The Changing face of stigma

I guess with the ‘A time to change’ http://www.time-to-change.org.uk/ anti-stigma campaign in full swing many people are asking themselves what the big fuss is? It’s not like most people don’t feel there is stigma attached to having a mental illness nor that they don’t feel that there is discrimination but I guess many might wonder whether it really is worth spending so much money on a big campaign?

http://www.oneinfourmag.org/index.php/debate-should-mental-health-anti-stigma-campaigns-be-a-priority/

This person certainly thinks it might be a waste of money and if this article is anything to go by http://blogs.orlandosentinel.com/health/2010/09/16/mental-health-messages-actually-increase-stigma/ Mental health messages actually increase stigma. And given this and the poor state of investment into mental health services and research (see earlier post far reaching taboos) wouldn’t we be better off spending the money on them?

And in some ways I would agree however I have this niggling thought in the back of my mind that really these things are linked. That actually the reasons why we don’t have better funding and research is because there is such stigma surrounding mental health.

So what is stigma?

Well according to this report (and there are many definitions) (http://www.mentalhealthcommission.ca/SiteCollectionDocuments/Anti-Stigma/TimeforAction_Eng.pdf ) A TIME FOR ACTION: TACKLING STIGMA AND DISCRIMINATION Stigma is

Stigma is typically a social process, experienced or anticipated, characterized by exclusion, rejection, blame or devaluation that results from experience or reasonable anticipation of an adverse social judgment about a person or group.

However that doesn’t really explain anything about how stigma can manifest itself within society or the effects that it could have on the community but this article further sub divides stigma into three types

·         Health-Related Stigma viii can lead to exclusion, rejection, blame or devaluation of the individual affected by stigmatized conditions at a time when they are most in need of inclusion, acceptance and compassion. ix Negative social judgments about the conditions themselves can have significant implications for social and health policy. In addition to mental illness, contemporary stigmatized conditions include sexual dysfunction, HIV/AIDS, leprosy and epilepsy. x

·         Self Stigma” describes the process by which individuals internalize negative attitudes about their own condition xi - concluding that they are unworthy of anything other than poor treatment. They come to expect rejection, and they receive it – an experience which then reinforces the original expectation. In response, they develop coping strategies which often include secrecy and withdrawal.xii

·         Courtesy Stigma describes the stigma-by-association experienced by those who are closely associated with stigmatized people. xiii Families, friends and mental health professionals – all of whom may experience courtesy stigma – may be seen by the rest of society, as “normal yet different”, by virtue of their affiliation. To protect themselves against the negative social judgment implicit in that label, close associates - including mental health professionals - may distance themselves from the stigmatized person, thus reinforcing the “us/them” dichotomy of which people with mental illness are so acutely aware.xiv Some theorists suggest that chronic under-funding of psychiatric services and research is, at least in part, a manifestation of courtesy stigma on the part of policy makers

Which to my mind actually clarifies different aspects of the problem and highlights that actually stigma on this level has very far reaching consequences that I feel an awful lot of people could overlook, particularly the last suggestion. It may only be a suggestion but I think it asks a question that many of us avoid even thinking about.

How deep does it go?

For instance, the press are having a field day with welfare reform often reporting very inaccurate or misleading/poorly explained statistics and the government appears to be doing nothing to stop them. Not only that they have repeatedly cut funding to the NHS and have not made funds available for research either. I am not suggesting that the government is full of prejudice people but merely that they are affected by it and because they have the power to make these decisions it shows itself more. Sadly I feel that when the government says that the country is behind them they might not be far wrong. That actually despite so many people being up in arms at the way they have implemented their changes they are not that bothered that they have happened. I do believe there are an increasing number of people who really are bothered, however it seems the country’s inability to do anything proactive is allowing these changes to go through far too easily.

And really if stigma on this scale is occurring then every effort should be made to change it and it really isn’t unreasonable to spend the £18 million over the 4 years that the time to change campaign is spending since changing the amount of stigma may well result in money being made available, better research being done, better care being given, more people getting the treatment that they need and a better quality of life for all.

I guess the biggest problem is that part of me doubts very much that spending the money on the campaign or any campaign will bring about the desired changes. Certainly the article above says that they’ve made the situation worse not better (not in the UK). This report about an anti stigma campaign in Cambridge UK isn’t that encouraging either http://www.biomedcentral.com/1471-2458/10/339/ Evaluation of a brief anti-stigma campaign in Cambridge: do short-term campaigns work? It seems a mammoth task and one fraught with problems that could go so badly wrong however I remind myself of HIV and wonder whether when people set out to attack the stigma associated with it they felt that anything could be achieved? Probably not and although the problems were not as long lived or as deeply ingrained they was certainly a great depth of similar feeling. And if you want another indicator then look to homosexuality and how the stigma has changed there too.

I feel it may be the ingrained nature of the stigma associated with mental illness that has promoted this feeling that whatever is done will make no difference, ‘A hopeless task that ought not to be attempted.’ And yet things do change.