by Chris Jones
Last year, the American Journal of Psychiatry published a worrying report which suggested that attitudes towards mental illness in the US are not improving, despite an increase in campaigns raising awareness. Although that study suggests that anti-stigma campaigns should focus on people rather than diseases, emphasising the capabilities of people with mental illnesses, I would go further and argue that one of the reasons for the failure of these campaigns is the concept of stigma itself, rather than just the way it is used.
Irving Goffman, who has published one of the most influential books on the theory of stigma, calls it ‘a special discrepancy between virtual and actual social identity’, so that to be stigmatized is to defy social norms in a way that others find uncomfortable. The problem with addressing ‘stigma’ as an issue is that it presupposes a problem with the individual. With a history going back as far as the Biblical Mark of Cain, the idea of a physical or social mark of difference has been used to justify the social ostracism of lepers and prostitutes as well as people with mental illnesses. Focusing campaigning efforts on ‘stigma’ does not remove the perceived mark, but provides a ‘social category’ into which people with mental illnesses can be put.
As there are stereotypes of how to ‘be’ disabled, a ‘sick role’ in which the patient is required to conform to medical advice, and to act out the character of either a cheerful invalid or a heroic cripple, there are also ways to ‘be’ mentally ill. Addressing stigma suggests there is a problem with the individual that requires action on their part as much as the part of those around them, that there is an absolute distinction between people with mental illnesses and people without. The concept of stigma sees this distinction as insurmountable, aiming instead to provide a less-bad social category for people with mental illnesses to occupy.
I don’t think it is helpful to make this absolute distinction. That is not to say that I deny that the existence of mental illness, or its impact on people’s lives, but that I see no reason why people with mental illnesses should be defined by and reduced to their diagnoses. Separate social categories are both the cause of and caused by social inequality, so emphazsising these categories will never be the best way to allow people with mental illnesses to engage in society on equal terms.
Rather than discussing ‘the stigma of mental illness’, I suggest the solution proposed by Liz Sayce, a long-term British disability rights and policy worker, that we focus on discrimination against people with mental illnesses rather than the stigma of the illnesses themselves. This conforms to the suggestions in the AJP report, while also transferring the focus away from the individuals affected by discrimination and onto those who are doing the discriminating. It is not the fault of people with mental illnesses that they suffer from discrimination, it is the fault of a society which has so far refused to accept the fact that ‘mentally ill’ is not a separate social category containing ‘crazies’ and ‘psychos’, but a cross-section of society as a whole, containing more differences than similarities. Focus on discrimination allows us to draw attention to individual cases where mentally ill people are unfairly targeted, and from there to break down the barriers to social inclusion from the inside.
Chris Jones has just completed an MSc thesis on challenges to public perception of mental ill-health in recent Scottish drama at the University of Edinburgh, and is about to begin research for a PhD in Drama at the University of Kent, examining the representation of psychic distress in British drama. He blogs at http://madnessandtheatre.wordpress.com/