The stigma effect

Social stigma, as a phenomenon, has roots that penetrate into the depths of time. The term “stigma”, which has prevailed in English-language bibliography but also internationally, with minor variants, stems from the Greek language, where “stigma” means a mark indelible to someone that society wants to exclude, by attributing negative and degrading qualities to him. The etymology and meaning of the word “stigma” betrays the semantic charge that has accumulated over the centuries: In ancient Greece, they marked the slaves to make clear their subordinate position in social stratification. In the Middle Ages they stunned the criminals, the “deviants” in general, as a sign of distraction, with incandescent iron in order to make their “unruly” behavior distinct.


Distinctions and Diversity

Over the centuries, the importance of stigma has become synonymous with unfavorable discrimination in “different” people. Among the causes of this “difference”, besides specific behaviors and situations that may characterize the individual, there are also specific disease entities, which have a particularly negative burden on their acceptance by the common mind. Diseases with “visible signs”, such as leprosy and syphilis in the past, were stigmatized, which later gave their place to more modern plagues, such as cancer and AIDS. Thus, in recent years, the word “stigma” is used to show that certain illnesses raise prejudices at the expense of people suffering from them.
The misty diseases of the soul

The illnesses of the soul, with signs of difference in the patient’s behavior being visible, always belonged to the sick entities that received a particular and dark connotation in the collective representations. Today, despite the rationalization of perceptions, the advancement of scientific thought, and the retreat of earlier mental forms of understanding and interpreting the world, mental disorders continue to constitute for a large part of the population a “foggy field,” infused with prejudices and mythological beliefs. In the modern world, the area of mental disorders is one of the last bulwarks where – in spite of the times – the irrational fear and collective offense against the “difference” survives with such an intensity that it is experienced as a threat. A threat, either symbolic, towards collective identity, or more real, in terms of social interaction.


The term “schizophrenia”

Although all mental illnesses are accompanied by a degree of stigmatization, the most severe bring the heaviest stigmatic burden, and in particular schizophrenia, which, due to the etymology of the word and the nature of its symptoms, is considered as the most stigmatized disorder . In the representations of the common mind, the term “schizophrenia” represents the mysterious, the enigmatic, the unintelligible, the “other”, the stranger from the collective identity and constitutes the most intensely colored reference to the mental illness in general. Schizophrenia inspires fear and instinctive avoidance behaviors in social interaction that come to be “justified” by perceptions of the patient about his unpredictable behavior, danger, social dysfunction, inability to respond to demands of work and family life, Perceptions that are automatically recalled in the mind by listening to the word “schizophrenic”.


What causes stigma

In this way stereotypes and prejudices associated with mental illness predetermine the negative treatment of the patient and are expressed either directly or indirectly, explicitly or implicitly, influencing both the perceptions that are perceived towards him and the behavior and practices of discrimination adopted in the social field and lead to its social exclusion. The person bearing the “stamp” of mental illness is treated with fear and distrust in interpersonal and social relationships. The discrimination against him, meaning the unequal and discriminatory treatment due to mental illness and therefore the deprivation of the rights that every citizen enjoys, lies in key areas related to the social status of the individual: the labor market, finding a home, even in the treatment the individual receives from health services. Stigma stands as an obstacle to any attempt by the mentally ill for a decent and autonomous living in society, significantly degrading his life quality.

 

The stigma, another symptom that tortures the patient

In any case, these effects are catalytic for people who are sick. The psychological pressure and the difficult conditions that shape their everyday life exacerbate their already aggravated mental health, with a significant impact on the course and outcome of the illness itself. At the same time, the experience of stigmatization from their social environment erodes their self-image, creating doubts and guilt and eventually leading them to their self-stigmatization. However, the effects of stigma are not limited to the patient alone. They extend to the people of his close environment, his family, who suffers along with him and, in turn, faces a high degree of social rejection. Stigma affects all those associated with the patient and the illness: mental health professionals, psychiatric institutions, psychiatric and psychological services, and treatment methods. Apart from the psychological and practical implications, the stigma effect is significant, to the point that public opinion affects formal social policy and institutional treatment of people with mental disorders.


Theoretical analyses, modern depictions

As a phenomenon, stigma was theoretically and empirically recorded for the first time by Goffman, who refers to the identity of a person who has a socially undesirable feature and a loss of his social status. More specifically, stigma refers to the relationship of the individual with his social environment, which differentiates it from the rest of society and leads him to lose almost his human capacity, as the “undesirable feature” ends up being the main axis of his definition.
Research on the stigma

Research on the stigma associated with mental illness has been greatly enhanced in the early post-war years by the interest generated by Thomas Scheff’s “theory of characterization” or “theory of labeling”. According to this, the social attitude towards people who are different – or deviate from the average – does not depend on the behavior of the latter as much as on the “label” attributed to them by their social environment. Thus, a person will distance himself from a psychiatric patient not necessarily due to personal experience, but because of the negative impression he has on him and which is determined by the negative “label” of the term “mental illness.” The behavior of the patient himself, even if he does not reinforce this advance impression, seems to be unable to prevent his social rejection, as the meaning of the “label” seems to go beyond and overlap his behavior. The fact that society reacts on the basis of a stereotype, a preformed and uncritically generalized perception towards the person bearing the “label” of mental illness, magnifies the chance that this person will follow the “career” of a chronic mental patient, which he will not be able to easily disengage from.


Stigma and society

Stigma is therefore a complex concept and process that involves prejudice, stereotyping, social deviation, marginalization and discrimination, but extends beyond these concepts, defining the identity of the individual as a whole. It is precisely because stigma refers primarily to the identity itself, individual and social, and because, at the same time, the characteristics of identity that are considered desirable vary in every society and culture, there is a remarkable differentiation regarding the characteristics that are stigmatizing in every cultural context. However, the stigmatization process is a global and timeless phenomenon, albeit with different forms and shades, and is observed in all societies and cultures. However, its multiple manifestations are not only intercultural, but also to the extent of its consequences, which are particularly noticeable at individual, team and social level. They are branching out across the social fabric and affecting the whole of society.


The depictions of mental illness in the media

In the consolidation of social stigma, mass media also play a key role, with the dominant role of television in the conveying messages on which public opinion is formed. The depictions of mental illness in the media are systematically prone to go to its most negative aspects, with particular emphasis on the supposed violence and risk of mentally ill patients. The stereotypical image of the “schizophrenic” or “maniacal” murderer, often projected, usually misleading and terrifying, does nothing more than replicate bias and fear, consolidating social rejection and marginalization of people who suffer.

 

The effort to fight stigma

Despite the specific strategies and efforts that have so far been made, the stigma which accompanies mental illness is difficult to eradicate. It is impressive that in the modern world, where humanitarian movements are flourishing, the social stigma associated with mental disorders remains strong and ignorance and deceptive logic for the mentally ill continue to prevail. For this reason, the fight against stigma is a key factor in the modern, comprehensive and multidimensional treatment of mental illness, while at the same time it constitutes also a global challenge. To this direction, the World Psychiatric Society (WHO) launched in 1996 a large, international program to combat stigma associated with the most severe mental disorder, schizophrenia, having as a central message “Open the doors”, a message that contradicts the logic that wants patients outside the walls and marks an opening to society as well as from society towards people with mental health problems.

Numerous and various strategies are devised to help modify distorted beliefs about mental illness, change and improve attitudes towards individuals who sufferer and limit stigma. Corrigan argues that the three main strategies for mitigating negative stereotypes and reducing social stigma are protest, education and contact. A protest, mainly towards the media, regarding the inaccurate and negative representations of mental illness and its sufferers, as well as the language that is commonly used, is often unsubstantiated and stigmatizing for the patients and their families. Education of the population through the provision of reliable and scientific information is necessary in order to destroy the myths and stereotypes about mental illness. Last but not least, contact, as a strategy which promotes communication between community members and people with a psychiatric problem.


The aim is to break the prejudices

It is scientifically documented that social attitudes are difficult to change, as it is equally difficult to dismantle the myths and prejudices surrounding the mental disorder. The survival, of course, of these mental constructions over time, in spite of cultural development, testifies to their resilience. Proper information is a prerequisite for their change, but it is not enough. The disruption of prejudices and related stereotypes that contribute to the formation of negative attitudes towards “different” groups is a process that requires concerted action, long-term effort, dissemination of information, cooperation and involvement of many different people and factors from different fields of society, culture and art.

NIKOLAOS ATH. KARAKATSANIS

PSYCHIATRIST-PSYCHOTHERAPIST

IATROS A.T.P.S.Y.T.E.