Solving for stigma in mental health care

Abstract

When we face an equation with an unknown variable, we ‘solve for x’, using methods that allow us to isolate and identify the unknown. Stigma is a known variable in health care equations, but remains impactful in a variety of ways that are not fully mapped or understood. In other words, stigma is a known unknown: it presents potential obstacles to the delivery of effective health care, but what kind of obstacles, of what size and significance, and for whom is often unclear. This paper investigates what Erving Goffman called the ‘stigma situation’: ‘the situation of the individual who is disqualified from full social acceptance.’ The core argument is that to successfully incorporate the experiential knowledge of mental health care service users, we must first solve for stigma—that is, we must determine the nature and scope of its significance, and then mitigate its effects. The present paper begins by demonstrating that stigma in mental health care remains an obstacle worthy of sustained attention. It then discusses typical methods taken in efforts to destigmatize mental illness, and suggests that additional work is needed in the clinical context of mental health care. The pervasiveness and complexity of stigma requires diligence in clinical settings to integrate the experience of mental health care service users and work towards an adequate model of recovery.

Philosophy and the clinic: Stigma, respect and shame

“…These important themes are developed further in this edition, which includes a special section on stigma, shame and respect. This section includes papers aimed at identifying, understanding and addressing discrimination in clinical settings 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 and on respect and shame in healthcare and bioethics. 20 , 21 , 22 …”

“…The concluding section of the edition focuses on the closely related concepts of stigma, shame and respect and how these have an impact on health and clinical practice. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 …”

“…The hope was that this focus would speak directly to health professionals, so as to help them understand these dynamics in a way that might prove useful in their own practice, and in the hope that patients’ lived experiences of discreditation and degradation would take prominence over academic theories. The section includes papers designed to open up debates on understanding and addressing stigma in a range of contexts, from the labour room 17 to mental healthcare 16 , 19 and the treatment of ‘deviancy’ and ‘looked‐after children’. 15 , 18 Authors raise challenging questions about the development of our uses of language in the context of care, 12 , 15 , 16 , 17 , 18 , 19 and the relationship between stigma and important analyses of power asymmetry 12 and epistemic injustice.…”

“…The section includes papers designed to open up debates on understanding and addressing stigma in a range of contexts, from the labour room 17 to mental healthcare 16 , 19 and the treatment of ‘deviancy’ and ‘looked‐after children’. 15 , 18 Authors raise challenging questions about the development of our uses of language in the context of care, 12 , 15 , 16 , 17 , 18 , 19 and the relationship between stigma and important analyses of power asymmetry 12 and epistemic injustice. 15 , 17 …”

“…11 These important themes are developed further in this edition, which includes a special section on stigma, shame and respect. This section includes papers aimed at identifying, understanding and addressing discrimination in clinical settings [12][13][14][15][16][17][18][19] and on respect and shame in healthcare and bioethics. [20][21][22] The edition opens with a number of papers that address core issues in health philosophy, which have been the preoccupation of the philosophy thematic editions of this journal for over a decade.…”