Stigma has been defined as a deeply discrediting attribute that reduces a person to one who is in some way tainted and can therefore be denigrated. It is a pervasive problem that affects health globally, threatening an individual's psychological and physical well-being. It prevents individuals from coming forward for diagnosis and impairs their ability to access care or participate in research studies designed to find solutions.

Stigmatization of certain diseases and conditions is a universal phenomenon that can be seen across all countries, societies and populations. It refers to the relation between "the differentness of an individual and the devaluation society places on that particular differentness". For stigmatization to be consistently effective, however, the stigmatized person must acquiesce to society's devaluation. When people with "differentness" internalize society's devaluation, they do not feel empowered to change the situation and the negative stereotypes become an accepted part of their concept of the disorder. The labelling, stereotyping, separation from others and consequent loss of status highlight the role of power relations in the social construction of stigma (22).

People differentiate and label socially important human differences according to certain patterns that include: negative stereotypes, for example that people with epilepsy or other brain disease are a danger to others; and pejorative labelling, including terms such as "crippled", "disabled" and "epileptic".

In neurology, stigma primarily refers to a mark or characteristic indicative of a history of neurological disorder or condition and the consequent physical or mental abnormality. For most chronic neurological disorders, the stigma is associated with the disability rather than the disorder per se. Important exceptions are epilepsy and dementia: stigma plays an important role in forming the social prognosis of people with these disorders. The amount of stigma associated with chronic neurological illness is determined by two separate and distinct components: the attribution of responsibility for the stigmatizing illness and the degree to which it creates discomfort in social interactions. An additional perspective is the socially structured one, which indicates that stigma is part of chronic illness because individuals who are chronically ill have less "social value" than healthy individuals. Some additional aspects and dimensions of stigma are given in Box 1.5.

Stigma leads to direct and indirect discriminatory behaviour and factual choices by others that can substantially reduce the opportunities for people who are stigmatized. Whatever the mechanisms involved, stigma is an important public health problem. Stigma increases the toll of illness for many people with brain disorders and their families; it is a cause of disease, as people

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