Stigma by Association (Mental Illness)

Stigma by Association (Mental Illness)

The friends, family, and caregivers who are associated with those individuals who suffer from mental illness experience stigma by association (SBA) that is a phenomenon that requires more attention. Some of the social injustices can be considered in the present surrounding of improved focus on social justice followed by the person’s stigmatization of those who are stressed with the task to support a friend or family member who is mentally ill (Ebsworth & Foster, 2017). This essay explains the concept of stigma and stigma by association with their relevant examples. It also provides an overview of the negative effects of stigma and SBA on the mental health of the caregivers, friends, as well as on the family by considering some case studies based on stigma by association. Finally, the case also considers the effective methods and enhances awareness to combat with SBA that should be initiated to support people experiencing SBA and to deal with people with mental illness (PWMI) as impacted by SBA on the family members, friends, and the support structure of mentally ill people.

Stigma is a mark or brand on a person who suffers from mental illness, physical disability or any sort of sickness(Bos, Reeder, & Stutterheim, 2013). It is a disgrace and social rejection for the patient who is suffering from mental illness due to which society differs him or her from a normal individual. There are two types of Stigma’s Social Stigma and Self Stigma (Bos et al., 2013). Social Stigma includes public stereotypes, prejudice, and discrimination, for example, all bipolar patients are mad this is a public stereotype, bipolar clients scared me this is prejudice, I don’t like to make friends who diagnosed with bipolar this is discrimination. Whereas in self-stigma, there are also self-stereotype, self-prejudice and self-discrimination such as if a person at workplace thinks he may be incompetent to do provided work from his boss this is self-stereotype, to agree with his stereotype called self-prejudice, and if person thinks he cannot do a job and stopped looking for work is called self-discrimination(Bos, Reeder, & Stutterheim, 2013).

Another example could be a patient with HIV positive who feels rejected by society, he is denied getting any healthcare or medical treatment, he isolates himself from society, and the patient feels low in self-esteem, low in confidence. The patient finds it very hard to tackle the situation. This shows that stigma can be felt internally by the person and also can involve a social component, both of which can influence the person’s wellbeing. Mental illness is a condition where stigma is particularly bad. Stigma is when people see a person in a negative way because of his/her mental illness. This can lead to discrimination as people treat that person in a negative way because of his mental illness. Stigma happens when an individual defines someone by their illness to a certain extent than who they are as an individual. For instance, someone might be labelled ‘psychotic’ rather than ‘an individual experiencing psychosis’ (Hernandez, Tonidandel & McKay, 2016). It can be shown that the social stigma and discrimination that people with mental illness experiencing can make their problems worse, creating it harder for recovery. This may cause an individual to avoid getting the assistance they need because of having a fear of being stigmatized.   Also, many patients have been rejected in the past in their job interviews due to their mental illness. It is clear that stigma is not just a physical mark but can influence a person and their whole life. Stigma can also be felt by a family member, and this is call stigma by association or courtesy stigma (Van der Sanden et al., 2016). Stigma by association can have a negative effect on patients but also their family members, friends, caregivers, or whoever looks after the patient. Society puts a patient into a different category in which they think a patient with mental illness is NOT a normal person and cannot live a normal life (Bos, Reeder, & Stutterheim, 2013). These attitudes are harmful and based on prejudice and stereotypes.

Stigma by association is also referred to as the ‘courtesy stigma’ that includes the disapproval evoke by society and people as the result of connecting with stigmatized persons (van der Sanden, Stutterheim, & Bos, 2016). The associate stigma or courtesy refers to the process whereby an individual is stigmatized by the association virtue with another stigmatized person. (van der Sanden, Stutterheim, & Bos, 2016) found that the previous research has found that the experiences of the family members of SBA predict the lower quality of life and psychological distress. Moreover, a stigma is a negative deviance type that marks an individual’s reputation and identity that bears the blemish. It marks the bearer as an individual to be socially excluded or avoided. It is because the person with mental illness is stigmatized more severely as compared to those people with other health conditions.

There are many factors that relate to a patient, friends, family members, caregivers, then Society and media. An example of stigma by the association in India is if in the past a girl been raped, family members felt so embarrassed and ashamed, they tried to avoid taking their girls anywhere in the society, and they try to hide this thing as according to them no one will get marry her. The society also used to pass bad comments to the girl and their family members as well as contributing to the families sense of stigma and shame. Another example is depression when people suffer from depression and society, put them into a different category; they think depression means he or she cannot live his normal life ever. Research has found that family members, caregivers tried to hide their families’ members’ depression from others, such as friends to stop any judgement. The other impact of stigma by association is that family members also feel stresses and burden. Even siblings of the patient feel ashamed to go into society. It can found from this research that stigma by association can lead to depression in family members and also shown that parents of children with mental illness feel blame.  Ebsworth and Foster (2017) found that if a child suffers from mental illness society blames parents and according to them it’s their bad parenting which causes mental illness to the child, public blame the family for this, even according to science biological and genetics are the main cause for child’s mental illness, but society still thinks that it’s bad parenting, due to which family members feel shame as they have been blamed(Ebsworth & Foster, 2017).

Family members avoid contacting neighbours, social activities, for example, they stop taking child/patient to parties, weddings (Ross, 2017). SBA can lead to a family burden on family members which further lead to several problems such as financial problems, family quarrels, worries about patient’s future for example parents worried about child’s future after them, as due to his or her mental illness child has already missed some career options (Ross, 2017. Everyone in the family looks after a patient who suffers from mental illness, and they feel it’s too much on them so to have a rest they might hire private career for a patient which is a financial problem for family, SBA leads to family arguments as well for example if child’s parents are separated there is arguments that who looks after more or who are doing more jobs and who are doing less (Ross, 2017). Moving further SBA can be the main reason for psychological distress and destroy the quality of life of the family members (Goldstein, 2017). Psychological distress represents the negative mental health symptoms, for example, depression, loss of emotional control, etc., whereas in quality of life an individual of his or her image in the society, their goals as family member think they do not have any life due to burden of client’s care (Hernandez, Tonidandel & McKay, 2016).

SBA not only affects family members, but it also affects how a caregiver/family member sees their patient, which can lead to a negative impact on their relationship(Ebsworth & Foster, 2017). For example, siblings of a patient do not want to take patients with them outside to play, which put a bad impact on their relationship.

The research study conducted by (van der Sanden, Stutterheim, & Bos, 2016)with 503 family members of those persons with mental illness investigated the prevalence of different coping strategies. The researcher has investigated the role of determined coping strategies as the mediators of the relationship between the family burden and SBA and results, such as quality of life and psychological distress. This study resulted that both perceived SBA and family burden (family quarrels, missed career opportunities, time-consuming activities, worries about the patient, and financial problems) are linked with lower quality of life and greater psychological distress, and this relationship is mediated by the most coping strategies. Van der Sanden et al. (2016) concludes that the adaptive coping strategy is mainly relevant to decrease negative outcomes, whereas the main maladaptive coping strategies are relevant to increase negative outcomes.

Moreover, a research study conducted by(Ostman & Kjellin, 2002) depicted that stigma not only affects PWMI but also affects their families. This study provides an understanding that how stigma affects the family members from the perspective of both their contacts with psychiatric services and their psychological responses to the ill services will increase the interaction and connection with family members. It is also found in this research study that a majority of relatives experienced psychological factors of SBA in which 18% of the family members had at times thought that the PWMI would be better off dead whereas ten per cent had experienced suicidal thoughts. SBA was higher in the family members and relative of PWMI experiencing mental health issues of their own and was also impacted by the background characteristics of the patient.

The research study of (Remko & Arjan, 2015)found that persons with mental illness are not only the stigmatization recipient but also their immediate family members are subjected to SBA. A semi-structured interview is conducted in this research, with 23 immediate family members of those persons with mental illness to study the experience of SBA. It is reported by the participants that they experience the SBA from the civil servants, mental health professionals, and community members. The participants such as spouses and parents have responded to different expressions of SBA than the children and siblings, the research respondents who lived together as a family member with the person with mental illness responded increased experience of SBA. In contrast to the male respondents, female respondents stated others are thinking as they are overprotective and as sustaining, maintaining, and perpetuating the mental illness of their family members(Remko & Arjan, 2015). The relevancy to these factors indicates the need for emotional support provision and modified education in respect of the family members of those individuals with mental illness. In addition, there should be in-service training for mental health professionals including the development of the important social skills that facilitate the appreciation of the familial roles and relationships, concerns, fears, and problems of family members (Goldstein, 2017).

SBA is an experience that needs further research and education program that should be provided to the people with tools in coping with SBA and also increase awareness that how SBA influences them and their relatives with mental illness (Ross, 2017). The increasing social awareness trend and taking initiatives towards social justice, the fact that PWMI’s family members, caregivers, and friends are subject to stigma. They also face problems related to psychological stress, low quality of life and social isolation as the violation of social justice and family members are also stigmatized by a civil servant and professional health professionals that is more problematic. It is considered from these that SBA is really a psychologically painful experience for the relatives of PWMI, and most stigmas do not consider as positive function in the current society (Ebsworth & Foster, 2017).