Stigma and mental illness

STIGMA AND MENTAL ILLNESS
PREPARED & PRESENTED
BY
RICHARD OPOKU ASARE
MEd, BEd (Hons) (Health Science), RN (Dip)-RMN, Cert. Ed

OUTLINE OF PRESENTATION
asareor@yahoo.com©2014
2
1. Introduction
2. Definitions
3. Overt and subtle signs of
stigma
4. What is difference
between Stigma and
discrimination
5. What is mental health
stigma
6. Causes of stigma
7. Common examples of
stigma
8. Consequences of stigma
9. Effect of stigma
10. Conditions stigmatized in
mental health
11. Types of stigma
12. Process of stigma
13. Manifestations of stigma
14. Challenging/combating
stigma
15. Other ways of fighting
stigma
16. How to cope with stigma
and discrimination (towards
mental health & illness)

INTRODUCTION
Stigma is a broad term which is used to describe the
negative and stereotypical thoughts, attitudes, and
feelings about people on the basis of the traits of a
person, which can include gender, skin colour, sexual
orientation, religion and mental illness. It has been
used to label certain groups of people as less worthy
of respect than others. These attitudes in the
community are supported by ignorance, prejudice
and discrimination, and are perpetuated when
mental illness is represented in an inaccurate way
by the media.
3

INTRODUCTION – CONT’D
There are still attitudes within most societies that
view symptoms of psychopathology (i.e., mental
illness) as threatening and uncomfortable, and these
attitudes frequently foster stigma and discrimination
towards people with mental health problems. Such
reactions are common when people are brave enough
to admit they have a mental health problem, and
they can often lead on to various forms of exclusion
or discrimination – either within social circles or
within the workplace.
4

INTRODUCTION – CONT’D
Stigma is therefore used as a negative label to
identify people with mental health problems. It,
thus, has its roots in fear and misunderstanding.
Many people hold negative opinions towards people
with mental health problems because they do not
understand the issues involved and because they are
relying on myths and misconceptions.
As health professionals, we are committed to
ensuring that people with mental health difficulties
must enjoy the same rights on an equal basis with
everyone without discrimination.
5

DEFINITIONS
 Stigma is defined as a sign of disgrace or
discredit, which sets a person apart from others
(Bryne, 2000).
 Erving Goffman (1963) defined stigma as the
process by which the reaction of others spoils
normal identity.
 Stigma is an attribute, behaviour or repetition
which is socially discrediting in a particular way;
it causes an individual to be mentally classified
by others in an undesirable, rejected or
stereotyped rather than in an accepted normal
one. 6

DEFINITIONS – CONT’D
 Stigma results from a process whereby certain
individuals and group are unjustifiably rendered
shameful, excluded and discriminated against
(WHO, 2002).
 Stigma is the process of blaming a person
wrongly and devaluing him or her for having an
illness or being in an undesirable situation (Ofei
& Abaka-Quansah, 2009).
 Discrimination: means any distinction, exclusion
or preference that has the effect of nullifying or
impairing equal enjoyment of right.
7

OVERT AND SUBTLE SIGNS OF STIGMA
 An overt stigma, example is making negative
comments about people with mental illness or
discriminating against them.
 A subtle sign is believing and perpetuating the
many destructive myths about mental illness,
such as the idea that people with mental illness
are violent or dangerous.
Stigma can lead to discrimination.
8

WHAT IS THE DIFFERENCE BETWEEN
STIGMA AND DISCRIMINATION?
 Stigma is considered to be an opinion or
judgement held by individuals or society. If these
prepositions are acted upon, these actions may be
considered to be discriminatory.
Discrimination may be obvious and direct, such as
someone making a negative remark about the
person’s mental illness or his treatment.
9

WHAT IS THE DIFFERENCE BETWEEN
STIGMA AND DISCRIMINATION? –
CONT’D
Or it may be unintentional or subtle, such as
someone avoiding the individual living with mental
illness because the person assumes the mentally ill
person could be unstable, violent or dangerous due to
his/her mental health condition. The one living with
mental disorder may even judge himself/herself.
Discriminating against someone at work, denying
access to education, accommodation, entry to
premises, membership of a club or association, or the
provision of services under the guise of the
individual having mental illness is unlawful (Mental
Health Act 846, 2012; Disability Discrimination Act,
1992; visit the website of the Australian Human
Rights Commission).
10

WHAT IS MENTAL HEALTH STIGMA?
Mental health stigma can be divided into two
distinct types:
Social stigma is characterized by prejudicial
attitudes and discriminating behaviour directed
towards individuals with mental health problems as
a result of the psychiatric label they have been given.
Perceived stigma or self-stigma is the
internalizing by the mental health sufferer of their
perceptions of discrimination (Link, Cullen,
Struening & Shrout, 1989), and perceived stigma can
significantly affect feelings of shame and lead to
poorer treatment outcomes (Perlick, Rosenheck,
Clarkin, Sirey et al., 2001).
11

CAUSES OF STIGMA
 Ignorance/misconceptions – misperceptions about the cause
or onset of the disease as a curse from the gods,
punishment for one’s sins, witchcraft, black magic,
demonic, spirit possession, etc.
 Cultural factors/belief system – this about the myth and
misunderstanding
 Media – Stigma in the media is especially harmful because
the media plays an important role in shaping and
reinforcing community attitudes, i.e., spreading wrong
information. For example, cinematic depictions of
schizophrenia are often stereotypic and characterized by
misinformation about symptoms, causes and treatment.
Schizophrenic characters portray violence behaviour, carry
dangerous act, and commit suicidal and homicidal
behaviours. 12

CAUSES OF STIGMA – CONT’D
 Fear – people fear the unknown outcome of the
condition; the condition itself and burden of care.
 Lifestyle – such as smoking and other drug use,
and the act being seen as shameful.
 Lack of treatment facilities – the presence of
inadequate preventive facilities.
 Lack of information systems – lack of education
to both professionals and to the general public.
 Economic instability – deals with poverty.
13

 Previous experience – most people have
experience some form of the disease that might
be similar to that particular disease that is
stigmatized. They may also have seen people die
from the condition in a bizarre circumstance due
to family/societal neglect. Sometimes, people
compare and test, and question the information
they have heard with their own experiences,
beliefs and common sense.
14

 Medical diagnosis – the medical model implies
diagnosis, and diagnosis implies a label that is
applied to a ‘patient’. That label may well be
associated with undesirable attributes (e.g., ‘mad’
people cannot function properly in society, or can
sometimes be violent), and this again will
perpetuate the view that people with mental
health problems are different and should be
treated with caution.
15

COMMON EXAMPLES OF STIGMAS
 People with mental illnesses are crazy
 Schizophrenia is the same thing as multiple
personality disorder.
 People with mental illnesses are always
dangerous and violent.
 “Psycho” and “psychotic” mean violent and
dangerous. (Psycho is more of a common slang
meaning violent and crazy person. Psychotic
when used medically actually refers to psychosis,
or serious state of sickness where a person is
suffering from very severe degrees of their
symptoms, such as delusions, hallucinations and
so forth.) 16

COMMON EXAMPLES OF STIGMAS –
CONT’D
 Cannot simply “get over their problems,” i.e., get
your head straight, smarten up, etc.
 Stigmas are often fixed ideas or judgements
 Stigma often includes prejudice and/or
discrimination.
 The tone of voice or bodily language people might
use when describing mental illness.
17

CONSEQUENCES OF STIGMA
 It could lead to prejudice; for example, that mental
disorders are dangerous.
 Mistaking belief – that mental illness is a curse
from the gods, witchcraft, black magic, etc.
 Misleading media information.
 Damaging self-belief, i.e., sense of personal worth
and self-esteem is affected; the person becomes
shameful and unwilling to seek medication
attention, or disclose an illness.
 It leads to negative attitude towards professionals
who have dedicated their lives to serve and care for
those suffering from the condition(s).
18

EFFECT OF STIGMA
 Loss of confidence
 Failing to seek medical attention
 Low self esteem
 Divorce
 Keep people from accessing counselling
 Stigma prevent others from caring for the
mentally sick
 Loss of job/lack of employment
 Financial problems
 Rejection
19

EFFECT OF STIGMA – CONT’D
 Missed opportunities
 Defensive
 Become withdrawn
 Become or feel ostracized
 Might start avoiding confrontation at all costs
 Might bottle it up and ‘explode’ or get angry
about it
 Undervalued
Some of the harmful effects of stigma can include:
20

EFFECT OF STIGMA – CONT’D
 Reluctance to seek help or treatment.
 Stigma hinders efficient and effective recovery from
mental health problems.
 Lack of understanding by family, friends, co-workers
or others the patient know.
 Fewer opportunities for work, school or social
activities or trouble finding housing.
 Bullying, physical violence or harassment.
 Health insurance that doesn’t adequately cover the
patient’s mental illness treatment.
 The belief that the patient will never be able to
succeed at certain challenges/jobs/profession or that
s/he can’t improve his/her situation.
21

CONDITIONS STIGMATISED IN
MENTAL HEALTH
 Epilepsy
 Schizophrenia
 Mental retardation
 Substance abuse
 Post-traumatic disorder (anxiety)
 Depression
 Dementia
 Delirium
 Antisocial personality disorder
22

TYPES OF STIGMA
 Self stigma – is where individuals with mental
illness feel they are being judged by others, so
they feel disgraced, blame and isolate
themselves from people. It is one of the most
harmful effects of stigma. Self stigma occurs
when it alters how the person views
himself/herself. The person living with mental
illness may mistakenly believe that his/her
condition is a sign of personal weakness or that
s/he should be able to control it. Besides, self-
stigma is the acceptance of prejudiced
perceptions held by the patient.
23

SELF STIGMA – CONT’D
This can lead to reluctance to seek treatment,
excessive reliance on others; social withdrawal,
poor self-worth and it may also lead to abuse of
alcohol and drugs.
Thus, self stigma can lead to self-blame and low
self-esteem.
25

TYPES OF STIGMA – CONT’D
 Felt stigma – the perception or feeling one has
towards people with same specific disease or
condition which they also have.
 Enacted stigma/Discrimination – this is
where there is discrimination against individuals
living with mental illness or people who have
some of the condition or disease in their
community.
26

OTHER TYPES OF STIGMA
1. Physical deformity (external or overt deformity)
– deals with stigma against one’s physical
disability such as having scars, leprosy, cleft lip or
palate, muscular dystrophy.
2. Poor personal trait – such as being perceived
rightly or wrongly, as weak-willed, domineering or
having unnatural passions, and rigid beliefs, and
being dishonest may be seen as deviations in
personal trait. Besides having mental disorder,
having criminal record, and once imprisoned,
unemployed, drug and alcohol addiction,
homosexuality, suicidal attempt, and radical
political behaviour are stigmatized against in this
way under personal trait deviation.
27

OTHER TYPES OF STIGMA – CONT’D
3. Tribal outgroup status (Tribal stigma) – are
traits, imagined or real, of ethnic groups,
nationalities, race or religions that are deemed
to constitute a deviation from what is perceived
to be the prevailing normative ethnicity,
nationality, race or religion. For example, being
African American or being of Arab descent in
the United States after the 9/11 attacks may
carry a tribal stigma (Campbell & Deacon,
2006).
28

PROCESS OF STIGMA
The stages in the process of stigmatization include:
1.Labelling – the process of stigma begins when
individuals with mental illnesses are first
identified, marked and labelled, and seen to be
different from others.
2.Negative reaction – there is negative behaviour
towards individuals with mental illnesses because
their situations are seen as a result of their sinful
behaviour or a curse from the gods.
29

PROCESS OF STIGMA – CONT’D
3. Shunning – they are shunned, rejected,
avoided, and separated from other people,
family or community because of their disease
state.
4. Lose of status – these individuals lose their
respect, position, dignity, statuses, and even be
isolated from the family or community. Some
individual’s rights are even trampled upon and
are sacked from their work place, school, or
even ejected from their place of residence.
30

MANIFESTATIONS OF STIGMA
Stigmatization manifests in the following forms of behavior:
1.Physical stigma. People living with mental illness,
HIV/AIDS, and other infections are isolated physically (not
allowed into shared spaces, not allowed to share clothing,
eating utensils, etc.) or, in extreme cases, may even
experience forms of physical attack.
2.Social stigma. When people are isolated socially and they
start losing their social identity and their social structure
starts dissolving (not being invited to social events, loss of
communication with loved ones, not being visited, loss of
friendships, etc.). But there is also the loss of privacy, the fact
that his/her (your) illness is forced into the open.
31

MANIFESTATIONS OF STIGMA – CONT’D
3. Verbal stigma. When people use pejorative
language when referred to someone living with
mental illness, HIV/AIDS, etc. or in reference to
the illness itself.
4. Institutional stigma. When people lose their
jobs or any other form of discriminatory
practice.
32

CHALLENGING/COMBATTING
STIGMA
The three most successful ways of reducing stigma
are:
1.Education involves replacing misperceptions
with actual facts.
2.Contact involves changing public attitudes about
mental illness through direct interactions with
people who have experienced mental illness.
3.Protest is used as a way to suppress negative
behaviour, and is most commonly used to challenge
the way that the media present mental illness.
33

CHALLENGING/COMBATING STIGMA –
CONT’D
To challenge stigmatization, Campbell, Foulis,
Maimane, and Sibiya (2005) summarise three main
approaches:
Firstly, there are efforts to educate individuals
about the non-stigmatising facts and why they should
not stigmatise.
Secondly, there are efforts to legislate against
discrimination.
Thirdly, there are efforts to mobilize the
participation of community members in anti-stigma
efforts, to maximize the likelihood that the anti-
stigma messages have relevance and purchase,
according to local contexts. 34

OTHER WAYS OF FIGHTING STIGMA
 Breaking the culture of silence about causes
mental illness.
 Using group dynamics to discuss issues of
stigma.
 Sharing knowledge on issues at stake.
 Being a role model.
 Counselling individuals.
 Passage of law, e.g., Mental Health Act 846
(2012).
 Mental health taught as a subject in the schools.
 Establishment of health care facilities. 35

OTHER WAYS OF FIGHTING STIGMA
– CONT’D
 Stigma against mental illness should be part of
political agenda.
 Create more supportive environment with people
with mental illness.
 Serve as an advocate.
 NHIS should cover drugs and other treatment for
mental illness.
 Media should talk positively about mental
health.
 Dissemination of information in the community.
 People with mental illness could also form
association. 36

PEOPLE LIVING WITH MENTAL DISORDERS
SHOULD, WHERE POSSIBLE, BE
ENCOURAGED TO:
 Go public and share their experience of illness
and of discrimination.
 Participate in information and education
campaigns.
 Join (or where necessary form) associations and
support groups.
 Express their needs to service providers, NGOs
and government.
 Join in planning services that avoid stigma and
discrimination.
 Challenging and reporting any professional
practice that is stigmatising or discriminatory.
37

HOW TO COPE WITH STIGMA AND
DISCRIMINATION (TOWARDS MENTAL
HEALTH & ILLNESS)
1. Educate yourself, help yourself first
2. Educate others (after you have a good
knowledge of issues and the science behind it,
and symptoms, and medications, etc.). Be an
advocate for those that can’t voice proper
knowledge about mental health issues.
3. Have an understanding of our illness. It is
unfortunate that often people with the illness
do not believe they even have it, and turn down
medication. It often takes an event of
hospitalization or severe sickness or illness to
make people realize they do actually have an
illness, so more education is needed to prevent
some of these things from happening.
38

HOW TO COPE WITH STIGMA AND
DISCRIMINATION (TOWARDS MENTAL
HEALTH & ILLNESS) – CONT’D
4. Find people with similar values and beliefs
(even in areas outside of mental health)
5. Be aware of your thoughts and reality test them
6. Assertiveness (be assertive), it can help combat
a lot of troubles such as low self-confidence and
low self-esteem that are often a symptom of
mental illness.
Positive affirmations
- We are not alone
- We have choices
- We can have a say 39

END OF LECTURE
THANK YOU
40

Stigma and mental illness

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