Stigmatizatipn pf the i I mentallVl l Î!1
The term stigma derives from the Greek and refers to bodily signs designed to expose something unusual and bad about the moral status of the signifier. Such signs were 'cut or burnt into the body and advertised that the bearer was a slave, a criminal, or a traitor', (!> someone to be avoided, especially in public. In Christian times, two metaphorical modifications were added. The first referred to physical, bodily signs of spirituality or grace, so-called stigmata, including eruptions and wounds on the body similar to those suffered by Jesus Christ.(2) The second referred to bodily signs of a physical disorder, as in the classical stigmata of leprosy or advanced alcoholic cirrhosis. However, the conventional contemporary use of the concept of stigma involves the notion of an attribute that is discrediting. History is replete with examples of stigmatization on grounds of race, ethnicity, gender, social status, nationality, and sexual orientation, as well as physical and mental functioning. The sociologist Erving Goffman, in a classic book devoted to the analysis of stigma, (1) points out that the person with a stigma is more often than not defined as somehow less than human, and that to explain and justify stigmatization human beings tend to construct a particular theory or ideology. The stigmatization of the mentally ill, for example, rests on theories of moral weakness, dangerousness, contamination, and culpability.
It has, however, been argued, most cogently by Sayce,(3) that the concept of stigma has not been useful as a rallying point for collective stategies to challenge prejudice and that the concept of stigma is itself stigmatizing. A New Zealand national strategy to combat discrimination against the mentally ill argues: (4)
Years of research into public attitudes and stigma have not led to the development of effective models for change ... Whereas stigma attaches to the consumer, discrimination results from the actions of others. If placed in a human rights framework, there is clear evidence that widespread discrimination is exercised against people with mental illness. More importantly, that framework also offers a well-tested methodology for identifying and resolving discriminatory practices.
Most of us learn our expectations and stereotypes of mental illness behaviour during early childhood and, whilst much of the imagery involved is spurious, such expectations and stereotypes are continually reaffirmed and reinforced in ordinary social interactions. Much of the language of mental health has been absorbed into the public discourse in a manner which is quite explicitly stigmatizing—the use of such terms as 'psycho', 'nutter', 'maniac', and 'schizo' to demean and denigrate contaminates and degrades the entire field of mental health and has been the subject of much adverse criticism.(5)
The political abuse of psychiatry has given psychiatrists cause to be alert to the professional danger of being misused as agents of social control and contributors to the process of stigmatization of the mentally ill. Western psychiatry, as Littlewood and Lipsedge (6) have suggested, tends towards conservatism in its attitude to the social order, and others(7.,8) have argued for greater recognition to be paid to the social and cultural assumptions on which much psychiatric theory and practice are based and which can contribute to subtle stigmatization of psychiatric ill individuals within the mental health services.
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