I have just been reading some work written by people looking at issues of stigma and discrimination in mental health, some of the material made me think quite a lot about this subject. Not only did the work state the obvious – things we already know such as people with a mental health issue treated differently to others, but it also examined the role of mental health nurses and I couldn’t help but recognise some of these statements were actually true.
Much is written about stigma and discrimination in mental health, particularly regarding service users, patients clients etc. Erving Goffman, in his book Stigma: Notes on the Management of Spoiled Identity (1963), describes stigma as ‘ a special kind of relationship between attribute and stereotype. An attribute that is deeply discrediting, that reduces the bearer from a whole and usual person to a tainted, discounted one. We believe that a person with stigma is not quite human. We tend to impute a wide range of imperfections on the basis of the original one. We may perceive his defensive response to his situation as a direct expression of his defect’. Goffman goes on to point out that stigma is generated in a social situation. It is a reaction by society that spoils a person’s identity by a set of imposed norms that are brought to bear on an encounter.
There are ‘them and us’ distinctions that underpin prejudice and discrimination and pervade mental heath services. People with mental health problems are devalued and, therefore those who work with them are also devalued by association: this is termed ‘courtesy stigma’ (Goffman 1963) or ‘stigma by association’ ( Neuberg et al 1994) The image of the psychiatric nurse compared to that of busy A&E ‘angel’ or life-giving midwife is seen very differently. Psychiatric nurses receive least recognition, affirmation, acknowledgement and validation from their family and friends (Cronin-Stubbs & Brophy 1985) and the psychiatric system as a whole is downgraded to a ‘Cinderella service’.
In an attempt to preserve our status, it might be tempting for mental health nurses to dissociate themselves from the devalued patients, to amplify differences in order to reduce the perceived threat from ‘out-group’ members (Heatherton et al 2003). When out with clients/patients/service users, it is often clearly demonstrated that you have not chosen to be with this person, that you are not a friend, neighbour, relative, but are with a patient AND are just doing your job!
Does this happen?