Dave's Progress. Chapter 49: Anticipated or Actual: How Real is Stigma?

I have been thinking recently about how the stigma surrounding mental ill health directly affects me, and I have come to the conclusion that, despite suffering certain unfairness early on in my illness, from friends, family and I have to say, mental health services themselves, the discrimination I now face seems less "real", in that it is anticipated, rather than actual. In fact, it could be that it is "all in my mind" sometimes.
If I use an example to explain. Often, when I go to get my hair cut, the barber will inevitably engage me in conversation and ask, "not at work today,then?" At the sound of this question I often recoil in horror, because I often think it will lead to me having to explain why I do not do full-time paid work and, as an inevitable consequence of that, revealing the fact that I have experience of mental ill health. While I do not wish to censor myself or be dishonest, I feel I am faced with a difficult choice. Do I tell the truth and just hope that the barber has an enlightened attitude, or do I lie because I expect him, in other words I "anticipate" him, to give a negative response. Indeed, I have read that the anticipation of stigma can be as big a problem as "actual" discrimination, in that it affects the behaviour of those with mental illness and can be seen as a form of "self-stigma".
However, when one looks at the statistics about discrimination, it is not surprising that many are affected by "anticipated" stigma. Just to quote a few facts from a survey by the Mental Health Foundation in 2000 which questioned people with experience of mental illness:
- over half had experienced some form of unfair treatment from their families- this ranged from lack of understanding to outright hostility, name calling and enforced isolation.
- 41% of people with experience of mental illness had faced harassment in the community- almost three times the harassment faced by the general public.
- 6 out of 10 people thought they had been turned down for a job because of their experience of mental distress.
- 44% had experienced discrimination from their GPs.
- 1 in 4 had been turned down for financial services, including insurance policies, bank loans and building society loans.
- In a 2000 Mind survey, 75% of professionals working within the criminal justice system felt that people with experience of mental illness, who were victims of crime, got a rough deal from the system.
- 1/4 of the public believed that anyone with a history of mental ill health should be excluded from public office (bang goes Winston Churchill, then!)
- In terms of the press, 75% of tabloid editorials about mental ill health linked it to violence.
Reading this, and being aware of such discrimination, it is hardly surprising that many "anticipate" stigma in some form, and so it seems those who experience mental ill health can get stuck in a self-justifying negative loop, where isolation can appear like a good idea in the face of all this unfairness, reinforcing stigma, without necessarily having "actual" experience or evidence of it.
Indeed, on the other hand, I have experienced the other side of public attitudes. When we actually got out amongst the public at the Time to Change Roadshow, I was truly heartened by the mostly positive, sympathetic and fairly enlightened views of most of the people we met that day. OK, some still seemed to remain ignorant, but the overall impression I got was of a genuine understanding for those who experience mental ill health. Instead of sitting in the office, pouring over the negative statistics related to stigma, the public had actually been engaged and found to be largely understanding.
And this would appear to be at the crux of the matter. One of the only evidentially proven ways of battling stigma is to get people together, to mix those who have experience of mental ill health with those who don't, thereby confounding some of the stereotypes and myths which surround mental illness. So it would appear that the either self-imposed or imposed social isolation
caused by both "anticipated" and "actual" stigma, works against this route to equality and further integration. All too often, it appears to me, that those with experience of mental ill health form sort of ghettos, where it is, more often than not, rare to mix with those who do not have experience of mental illness. OK, so the machinations of stigma, which we cannot deny are real, would seem to prevent this sort of mixing, but the spectre of "anticipation" would seem to complicate the matter even further.
Indeed, I know of one person with mental illness who often writes to our local paper who complained that it would be "cruel" to return people with mental illness to society, until society itself becomes less "cruel". His experience of being taunted and harassed by youths in his local area has led him to this depressing conclusion.
So, perhaps the burden of responsibility lies with the public, the media, employers, the law and other areas of society to prove that there is genuine change out there and that not all are as prejudiced as the statistics would seem to make out. Indeed, prove that it is perhaps all, just a little bit, "in the mind". Only then will the mentally unwell perhaps begin to put their heads above the parapet and mix, openly, with mainstream society.
That's all for now from your normal, average paranoid and delusional man.


Hope Ambassador said…
Hi Dave,
Very thought provoking post; thank you for the data from Mental Health 2000 about people's experience with stigma in their life.

In some ways, I have suffered more from anticipated stigma. I was quite conflicted about telling my current employers (I work in an addiction facility where my employer is a brillian guy who is also in recovery from addiction). When I did finally disclose, after 2 1/2 years of working there, I was thoroughly supported and it was a non-issue, really.

I do think, though, that this was partly because I had proven myself to be responsible and an excellent employee over the past 2 1/2 years.

I think, also,that people who are doing well and are accomplished need to come out with their mental illness so that people who are struggling have role models. And, I think this may help expand the boundaries of society's expectations for people with mental health challenges.

Thanks for blogging! I look forward to reading more of your insights!
David said…
Dear Sonya,
Thankyou for your comment.
It may well be that, if you can prove yourself, mental illness, like race, sexuality or gender, should become a "non-issue". I know I am treated fairly and my diagnosis is not an issue with the people I do voluntary work for. In fact, in many instances it is a bonus and helps me in my work. But, again, this is a mental health charity, where, perhaps, my illness is more understood and accepted.
In the recent "Time to Change" campaign in the UK, which seeks to end discrimination against those with mental ill health, various celebrities have "come out" about their mental illnesses. So there are role models out there.
Again, thanks for commenting and I hope you get the time to mull over more of my blog. I would be very interested to know what you think.
Yours with Very Best Wishes,
Pink Girl said…
Hi David,
I too often self-stigmatise, although I am trying not to. In the pub on Friday night, after explaining once again that no, I really did not want a drink, diet coke is fine with me, we got onto the subject of mental health. After listening to people's opinions for half an hour, I finally piped up that I too have a mental health illness, and to my surprise everyone was very supportive, open and asked me questions about it, rather than brushing it aside. It just goes to show how sometimes people can really surprise you.
L x
David said…
Dear Laura,
I totally agree and it was truly heartening to see that many have open and understanding attitudes at the Time to Change Roadshow. Although we all know that stigma is "real", it is always good to get positive responses.
Thanks for your comment and good luck with the whole drinking thing.
Yours with Very Best Wishes,

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