By Elizabeth Stewart

Elizabeth Stewart is Family Drug Support Aotearoa New Zealand’s guest contributor. She is a health professional with an interest in personality psychology.

Some things we choose to share with our family/whanau, friends, and acquaintances. Such things may include: our successes, family members’ successes, holiday plans and even just small everyday matters. Some things we cannot easily share because there may be a stigma1 attached to them.

A stigma is a sort of secret which causes us shame and makes us want to conceal or hide it. If the stigma is one that can be hidden it may become a “concealed stigma.” So maybe you have a concealed stigma—so far so good—why not just keep such secrets to yourself?

Humans are extremely social, and our extra brain-to-body ratio compared with other animals is theorised to purely cater for social concerns! We can understand how others feel by listening to what they say, but we can also interpret the distress of others just by observing tiny fleeting facial expressions. It takes a lot of effort for humans to conceal secrets. Attempts to conceal stigmatised secrets may confuse and worry those around us, because while our mouth may be saying one thing our expressions may be telling an entirely different story. 

When we conceal a stigma, we must think about everything we say, and remember who knows the “secret” and who doesn’t. We may worry what will happen if someone finds out the secret anyway. It is very easy to underestimate just how many hundreds of thousands of everyday New Zealanders conceal the same stigma and distress. Researchers Wamamili, Stewart, and Wallace-Bell2 found evidence that family and friends in New Zealand society were widely impacted by the alcohol and other drug use by those they cared about.

What exactly is the Problem? 

Research by John E. Pachankis3 revealed the downsides of concealing any type of stigma. Many different stigmas were investigated. Pachankis explained how one’s thinking may be altered by bearing the burden of concealing a stigma. People may start to notice things relating to the stigma everywhere; in the newspaper, on the television, seemingly everywhere they look. Concerns about being “discovered” may be constantly on the person’s mind. The person affected may become preoccupied, hypervigilant, and even suspicious when the innocent mention of things which may be related to the stigma, or its concealment are discussed. That in turn may result in shame, anxiety, depression, and even hostility being felt.

Unfortunately, life being what it is, some people find it easier to isolate themselves by avoiding socialising, which negatively impacts relationships and friendships, and whanau/family functioning. When people are not able to discuss their concealed stigma, the stigma can even cause people to downgrade the way they value themselves, and can make them see themselves differently, even viewing themselves as a “lower quality person” despite this not being true. This unfortunate and entirely inaccurate self-assessment is reported to be a side-effect of concealing virtually any stigma you care to name, including having a whanau/family member with challenging alcohol or other drug use.

Is there a Solution?

In normal circumstances these feelings may be relieved by talking with others who may help us “put things in perspective” and tell us the truth: that alcohol and other drug issues are widespread and extend to all areas of New Zealand society, and that, in many cases they also have a brother/daughter/father/uncle, or otherwise, with challenging alcohol or other drug use. When someone else is told they are often glad you mentioned it, because keeping their own stigma concealed is affecting so many areas of their life too. A “concealed stigma” is by nature concealed; therefore, finding others with the same concealed stigma can be difficult.

Scientific research by the personality and social psychologists Deborrah E. S. Frable, Linda Platt, and Steve Hoey4 showed that when people with an unconcealed (not hidden) stigma were compared with those concealing a stigma, those with an unconcealed stigma experienced much higher self-esteem, self-regard, social confidence, self-ratings of physical appearance and physical abilities, and even slightly higher confidence in their academic abilities than those concealing a stigma. People that had an unconcealed stigma had lower levels of anxiety, depression, and hostility, than those with a concealed stigma. These scientists advised that the way to lift “self-esteem and mood” and reduce “negative cultural messages” related to a concealed stigma, is to associate with people sharing the same stigma. 

Support is available in several ways, including attending a support group and receiving therapy from professionals that understand alcohol and other drugs. 

The advantages of attending a support group were found to be many. When associating with those sharing the same concealed stigma as oneself, self-esteem was significantly higher, anxiety was significantly lower, and depression was also significantly lower among members of groups sharing concealed stigmas. It was suggested that support group benefits arise because one stops feeling so alone with the hidden stigma, and ceases feeling like the “only one”. When attending a support group, just by seeing and talking to other “normal” people who are experiencing the same issues, we receive “feedback” that may be very helpful for all areas of functioning. By meeting others facing similar challenges, we are reassured that we are OK too. Feelings of isolation may be relieved, and there is likely to be a decrease in social avoidance5, depression, shame, and anxiety, and even the frequency of intrusive thoughts regarding the concealed stigma. One of the most important improvements is likely to be the interruption of the cycle of: worry→upset→social isolation→feeling negative about oneself→increased worry.

Support from non-judgemental professionals who can provide evidence-based therapy on a one-to-one basis can also be very useful. Research shows that with appropriate therapy (e.g., the 5-Step method programme used by FDS practitioners) the experienced burden among family members can be reduced, while coping and resilience can be increased6.  

Coming out about a concealed stigma to carefully selected people is predicted to bring great relief, enabling one to build coping7 and resilience8. A support group is a great place to meet with others in a safe, confidential situation. You may need to take some tissues: it can be a huge relief to finally feel ‘normal’ again and to share your feelings with others who understand the challenges you are facing. Sharing what you have learned during your own journey is likely to benefit others on their journey. Telling one’s story, and hearing the stories of others, can be very helpful. You may then reflect on the experiences of others, to help inform your own decisions. 

Elizabeth Stewart is Family Drug Support Aotearoa New Zealand’s guest contributor. She is a health professional with an interest in personality psychology.

The FDS Family/Whānau Zoom Support Group, located under Courses and Events on this website could be a great starting place to find social support with others sharing a similar journey.

The 5-Step Method Programme provides one-to-one therapy and is located under Courses and Events on this website. This could be a great starting place to build coping and resilience as outlined in the article above. Register online.

___________________________________________________________________

1. stigmas: a mark of shame, disgrace, or embarrassment associated with a person
2. Wamamili, B., Stewart, P., & Wallace-Bell, M. (2021). Factors associated with having family/whānau or close friends who used alcohol or other drugs in harmful ways among university students in New Zealand. International Journal of Environmental Research and Public Health, 19(1), 243-252.
3. Pachankis, J. E. (2007). The psychological implications of concealing a stigma: A cognitive-affective-behavioral model. Psychological Bulletin, 133(2), 328–345. doi:10.1037/0033-2909.133.2.328
4. Frable, D. E. S., Platt, L., & Hoey, S. (1998). Concealable stigmas and positive self-perceptions: Feeling better around similar others. Journal of Personality and Social Psychology, 74(4), 909−922.
5. social avoidance: may include not seeing your friends, avoiding socialising, isolating yourself somewhat
6. Copello, A., Templeton, L., Orford, J., & Velleman, R. (2010). The 5-step method: Evidence of gains for affected family members. Drugs: Education, Prevention & Policy, 17(s1), 100-112. https://doi.org/10.3109/09687637.2010.514234
7. coping: managing stressful circumstances successfully
8. resilience: the capacity to recover from difficulties and possessing a certain ‘toughness’ and optimism