Nov 28, 2021

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Stigma is a very dangerous and destructive phenomenon, especially when the people who are labeled with negative characteristics are not to blame for what happened to them. The word, which originates in ancient Greece and referred to a physical brand or mark applied to social

outcasts such as slaves or “traitors,” indicates socially devalued status and refers to severe social disapproval of personal characteristics, beliefs or behaviors that are perceived to be deviant from cultural norms


Today, stigma involves stereotypes and glues cognitive labels to members of devalued groups and prejudice. Ultimately, stigma leads to discrimination, thus limiting the exercise of human rights of those in disadvantaged groups and their access to life opportunities 


Two Israeli researchers – psychiatrist Prof. Itzhak Levav of the University of Haifa and psychologist Prof. Ora Nakash of the Interdisciplinary Center (now Reichman University) in Herzliya have been long been studying the effects of stigma on patients with mental illness, their suffering and treatment in a multicultural society like that in Israel. They argue that no sector in the population in most parts of the world is free of this complex and ubiquitous social phenomenon and suggest some directions to face the heavy burden of stigma in people with mental illness.


For example, surveys have shown that more than two-thirds of the American public view people with mental illness as “dangerous,” while seven out of 10 respondents in a survey in Germany shared the view that

former mental patients are disadvantaged when it comes to applying for a job or dating. A similar proportion of mental health professionals surveyed in Switzerland favored revoking drivers’ licenses of persons who suffered from psychiatric conditions. 


The researchers assert that pro-active efforts to fight stigma must be developed, including in the way the media depict people with depression, bipolar disorder, schizophrenia and other psychiatric conditions, and that the public and professions need to increase their empathy.


People with mental illness who feel they are stigmatized often do not seek help on time and thus their treatment is delayed and less successful. Some may stop getting treatment altogether. 


Naturally, people categorize others into groups, said Levav and Nakash, and regard those who are different from them as being “out,” while they tend to minimize differences among members of the same category and tend to exaggerate differences in other groups (such as “all persons with mental illness are violent.” This is especially true when they have other

characteristics, such as being part of a lower socioeconomic class or being migrants from other countries. They also remember more positive information about members of their own group than those of other groups. 


These processes added Levav and Nakash, directly contribute to the pervasive biases that people have for ingroup members (“healthy”) over outgroup members (“the mentally ill”). They even refer to people of their group as “we” and “us”) and the others as “they” and “them.” 


It is easier to discriminate against people in the “other” group and even to behave in a more greedy and less-trustworthy way toward members of other groups than if they were reacting to each other as individuals. When you denigrate “others,” you tend to feel more self-esteem.


Those who make fun of or stigmatize others seem to have little to lose – and they grow in self-esteem — as nobody will punish them for it, the two 

Therefore, stigma takes hold when a group with social power denigrates a less powerful group such as those suffering from mental illness.


“Stigma acts in multiple ways, both overt and subtle. Its impact extends from delaying prompt consultation through hindering the course of treatment and interfering with rehabilitation and social inclusion,” said Levav and Nakash, so stigma “constitutes the hidden burden of mental illness.” 


The majority of Israelis are Jewish, but they are vert heterogeneous – ranging from those of Europe-American origin with a Western medical tradition to those from Ethiopia, who hardly use it. In addition, about 20% Muslims, Druse and others. Each of these groups have their own set of mental health-related knowledge, attitudes and practices


Levav and Nakash noted that Israel has a National Health Insurance system in which health care – including psychiatric treatment – is freely available. It used to be provided through the Health Ministry, but changes in legislation shifted this responsibility to the four public health maintenance organizations of which all residents are members. 


Fortunately, they argued, the growing awareness of mental health issues and related stigma among the Israeli public and policymakers in the past two decades contributed this psychiatric reform, which provided a basket of psychiatric rehabilitation services. 

One of the apparent results of this reform is that more Israelis with mental disorders are living in the community instead of being hospitalized in psychiatric institutions and can make free use of rehabilitation services for supportive education and employment and housing in the community. This positive shift towards growing community services strengthened the community’s influence on the rehabilitation process and the recovery and social inclusion of persons with mental illness.


“Although one would hope for improvement in the acceptance of persons with mental illness and reduction in stigma, recent studies show that the Israeli public holds negative, stereotyping attitudes and that there is evidence of discriminatory behaviors toward persons with mental illness,” they continued. 


A survey of over 1,500 Israeli adults aged 21 and older that examined attitudes toward persons with psychiatric disorders and asked which are their most common characteristics showed that more than half thought they behave “bizarrely, have language irregularities and an unkempt personal appearance.”  Fully 80% of respondents claimed that people with mental illness are “unpredictable” and that while 64% agreed that they can be employed, 58% thought that they cannot work in a “normal job” such as being a bank clerk. 


Because of stigma, 40% said they wouldn’t want a person with mental illness living in their neighborhood; 88% declared that they would not let a person with mental illness take their children to school; and 50%, said they were willing to help a person with mental illness but were not willing to be his or her friend.


The stigma comes not only from healthy groups; many of those with mental problems stigmatize themselves and feel hopelessness, low self-esteem, little self-confidence, and a feeling of shame and tend to isolate themselves. 


Israeli-Arabs and ultra-orthodox (Haredi) Jews are much less likely to seek psychiatric help than others. In the Arab world, stigma is attached to mental health services, so many are willing to consult only with their general practitioner rather than with psychologists, psychiatrists or other mental health professionals. 


If troubled Haredi Jews do seek professional help, said Levav and Nakash, they tend to drop out of treatment early, so most of those who remain under care suffer from severe psychopathology. The fear of stigma, especially that it will prevent them or their children from making arranged marriages; contact with the secular world, being in the same room with therapists of the opposite sex, and the suspicion that therapists who are no religious will cause them harm have also been noted. 


They recommend adopting strategies to overcome the stigma that will be directed to specific Israeli groups of influence, including employers, landlords, criminal justice professionals, policymakers, healthcare providers, the media, and persons with mental illness themselves and their families. When people with psychiatric illness tell their personal stories at work, these personal narratives help employers and co-workers relate to them with less stigmatizing and more accepting behaviors.