Impact of intersectionality on the stigma associated with psychosis
The stigma associated with mental health is a persistent challenge in our society. When we talk about psychosis , this stigma becomes even more evident. There are a number of myths surrounding psychosis that have been perpetuated over time due to misinformation and the repetition of negative portrayals by the cultural and media industries. Some of these widespread prejudices refer to a supposed dangerousness, the person's lack of recovery, or the guilt of the person experiencing it, among others.
Ten myths about psychosis
If we add to all these prejudices other aspects of a person's personal and social environment, such as ethnicity, gender and gender identity, or socioeconomic status, we find that the stigma surrounding this person multiplies and ends up becoming a discriminatory element that is difficult to overcome. These factors are what we know as intersectionality; that is, how a person's different social identities overlap and what mechanisms of oppression or discrimination are activated: racism, sexism, various phobias (homophobia, LGBTQ+phobia, fatphobia, classism, etc.).
In the case of psychosis, intersectionality can amplify stigma and worsen the difficulties people face in accessing the health system to obtain a diagnosis, treatment and adequate support; as well as in developing in the rest of their personal, work, educational or social dimensions with which to develop their life project.
The stigma in psychosis
People with psychosis are often perceived as "dangerous," "incapable," or "beyond repair." This stigma, often structural but also social and self-perceived, can lead to social isolation, loss of employment and academic opportunities, and even mistreatment in healthcare settings.
Stigma has a direct impact on the person and their decisions, as it can discourage them from seeking professional help for fear of being judged or rejected.
Discrimination does not act in isolation. People with psychosis who also belong to vulnerable groups may experience multiple layers of stigma:
- Ethnic background : Some racialized communities are less likely to receive appropriate diagnoses and evidence-based treatments. In many cases, their psychotic experiences may be dismissed or misinterpreted by professionals who do not understand their cultural perspectives.
- Gender : Women with psychosis may be underdiagnosed or mislabeled, while men may be seen as more "dangerous" for the same symptoms.
- Poverty : People from disadvantaged economic backgrounds often lack access to quality mental health services, a situation that perpetuates the cycle of marginalization. This situation is especially critical for homeless people, around whom even more misconceptions exist, making it much harder to understand the entire phenomenon.
- LGBTQ+ Identity : LGBTQ+ people may face stigma not only because of their sexual orientation or gender identity, but also because of their mental health. This can make it difficult for them to find safe spaces to talk or receive support.
The impact on access to treatment
These multiple forms of stigma have real consequences:
- Delays in diagnosis or treatment.
- Limited access to culturally and socially sensitive resources.
- Higher likelihood of experiencing discrimination in health or social institutions.
- Increased risk of marginalization, poverty and social exclusion.
Strategies to combat stigma from an intersectional perspective
Breaking the cycle of stigma requires overlapping, medium- and long-term strategies with varying levels of complexity because, as we have pointed out, stigma is structural, social, and self-perceived. There is, however, a fundamental initial principle that cannot be overlooked in the design of these strategies: addressing intersectionalities. It is therefore necessary to recognize the individual and collective factors that impact a person's experience, how they are perceived by their fellow citizens, and the difficulties these factors entail, in order to design effective projects and strategies.
As an example, some major strategic lines that this perspective encompasses are:
- Community education. Raising public awareness about what psychosis really is and debunking myths associated with these disorders. This includes recognizing the diversity of experiences based on factors such as culture and social context.
- Professional training. Promote training in intersectionality among mental health professional teams, to understand the specific barriers and needs of people with diverse identities.
- Positive narratives. Empowering people with psychosis, in all their diversity, to share their experiences and stories of overcoming adversity and resilience.
- Equitable access to mental health services. Ensure that all services are accessible, inclusive, and respectful of cultural, gender, and sexual diversity.
- Inclusive policies. Promote laws and policies that protect people with mental disorders from multiple forms of discrimination.
- Empathy and understanding. Only by addressing these intersections can we move towards a more just society, where everyone has the right to be heard, understood and cared for, regardless of their circumstances.
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