The social stigma associated with mental disorders and psychological problems is long-standing. In fact, the very word “stigma” has negative connotations and comes from ancient Greece, where a stigma was a brand with which slaves or criminals were branded.
For centuries, society hasn't treated people with depression, autism, schizophrenia, or other mental illnesses much better. In the Middle Ages, mental illness was considered a divine punishment. The sick were thought to be possessed by the devil, and many were burned at the stake or thrown into the first asylums, where they were chained to walls or their beds.
During the Enlightenment the mentally ill were finally released from their chains and institutions were created to help them, although stigma and discrimination reached an unfortunate peak during the Nazi period in Germany, when hundreds of thousands of mentally ill were killed or sterilized. .
Today we have not yet completely freed ourselves from the stigma that accompanies mental illness. Many people continue to perceive emotional problems as a sign of weakness and a cause for shame. In fact, this stigma not only affects people with the disorder but also extends to their family members, closest friends, and even workers who help them.
The stigma of courtesy, a widespread social rejection
Even family, friends and close people can suffer the so-called "stigma of courtesy". It is about the rejection and social discredit associated with people who are in a relationship with those who are "marked". In practice, the stigma of the person affected by the mental disorder carries over to those who have family or professional relationships with them.
Family stigma is the most common and usually affects the parents, siblings, spouses, children, and other relatives of the person suffering from the disorder. But it is not the only one. A study conducted at the University of Victoria revealed that the stigma of association also extends to those who work with socially marginalized and excluded groups. The stigma of courtesy has a strong impact on these people as well. They recognize that their friends and family do not support or understand their social work and that professionals from other institutions and people in general treat them badly. This obviously ends up affecting their health and is one of the main reasons that leads them to quit their jobs.
Narratives of guilt, shame and contamination are the main factors that give rise to the stigma of courtesy. Narratives of guilt suggest that those who are connected in some way to stigmatized people are guilty or responsible for the negative social implications of the stigma. Instead, the contamination narratives suggest that those people are likely to have similar values, attributes, or behaviors. Obviously these are baseless stereotypes that have been transmitted over time and that we have not been able to completely eradicate from our society.
The long shadow of stigma by association and the damage it causes
Family members subject to the stigma of courtesy feel shame and guilt. Often, in fact, they blame themselves because they think they have contributed in some way to the family member's illness. They also experience profound emotional distress, increased stress levels, depression, and social isolation.
Of course, the weight of the stigma of courtesy is felt. Researchers from the Columbia University they interviewed 156 parents and partners of psychiatric patients who were admitted for the first time and found that half had tried to hide the problem from others. The reason? They experienced firsthand the misunderstanding and social rejection.
A particularly shocking study conducted at Lund University in which 162 family members of patients admitted to psychiatric wards were interviewed after acute episodes revealed that most felt the long tentacles of the stigma of courtesy. Furthermore, 18% of relatives acknowledged that on some occasions they thought the patient would be better off dead, that it would be better if he was never born or that they never met him. 10% of those relatives also had suicidal thoughts.
The quality of the relationship with the affected person also suffers from this extended stigma. A series of studies conducted at the University of South Florida revealed that courtesy stigma affects parents of children with disabilities by inhibiting social interactions and giving them a negative aura. These parents perceive the judgment and blame of others regarding their child's disability, behavior or care. And Social perception ends up exerting negative pressure on the relationship between stigmatized people and their families. The result? The social support that people with a mental disorder receive is reduced.
How to avoid the stigma associated with mental disorders?
Sociologist Erwin Goffman, who laid the foundation for stigma research, wrote that "There is no country, society or culture in which people with mental illnesses have the same social value as people without mental illnesses". It was then the year 1963. Today we are in 2021 and little has changed in the popular imagination.
Studies have shown that the best way to get rid of those stereotypes, which do so much damage, is not to launch empty campaigns that only serve to fatten the pockets of advertising agencies and clean consciences, but that there is a less spectacular and much more effective way. to reduce the stigma of courtesy: contact with those affected.
It is simply a matter of broadening the gaze. If we take into account that about 50% of the population will experience an episode related to a mental disorder during their life - whether it is anxiety or depression - it is very likely that we know someone who suffers or has suffered from an emotional problem. If we are aware of the existence of these people in our life and the problems they go through, we will have a more realistic picture of mental disorders that helps us rethink our stereotypes to develop a more open, tolerant and understanding attitude.
Sources:
Rössler, W. (2016) The stigma of mental disorders. A millennia ‐ long history of social exclusion and prejudices. EMBO Rep; 17 (9): 1250-1253.
Phillips, R. & Benoit, C. (2013) Exploring Stigma by Association among Front-Line Care Providers Serving Sex Workers. Health Policy; 9 (SP): 139–151.
Corrigan, PW et. Al. (2004) Structural levels of mental illness stigma and discrimination. Schizophr Bull; 30 (3): 481-491.
Green, SE (2004) The impact of stigma on maternal attitudes toward placement of children with disabilities in residential care facilities. Soc Sci Med; 59 (4): 799-812.
Green, SE (2003) "What do you mean 'what's wrong with her?'": Stigma and the lives of families of children with disabilities. Soc Sci Med; 57 (8): 1361-1374.
Ostman, M. & Kjellin, L. (2002) Stigma by association: psychological factors in relatives of people with mental illness. Br J Psychiatry; 181:494-498.
Phelan, JC et. Al. (1998) Psychiatric illness and family stigma. Schizophr Bull; 24 (1): 115-126.
Admission Stigma of courtesy, when social rejection extends to the family of people with mental disorders was published first in Corner of Psychology.
