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Stigma by Professionals
Doc. Dr. Sci. Slađana Štrkalj Ivezić
Psyciatric Hospital Vrapče
Croatia
Stigma
• Public opinion of mentally ill persons:
– dangerous, irresponsible, not capable for
life decisions, hard to talk to, responsible
for causing the mental illness, non
curable (schizophrenia), weakness of the
character (anxiety disorder and depression)
• Public reaction: lack of empaty
desire for social distance and rejection
Stigma is universal phenomenon
• Stereotyped negative attitudes toward
mentally ill are universal phenomenon
(public, professionals, patients)
• Self-stigmatization means accepting the
negative stereotype of mental illness
Stigma and hospitalization/treatment
Psychiatric Hospital is used to isolate
dangerous people
Psychiatric hospital used repressive
methods
The medical treatment doesn’t cure but
drugs people
Why to talk about Stigma among
Professionals ?
• Experience of mental illness causing low
self-esteem and shame
• Switch from hospital to community
treatment did not influence the selfperception of stigma by the patient
• Patient –therapist relation is healing
relation and should be free of stigma
Why to talk about Stigma by
Professionals in Mental Health?
• Stigma of mental illness is obstacle in the
treatment of mentally ill persons and negatively
influence the outcome
• Stigma increase risk for depression and suicid
• Influence of stigma on persons life is not assesed
regulary so it is not consider in treatment plan
• Treatmen plan for diminishing negative
consequences of stigma is nedeed for patients as
well as professionals
Circulus Viciosus of Stigma
• Stigmatizing attitude are mostly coming
from unconsciousness what is every
important to know for people treating these
patients ( countertransference )
• People easely project fear of madness or
weakness into mentally ill stereotype
(shizofrenia, anxiety, depression)
Pilot research:Patients and their
Experience with Stigma
• Disrespect, ignorance, gossiping, calling names like:
lunatic, madcap, crazy …
• Incapable for job and employment, avoided, isolated from
the community, thrown away as waist, controlled more
than necessary for their benefit, considered dangerous,
environment felt pity for them
• With no reason they were treated with doubt, they
experienced lack of understanding for their problem in
their environment, there was lack of empathy for them ,
they were treated as non curable and lost cases
From whom they experienced
inappropriate reactions?
• Family, friends, neighbors, at the working place,
physicians, psychiatrists, nurses and paramedics
staff
• Psychiatrists were not taking them serious, there
was a lack of communication with psychiatrists
who were imposing to the patients their own
personal values as proper ones and haven’t give
them enough information on their illness.
Ethic Guidelines: Madrid
Declaration
• Patient is a partner in treatment
• support autonomy , trust, respect,
agreement, right to be informed, to have
confidential relation and privacy,
• Enforces self-efficiency and targeting own
goals of treatment
• Implements biological, psychological and
social methods of treatment
Stigma and Diagnosis
• Many patients do not know their diagnosis. They read it in
the medical documentation, they talked between
themselves, they are told that they have psychosis or
endogen psychosis without explanation what is it.
• Professionals have fear that diagnoze will stigmatize
patients
• Giving diagnosis to early is unnecessary stigmatization
Stigma and research data
Recovery form psychiatric disorder is
possible, date (outcome and treatment) are
more optimistic than pesimist
DSM IV: schizoprenia as cronic disorder
How come that we used the more
pesimsitic data?
Stigma of non-curability of mental
illness and its chronic character
Dispite the optimistic date from the research, too
often the patient doesn’t experience optimism and
hope from therapist regarding the prognosis of
their illness
Relaps of illness is conected with stoping the
medications and not as an interaction of
biological, psychological and social factors.
Stigma/ Education about Illness
• Patient has a right to have stigma free information
about the illness
• Free of personal standpoints of professions
which are in collision with the researches
Supporting Stigma
• If we are not openly talking about the diagnosis or
if we talk in stigmatizing way, spreading myths
and not facts ( Expl. Schizoprenia is genetic
disorder) , than we support the myth about “the
horrible and incurable decease”.
• Patient has a need for normalization of his
experiences in order to continue with his life
Symptoms of Illness and
Terminology
• Psychotic symptoms should be described in
the same manner as somatic symptoms
• Mad house, lunatic, crazy-nut – these are
terms that will survive in social
environment
• If professional is using these terms she/he
is expressing stigma and lack of respect for
the patient
Unnecessary Paternalism:
incapacity-stigma
• It is considered that the patient will not
understand what is in his/her best interest, so
professionals is “taking over” responsibility for
the patient and knows what’s the best for her/him.
• Not giving the information on diagnosis, treatment
and planning of treatment in agreement with
patient; right on the choice of treatment is often
conected with stigma on incapacity.
Paternalism and incapacity-Stigma
• Unnecessary paternalism contributes the
most to violation of privacy, confidentiality
and repression
• From the ethic point of view one person
gives herself/himself right or abuses his/her
position to bring decisions for another
person.
Guardianship, Stigma and Human
Right
• Guardianship as supstitute for treatment
• Incapacity stigma
• Deprivation of legal capacity and
independent decision-making
• Based on stigma related to incapacity and
inability of recovery
• To much guardianship is stigma relating
Stigma of danger
• Professionalss will asses a psychotic patient as
dangerous and disabled due to stigma
• Admited patient could be placed to the closed
ward even when there are no reasons for doing so
• He/She should give the evedence that he is not
dangerous before he/she will be placed at open
ward
Restriction of Freedom and Stigma
of Being Dangerous
• Restriction of the freedom of movement and using
restrains could be conected with danger-stigma
and disability-stigma and not the outcome of the
real necessity for doing so.
• the precise guidelines are needed regarding the
restriction of movement and usage of restrains.
• Individual assesment of risk
Mistrust and Stigma
• Patient often finds him/herself in a situation that
they have to prove that he/she can be trusted and
that he has to earn credits for “privileges” such as
freedom of movement, right to keep with him
personal belongings, communication with outer
world, over-controlling of the regular intake of
medicines.
• Neglect of rights can be conected with stigma
Stigma of Hospitalization
• Persons treated in psychiatric hospital are
observed as more messed-up and are more
stigmatized.
• Unnecessary hospitalization may burden a
patient with stigma
Anti-stigma Programs for professionals and
antistigma treatment plan
• Stigma is often included in diagnostic procedure
and treatment of psychiatric illness and represents
an obstacle in the treatment
• Interventions of profesionals could be guided by
stigma and they should be more aware about it.
• Stigma operate on uncounsousses level
(countertransference)
• Strategies for minimizing the effects of stigma
shoul be the part of treatmen plan
Patients experience :successful
cooping with stigma
“There are good medications for the
treatment of madness but there are not
medications yet for human stupidity”