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 empatydesire 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 self-perception 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”