Stigma, Social Exclusion, and Implications for Practice - Essay Example

Stigma, Social Exclusion, and Implications for Policy and Practice Introduction Individuals often possess real social identities in addition to virtual identities; whereas virtual identities connote the individual traits or personalities, social identities represent the gendered perspectives of how people should play their roles in society. Psychologically, stigma can be conceptualized as the inconsistency between social identities and virtual identities (Goffman 1963, p.7); for instance, virtual identities that depict individuals as unreliable may conflict with their actual social identities thereby inhibiting individuals’ confidence in their self-worth and competence, consequently resulting to ‘spoilt identity’. In this regard, social labelling that discredits individuals’ virtual identities (Crocker et al 1998, p.505), inevitably leads to stigmatization that often times leads to distortion of individual identities. Social exclusion, on the other hand, refers to the state of being locked out from participation in the central social activities in one’s own society (Burchardt et al 2002, p.30); this means that if an individual fails to take part in social activities then they are ‘socially excluded’. The purpose of this paper is to explain what is meant by the term ‘stigma’, and to explore the possible linkage there is between this term and the concept of social exclusion; consequently, the conclusion of this paper will draw upon this knowledge to give implications for policy and practice. Stigma Simply put, stigma denotes ‘a mark of shame’ (Oxford Dictionaries, 2012), concomitant particularly with certain individuals in the society, thus, people who are stigmatized actually view themselves inferior due to social labels that describe them so, distorting their real identities. According to Chamberlin, stigma often leads to discrimination implying that the individual being stigmatized has a problem (Sayce 1998, pp.331-332); in this case, language is a powerful tool that functions in the creation of certain perceptions and stereotypes about individuals. When people make biased judgments concerning others, this negative labelling coupled with the resultant social labels and subsequent stigmatization that arises can be attributable to mental health issues. Language is very effective in helping people with mental illnesses to manage and eventually overcome their problem especially because the words used in reference to people influence their perceptions and expectations respectively (Lynn 2010 p.1). For instance, existing knowledge shows that relapse rates of patients with mental problems after 7 years are greatly influenced by serious comments during interactions within the family (Newton 2013, p.97); in this case, language that is discriminatory in nature often undermines the course of recovery for these patients. There are two kinds stigma namely; self-inflicted stigma and socially inflicted stigma, whereby the latter refers to individuals’ internalized feelings of stigmatization unlike the former, which results from the social stereotypical perceptions of individuals. Self-inflicted stigma occurs when individuals become ensnared in, and accept social prejudices of the dominant culture in society by applying them to their identities thereby feeling inferior and incompetent (Winnie and Crystal 2006, p.1800). In self-inflicted stigmatization, individuals’ project social identities that reflect their internalized feelings of disgrace; for instance, theory posits that Schizophrenics sense of self-worth and ill-health perceptions are a reflection of their internalized feelings concerning their social identities. However, the possibility of ‘self-exclusion’ has always been contentious given the difficulty in determining the extent to which it can be voluntary in the social context that naturally inhibits stigmatized individuals’ participation (Boardman 2010 p.13). In this respect, individuals are already exposed to constraints to participation in the form of damaging language and negative discourses in their societies, consequently, peoples’ notions concerning their illnesses after testing positive for mental illness in society espouses from these constraints. Stigma or negative labels become accepted as marks of identification for individuals either due to the duration of application or due to their negative influences, thereby leading to conformity; people apply stigmatizing labels on themselves to describe their identities as well. In this case, the idea of ‘self-inflicted’ stigma is a sort of self-fulfilling concept, a distorted perception of a situation that evokes new behaviour eventually qualifying the validity of the corrupted view (Merton 1968 p.477). Social Exclusion Social exclusion describes what happens to individuals when they are cut out from key social exchanges such as employment, housing, health services, among other things; in this regard, individuals who fit this description are more likely to be victims of unemployment, low income, poor living conditions, in addition to high crime involvement associations. Further dimensions of the concept propose the inclusion of issues of impairment, discrimination and weakened social role, in addition to continuous rejection and consequential low expectation and hope for the mentally ill (Sayce 2001, p.122). Social exclusion can also be conceptualized as the extent to which individuals are rendered incompetent to take part or get involved in major socio-economic and cultural aspects of the society in which they live in (Royal College of Psychiatrist, 2009); this means that constraints rather than choice impede individuals’ participation in social activities. Social exclusion takes place at different levels in different ways- for instance, it can occur at an individual, family, or even possibly at a much larger level; however, the micro and macro level cause-effect relationships of social exclusion often run into each other. Social exclusion could be either self-inflicted or socially imposed, especially when the dominant groups of people exclude the insignificant others in pursuit of selfish interests; overall, social exclusion occurs when the dominant groups establish and maintain disadvantage through stigma and stereotyping (Schneider, 2009). Arguably, individuals with mental illnesses are the most socially excluded in societies around the world today (Sontag, 1978), which is attributable to the pervasive discrimination labelled against them. A combination of stigma and social exclusion can yield a very profound and devastating impact on individuals with mental illness including a low self-esteem, depression, loneliness, and feelings of personal inadequacies or incompetence. Mental health problems are often prone to stigmatization that eventually results to underestimation, infrequent diagnosis, and treatment (Riecher-Rossler et al, 2006); consequently, lack of sufficient knowledge concerning mental health issues results to socially constructed stereotypes and negative discourses regarding the mentally ill, thus stigmatization, social exclusion and unfair discrimination. Stigma versus Social exclusion According to new research, stigma is inevitably linked to social exclusion and, disharmony in participant propositions notwithstanding, the correlation between the two concepts remains affirmed; according to this survey, most of the participants experienced exclusion, or were forced to distance themselves from activities in response to stigmatization (Figure 1: Appendix). In addition, the participants also exempted themselves from social undertakings due to discrimination, projected biases, and concerns of social incompetence. For instance, most people with mental illnesses exclude themselves from the employment arena because they live in fear of the anticipated discrimination that might ensue from a disclosure of their conditions. Besides, it is hard for the mentally ill individuals to gain employment opportunities and when they do their shifts are short (Meltzer et al, 1995) due to stigmatization that results from negative social discourses and stereotypes accordingly; for instance, a large population of the population with mental health problems remains excluded from employment opportunities (Labour Force Survey, 2002). The complexity of the mental health experience naturally implies that individuals themselves have to choose whether, and to what extent, they would disclose it (Corrigan and Lundin 2001 p.121); reason why individuals with mental health issues always present with fears of anticipated discrimination, and inequality with regards to career opportunities and promotions at the workplace (Mind 2011, p.2). Social exclusion leads to unequal treatment because stigmatized individuals are less likely to be employed, or even housed due to discrimination, and they are often victimized for crimes in the society (Coon 2006 p.519); this means that the stigmatized are subject to discriminations that exclude them from social exchanges (Hinshaw 2007 p.25). Discrimination occurs based on many benchmarks, besides mental health, including but not limited to demographics such as income, gender, age, among other social identifiers. For instance, exclusion from employment leads to poverty and over-dependency on welfare services, which further enforces stigmatization of individuals in society because their inability to contribute to social development through economy building ventures. Most schizophrenics in western countries present with heightened anxiety and depression in response to their lack of employment due to discrimination (Newton 2013, p.99), and supported employment can reduce social exclusion and enhance their recovery (Solar, 2011). These findings are consistent with the propositions by some participants in the survey who blamed their social exclusion not to stigma explicitly, but to their anxiety for being incompetent (Time to Change, 2008 p.7). Further, even in the absence of stigma itself, it is the anticipation of discrimination that forces individuals to exclude themselves from social activities; the victims’ reasons for self-exclusion are informed by their internalized feelings of inadequacies, self-esteem due to social discourses that act as constraints to effective participation (Boardman 2010 p.13). In response to anxiety, individuals often become tense, unsettled, and on high alert over impending threatening situations (Rachman 2004, p.3); this anxiety over individual inadequacies and self-esteem that eventually excludes them from participation largely emanates from social prejudices rather than from the diagnosis of mental illnesses themselves. The societal reactions to the mentally ill greatly fuels their self-perceptions and self-exclusion from further participation in social activities; in this regard, the true source of the perceived threat, stigmatization, is the society and not the stigmatized individuals themselves. It then follows undeniably that the mentally ill do not simply doubt their abilities, somewhat, social-exclusion emanates from the anticipation of social discrimination, stigmatization (Time to Change, 2008). Power, especially socio-economic and political power, is inadvertently a precursor to stigma and social exclusion because it must be exercised for stigmatization to occur; power leads to the realization of stigmatization components of labelling, prejudices, exclusion, and diminishment of identities, thus without power there can be no discrimination (Link and Phelan 2001, p.375). Modern theorists view stigma as the virtual lack of power and inferiority label that society ascribes to individuals, concomitant to their traits (Frost 2011, p.1), and in relation to the views of Link and Phelan, society has an incredible capacity to define situations such as a mental illnesses as deviance from the normal, further reinforcing stigma. Agencies or sources of power within the society have autonomy over the (Boardman 2010, p.14), they are the ones responsible for doing the exclusions, and this fits perfectly with the notion of relative powerlessness proposed by Herek. In this regard, it is clear that stigma and social exclusion are inevitably tied together, and various propositions have been put forwards to explain their origins, especially in relation to power agencies and social stereotypes within the society. There also exists different ways of exercising power, depending on the particular power sources, whether private or public in the varied institutional agencies within the society such as schools, hospitals, among others. Apart from the collective exercise of power as a strategy to stigmatize individuals within the society, subtle elements of discriminative power also, manifest in close, personalized contexts such as at the family level by family relations, friends, or even health professionals. Currently, the link between social exclusion and practitioners in the mental health arena focuses on the question of practice within a framework of services directed at supporting the mentally ill. However, the mentalist’s conceptualization of social exclusion is constrained by the variations in classification, which eventually influences the provisions offered to the mentally ill by health practitioners accordingly. For instance, service users contend that the mental health amenities’ operational model, overemphasis on the illness, in addition to its misguided control and low expectations, is indeed part of the crisis (Berry et al 2010, p.412). In this case, social exclusion is strongly linked to the pervasive stigma, resultant discrimination, and low regard and/or expectation of the mentally ill. Implications for Policy and Practice Undeniably, negative perceptions concerning particular forms of disability and mental illnesses emanate from the society as opposed to from the mentally sick or disabled individuals themselves; this means that society has to alter its discourses to eradicate all forms of stigma against groups of individuals. Currently, there has been a considerable effort through advocacy campaigns to shift focus from individuals to those who are responsible for stigmatization (Time to Change, 2008); this has significant implications on policy and practice because now it means that the roadmap to eliminating stigmatization is counteracting social biases that the mentally ill are ineffectual and undeserving. In addition, by approaching the problem as having roots in society implies that policy and practice has to generate new, positive discourses that promote ability rather than highlighting disability of individuals with mental illness, thus further enforcing stigma. Many a times, mental health practitioners usually recommend personal views of exclusion by dwelling on the inabilities rather than the capabilities of service users, unaware of the ramifications of such discourses on the mental health and recovery progress of individuals. In this regard, the practitioners occupy a position of power that directly discriminates individuals with mental health problems when exercised; the medical model of mental health facilities aims at normalizing service users so they can fit in society and be included in social activities (Berry et al 2010, p.413). This is never effective because the negative identities of service users have a counteractive effect of devaluing their experiences, thereby undermining their individualities by forcing them to ascribe to inappropriate stereotypical norms. A way forward for policy and practice is for mental health practitioners to alter individual practice to fit the implementation of relationship-based interactions between them and their clients, service utilizers (Scie 2009, p.2). To this effect, mental health services will achieve outcomes desirable by the mentally ill, rather than prescribing to processes that are driven by misguided, stereotypical conceptualization of exclusion. Nevertheless, health facilities, and all other institutions that individuals with mental illnesses may decide to exclude them from or be restricted from accessing due to stigmatization have to adopt policies that address discrimination based on whether stigma is imposed by society or self-inflicted. The challenge foreseeable in this is establishing exactly the particular extent that the perceived self-inflicted stigma and self-exclusion are indeed voluntary, which will consequentially challenge the notion of socially generated stigma because individuals will be responsible for stigma and own social exclusion. Nonetheless, policies should focus intensely on understanding and sensitivity to mental health, in addition to individual views of the service users concerning how they want to be supported; increased choice and control of services will enhance recovery of service users (Scie 2009, p.2). Presently, many organizations have already made these implementations but service user involvement is still below the recommended level (Berry et al 2010, p.414), with services continually undermining the significance of these practices. A way forward for services is to consider a meaningful evaluation and rectification of attitudes and their fundamental principles guiding their service delivery, to address quickly stigmatization and social exclusion in society. Furthermore, policy and practice should ensure that the mentally ill are able to secure employment that can be both a source of livelihoods and a route for upwards social mobility, to promote the individuals’ mental health, social connections, and social inclusion in key activities in the society (Evans and Repper 2001, p.15). Policies should also focus on establishing flexible workplaces, to allow individuals with mental illnesses to manage their conditions while on the job; however, the expediency and capacity of some employers, such as the SMEs to offer personalized job experiences that cater for their employee needs is highly debatable because of their misguided conceptualization of the Disability Discrimination legislation. In addition, SMEs tend to overemphasize severe and enduring in their conceptualization of mental health illnesses (Sainsbury et al 2008, p.10); equally important for policy and practice is the incorporation of psychological therapies to encourage individuals with mental illness to feel more motivated to return to retain their jobs or to go back at their workplace. Overall, the challenge for policy and practice is to eliminate all forms of stigma and the resultant social exclusion, and to establish joint linkages with other agencies and mental health services that will provide the relevant services required by service users to remain in their jobs. Finally yet importantly, policy and practice should seek to minimize difference as much as possible by avoiding using discriminatory identifiers that undermine integration within society because, largely, diagnostic labels for mental health complications affect the mentally ill negatively. For instance, even if the symptoms of a mental illness have been repressed effectively, the diagnostic label always persists thereby hurting individuals’ self-esteem (Newton 2013 p.24); consequently, the anxiety and/fear resulting from the anticipation of labelling, and subsequent stigmatization often undermines the recovery progress. Minimization of differences will also guarantee recovering individuals of their deserved respect of others in society; education and sensitization campaigns should target to pass information and knowledge concerning mental illnesses first to the recovering individuals themselves to boost their diminishing self-esteem after diagnosis with mental disorders, and the larger society (Davis 2006, p.267). Such programs that highlight mental health issues by promoting mental health information in positive ways will cultivate the idea that the mentally ill are not the insignificant ‘others’ as it is widely believed, but significant members of the wider society. More so, highlighting this condition decriminalizes the mentally ill by reducing and even possibly erasing the socially constructed associations between media violence and individuals who are mentally ill (Newton 2013 p.24); the media, often accustomed to spreading stereotypes concerning mental health illnesses, can play a central role in sensitizing the societies by erasing all the societal stereotypes (Bryne, 1997). Ultimately, the concepts of stigma and social exclusion are based on the socially constructed stereotypical differences that yield inconsistencies in the virtual and social identities of individuals. Stigma may arise out of unfair, negative discourses and social biases labelling individuals and/or groups of individuals within the society, or out of the exercise of power over others. Discriminatory labels or attributes are applied by the dominant cultures or those in power to categorize the insignificant others, thus enshrining stigma against the group, consequently instigating social exclusion from key activities such as employment in the community, besides enforcing constraints to participation. Stigmatized individuals often exclude themselves due to their internalized feelings of socially ascribed inadequacies and low self-esteem, a sort of ‘self-inflicted stigma, and voluntary exclusion; consequently, exclusion from social activities often results to unemployment and overreliance on government support programs, thereby enforcing stigmatization even further. From these discussions, it follows undeniably that stigma is directly linked with the concept of social exclusion, and there are quite a number of implications for policy and practice in the provision of mental health services. Overall, policy and practice has to rethink the conceptualization of both stigma and stigmatized versus social exclusion to incorporate the necessary amendments in practice, which will facilitate a quick recovery and integration of the mentally ill back in the society. References Berry et al., 2010. ‘Expectations and illusions: a position paper on the relationship between mental health practitioners and social exclusion’, Journal of Psychiatric and Mental Health Nursing, 17, 411–421. Boardman, J., 2010. ‘Concepts of social exclusion’, in Boardman, J.; Currie, A.; Killaspy, H. & Mezey, G. (eds) Social Inclusion and Mental Health. London: The Royal College of Psychiatrists. Bryne, P., 1997. Psychiatric stigma: past passing and to come. Journal of the Royal Society of Medicine, 90 p. 618-621 Burchardt, T., et al., 2002. ‘Degrees of exclusion: Developing a dynamic, multidimensional measure’, in J. Hills, J. Le Grand & D. Piachaud (eds) Understanding Social Exclusion. 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(1998) ‘Stigma, discrimination and social exclusion: What’s in a word?’, Journal of Mental Health, 7 (4) 331-343. Schneider J., (2009), Community work-a cure for stigma and social exclusion. The Psychiatrist, Vol 33 p.281-284. SCIE., 2009. ‘At a glance 18: Personalisation briefing: Implications for community mental health services’. [Online] Available at: http://www.scie.org.uk/publications/ataglance/ataglance18.pdf [Accessed 28 June 2013]. SCIE., 2009. At a glance 18: Personalisation briefing: Implications for community mental health services. Available at: http://www.scie.org.uk/publications/ataglance/ataglance18.pdf [Accessed 28th June 2013]. Solar, A. (2011) Supported employment can reduce social exclusion and improve schizophrenia. Australian Psychiatry, Vol 19 No 1. Sontag, S., 1978. Illness as a metaphor. Farrar, Straus and Giroux Time to Change (2008) Stigma Shout: Service User and Carer Experiences of Stigma and Discrimination. London: Time to Change. Winnie, W. S. & Crystal, F. M. (2006) ‘Cognitive insight and causal attribution in the development of self-stigma among individuals with schizophrenia’, Psychiatric Services, 57 (12) 1800-1802. APPENDIX Figure 1 - Time to Change (2008) Stigma Shout: Service User and Career Experiences of Stigma and Discrimination. London: Time to Change. Read More