Health: Declining stigma attached to mental illness

A campaign sponsored by Mind, Rethink and the Institute of Psychiatry, and supported by £18m public funding, claims that stigma still prevents people with mental illness from seeking help. Endorsed by Alastair Campbell, Ruby Wax and Stephen Fry, the “Time to Change” initiative uses peak-viewing TV advertising to tell the public that it is no longer acceptable to discriminate against people with mental illness.

Yet while people with severe mental illnesses such as schizophrenia may continue to experience shame and blame, the willingness of many more to embrace a range of psychiatric diagnoses raises the question of whether we can really say that stigma is still a significant force.

In the 1960s, the Canadian sociologist Erving Goffman used the term stigma to describe the “situation of the individual who is disqualified from full social acceptance”. Yet over recent decades there have been some remarkable changes.

Transforming a stigma

For example, homosexuality – one of the categories of stigma that featured prominently in Goffman’s study – was then defined by doctors as a disease and by the police as a crime. Yet in 1974 it was removed from the list of disorders recognised by psychiatrists and the gay movement helped to transform a stigma into a politicised identity. In this decade, the emergence of popular television shows such as Queer Eye for the Straight Guy implied that to be gay was not only socially acceptable but culturally superior.

This does not mean that prejudice has disappeared, or that gay people do not still experience discrimination or abuse. But it does mean that such behaviour no longer enjoys official approval. Indeed police-sponsored campaigns against homophobia confirm that homosexuality has become an issue the authorities can use to improve their relations with the public and bolster their legitimacy. Similar campaigns against racial and domestic violence (the sort of activities more or less openly endorsed or condoned by the police in the Goffman era) reflect parallel transformations of stigma into identity and opportunity.

Culture of victimhood

The ascendancy of a culture of victimhood has encouraged people to embrace labels as badges of status and entitlement that would once have been considered stigmatising. Although it is true that few still willingly accept what Goffman described as the “spoiled identity” of “schizophrenic”, many seek the fashionable labels of bipolar disorder or post-traumatic stress disorder, and even more embrace the identities of being a victim of work-related stress or suffering from anxiety and depression. A flourishing literature suggests we accept as a gift a diagnosis of attention deficit hyperactivity disorder or Asperger’s syndrome, in adults as well as in children.

Through all the shifts in stigma over the past half century, one category identified by Goffman has endured: the urban, unrepentant poor. Goffman found that “in their relations to the public institutions of our society” they were second-class citizens – and second class citizens they remain. Their disqualification from full social acceptance is closely associated with their persistence in smoking and tendency towards obesity, the twin stigmata of the contemporary underclass.

While challenging stigma in areas where it is no longer a social force, the medical profession plays a leading role in promoting stigma where it continues to sanction discrimination and social exclusion.

● Michael Fitzpatrick is a GP in Hackney. His book Defeating Autism: A Damaging Delusion has just been published by Routledge