Rose, the author of Untangled: A Story of Resilience, Courage, and Triumph, says that once she started to tell family, friends, and people at speaking engagements about PTSD, she started to face stigma. “I’m pretty articulate, and I look okay, so those two things already set me up for a lot of stigma,” she says. People would often tell her, “You don’t look sick,” “When are you going to get over it?” or “Can’t you just forgive so you can get better?” “It feels like you’re coming from a place where you always have to explain,” Rose says. “At first it made me really sad, and it made me feel like, ‘Well, I’m faking it,’ and ‘What’s wrong with me?’ and ‘Why can’t I just get over it?’” The stigma also caused Rose to lose a lot of friends who couldn’t accept that she wasn’t the happy, smiling woman they had always known. “People just wanted me to be okay,” she says. Perhaps most shocking of all was when a doctor Rose saw for a checkup made a disparaging comment upon learning she had PTSD. As Rose recalls, “She looked at me square in the face and said, ‘You have PTSD? Why can’t you just get over that?’” Stigma around any issue typically surfaces as a result of public fear and a feeling of being out of control, says Arielle Schwartz, PhD, a clinical psychologist in Boulder, Colorado, and author of The Complex PTSD Workbook. They can face stigma from family members, friends, and their community, as well as in the workplace, and that stigma can take many different forms. There are four types of stigma: (2) Public Stigma The general public endorses stereotypes and discriminates against the person with a mental illness. Self-Stigma The person with a mental illness internalizes the beliefs of others. Label Avoidance If the person with a mental illness perceives social stigma, they will avoid being labeled by not seeking treatment. Structural Stigma This includes the social and institutional policies and practices that can affect healthcare coverage and legal matters, for example. People who suffer from self-stigma may have low self-esteem and believe they’re not capable of working, living independently, or being healthy. (4) When people with PTSD face stigma from people in relationships, they may start to believe that they’re weak, damaged, or not good enough, and as a result, they believe others don’t want to be around them. This effect can lead people with PTSD to draw inward, keeping their pain to themselves, Dr. Schwartz says. In fact, a study in Psychiatric Services found that people with serious mental illnesses who had a moderate to severe level of internalized stigma also suffered with a lower self-esteem, reduced confidence in their ability to recover, and additional psychiatric symptoms. (5) Stigma can prevent military service members from seeking treatment. A meta-analysis in the journal Epidemiologic Reviews found that two of the most common concerns military personnel had about seeking help were that their unit leadership might treat them differently and that they would be seen as weak. But stigma doesn’t prevent everyone from seeking help: Some studies in the meta-analysis found that military personnel with mental health problems still sought out treatment or reported being interested in doing so. (7)
What Organizations and the Government Are Doing to Help Reduce PTSD Stigma
“There is this sense that people are starting to realize that you can do something about it and it’s something that happened to you — it’s not something that you could have prevented or were born with,” says Obianuju Berry, MD, a psychiatry instructor at Columbia University Medical Center in New York City. Within the last 10 years, there have been attempts by the U.S. Department of Defense, U.S. Department of Veterans Affairs (VA), military, and American Psychological Association to help reduce the stigma associated with PTSD and all types of mental illness, and to encourage people to seek help. In 2012, the Department of Defense and the VA announced that they would invest $100 million into research to improve the diagnosis and treatment of PTSD and mild traumatic brain injury. There has also been a push by the military and some psychiatrists to change the name to post-traumatic stress injury, in an effort to reduce the stigma. Although social media can be a place where stigma can breed, it can also be a powerful tool to end the stigma, as can be seen through the #stopthestigma and #SilencetheShame movements. Some research suggests that people with PTSD who share their stories on social media may be practicing a form of self-care. (8) “There’s a lot of ways people are being encouraged to be real and be vulnerable,” Schwartz says.
How People With PTSD Can Overcome Barriers to Care
“PTSD is really a disorder of failed recovery, and the reason that it occurs is because of a lack of support,” Schwartz says. “With the understanding that with sufficient support most people are resilient, most people can work through the effects of post-traumatic stress, seeking support is not something to be shameful for. It’s something that all humans need.” Experts agree that increased awareness about PTSD is needed. But therapists who try to push a diagnosis or medication can sometimes be a barrier to getting the right treatment. “Sometimes it can be better found in peer-support-type organizations or peer-counseling organizations that have less of that medical model,” Schwartz says. Fortunately for Rose, the stigma she faced after her diagnosis did not prevent her from seeking treatment. In fact, her husband and two children educated themselves about PTSD and sought out their own help. “They always call this our new normal,” she says. Rose also found a way to channel her pain into something positive with her writing and public speaking. “I want to bring awareness to the forefront and help end the stigma of living with PTSD,” she says.
