The stigma linked to 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 mark with which slaves or criminals were marked.
For centuries, society didn’t treat people with depression, autism, schizophrenia, or other mental illnesses much better. In the Middle Ages, mental illness was considered a punishment from God. The sick were thought to be possessed by the devil and many were burned at the stake or thrown into the first madhouses, where they were chained to the walls or to their beds.
During the Illuminism the mentally ill were finally freed from their chains and institutions were established to help them, although stigmatization 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 shed the stigma that accompanies mental illness. Many people continue to perceive emotional problems as a sign of weakness and cause for shame. In fact, this stigma not only covers people with the disorder, but also extends to their family members, closest friends and even the workers who help them.
The Courtesy Stigma, a widespread social rejection
Family, friends and close people can also suffer what is known as “courtesy stigma”. It is about the rejection and social discrediting associated with people who have a relationship with those who are “marked.” In practice, the stigma of the person affected by the mental disorder is transferred 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 who suffers from the disorder. However, it is not the only one. A study conducted at the University of Victoria revealed that stigma by association also extends to those who work with socially marginalized and excluded groups. In these people, the courtesy stigma also has a strong impact. 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. That, of course, ends up affecting their health and is one of the main reasons that leads them to leave their job.
Narratives of guilt, shame and contamination are the main factors that give rise to stigma by association. Guilt narratives suggest that those who are linked in some way to stigmatized people are guilty of or responsible for the negative social implications of stigma. Instead, contamination narratives suggest that those people are likely to have similar values, attributes, or behaviors. Obviously, these are stereotypes without any foundation that have been transmitted over time and that we have not managed to completely eradicate from our society.
The long shadow of stigma by association and the damage it causes
Family members subjected to the courtesy stigma experience great shame and guilt. In fact, they often blame themselves because they think they have contributed in some way to the family member’s illness. They also often experience deep emotional distress, increased levels of stress, depression, and social isolation.
Certainly, the weight of stigma by association is heavy. Researchers from Columbia University 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 felt incomprehension and social rejection firsthand.
A particularly shocking study conducted at Lund University in which 162 family members of patients admitted to psychiatric wards after acute episodes were interviewed, revealed that most felt the long tentacles of the courtesy stigma. In addition, 18% of the relatives acknowledged that on some occasions they thought that the patient would be better off dead, that it would have been better if he had never been born or that they had never met him. 10% of those relatives had also had suicidal ideas.
The quality of the relationship with the affected person also suffers as a result of this widespread stigma. A series of studies conducted at the University of South Florida revealed that stigma by association affects parents of children with disabilities by inhibiting social interactions and giving them a negative halo. These parents perceive the judgment and guilt 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 family members. The result? The social support that the person affected by a mental disorder receives is reduced.
How to avoid the stigma associated with mental disorders?
Sociologist Erwin Goffman, who laid the groundwork for stigma research, wrote that “There is no country, society or culture where people with mental illness have the same social value as people without mental illness.” 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 that cause so much damage is not to launch empty campaigns that only serve to fatten the pockets of advertising agencies and clear consciences, but that there is a less spectacular way but much more effective for reducing the stigma by association: the contact with affected people.
It is simply a matter of broadening our gaze. If we take into account that around 50% of the population will experience an episode linked to a mental disorder throughout their life – whether it be 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 lives and the problems they go through, we will have a more realistic image 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. Healthc Policy; 9(SP): 139–151.
Corrigan, P. W. et. Al. (2004) Structural levels of mental illness stigma and discrimination. Schizophr Bull; 30(3): 481-491.
Green, S. E. (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, S. E. (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, J. C. et. Al. (1998) Psychiatric illness and family stigma. Schizophr Bull; 24(1):115-126.
