from Part III - Social factors and the outcome of psychosis
Published online by Cambridge University Press: 07 December 2009
Introduction
Many people with mental illness are subjected to systematic disadvantages in most areas of their lives. Why should this be so? What can we learn from other conditions whose image may have changed over time? Should we fatalistically accept that these processes of exclusion are somehow tribal, deeply rooted and resistant to change? Or is it realistic to see stigma and discrimination as cultural constructions, which we can collectively change if we understand them clearly and commit ourselves to tackle them? These issues are at the core of this chapter.
The starting point: stigma
The unavoidable starting point for this discussion is the idea of stigma. This term (plural, stigmata) was originally used to refer to an indelible dot left on the skin after stinging with a sharp instrument, sometimes used to identify vagabonds or slaves (Cannan, 1895; Hobbes of Malmesbury, 1657). The resulting mark led to the metaphorical use of ‘stigma’ to refer to stained or soiled individuals who were in some way morally diminished (Gilman, 1985). In modern times stigma has come to mean ‘any attribute, trait or disorder that marks an individual as being unacceptably different from the ‘normal’ people with whom he or she routinely interacts, and that elicits some form of community sanction’ (Goffman, 1963; Scambler, 1998).
Stigma and physical conditions
While this chapter is concerned specifically with people who have diagnoses of mental illnesses, the stigma concept has also been used extensively for some particular physical conditions (Mason, 2001).
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