by Erving Goffman, Jason Aronson [publishers], New York, New York, 1974 (1963)
"Stigma refers to a cluster of negative attitudes and beliefs that motivate the general public to fear, reject, avoid, and discriminate against people with mental illnesses. Stigma is widespread in the United States and other Western nations. Stigma leads others to avoid living, socializing, or working with, renting to, or employing people with mental disorders - especially severe disorders, such as schizophrenia. It leads to low self-esteem, isolation, and hopelessness. It deters the public from seeking and wanting to pay for care. Responding to stigma, people with mental health problems internalize public attitudes and become so embarrassed or ashamed that they often conceal symptoms and fail to seek treatment." -- Executive Summary of New Freedom Mental Health Commission, Achieving the Promise: Transforming Mental Health Care in America," lined/'versified' text for which may be found at a recent work of my construction on Google Base (link here) -- with the help of Notepad + + and Mr. Alan Reed's "Simple Concordance Program" freeware; this quotation is at paragraph-number 353.
Abundantly, for the people who are mentally ill, stigmatization is a living, real problem. We must stay out of "trouble"-- meaning concretely the mental hospitals, but also too frequently jails and homelessness-on-the-streets; on the other hand we are systematically given "trouble- that-betroubles-us-the-more"-- as when we are discriminated against in non-psychiatric-medical-treatment, loans, housing rental/mortgage, employment, even at known times in voting and jury-duty. This social force has not gone unnoticed in social-science literature of late, and has become a buzz-word-sanguine in psychiatric literature. [See, for example, "Stigma in Psychiatry," by Alison J. Gray, Journal of the Royal Society of Medicine 95:72-76, February 2002 ; ALSO " Usages épistémiques et sociaux de la stigmatisation. Pour une approche philosophique du concept de stigmatisation,"
Marie-Joseph Bertini, L'Information Psychiatrique 83(8), 2007 (English translation of abstract available at this link) ; ALSO "Stigma ! Vaincre les discriminations en santé mentale," by
Jean-Luc Roelandt, Aude Caria, L'Information Psychiatrique (translated English abstract at this link.) ] In this entry I shall hearken back to what may be the first seminal literature on the subject of stigmatization-- essentially as it is defined in the first paragraph, above-- in the work Stigma: Notes on the Management of Spoiled Identity by Erving Goffman, Jason Aronson [press], New York, New York, 1974 (1963.)
Prior to the advent of this last-mentioned work, to be reviewed below, the word "stigma" largely had a usage with theological overtones. We know of the "stigmata" (the plural of "stigma" from the Greek) of the Five Wounds of Jesus and reputedly of saints, but even here there was some sense too that a stigma was an emotional scar/mark that adversely affected one's social identity.
It was Goffman, though, who seemingly brought to front-and-center this terminology for use with all people who bear "marks"-- visible and invisible which have the effect of discrediting them in their communities/society (page 4.) Here Goffman does not restrict stigmatization to mental patients (although they are here acknowledged to suffer from stigmas) but of the general class of discredited folk: Goffman in a word strives properly for a truly sociological view of stigmatization as a social process (pages 146-147.)
However, Goffman has much to say that is 100% germane to the condition of mental health consumers here-and-now, and from its publication mental health advocates of all types have proffered this as being 'about persons with mental illness.' Very briefly, I shall outline some of these contributions to uplift for the mentally ill humanity, then discuss their implications for our lot.
Goffman says that the principal [existential] issue with the stigmatized is one of "acceptance" (page 8.) The stigmatized person's main objective is to be acknowledged as essentially normal (page 20) in which "... [o]ne phase of this socialization process is that through which the stigmatized person learns and incorporates the standpoint of the normal, acquiring thereby the identity beliefs of the wider society and a general idea of what it would be like to possess a particular stigma" ( page 32.) In other words-- stigmatized persons-- including people with mental illness -- tend in time to take on the prevailing views of society about themselves and their general and stigmatizing condition(s).
This trend has untoward consequences. One possibility is to attempt to "pass" as having no stigma, or to hide its indications [ "reverse passing"]-- "[t]he management of undisclosed discrediting" (page 42 and sequence.) This passing-tendency is well-known among the persons with mental disability-- we are told explicitly and implicitly "not to talk about your old psychiatry." It is easier to "pass" with a psychiatric condition than might be in other social situations-- among black people and Asians for example this is by no means easy to do-- although plastic/cosmetic surgeons do busy themselves frequently with requests to make clients "pass for white." [ Regard this phenomenon in China, Korea, and Japan; observe also the 'whiteness' of Michael Jackson on mag covers.] The mentally ill person may often easily "pass for straight" by assuming a normal lifestyle and NEVER EVER HINTING that 'abnormal' psychology is afoot somewhere about.
Goffman speaks of another trend which is telling to me: the movement to "come out of the closet," and do supremely-competent works, publish, produce "be fruitful and multiply" this surfeit of competence. We have long known of the"special Olympics" generically-speaking-- those who by excellence prove themselves to a hesitant world, and by universal acclaimation win the "laurel wreath" of societal victory-- simple appreciation for "being great." Of very late, so recently out of life-incarceration in the public asylum, we mental health consumers have also taken this route. In my experience, people like Kay Redfield Jamison (a psychologist with bipolar disorder and expert on bipolar in her own right), Nobel-prizewinner John Nash (a person who has "gone public" as having schizophrenia), Ernest Hemingway ( a great writer who had bipolar disorder); and of late mention is made that Abe Lincoln and Winston Churchill suffered from major depression; theologically, it is even argued that Biblical prophet Ezekiel had major mental illness [perhaps associated in my estimate with temporal lobe epilepsy-- see analysis in Peake's Commentary on the Bible, Routledge, London, United Kingdom,1997 (1962), page 569.] Coupled with this tendency is a trend toward specialty -- and interesting-- publications indicative of transcending stigmatization (Goffman, page 25.) In the budding mental health consumer movement, there is a decided thrust to "go public" by publishing openly the haps/mishaps befalling the persons who are mentally ill, showing up now on the "Web" in abundance.
It must be remembered that Goffman is a sociologist: he intends here to describe stigmatization from a detached, objective-as-he-can-get perspective. At one point toward the end of the work, he even goes so far as to say that stigmatization may have a socially useful function, that is, for controlling "deviance" (page 138), but almost immediately prior he DOES accede that
"Tension management and information management have been stressed-- how the stigmatized individual can present to others a precarious self, subject to abuse and discrediting. But to leave it at this creates a biased perspective, imputing a solid reality to that which is much shakier than that. The stigmatized and the normal are part of each other; if one can prove vulnerable, it must be expected that the other can, too. For in imputing identities to individuals, discreditable or not, the wider social settings and its inhabitants have in a way compromised themselves; they have set themselves up to be proven the fool" (page 135.)
This truth is just beginning to "register" in the American psyche, concomitant with the emerging consciousness of persons with mental illness that they are-- as Jesse Jackson utters every Project PUSH meeting-- "I AM SOMEBODY." Clearly there was a time, not long ago at all in history, when the opposite was shoved on folk with mental illness: the message that we are second-third-fourth-fifth-sixth-seventh-eighth-ninth-tenth-eleventh-twelfth-thirteenth-class citizens-- if even that.
Therefore for mental health consumers in the 21st century, Goffman's message rings with particular relevance. What is to be gained-- except to flatter social arses and boors-- our silence and our "passing with invisible disability" when we can be proven able, enabled ?
The road for us-- the peers who have suffered from the stigma of mental illness--need now to become lionized, courageous, resourceful. "Merely following doctor's orders" on the backwards and bedlam-barracks is not the order of the day. Bravely, and responsibly we need face our "New Freedom" and banish to the shadows every vestige of the sadisms-- and its obverse-- the patronizations-- which have heretofore held us captive. We can do this in partnership with the possessed of "wiseness" -- outsiders who understand but do not experience our condition except vicariously(Goffman, page 29): with this confederation we certainly will WIN.
Therefore let us-- the stigmatized and all wise ones-- down this promising path. We cannot but succeed. The way is easy for we have been accustomed to keeping-balance under conditions of imputed failure. I say again, WE SHALL WIN, WE SHALL WIN, WE SHALL WIN!!!
-- Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV-TR # 296.44
Telephone: 1 (502) 561-5419
Email: freethink@insightbb.com
posted by Louisville Hermitage @ 5:16 PM
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