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Demystifying Stigma: What is it and how to curb it?

Demystifying Stigma: What is it and how to curb it?

Demystifying Stigma: What is it and how to curb it?

Stitzein is a term that goes back to the ancient Greeks; it was a mark placed on slaves to “identify their position” in society and indicate their reduced value. (Arboleda-Florez, 2002)

This term was extrapolated to what is now the social construct of ‘Stigma’.

Goffman (1963) in his book: Stigma: Notes on The Management of Spoiled Identity, explains that our routine or habituated social interactions allow us to deal with “anticipated others” without much differentiation to them if they fit in the “social identity” that is manifested in our minds and demanded by us from them; however, a stranger whose attributes are “undesirable” to us is “reduced in our minds from a whole person to a tainted, discounted one”.

Although Stigma can be found across a host of social situations, in the case of Psychiatric Disorders, Arboleda-Florez (2002) explains that Mental Illness is associated with shame and weakness of character and causes the person who is suffering and their family to be apprehensive and thus, hide the person’s symptoms or hide the person themselves to avoid exclusion from society.

According to Corrigan (2004) Stigmas are a result of four Social-Cognitive processes, i.e., cues, stereotypes, prejudice, and discrimination. To elaborate, he explains that cues about mental illness are taken from psychiatric symptoms, deficits in social skills, certain physical appearances, and labels.

For example, a person suffering from psychosis might manifest bizarre behavior that elicits stigmatizing reactions, and the general public might use that behavior as a marker for all mentally ill patients, thus, leading to stereotypes. Stereotypes about people with mental disorders range from violence, incompetence, and character judgment which is usually negative, for example, viewing them as weak. Such stereotypes lead to the cognitive-affective process of Prejudice where the person evaluates and might deem people with mental illness as “scary and unsafe”, even for disorders such as Depression if labeled. Finally, the emotional response of Prejudice leads to the behavioral aspect of stigma, i.e., discrimination. Discrimination may be manifested in exclusion from the workforce, and in societal engagements in general.

He also made a distinction between ‘Public-Stigma’, which is endorsed by the unaware Public with lack of information and in the forms of examples cited above, and ‘Self-Stigma’ wherein the afflicted individuals with mental disorder stigmatize themselves, i.e., internalize the notions stemming from prejudice and stereotype on themselves, and may harm the self-esteem of the individual as they may associate themselves with the labels associated with mental illness, thus, also prompting them to not seek help.

How Does Stigma Come About?

Ahmedani (2011), gives us an insight into the six dimensions of Stigma, namely Concealability, Course, Disruptiveness, Aesthetics, Origins, and Perils given by Jones et al. in 1984 and also merges it with dimensions of Stability, Controllability, and Pity given by Corrigen et al. (2000)

He explains that Perils are how dangerous society perceives a person with a Mental Disorder. Another dimension, Aesthetics, relates with factors of what society perceives as expected behaviors, and behaviors that are not pleasing are met with discomfort and avoidance. For example, a person living with schizophrenia might experience catatonia, and another person might become uncomfortable in their presence due to a mismatch in the social skills that the latter has as their schema. Thus, the displeasure experienced by one’s psychiatric symptoms becomes a cause of stigma.

Stigma is also related to origins of a disorder which answers the question about “How did the illness come about?”. If the origin is stemming from a biological origin, or origins that are more acceptable in a certain culture, the person living with the disorder is met more with the dimension of Pity, as opposed to a person whose origin might be psycho-social in nature, and thus, is seen as the one who is unable to “control” their illness merely by effort. Thus, the dimension of controllability puts the onus on the person, further labeling them as weak and stigmatizing.

The dimensions of Course and Stability are overlapping in the sense that they seek to answer if the individual’s illness is reversible or irreversible, and if the person will ever be stable enough to hold down a job or have “success” in society.

Disruptiveness is linked to course and stability and tries to evaluate if the person is able to have successful interpersonal relationships with others in society.

Finally, Concealability is related to the visibility of the mental illness. For example, a disorder like Depression may go unnoticed, but symptoms of schizophrenia that are highly pronounced may lead to more visibility and thus, more stigmatization.

What does Stigma do?

Stigma adds to the problems of the person with a mental disorder. There are a host of domains affected including but not limited to self-esteem and self-efficacy, employment and housing, interpersonal relationships, and treatment-seeking. (Sickel et al., 2014)

- Self Esteem and Efficacy

Corrigan’s ‘Self-Stigma’ plays a role in determining the self-esteem and efficacy in individuals with Mental Illness. The individual tends to label themselves and even justify the isolation they face. This may in turn affect the individual’s own capacity to deal with situations even when they have the resources to.

-Housing & Employment

Many individuals with mental illness are not able to function due to internalized stigma at the workplace or may find themselves not seeking jobs because of the stigma. Many times, individuals are discriminated against because of having a psychiatric illness and are often excluded out of the employment realm. This in turn affects the finances and insurance capabilities of the person and also implies that housing is a major obstacle they are not able to achieve on their own.

- interpersonal relationships

Mental Health Stigma affects close interpersonal relationships of individuals with mental illness and thus, lack the social support needed for recovery. The stigma is also found in mental health workers and may such relationships may be a reason of concern for the person to seek help for psychological conditions.

- Lack of Autonomy

Many times patients with severe mental illness are pronounced unsound to make decisions on their own, suggesting that for many important decisions of their life, they rely on the person who has control over making their decisions. This may cause distress to individuals with mental illness especially if they want to make a decision and they don’t trust the other person or the in certain situations the other person takes advantage of their power.

How Should Stigma Be Reduced?

Stigma reduction has been associated with three strategies: Education, Contact, and Protest (Corrigan & Watson, 2002)

- Protest

Protest is raising a voice against the inaccurate representation of mental illness and a way to challenge the stigmas associated with it perpetuated by media and the general public.

© 2020 Bhavya Malhotra

Although protests are a way to withdraw misrepresentation, they don’t always offer a psychological change within the mind of people. Therefore, protest is a form of reactive strategy and might not be a long-term solution, although, it is still a solution.

- Education

Education is a more reform-oriented approach as opposed to protesting and offers the public the facts of the matter and helps the public make more informed decisions, suggesting, that education will help to not perpetuate stereotypes. Education of the same can be complemented with school and university curriculums or even through Education Programs in the form of workshops.

- Contact

When a person who is not mentally ill meets a person with mental illness who is employed, and lives within the community discounts stigma as it challenges their notions and schemas of what a mentally ill person should be or look like, and therefore, make society a more just and safe place for individuals living with mental illness.

In conclusion, reducing stigmas can ensure a better quality of life for people struggling with mental illness as they can find support from people and not be excluded from society.

References:

  1. Arboleda-Flórez J. (2002). What causes stigma?. World psychiatry : official journal of the World Psychiatric Association (WPA), 1(1), 25–26.

  2. Goffman, E. (1963). Stigma And Social Identity. In Stigma: Notes on the management of spoiled identity (p. 3). Penguin.

  3. Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist, 59(7), 614-625. doi:10.1037/0003-066x.59.7.614

  4. Ahmedani B. K. (2011). Mental Health Stigma: Society, Individuals, and the Profession. Journal of social work values and ethics, 8(2), 41–416.

  5. Sickel, A. E., Seacat, J. D., & Nabors, N. A. (2014). Mental health stigma update: A review of consequences. Advances in Mental Health, 12(3), 202-215. https://doi.org/ 10.1080/18374905.2014.11081898

  6. Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness. World psychiatry : official journal of the World Psychiatric Association (WPA), 1(1), 16–20.

© 2020 Bhavya Malhotra