The stigmatization of people with psychiatric diagnoses

Stigmatization is a process by means of which a person is credited with a set of characteristics that are considered socially undesirable. That's why it is a process connected with discrimination and social exclusion.

Unfortunately, stigmatization is also a highly frequent process in clinical spaces where mental health professionals carry out their work (and not only in mental health). This has had very negative consequences both for people with a diagnosis and for their families, which is why it is currently a relevant issue and much discussed in different spaces.

In this article we explain what is stigmatization, why does it occur, what consequences has it had and through which proposals it has been tried to mitigate in different contexts.

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Psychosocial stigmatization: from stigma to discrimination

The use of the word "stigma" makes it possible for us to take up the concept of "stigma" and use it as a metaphor in social studies. Stigma in this context refers to

a trait or condition that is attributed to a group of people and that causes negative attitudes or responses to be established.

The application of the term "stigma" in sociology was popularized by Erving Goffman in the 1960s, who would define it as a “deeply discrediting attribute” that is related to a stereotype negative about physical traits, behaviors, ethnic origin or individual conditions understood in terms of danger (e.g. disease, migration, disease, crime).

Thus, stigmatization is the process through which a group acquires a differential trait or an identification "mark", which is valued by other groups as the outstanding trait, which has as a consequence different forms of discrimination towards that group "marked".

The reason why stigmatization causes discrimination is because it is a process in which our attitudes are put into play, understood as a phenomenon of cognitive, affective and behavioral components; Despite being different from each other, they are strongly connected.

It is these attitudes that help us to classify or categorize what surrounds us in terms of "good" or "bad", "Undesirable" or "desirable", "adequate" or "inappropriate", which often also translates into "normal-abnormal", "Healthy-sick", etc.

These categories, being loaded with affective and behavioral components, allow us to establish parameters in interpersonal relationships. For example, that we avoid approaching what we have categorized as "undesirable", and so on.

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Who does it usually affect?

Stigmatization is not a phenomenon that only affects people with a diagnosis of mental disorder. It can affect a large number of people and for different reasons. Generally speaking of "vulnerable" collectives or groups to refer to people who are systematically exposed to being stigmatized and experiencing discrimination.

The “systematically” thing is important because far from being vulnerable per se, these are people who are being constantly vulnerable as a consequence of an organization and social structures determined. People who are constantly exposed to situations of exclusion, and who paradoxically have less chance of being protected.

In this sense, discrimination is not only an individual phenomenon (which determines how we relate to a specific person), but a structural one, which it is also found in policies, in manuals, in how public spaces are made up, in the other spheres of social life.

Thus, for example, there may be stigma, negative attitudes towards racialized people, towards people with disabilities, towards people in a situation of poverty, towards non-heterosexual people, towards people with different medical diagnoses, to mention only some.

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Danger as a stigma in "mental disorders"

The social imaginary of dangerousness in relation to "madness" it has evolved significantly over time. This evolution has been reinforced to a large extent by the care structures that still exist in many places.

For example, the mental institutions on the outskirts of cities, which confirm the myth of dangerousness in the social imaginary; as well as with coercive practices without informed consent, or with forced consent.

Danger and violence have become stigmas because they make that we recognize them as the outstanding features of the person who has the diagnosis, with which, the logical consequence is automatic and generalized exclusion, that is, it occurs even if the person has not committed violent acts.

Fear and exclusion: some consequences of this social phenomenon

If danger is what we conjure up most quickly when we think of "disorders" or "mental illness," then the The closest logical reaction is to establish distance, because with danger our alarms are activated and with this our fears.

Sometimes they are activated so automatically and involuntarily that it does not matter if they are justified fears or not (many times the people who feel the most "fear" are those who have never lived with someone who has a diagnosis psychiatric). The also logical consequence of all this is that people with the diagnosis are exposed to constant rejection and exclusion.

And unfortunately, mental health professionals are often not exempt from the above. In fact, in an attempt to understand this phenomenon and counteract it, in the last decades a huge amount of scientific studies have been carried out. that analyze the stigmas of health professionals towards service users, and how this hinders care and creates more problems than solutions.

Another consequence of stigmatization related to psychiatric diagnoses is that, being understood as something negative, dangerous and synonymous with chronic disease, a source of constant discomfort, people who may need mental health care are limited or stopped in seeking that care.

In other words, stigmatization causes fear and rejection not only towards people who have the diagnosis, but also towards going to the mental health services, with which, the discomforts intensify, the suffering is not accompanied, the behaviors become more problematic, etc.

Alternatives and resistances

Fortunately, given the unpleasant panorama described above, the specific case of people who have a diagnosis of mental disorder has been proposed as a topic that deserves special attention since the people with diagnosis and their families have spoken out against stigma and discrimination.

The latter has recently been supported by many mental health professionals, as well as by many public policies and international organizations. In fact, on October 10 of each year has been established by the UN as the International Day of Mental Health.

Likewise, on different dates and places around the world, people with a diagnosis have claimed recognition of the diversity of bodies and experiences, as well as the need to continue fighting against stigma in mental health and seek, above all, respect for the Rights.

Bibliographic references:

• López, M., Laviana, M., Fernández, L. et al. (2008). The fight against stigma and discrimination in mental health. A complex strategy based on the information available. Journal of the Spanish Association of Neuropsychiatry, 28 (101): 43-83
• Muñoz, A., and Uriarte, J. (2006). Stigma and mental illness. North of Mental Health, (26): 49-59.