Stigmas speak to the idea of difference and how difference shames us and those we know.
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Mental illness is nothing to be ashamed of, but stigma and bias shame us all.
Holding one's self responsible is a critical feature in stigma and in the generation of shame since violation of standards, rules, and goals are insufficient in its elicitation unless responsibility can be placed on the self. Stigma may differ from other elicitors of shame and guilt, in part because it is a social appearance factor. The degree to which the stigma is socially apparent is the degree to which one must negotiate the issue of blame, not only for one's self but between one's self and the other who is witness to the stigma. Stigmatization is a much more powerful elicitor of shame and guilt in that it requires a negotiation not only between one's self and one's attributions, but between one's self and the attributions of others.