What should we know about stigma?
What is stigma?
The term "stigma" comes from Greek and means to pierce, to make a hole; and according to the Royal Spanish Academy, it is defined as "disgrace, affront, bad reputation." If we apply these definitions to a sociological level, the process of stigmatization is the set of false attitudes and beliefs (stereotypes and prejudices) that discredit or reject (discrimination) a person or social group for being considered different, devaluing them and with significant consequences on how they perceive themselves (self-stigma).
In the health and social field, the stigmatization process has been used to negatively label a sociocultural, functional, physical or mental condition, trait or behavior, as well as race, ethnicity, age, sex, sexual identity, nationality, belief or religion.
According to Patrick Corrigan, director of the National Consortium for Stigma and Empowerment, the stigma toward people with mental health problems “is in the same category as racism, sexism, ageism…So the kind of prejudice, discrimination, that we know people of color experience is an injustice that also applies to people with mental disorders.” (Corrigan, 2004)
Stigma poses a barrier to social interaction and to accessing the basic conditions to exercise one's rights as a citizen.
This gives rise to societal backlash against people with mental health problems , fueled by false beliefs such as that they are "dangerous, incompetent, responsible for their disorder, and unpredictable." And the individual internalizes or self-stigmatizes these concepts: "I am dangerous, incompetent, and responsible."
In addition to having direct effects on people's dignity and self-esteem, stigma poses a barrier to social interaction and to accessing the basic conditions to exercise full rights as citizens to health and social care services.
What is social stigma?
If we look at the common use of the term "stigma," it seems to be a single, simple phenomenon. However, when addressing and analyzing the problem, we must consider the variety of socially related terminology used when referring to stigma, such as "discrimination," "prejudice," "negative social attitudes," "labeling," or "rejection," among others.
In the 1960s, sociologist E. Goffman defined stigma as "a situation of the individual being disabled for full social acceptance" (Goffman, 1963), associating stigma with three traits: "physical defects," "character defects," and "ethnic or tribal factors," which today would be physical, psychological, and sociocultural traits .
Stigma, as the organization Obertament points out, is a complex and multidimensional social phenomenon. In the case of mental health, it constitutes a global problem, and the fight to eradicate it should be a priority in any free and democratic society.
What is self-stigma?
People with mental health problems often experience conflicting and frequently negative opinions and feelings, and they are often aroused by the same reactions as society, adopting behaviors and manifesting attitudes similar to those of the general population, such as accepting social stereotypes and prejudices related to violence, dangerousness, inability to manage and incurability, while at the same time facing the effects of their own mental disorder.
Self-stigma is one of the major difficulties for the recovery of people with mental health problems, as it prevents their integration into the community and the creation of life projects.
According to Jennifer Boyd, a professor at the University of California, "the biggest challenge for people with mental health difficulties is recovering from the stigma they carry within them . This is what prevents them from getting closer to the things that are important to them; a real tragedy that increases the symptoms of the mental disorder, which are already serious enough." (UCM Chair - Group 5 Against Stigma, 2021).
Social stigma, and especially self-stigma, in the field of mental health is the biggest obstacle to recovery, as it prevents integration into the community and the creation of life projects for people.
Is stigma present among mental health professionals?
Why do we stigmatize?
People reject and discriminate through the association of a set of attitudes, following six steps known as the stigmatization process , which we should all break once and for all.
1. Labeling
The distinction and identification of a specific difference or label that negatively affects a group of people, in this case, people with mental health problems. The very label of "mentally ill" evokes personal opinions, prejudices, and feelings, regardless of the behaviors of the people labeled.
2. Stereotypes
These are the set of unfavorable characteristics we associate with labeled individuals, based on false beliefs such as violence, dangerousness, incompetence, or lack of willpower. The media plays a significant role here, amplifying this stigma.
3. The distance or separation
It involves considering people with mental health disorders as a separate and different group, creating a division between "them" and "us".
Discrimination manifests itself as a barrier to the exercise of rights and access to services, and is observed in areas such as access to housing and employment, or in significant social relationships.
4. Prejudices
They occur when, without direct or real experience, there is Conformity with pre-existing, generally unfavorable, beliefs, opinions, and judgments has emotional repercussions for both those who stigmatize (fear, anxiety, irritation, compassion, repulsion, sorrow) and those who are stigmatized (fear, anxiety, shame, irritability, incapacity). These repercussions are often underestimated, but they are relevant in reinforcing stigma and its consequences for behavior.
5. Discrimination
Attributing negative characteristics to people with mental health problems predisposes our attitude towards them, both in the use of discriminatory language, and with paternalistic, infantilizing and discrediting behaviors, rejection, condescension, overprotection and control.
Discrimination also manifests as a barrier to exercising rights and accessing services, which has a significant impact on the effects of mental illness. Direct discrimination is observed in areas such as access to housing and employment, or in significant social relationships such as romantic partnerships and friendships.
Furthermore, discrimination is reflected in the failure to comply with universal ethical principles such as:
- Justice: lack of equity in the quality of mental health care due to a lack of evidence in treatments and prognoses or the prioritization of resources.
- Autonomy: not the right to decide for oneself.
- Freedom: judicializing care, applying restrictive measures with involuntary treatments, isolation, mechanical restraints, etc.
6. Structural discrimination
Also known as power asymmetry, "us over them", it refers to the presence of structural factors or dimensions of public entities, policies, services or procedures in which stigmatization is practiced and rights are not respected.
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