STIGMA ON PEOPLE WITH MENTAL ILLNESS
Dani Refaat Hamze, Kamal Kashmar
Kharkov State Medical University
Supervisor of studies Bragina K.R.
Many people with serious mental illness are challenged doubly. On one hand, they struggle with the symptoms and disabilities that result from the disease. On the other, they are challenged by the stereotypes and prejudice that result from misconceptions about mental illness. As a result of both, people with mental illness are robbed of the opportunities that define a quality life: good jobs, safe housing, satisfactory health care, and affiliation with a diverse group of people. Although research has gone far to understand the impact of the disease, it has only recently begun to explain stigma in mental illness. Much work yet needs to be done to fully understand the breadth and scope of prejudice against people with mental illness.
Stigma comes from the Greek word stigma, ⌠mark■, which is related to the word stixeiu, i.e., to tattoo, to pick, to puncture. In Latin it became instigare, ⌠to urge■; therefore, stigma also leads to action, and this action is discrimination against the stigmatized person. To discriminate is to make adverse distinctions with regards to those stigmatized, and to make distinctions prejudicial to people different from oneself (in race, in color or sanity). Here is vicious circle is closed, because discrimination leads to prejudice to stigma and stigma to discrimination.
The impact of stigma is twofold, as outlined: public stigma and self-stigma. Public stigma is the reaction that the general population has to people with mental illness. Self-stigma is the prejudice which people with mental illness turn against themselves. Both public and self-stigma may be understood in terms of three components: stereotypes, prejudice, and discrimination.
The fact that most people have knowledge of a set of stereotypes does not imply that they agree with them. For example, many persons can recall stereotypes about different racial groups but do not agree that the stereotypes are valid. People who are prejudiced, on the other hand, endorse these negative stereotypes ("That''s right; all persons with mental illness are violent!") and generate negative emotional reactions as a result ("They all scare me!"). In contrast to stereotypes, which are beliefs, prejudicial attitudes involve an evaluative (generally negative) component. Prejudice also yields emotional responses (e.g., anger or fear) to stigmatized groups.
Prejudice, which is fundamentally a cognitive and affective response, leads to discrimination, the behavioral reaction. Prejudice that yields anger can lead to hostile behavior (e.g., physically harming a minority group). In terms of mental illness, angry prejudice may lead to withholding help or replacing health care with services provided by the criminal justice system. Fear leads to avoidance; e.g., employers do not want persons with mental illness nearby so they do not hire them. Alternatively, prejudice turned inward leads to self-discrimination. Research suggests self-stigma and fear of rejection by others lead many persons to not pursuing life opportunities for themselves.
Stigma is a very powerful mechanism. A striking aspect of stigma about mental disorders is universal. Stigma has been recognized in mental health care in countries with extensive service and those with limited services. Programmers to fight stigma and discrimination should address the study of local experience in different groups using qualitative and quantitative methods; the interventions should be group specific and the effort at mental health literacy should focus on the understandability of mental phenomena and on the ⌠normalicy■ model rather the deviance model.
