Challenging stigma in mental health

I remember going in the front door and seeing the reception desk on the right, looking to the left and seeing some couches and coffee tables. I remember looking behind me and seeing the door we had just come in through, and asking my mother why I couldn’t see through the frosted glass windows on either side of the door. She said, “Jim, some people don’t like being seen at this kind of doctor.”

source Jim Buchanan on mythoughts62 blog

Jim writes evocatively about the subtle and the not so subtle effects of stigma in mental health.

In Medieval English, stigme  was a "mark made on skin by burning with a hot iron" Branding criminals, runaway slaves, and other 'undesirable' people was a practice dating back to Anglo-Saxon times, hence the modern definition of stigma as a "mark of disgrace." 

​These punishments were not just meant to be painful, they were also placed so that they would be visible to others. The person would be permanently marked out for suspicion and distrust. Thus, you can't talk about stigma, without also talking about shame.

So we can now define a purpose to stigma,

• It makes visible an 'undesirable' behaviour or quality,

• It targets shame at people who have this 'undesirable' behaviour or quality, in order to,

• Exert control over this 'undesirable' group.

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Shame versus Embarrassment

Shame and embarrassment are two similar emotions with a very important difference. We become embarrassed over something we have done, where as we feel shame over something we are.

Shame is a much deeper and more destructive emotion. It's an assault on our sense of self. It strikes right at the heart of our identity.

Feeling shame is extremely unpleasant. Just thinking about a situation in which we could feel shame will cause a great deal of anxiety. This fear of shame leads us to try and hide who we are. 

Stigma in a modern society

Unlike our medieval ancestors we no longer brand people with hot irons. Our modern equivalent is labelling, 

• We make it visible by giving it a name, such as "mad," "looney," or "crazy." 

• We target shame, by attaching undesirable qualities. Mental health is often viewed as a personal defect or weakness, "a stain on your character." It's also associated with a suspicion that people with mental health problems are dangerous and/or violent. In truth, they are neither weak nor dangerous.

• We exert control by creating institutions and devising 'treatments'. 

On the last point, there has been a reduction in the amount of stigma associated with mental health, and you can see this in the way that services are provided. 

Many of the large institutions, which were once tucked away out of sight, have been replaced with smaller institutions located within local communities. If you have a mental health problem you will in all probability be treated by your GP in your local surgery, than be seen by a psychiatrist at a remote institution. 

The kind of treatments have also shifted. There has been a general shift away from life altering and intrusive treatments to ones that aim to minimise side effects. 

Although treatments have arguable got better, there is still a control element to them, which Thomas Szasz, a leading critic of psychiatry, explains in detail in an interview on www.psychotherapy.net. 

Challenging stigma

Stigma is generally something which is challenged on a societal rather than individual level. It happens when groups of people come together, and present a counter-narrative which challenges dominant assumptions about the stigmatised group.

For example Gay Pride is a movement designed to challenge shame and social stigma directed at lesbian, gay and transgender people. 

Within the mental health arena, challenging stigma has taken the form of organisations such as Mind, which frame their stance as "respect and support" for people with mental health problems, and the growth of bloggers such as Amy's Relief From Anxiety, who writes about her experience of mental health. Other campaigners such as Jim Buchanan writes blogs and runs a Twitter account, @jbuchana, where he posts articles about mental health. 

Creating 'thick' narratives about the lived stories of real people with mental health problems helps to dislodge 'thin' stigmatising narratives that exist around mental health. It creates a 'voice' which can be heard.  
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 Talking about your mental health

For many people this is still difficult, especially if it means telling your employer. While many employers are understanding, not all are supportive of their staff who have mental health problems.  Sometimes stigma can come from colleagues, as Jim's account powerfully illustrates. 

Telling people you know on a personal level can also be difficult. Heather's frank account on Time to Change, takes you through the kind of feelings people have talking to others about their mental health, with her experience of telling her boyfriend.

Talking about your own mental health, should be because you want to, and not because you feel an onus to. 

If you are considering telling someone about your mental health, you may find the tips and stories on Time to Change helpful.

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title photo by ​snbboy