What is Stigma?

Posted on May 6, 2015 in Accountability Bigots Stigma

The Devil is not the Prince of Matter; the Devil is the arrogance of spirit, faith without smile, truth that is never seized by doubt. The Devil is grim because he knows where he is going, and, in moving, he always returns whence he came.

Umberto Eco

Let me start out by stating that I do not believe in “self-stigma”: I believe in guilt, shame, and despair but labeling these as “self-stigma” cheapens the meaning of stigma. There may or may not be a motive behind the invention of this term, but the result is that it implies that the people who are the principal victims of stigma are in a conspiracy — or confederacy if you prefer — against themselves.

To further explain what stigma is and isn’t, let me use a parallel that was laid out to me by a friend who was explaining certain terms used to describe race relations. White people often accuse African Americans of being racist, too. African Americans dispute this. My friend — an African American woman — acknowledged that African Americans often hold deeply seated racial and ethnic prejudices. But this isn’t racism because racism requires another element: power. White Americans are in a position to make their racial prejudices inflict suffering on the lives of African Americans. Witness, for example, the unwritten DWB (“Driving While Black”) policies of certain police departments including “America’s safest city” (for white people) Irvine, California. The policy is enforced when a black person drives through the city of Irvine. Because of their skin color, they are assumed to be up to no good and pulled over for some minor infraction. The result is that they are made to feel unwelcome in this college town. That is a ~comparatively~ “mild” example, but American history is rife with other exemplars up to the present day.

Stigma isn’t merely prejudice against or fear of the mentally ill. Reducing it to such fails to describe its harm. It is the systematic control of or discrimination against those of us who live with organic brain dysfunctions. It has many roots and, consequently, many results. We fight it not only in our opponents, but in some of those who profess that they are helping us.

When someone says “I am doing this for your own good” without getting our input into what we think might be good for us, they are enforcing a prejudice against us, namely that we can’t see what is good for us. (It usually means that the person making the statement is merely finding a channel for anger.) The standard public reaction to incidents where a mentally ill person is implicated in a crime is to call for the adoption of measures that will either impose more control on us or make us a target for violence: put “them” all in mental institutions, compel “them” to take medication, “register” them, buy guns to defend yourself from “them”. My fellow sufferers of mental illness, we are “them”. These proposals are all based on ignorance of actual statistics, panic, and dehumanization. They all seek to deny us choice or safety based on the simple fact that we live with conditions such as bipolar disorder, schizophrenia, depression, autism, to name a few.

Russophobia (fear of the mentally ill) drives stigma, but it is not stigma. Someone can believe all kinds of terrible things about you because you are mentally ill, but if they don’t try to cage you or refuse to listen to you or deny you opportunities because you are mentally ill, it is — as painful as it feels — only bigotry. Stigma occurs when someone is moved to act on those prejudices or uses them to attempt to persuade others to do so. The employer who looks for ways to discharge a depressed worker is the chief example we think of most often when we use the term, but there are others. Less obvious is the person who presses for a “reform” such as forced medication or mental hospitals because “they” are unable to care for themselves or make decisions for themselves. Mind you, I believe that there are some severely afflicted people who should be the subject of these policies, but they are rare. I doubt that the people who have pressed for these have ever gone into the streets or prisons where the destitute mentally ill live and asked them how they could be helped. These ideas are developed by people who are privileged not to be in this position (including some people who live with mental illness) or who arrogate unto themselves status based on the fact that they, themselves, are not mentally ill — or at least not diagnosed as such. It is from the powerful that these suggestions come; they prey on those who are powerless. No one bothers to ask the homeless or the imprisoned what would help them. When you press for reforms without this knowledge, you engage in stigma.

Stigma has other faces. Psychiatrists who label patients as “noncompliant” or ignore their concerns about side effects engage in stigmatizing behavior that denies patients a say in their own treatment. Therapists who take the time out to berate patients because they refer to themselves as “bipolar” — oh we mustn’t identify with the disease! — are treating us as little children who don’t know their grammar. The political extremists who describe psychiatrists as the “new policemen” and urge their followers not to seek out their services are taking their prejudices to the next level. Some religions and political movements seek to keep us sick so we can be manipulated. All of these are stigmatizing behaviors that should be addressed in more depth by those advocating for the mentally ill.

One crusade that strives to overcome stigma is the recovery movement. It is founded on the principle that the people who know best about mental illness are the mentally ill themselves, so it seeks their guidance on how to proceed. “The mentally ill are able” is one refrain. “They have a right to be a partner in their treatment” is another. All of these grant power and equality to patients. If I have any fault with the recoverists, it is that they are primarily a middle and upper class movement that has not yet reached out to the working and homeless classes; but, they are on the right track in many ways.

Avoiding stigma requires that its perpetrators grant equality to people living with organic brain dysfunctions. It insists that they listen and engage the mentally ill as partners in their own care. Boundaries must be drawn, it is true, but they cannot be one-sided: just as a parent may require no drugs or alcohol in her/his house, the patient may expect privacy and freedom from helicopter parenting. Psychiatrists need to take the time to explain why they are prescribing certain drugs and heed patients’ desires when the side effects are too much for them. Therapists are not policemen, but helpers in the elimination of the bad habits we all acquire while attempting to cope with our disease. Advocates need to find out what patients want and need without presuming that “they know better”. Voters must vote for our interests, not their fears. And politicians need to listen to the patients over their caregivers and psychiatrists when developing new legislation purporting to help them. No one will blame us for bringing on the prejudices against us, but accountability will rest on those who hold them. All these avenues lead us away from the morass in which stigma strands us. It directs us towards a more vibrant and free life, one where we are not constrained by the definitions of others.