Dr Benjamin Janaway @drjanaway Psychiatrist, Writer and Science Communicator. Working on a novel. Widely published. Media enquiries via DM. RTs usually endorsements. Future Silver Fox. Jun. 09, 2019 3 min read

A little thread about Stigma and the four key components as proposed by Thornicroft. Stigma can be defined as:

'a mark of disgrace associated with a particular circumstance, quality, or person'

This could be age, race, presence of illness, sex gender or other quality.

The process of stigmatisation is composed of:

1) Labelling: marking personal characteristics that lead to a perception that someone is 'different' to oneself. This could include skin colour or religious background. Within my work it relates to presence or fear of a diagnosis.

2) Stereotyping: linking behaviour with the label. This is something we all see daily and can be either helpful, destructive or neutral in a general sense, but will not extend to an individual. For example: all doctors are good communicators. All republicans are christian.

3) Separation: The combination of the above (and below,) leads to the idea that the group presupposed to represent the qualities and behaviours of the targetted are actively viewed as 'outside' of normal society, which tends to be negatively skewed.

4) Status loss: The targetted group are actively discriminated against in a variety of ways. This could include human rights (i.e no right to have a home or work,) financial (less pay,) physical and berbal (actual attacks,) ignorance or dismissal within society.

Why does this matter to me? I am sure that all of you will have, and actively do, engage in addressing stigma every day. There is no way of me saying that one issue is more important than another. But here is something that matters to me that I actually have experience of:

Mental Health stigma is a real problem, but things are improving. Classically, mental health disorder is not well understood by most (and only relatively more through science,) and the main impact it has on society is very negatively viewed. In contrast it is extremely common.

But people are scared to speak out about having a diagnosis. Why? Because, in part, of stigma. People with mental health disorders are often accused of being violent, criminal, immoral or risky to others. This is very rarely the case, and actually less so than the 'well'.

There is also an idea that 'being unwell' is somehow ones own fault, or represents some weakness of character. In older times, psychiatric symptoms were often linked to religious themes, the idea of punishment or unworthiness. We still see the term 'fighting his demons' today.

People are labelled not as 'having an illness', but for the lack of better parlance (and using the extreme,) 'being insane/nuts/crazy.' This idea is present in newspapers and film, and does not represent or define an individual in any meaningful way beyond caricature.

This caricature, ie of the patient with schizophrenia being violent, or the depressed mother harming herself, is a stereotype. Crucially, these stereotypes are usually negative newspapers saying that someone has killed a group of people must have psychosis.

Accurate or not (a journalist cannot diagnose,) it paints a picture of others of the same group (i.e anyone with a mental health disorder,) as kin or similar or responsible or at risk of doing the same. They are viewed differently, not as normal.

As such, they are discriminated against. Examples include patients with depression being called 'lazy' and refused benefits because 'normal people can work, its not a physical illness.' There are numerous other examples.

The solution to this, as with any stigma, is to look and understand where the false information comes from, and to what end it was created. This means taking the time to understand and experience what others in these groups feel and express.

People with mental health disorders are just like you and me in the majority of ways and deserve the same rights. They deserve no more discrimination or less respect than anyone else. So hopefully I have helped you spot discrimination in process and given you something useful.

Sorry for the long thread. Here is some Carl Sagan


You can follow @drjanaway.


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