Is stigma a useful idea?
Discussion about mental health always throws up the idea of stigma or the way that society judges people with mental health difficulties. But what is stigma and is it a useful thing to discuss anyway? Catherine Amey explores
Stigmatisation stems from the historical practice of branding members of society so that they carry a visible sign of disgrace, the mark of shame. Branding individuals in this way instantly conveyed their degraded status so that other members of society could act accordingly. Often this meant creating a distance so that the nonbranded individual could prevent his own social status from being tainted by association.
The mark of shame serves another function. It conveys information about the nature of that person’s disgrace, again informing ‘normal’ people how to behave. To save mental energy, it is easiest to assume that individuals carrying a specific label, such as mental illness, are all the same.
Stereotypes for people with mental health difficulties include that they are unreliable, difficult and weak and at the more severe end of the spectrum unpredictable and violent. If you accepted such a stereotype, you would want to avoid such individuals; you would discriminate. This means you would prevent people with mental health difficulties from joining your workplace, not rent accommodation to them and certainly not enter into a romantic relationship with a person who you knew had a diagnosed condition.
Therefore stigma seems to serve a dual function: it protects people from individuals who pose a potential threat while saving them the trouble of thinking too hard. But what are the downsides of stigmatising?
Them and us
One of the by-products of stigmatising mental health difficulty is the creation of a ‘them’ and ‘us’ scenario where the ‘them’ includes a quarter of the population. This means a quarter of the population may potentially self-stigmatise, that is internalise the negative beliefs that society holds against them. Not only can this cause a tremendous amount of unnecessary suffering to those with mental health difficulties but society as a whole misses out. If you truly believe you are worthless as a person, you are more likely withdraw from society. The talent and potential of up to a quarter of the population is therefore at risk by stigmatising.
Another result of stigma is the unnecessary fear it generates in the general population. Charities such as Mind have done a lot to erase the myth that people with mental health disorders are often violent; however, the unpredictability
element has not been tackled in the same way.
Even serious mental health difficulties, such as psychotic disorders, which can make people behave and talk in an unconventional way, are not especially rare. About 1% of the population will experience psychosis, perhaps the most stigmatised of all mental health conditions, at some point in their lives. If a person is experiencing an altered reality, simple compassion, rather than worrying about social convention, is key.
The Time to Change initiative has made excellent progress in challenging stigma and breaking the taboo around mental illness. Meanwhile, there has been more responsible media coverage, such as the reporting of Catherine Zeta Jones’ disclosure of bipolar disorder.
As part of my own experience of mental health difficulty, I have spent some time in a secure mental health hospital. When my friends came to visit me, they later confessed they were absolutely terrified. It wasn’t that they believed themselves to be in danger but the feeling that they didn’t know how to handle people who break social codes made them extremely uncomfortable. I introduced one of my good friends, who is particularly sociable, to a new friend I’d made in the facility who believed he channelled God. He introduced himself very politely but my very sociable friend went to pieces. What is the protocol for meeting people in communication with a deity? Debretts would have had nothing to say.
Catherine Amey’s book – Psychosis through My Eyes: A Personal and Professional Journey – is scheduled to be available as an ebook in September 2011 from Chipmunka Publishing – www.chipmunkapublishing.com
This article appears in the Autumn 2011 edition of One in Four magazine
Read more One in Four articles online
Interesting to see this addressed here – I wrote a guest post on the subject for NAMI Massachusetts earlier this year, and came to the conclusion that it’s probably better to talk about ‘discrimination’, as that is what we’re really talking about. Stigma has always suggested that there’s something inherent in the individual that marks them as different, and, to me, at least implies a degree of victim blaming.
My full blog post is here for those who are interested
I wonder about the validity of the numbers you state – 1% of the population will experience psychosis? As psychosis is a function of bipolar which, in itself, has an epidemiology estimated at 1.8% of population, it’s looking more prevalent even before adding in other conditions where psychosis is a part, or even the whole, of the condition.
As for stigma, you hit the nail on the head. Self stigmatisation by people with mental health is extremely destructive as people struggle to resolve who they are now over who they believe they used to be. Hard to get people to tackle the misnomer that they were significantly different ‘before’.
As for the concept of self worth being tied to stigma, I believe that stigma is only used as a tool to reinforce low self worth rather than to instigate it. To clarify the difference between this and the rest, self worth would already be low, stigma is then used to either scapegoat or reinforce (take your pick) what already existed in the thought process.
Very interesting post, I look forward to reading your book!!
I think the impact of a formal diagnosis can also be catasptrophic for some people. It reinforces the ‘difference’ and can marginalise people. Dealing with that label can be distressing in intself. I think we are all susceptible to developing mental health problems; given certain circumstances. It is very easy for people to ‘other’ or ‘label’ people so they dont have to deal with the reality that the person is a son/daughter/brother/sister/friend etc etc. I think alot of the discrimination is to do with a lack of undertsanding/exposure/education. What I find interesting/worrying is the amount of ‘professionals’ and people working within mental health who hold highly stigmatised and myopic views of people with mental health problems, that are deeply rooted in the days of the asylums and physchiatry.
anyone read Moncrieff or Bentall??
Pingback: Self-stigma: how I buy the negative hype | purplepersuasion
It’s great to see some examination of the idea that stigma is the one big mental health issue that has to be addressed at all costs. The campaign to address stigma assumes that all people with mental health conditions wish to disclose. People with mental health conditions interact with mainstream society in all kinds of ways and it is up to them if they wish to disclose. When access to mainstream is adopted as part of the care pathway it often leads to very fruitful outcomes. The anti-stigma campaign also assumes that mainstream society always stigmatises. It doesn’t.
John thanks your post. Can you identify when society stigmatises and when it does not? Thanks
Pingback: The JetBlue pilot’s breakdown is nothing to laugh about
very frustrating stigmatising article by Andrew Billen in Times today, ref. depiction of bipolar in TV Homeland series. He labels sufferers as ‘odd’ (headline), ‘mad’ (para 3), (‘crazy’ quote, para 5) and ‘nutty’ (last line) – I feel this really does harm – it hardens segregation and stigma, including self-stigma.
Mental illness is just one part of a person. That was the beauty of Homelands; it was not advertised as about bipolar…
Your article seems to speak of stigma as a social categorisation mechanism that is then used as a signal by members of the tribe, without making their own judgement. Is this what you meant?
I wonder if actually each person is making a judgement, but I am not sure on what basis – ignorance? fear that dealing with mentally ill people will be difficult and embarrassing as they may not follow normal social codes of behaviour? fear of physical violence? fear of contagion from contact? lack of sympathy (‘some should snap out of it’)? feeling that mental illness is untreatable so resources committed would be wasted?
I would be very interested in your view?