in a total institution: the mortification of the self is done via a series of humiliations and degradations by which the patient is disciplined.

“The mortification of the self” happens in parallel to the creation of a new identity—the identity of a psychiatric patient. The erasure of the civil self, which existed before the hospitalization, is supported by the administrative procedures, such as taking fingerprints, measuring and taking photographs. These procedures have a common goal to standardize the individual into an administrative unit, so that the unit can then be effectively controlled.

The new identity will be very restrictive in comparison to the identity before the hospitalization. During their stay, inmates of the closed psychiatric ward are constantly supervised and their behavior is watched all the time by the medical staff. Newly-admitted patients have to discover what kinds of behaviors are desirable and adaptive, and what kinds of behaviors are non-desirable and non-adaptive. When the process of hospitalization is over, the patient will hopefully realize that they need to control their behaviors with their own will and therefore internalize supervision of their thoughts, emotions and actions in some sort of panopticism (Foucault, 19952). Panopticon is a type of institutional building, typically a prison, where a single watchman can observe all the inmates’ cells: the prisoners are in their cells on the circumference, while the officer is in the center of the circle. This is also a very effective system of social control because the prisoners, knowing they are being watched all the time, eventually internalize supervision and gradually begin to surveil themselves, even when they are not watched by the officer.

Foucault’s idea that disciplinary power is transforming (in a very subtle way) observation into self-observation seems self-explanatory in the case of psychiatric patients. The psychiatric patient begins to realize the seriousness of his or her terrible “sin” and moral deviation during the time spent in the psychiatric institution. Psychiatric discourse gives a new outlook on one’s own identity too. Having a psychiatric diagnosis means that we now know that something is “wrong” with the person and we must undertake certain actions in order to make the person believe in that too. In other words, disciplinary power is always restrictive, prescriptive and normalizing—it must always stand in opposition to the object which is being normalized and then it must emphasize/strengthen the anomaly of the object, further justifying such normalization (Foucault, 20063). Once labeled as deviant, the person will be stigmatized by society. This stigmatization can create lots of problems and add weight to the already onerous burden of mental problems and unusual states of mind that the person experiences. It can also pave the way to internalizing public stigma.

Self-stigma is created when people who have been labeled as “mentally ill” internalize the experience of stigma, experiencing low self-esteem and low levels of self-efficacy.4 By internalizing stigma into self-stigma, one adopts the opinions and attitudes of his or her social surroundings, which negatively effects their self-esteem and quality of life.5 This process of internalization shows that people are very much affected by the views and attitudes of others. How we construe our identities is not separate from how others see us. Identity is created and constituted in the intersubjective space between people.6 7 Therefore, the problem lies exactly there—it seems that the society as a whole (or at least, modern societies) treats users of psychiatric services with a sense of reprimand/rebuke for the moral deviation which they represent.

My research showed that this harsh treatment might have a strong impact on psychiatric users and the ways in which they understand themselves (Musicki, 20188). After the user of psychiatric services comes out of the hospital, he or she comes to understand that social expectations have changed. The individual in question will be seen only as a “psychiatric patient” and nothing else. The person will be preemptively construed9 as a “mad person” or a “mental patient” so all their behavior will be interpreted in that manner—as the behavior of a madman. In some cases, the specific diagnosis of schizophrenia defines the person in their entirety. The person is “schizophrenic” and nothing else. Hence, everything that he or she does is seen as an act of a schizophrenic that should be taken with a cautious attitude and suspicion.

Before the first psychiatric diagnosis, psychiatric users saw themselves through many core roles based on which they built their sense of identity: for example, as a Good Father, Dancer, Loving Husband and Engineer. These core roles posed a good foundation for seeing themselves as functional individuals and members of society. But after the first psychiatric hospitalization, stigma began to be internalized into self-stigma, so the narrative of mental illness occupies master status in the lives of psychiatric patients.10 We might say that the self becomes monolithic and solidified, thus not having the possibility of being fluid and dynamic as before. Soon the user of psychiatric services reacts to stigmatization by becoming more distant and separate from the society, retracting themselves from friends and family. The isolation and loneliness they feel is exacerbated by guilt, remorse and hopelessness. In addition, psychiatric users spend a lot of time regretting and bemoaning because they cannot change the chain of past events which, in their opinion, had led to mental illness and psychiatric diagnosis.

In my research, psychiatric users often report that they experience a proliferation of psychotic symptoms, such as hallucinations, in response to isolation and internalizing stigma. In parallel to distancing themselves from psychiatric patients, other people will stigmatize psychiatric patients even more, which leads to self-imposed guilt and remorse, which then leads again to the internalization of stigma. This is how the vicious cycle continues, as it strengthens itself over the course of time: the more one internalizes stigma, the more she will distance herself from her social surroundings; the more she distances herself, the more she will experience proliferation of symptoms; and the more symptoms are visible and present, the more others will stigmatize and “force” the person into further isolation. One of the ways to break out of this vicious cycle is to observe one’s own behavior, recognizing which thoughts and emotions might be seen as pathological or identifying them as “symptoms.” In that way, normalization of the person to their social environment will soon lead to better social functioning, hence the person will adapt to their social surroundings, decrease social deviation and might even end isolation.

My research also showed the importance of civil society and volunteering organizations that provide venues where psychiatric patients can gather and socialize. By having a strong social support system and daily interactions with people who have similar problems, users of psychiatric services can find a way out of the self-stigmatizing cycle and new ways to recovery. This is also a way out of preemptive construing of themselves as “psychiatric patients” and nothing else. To have new friends who understand their suffering can allow them to understand themselves from a different perspective. Now the psychiatric user can connect to other users as human beings and experience the full spectrum of emotions that arise through interactions. Recovery is usually associated with the new identity of “the user of psychiatric services,” in which self-determination and agency are greatly emphasized. Instead of being just “psychiatric patients” or “mentally ill people,” the term “users of psychiatric services” implies an ability to make their own decisions and demand to be treated as human beings with dignity in relationship to psychiatrists and society in general.

The road to recovery can be rocky—and it usually is—but it is always somehow connected to the reduction of stigma. Recovery as a unique change of attitudes, values, emotions, goals, skills and roles11—not seen as simply going back to premorbid state—is much more than simply taking meds and trying to survive. It can be a path to personal growth where the experiences labeled as “mental illness” have a significant place in the unique life story of a person, and that place has a deeper meaning which should be explained and understood. It might also mean going to the psychiatrist’s office regularly and taking meds every day, trying not to think too much about the “symptoms” and finding joy in life in things like family. But recovery can also mean a new sense of purpose and new identity being formed in fighting against psychiatric power: social engagement, civil activism and so on. It can mean lots of things to different people. However, the common denominator behind all of these attempts is that people who start on the road to recovery have a higher sense of agency, self-determination and basic human dignity.

Let’s pause here for a moment. Human dignity should be something that we all share. What makes us human is our ability to recognize humanity in another person. We should not deprive other people of that basic sense of dignity; neither should we castigate them for the “sins” that they committed while they were having symptoms (a time they often describe as “a trance-like state” or “when my behavior was completely out of control”). Instead, we should try to understand them and help them. Just carefully listening to their stories is a good start. The most important thing to have in mind is not to lose patience, especially during potential setbacks. Human beings can overcome many hardships and psychological distress if they are together. All of us, professionals and users of psychiatric services, must direct our efforts towards creating a better system and a more just society that will serve people better. I hope that this will become a valuable goal for our generation.

Show 11 footnotes

  1. Goffman, E. (1961). Asylums: Essays on the social situations of mental patients and other inmates. Oxford, England: Doubleday (Anchor).
  2. Foucault, M. (1995). Discipline & punish: The birth of the prison. Vintage Books. New York, NY.
  3. Foucault, M. (2006). Psychiatric Power. New York, NY: Palgrave MacMillan.
  4. Corrigan, P. W., & Watson, A. C. (2002). The paradox of self–stigma and mental illness. Clinical Psychology: Science and Practice, 9(1), 35–53.
  5. Chavarria, M. J. A. (2012). Let’s try to change it: Psychiatric stigmatization, consumer/Survivor activism, and the Link and Phelan model (Unpublished doctoral dissertation). Dissertations and Theses. Paper 904. Retrieved from http://pdxscholar.library.pdx.edu/cgi/viewcontent.cgi?article=1903&context=open_access_etds
  6. Gergen, K. J. (2009a). An invitation to social construction. Thousand Oaks, CA: SAGE Publications Ltd.
  7. Gergen, K. J. (2009b). Relational being: Beyond self and community. Oxford: Oxford University Press.
  8. Musicki, V. (2018). Construction of mental disorder by the users of psychiatric services in Serbia (Original: Konstrukcija mentalnog poremećaja korisnika psihijatrijskih usluga u Srbiji) (Unpublished doctoral dissertation). Faculty of Philosophy, University of Belgrade. Retrieved from https://uvidok.rcub.bg.ac.rs/bitstream/handle/123456789/2322/Doktorat.pdf?sequence=1&isAllowed=y
  9. Kelly, G. (1991). The psychology of personal constructs. Volume 1. Theory and Personality. London: Routledge.
  10. Becker, H. (1963). Outsiders. New York: MacMillan.
  11. Anthony, W.A. (1993). Recovery from mental illness: The guiding vision of the mental health system in the 1990s. Psychosocial Rehabilitation Journal, 16(4), 11-23.
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Vladimir Musicki, PhD
Dr. Vladimir Mušicki is a psychologist and psychotherapist from Belgrade, Serbia. He works with people on a great variety of issues, focusing on anxiety, depression and past trauma experiences. His research interests include stigma and self-stigma of psychiatric users, the therapeutic alliance, and the narrativization of mental illness and psychiatric diagnosis by psychiatric users and their understanding of recovery.

35 COMMENTS

  1. “The danger hidden in a system of searching for identity externally is that after someone obtains a certain identity through others, they will manipulate him without him being aware…through the very identity they have given him. This is why they give him the very identity…” ~ Dimitri Halley

    “It is, of course, a false identity. They identify as a person with an allegedly broken brain, a person who will never recover, a person who has nothing much to look forward to, and they do this to the extent that even one’s birthday becomes a hopelessly tragic “mental illness” fest. This indulgence in the broken identity will garner much support and reinforcement from others who’ve also internalized the broken identity, and together a cohesive and self-perpetuating community organizes within the pits.”

    http://web.archive.org/web/20120607010903/http://bipolarbabbling.wordpress.com/

    I need to go save this URL on my archive thread so we don’t loose it but check it out, its a heavy hitter.

  2. Great article, thanks for words of truth from European country with such a stormy history.
    I suggest everyone who want to know the difference between nowadays dehumanisation and the proper phenomenological meaning of diagnosis, to read the first 70 pages of James Hillman’s Re -visioning psychology. There is no other book in which there is such a great logical explanation of what PSYCHOPATHOLOGY should means for us,- emphatic humans, not monsters, who are using DSM and power to destroy people. There is psychopathology, because we are psychological people.
    We must know the phenomenological truth of the psyche to understand its mechanism. The image, we do not have the proper image of psychopathology, because psychiatrists like Kraepelin and Bleuler have destroyed it.

    Thank you for important voice from Serbia! I hope that Hillman will help people in Serbia to understand their psychological life.

    https://www.youtube.com/watch?v=v8LY2VgiikE
    —–psyche ressurection.

  3. Thank you Vladimir,
    I liked a lot of this, but there are themes and parts I disagree with.

    First off, there is a problem with joining with other psychiatric patients in the format you describe, in order to see ourselves as something other than just psychiatric patients. We have such outlets where I live and though they are an improvement of institutions they do nothing to reduce distance from the wider community.

    Of course we need to join forces and organise, but its hard to see how this kind of ghettoization via daily interactions with each other mediated by volunteer or NGO organisations can solve the problem of seeing ourselves as ‘mental patients’.

    I have huge respect for people like Sera Davidow (sp?) and the kinds of organisations she describes here, but my own experience of survivors taking on the joint roles of activist and pseudo-therapists has been that it is far too close to ‘meet the new boss same as the old boss’. Some of those forging new identities via these organisations are doing so at the expense of their supposed peers by enacting much of the one-up one-down dynamics that it seems their bin-time taught them all too well. Experiencing abuse can teach abusive behaviours, it doesn’t necessarily teach wisdom and solidarity.

  4. Interesting read. I should say re-read. That’s for the ever-watching eyes. It took me five re-reads to get a handle. As evidenced by my browser history, which also evidences the frequency with which I went off-topic and continually examined information about frontal lobe injury. Additionally, this website has a plugin which evidences how long I stayed on the article each time, and where my mouse wandered.

    Actually, it didn’t as I have it blocked.

    I have just been passing messages via SMS. This is also on the record, kept for a year. And all these messages are continually scanned for keywords and phrases by AI systems.

    Just now I boiled a kettle. This created a known signature on the electricity system, recorded by the smart meter. So that my supplier and GCHQ are aware that (1) I’m at home, and (2) I’m probably having a cup of tea. And they’d be right, on both counts.

    I’ll stop exampling there, as it goes on, and it can frighten some people. But please stop suggesting that the Panopticon is theoretical and internalised.

    It is internalised, yes, by anyone with any amount of common sense.

    But it is not theoretical. It is a lived fact for everyone, particularly in the UK, the most sureveilled state in the so-called free world.

    Mental health patients in the UK are subjected to special provisions under UK surveillance law. This extends to new powers given to mental health teams nationwide who have new, and very close relationships with the secret services.

    This stuff used to be considered paranoia 101. But not any more. It is lived reality.

    • @rasselas.redux “Mental health patients in the UK are subjected to special provisions under UK surveillance law. This extends to new powers given to mental health teams nationwide who have new, and very close relationships with the secret services.”

      What?? This has totally passed me by. What “new powers” do MH teams have?

      • I’ll break this gently.

        Under RIPA (2000) and IPA (2016), Theresa May’s surveillance laws as Home Secretary and latterly Prime Minister, mental health teams have had the power to be informed about your internet history. This includes metadata such as sites visited, as well as other info such as Paypal* records, online banking records, social media data, pretty much any financial transactions conducted online. This also includes, email (by and large, depending on numerous factors). Now, having dug into this on and off for many years, it would seem that most of this information is provided, on request, by the appropriate regional police force who provide some kind of overview of the information which they can easily obtain, using a combination of national and bespoke local systems. But basically, the mental health services supply a list of names to the police who conduct the checks (and most likely hacks, if someone is using methods to circumvent surveillance) and supply a summary record. I haven’t so far been able to ascertain the level of detail of those summary records, but from what I can glean, they are interested in any personal information which broadens their forensic profiles. So expect a summary of buying habits, porn habits (if any), associations, sexuality, political interests, hobbies, searches, and so on.

        You have no right to access these records. You have no right to check their validity. Or decide who gets to see them.

        **********

        Be very careful about making a fuss about this. Never forget Dr Rita Pal. https://sites.google.com/site/ward87whistleblower/

        **********

        Has/is the use of RIPA and IPA powers by mental health teams proportionate and lawful?

        Since the murder of Jo Cox MP, by a mental health service user, the forensic profiling of mental health patients is now a routine matter and essentially the blanket reason given to justify the intrusive digital intelligence-gathering. Additionally, forensic psychology lists mental illness as a possible vulnerability factor in the radicalisation of a person, particularly the lone wolf type. Keep in mind that the most recent surveillance law gives the power to multiple agencies to either instigate or request a partner agency to deploy instrusive covert surveillance on a target individual. This can include microphone, cameras, and tracking devices, in any room/s in the home, and personal vehicles, for example. Although these days most people voluntarily append their person with a sophisticated intrusive surveillance device, namely their smartphone. And keep in mind that the internet is defined in RIPA as “a surveillance device”.

        IPA (2016) introduces a new crime for people involved in covert and overt surveillance. It is now a crime punishable by up to (I think) 7 years in prison to divulge to anyone that they have been, are being, or are going to be, subjected to overt or covert intrusive or non-intrusive surveillance. So if you raise this matter with your mental health service providers, expect to be met with incredulity.

        *(Paypal voluntarily share their data. They aren’t obliged to, as they are based outside UK jurisdiction)

  5. Once labeled as deviant, the person will be stigmatized by society…Self-stigma is created when people who have been labeled as “mentally ill” internalize the experience of stigma, experiencing low self-esteem and low levels of self-efficacy.

    A lot of words could be saved here, as this is the essence of the situation: Stigma is bigotry directed at those who have been subjected to psychiatric hate speech, i.e. “diagnosis.” Many people internalize this hate speech and start to hate themselves. Ergo: Eliminate psychiatric labeling and the problem of “stigma” has been solved.

    See how easy that was?

    • “So long as the statistics of normalizing developmental psychology determine the standards against which the extraordinary complexities of a life are judged, deviations become deviants” Hillman.

      I agree with you. But the problem lies not within the diagnosis but in the attitude towards it. We all have depression, but does not mean that anyone can control it using pseudo medical fetish. There are simply states of psyche that are far beyond happiness or control. And the problem is that people just want to get rid of them. There is a psychological need of depression, but you won’t hear that fact from authoritarian who will do everything to preserve economical status quo from the influence of sb “meaningless” suffering. So they get rid of those who are suffering claiming that they are ill, and they took away the proper meaning of the psyche. State does not take into account people in other psychological states than unity and hapinnes. Partly, this is because of Jung’s fixation over his own psychological unity. He has ruined the psychological minorities beyond unity fixation.

      People are robbed of the right to suffer, for which they have no control. And they can not change it. This is a tragedy. Apollonian unity – normal people – the MAJORITY- are beyond these so called ‘problems”, that is why I despise this easy arrogant higly antipsychological apollonian archetype. Hillman writes about apollonic psychopatic attitude towards the other states. Psychiatry without empathy is useless form of dehumanisation. Psyche needs respect not pity.
      Mental health movement does not need rights, psyche needs rights. Psychological man needs political defenders. People must start to respect their psyche before it will be too late, and goverment will be completely corrupted by pseudo medical moguls.

        • You can eliminate diagnosis, and still there is nothing behind word -depression, only medical BS.
          Sociology and politics won’t help you to describe what is depression.
          I wrote here many times that to describe depression we must use psychological language/ phenomenological. Not medical jargon which is false empiricism and hidden theology.. And that Kraepelin and Bleuler have destroyed the phenomenological attitude.
          How can anyone write something about depression without phenomenological attitude?
          What can you write about depression without psychological meaning of depression?

          That is why I write here that everone should read Hillman, because he , and only he was able to describe psychological reality. No one can do that, without his knowledge. And no one will do this without phenomenology of psyche.

          “Re- visioning psychology.” that book is a door, window to psychological reality.

          • Diagnosis without connections with phenomenology means nothing.The problem is that the cure is the illness.
            Depression is the cure for apollonian egoic psychopathy.
            We value mental health because it is easy. When you are healthy – you are in a huge room, you can do what you want. This is because apollo has got the least connections with death realms, IT IS NOT OUR ABILITIES THAT WE CAN CREATE AND FEEL HAPPY – IT BELONGS TO PSYCHOLOGICAL REALITY, AND WE ARE ROBBED FROM THAT TRUTH. And when you are in the state of psychosis, you are in small dark room , you can not move. Cause death won’t let you.

            Who pays more?
            I want apollonian authoritarians to kneel down before Hades reality and give a new value to psychopathology and things that lies beneath the empty term – mental illness. I give a value to diagnosis, to illness.
            And health, Jesus Christ, compared to Hades reality apollonians are empty material idiots. Economy and fetishes has got a meaning for apollonians. They means nothing in death reality.

            READ HILLMAN, STEVE. YOU ARE THE BOSS HERE, SO YOU MUST DEFEND PSYCHE. AND WITHOUT RE VISIONING PSYCHOLOGY YOU WON’T DO IT PROPERLY.

            We are talking about psychological reality, not material reality, so we must know something about that reality. And THAT REALITY was stolen by economy, by authoritarians economy. Economy is their only god.

          • Remember that Robert de Niro speech in Awakenings?
            All my life I feel like this – I am talking to walls. I do not want cure, money or nothing. I want RESPECT FOR THOSE IN DEATH REALITY. BECAUSE THEY PAID MORE THAN ENOUGH TO APOLLONIAN PSYCHOPATS..

            Because they are the most courageous people in the world of empty apollonians. They are the psychological minority and slaves of antipsychological barbarians

  6. Given that self-stigma translates into low self-esteem and low self-worth, then healing self-stigma would indicate shifting to positive and validating self-beliefs, despite outside messages, judgments, opinions, projections and prejudices. That’s an entirely different consciousness, and in turn, would create an entirely new reality for a person.

    I believe that is *the* journey to take, from self-condemnation to self-compassion and even self-love. When we feel good about ourselves, our feelings, words, thoughts, beliefs, and actions are quite different than from when we feel negatively about ourselves, producing different responses and results.

    We have the power to change only ourselves, not others. And, I believe, that is enough to bring significant change to the world. One person’s transformation affects everyone around that person.

      • I’d still distinguish between having predominantly positive self-beliefs vs. negative self-beliefs, and these do make a difference in how we create and experience our lives. These are also malleable and possible to shift, which to me is a transformational process. But personal prejudice is something only a person themselves can change, when they are ready to face their own self-judgments.

        And like I said, what actions anyone chooses to take or not take will depend on what they believe about themselves, what they are capable of, how supported they feel, how vulnerable one is willing to make themselves while challenging the status quo, how to navigate the anxieties of speaking one’s truth in opposition to “power,” etc. I think inspired actions comes from a commitment to one’s personal sense of truth above and beyond the prejudice which may surround them.

  7. as a stigmatized human being “in recovery,” I must say “Thank you!” for this article. I think…not to sound too, too bitter and angry, but…I think the psych establishment leverages stigma to keep people in line. As in…with insurance and “compliance,” one is “suffering from mental illness” or perhaps “seeking treatment for a substance abuse disorder.” Lower status, fewer $$$, non-compliance enter the scene…you’re a “pathetic weakling,” maybe even a “disgusting junkie.” I know this, because as a “trouble maker,” I’ve encountered it, first hand. I think my own experiences with the mental health system (granted, I’m in the US, so its a different, more punitive ball game) have led me to lean more towards a mix of Shulamith Firestone+Szasz or perhaps Kate Millet+Szasz+Jesus in debunking and exposing Mental Health, Inc., rather than shifting my gaze to dreams of a more humane, progressive, genuinely ‘helpful’ mental health industry.

    i do like your sociological references. here in the US, the psych people aren’t OK with sociologists unless they’re reaffirming the psych ideology+dogma. Many of the sociologists, for their part, seem to have real life -faith- in psychiatry and friends to save those damaged by “sick societies.” I find that…sickening, personally.

    • Hi YIS
      You’ve put your finger on something there.
      There is a difference between differentiating between the kinds of ways society damages people, and seeing psychiatry not as part of that sickness, but a good Samaritan, helping back up those who have been knocked down.

        • I seem to be failing to be clear lately.

          I meant that many sociologists in earlier times, (possibly more anti-authoritarian times), viewed the system, usually identified as the capitalist system, as damaging to pretty much everyone. There were sayings about those who were ‘adapted’ to such a sick society maybe being the craziest of all.

          It seems that more recently sociology has become much more pro-establishment. Rather than sick and damaging, the system seems to be seen as ‘tough’ by many modern sociologists – too tough for the “weak’ who ‘break’, These sorts seem to see psychiatry not as social control but as benevolent healers trying to help those who are not strong enough to cope.

          I hope this is clearer.