STIGMA, MENTAL ILLNESS, AND CULTURE

1. STIGMA, MENTAL ILLNESS, AND CULTURE Dr. Patricia Sherman April 3, 2007

2. Why is it when we talk to God, we’re said to be praying, but when God talks to us, we’re said to be schizophrenic?

3. Origins of Stigma • Ancient Greece – means “mark;” marks were placed on slaves to identify their position in the social structure and indicate they were of lesser value

4. People have always needed to determine where they are in relation to others • Reassuring to believe that someone is beneath you in the “pecking order”

5. Erving Goffman (1963) • Suggested that stigma had two major components: public one (reaction of general public to people with mental illness) and self-stigma (prejudice that people with mental illness tend to turn towards themselves

6. Stigma comes in three forms • Overt or external deformations • Deviations in personal traits (mental illness) • Tribal stigmas – traits of a race, nation, or religion that deviate from the normative race, nationality or religion

7. The more visible the stigmatizing mark or condition, the more society believes the individual should be able to control it and the greater the negative impact of not being able to do so

8. List ten groups that are stigmatized • When have you been stigmatized? • When have you stigmatized someone else?

9. Response to stigma • Try to get rid of what is stigmatizing • Make special efforts to compensate • Refuse to accept societal norms

10. Glossary of Terms • Labeling – the act of giving a name with a social meaning to a state or characteristic • Deviance – behavior which is socially abnormal and usually regarded as unacceptable

11. Primary deviance – the original deviance, which in the context of illness behavior, is that caused by the illness itself • Secondary deviance – the abnormal behavior which results from the social reaction to the primary deviance

12. Stigma – the negative value given to a characteristic which means that a person is spoiled in some way and liable to social rejection • Stereotyping – the act of labeling a person with one characteristic (often stigmatized) on the basis of their possession of another characteristic

13. Discreditable – a state where a person has a stigmatized characteristic, but this is not generally known. There is therefore a potential to be discredited or rejected if the characteristic becomes apparent • Discredited – the state where the stigmatized condition has become visible

14. Enacted stigma – the social rejection that has taken place as a result of being discredited • Felt stigma – the perceived social rejection of the stigmatized condition

15. Complete Attitude Scale for Mental Illness • What was difficult to answer? • What do you wish you could have answered differently?

16. Four components of stigma • Labeling people with a condition • Stereotyping people with that condition • Creating a division – “us” and “them” • Discriminating against people based on their label

17. Why is mental illness stigmatized? • Its name implies it is different from physical illness • Sounds as if it’s “all in one’s head” • Some people believe it results from poor choices

18. Belief that people with mental illnesses are dangerous and unpredictable, less competent, unable to work, should be institutionalized, can never get better

19. Some Health and Social Consequences of Stigma • Mental illness and addiction are common, but only 1/3 of those needing treatment seek it due to fear of discrimination • People deny painful symptoms and are reluctant to seek help at an early, more treatable stage of illness

20. The drop-out rate for psychiatric treatment is high because people do not want to be seen attending psychiatric clinics. • People with mental illness often hold the same beliefs as society at large and blame themselves for their illness

21. The major way people cope with stigma is to withhold information from those who could help them • Consumers expect to be rejected by the community and, therefore, are reluctant to engage with others

22. The effects of stigma and its resultant social withdrawal may have a greater impact on an individual than the illness • Family members are also harmed by stigma and may be blamed for causing or contributing to the illness

23. Community attitudes can negatively affect recovery rate • Mental health professionals are also often stigmatized, holding a diminished status in the eyes of other health care professionals and making recruitment challenging

24. Many mental health professionals share negative attitudes towards people with mental illness • The diminished attitude towards consumers is applied to self-help and peer-support programs, negatively affecting the number of referrals

25. People with mental illness are less likely to be appropriately diagnosed and treated for co-morbid medical conditions • Institutions, governments, and policy makers contribute to stigma by systematically under-funding mental health services

26. Discrimination towards people with mental illness leads to diminished employment opportunities, lack of career advancement, and hostility in the workplace • Stigma contributes to the persistent under-funding of research and treatment services

27. 74% of people with a mental illness reported they had experienced stigma in the last year • 16% reported stigma in the workplace • 13% from staff in a health service (SANE, Australia, 2006)

28. The elderly experience the double stigma of being old and mentally ill and are less likely to seek help; their illnesses may not be detected because of the belief that anxiety and depression are a normal part of aging

29. Other groups also experience a double or triple stigma – LGBT, people of color, women (“The gay community stigmatizes us for being mentally ill, and the mental health community stigmatizes us for being gay”)

30. Discrimination is experienced through a loss of human rights, including forced treatment, finding or keeping housing, the right to parent, access to loans, immigration, denial of insurance coverage, and over-representation in the criminal justice system • Adapted from Mood Disorders Society of Canada’s Stigma and Discrimination Research Workshop, Ottowa, ON – 10/2-4/06.

31. Complete Family Scale • Discuss in small groups • Report out to larger group

32. Some Facts About Mental Illness and Recovery • Mental disorders fall along a continuum of severity. Even though mental disorders are widespread in the population, the main burden of illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 Americans — who suffer from a serious mental illness. It is estimated that mental illness affects 1 in 5 families in America.

33. Most mental illnesses are biologically based brain disorders.  They cannot be overcome through "will power" and are not related to a person's "character" or intelligence.

34. The World Health Organization has reported that four of the 10 leading causes of disability in the US and other developed countries are mental disorders. By 2020, Major Depressive illness will be the leading cause of disability in the world for women and children.  

35. Mental illnesses usually strike individuals in the prime of their lives, often during adolescence and young adulthood. All ages are susceptible, but the young and the old are especially vulnerable.

36. Without treatment the consequences of mental illness for the individual and society are staggering: unnecessary disability, unemployment, substance abuse, homelessness, inappropriate incarceration, suicide, and wasted lives. The economic cost of untreated mental illness is more than 100 billion dollars each year in the United States.

37. The best treatments for serious mental illnesses today are highly effective; between 70 and 90 percent of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports.

38. With appropriate effective medication and a wide range of services tailored to their needs, most people who live with serious mental illnesses can significantly reduce the impact of their illness and find a satisfying measure of achievement and independence.

39. Early identification and treatment is of vital importance. By ensuring access to the treatment and recovery supports that are proven effective, recovery is accelerated and the further harm related to the course of illness is minimized.

40. Mental Illness Across Cultures • The expression of mental illness in many cultures is in bodily terms – headache, trouble sleeping, fatigue, stomachache, etc. • Hallucinations and delusions will be culturally relevant

41. Need to assess level of acculturation • Mental illness compounded by immigration experience, conditions leading to immigration, poverty, lack of health insurance, language difficulties, loss of support system, lack of access to traditional healers

42. Asian Indians and Pacific Islanders – very few receive treatment (1/6 of those who need it) • Deep-rooted stigma prevents many from acknowledging their illness

43. Stigma extends to families • Fear of not being able to marry • Psychiatric illnesses are considered curse from God, punishment for sins in past lives, or manifestations of evil spirits

44. Latino/a culture has expectation that people will be able to solve problems on their own • Serious stigma regarding mental illness • 75% of family members in Ethiopia report being stigmatized

45. Chinese use traditional medicine and healers • Tend to hide feelings; loss of face • Emphasis on family involvement • May use term for sadness that is translated as “congested”

46. In traditional Japan, suicide is valorized – it’s a way of maintaining honor by accepting responsibility • Japanese changing name for schizophrenia from seishi buntetsu byo (split-mind disorder) to togo shiccho sho (loss of coordination disorder)

47. African Americans tend to access treatment later – fearful it will make them look weak and not spiritual enough • Religious preoccupation may not be symptom of mental illness

48. In Poland, over 70% indicated that people with mental health disorders are called “crazy,” “loony,” “idiot,” “abnormal” • 3/5 Scots believed someone with mental illness would not be able to look after children

49. Zimbabwe – high rate of depression, especially among women, typically present with multiple physical symptoms • Many somatic complaints, especially related to the heart and head are metaphors for grief or fear

50. Afro-Caribbean immigrants often believe in obeah – a form of witchcraft containing elements of Christianity, animism, and folk medicine • Based on belief that it is possible to influence the health or well-being of another person from a distance