Stigma is an insidious social force that has been associated with multiple attributes, circumstances, health conditions, and social groups, and which unfolds at many different levels – social, institutional, and self-stigma. Mentally ill people represent one of the most widespread targets of prejudice, discrimination, and social exclusion. Consequences of stigma are alarming and dangerous; stigma has been associated with preventing people from seeking help, reducing compliance to treatment, increasing dropouts, and even increasing suicidal ideation. Stigma also affects health care professionals, providers, and organizations, with the effect of worsening the access to mental health care and treatment, but also increasing the social exclusion and impairing wellbeing. Nevertheless, the awareness and the recognition of stigma as a major societal problem has contributed to the development, validation, and implementation of many anti-stigma programs, some of which appear to be promising ways to fight against this insidious phenomenon.
TopIntroduction
According to the Oxford English Dictionary, the word stigma is referred to feelings of disapproval that people have about particular circumstances or characteristics that somebody may bear.
Stigma represents a sign of disgrace that has the effect of setting affected people apart from society. Stigma affects many different categories of individuals. Nevertheless, the focus of this chapter will be to review the state of the art of the literature concerning stigma toward mentally ill people by analyzing this insidious phenomenon from many different angles.
Stigma toward the mentally ill is prevalent in the general public (Angermeyer & Matschinger, 2005; Corrigan et al., 2003; Corrigan et al., 2012), and it is accompanied by prejudice and discrimination toward people affected by mental problems. Such discrimination has been observed across many different areas of life, such as employment, housing, social relationships, health care, and many others.
Alarmingly, stigma also exists among healthcare students and professionals, namely, the very people responsible for the care and treatment of those living with mental illness (Henderson et al., 2014).
Stigma, both in the general public and within health care services, has many insidious and dramatic consequences for those affected. For example, self-stigma and social stigma play a major role in delaying and, sometimes preventing, seeking professional mental health care. Institutional stigma deprives people of access to the same opportunities as others.
Finally, it is important to highlight how stigma has acquired even higher relevance in the context of the current COVID-19 pandemic outbreak for at least two major reasons. Firstly, quarantine, social distancing, and isolation have been shown to impact psychological well-being (Usher et al., 2020), triggering a variety of reactions such as maladaptive and avoidant behaviors, depression, stress, and even the so-called “headline stress disorder,” namely emotional responses such as stress and anxiety as a consequence of the continuative media reports, that may also trigger physical symptoms such as insomnia or palpitation, or lead to overt mental disorder (Talevi et al., 2020). Further, initial evidence has also been gained regarding the incidence of acute stress disorder and post-traumatic stress disorder in those who confronted the disease (Heitzman, 2020). Secondly, the COVID-19 pandemic appears to have worsened the issue of stigma: indeed, it has been shown that the pandemic has the effect of increasing the development of stigmatization and associated mental health consequences (Singh et al., 2020), in particular, toward an infected patient, or a close contact of someone infected, along with belonging to a particular race, religion, and social class, with the effect of reducing health-, help-, and treatment-seeking behaviors (Bhanot et al., 2021). Additionally, older people appeared to be particularly stigmatized, belonging to a category that was more heavily hit by the disease – at least in the early stages of the pandemic, causing older people hide early symptoms of the disease and do not seek healthcare because of fear of discriminatory behavior (Tehrani, 2020), hence constituting a major barrier to receiving a timely diagnosis and appropriate treatment, but also as an essential variable that increases mental health issues such as anxiety and depression (Saeed et al., 2020). Overall, these phenomena call for increasing forms of social and psychological support aimed at limiting the severe impact of the pandemic on psychological health (Cullen et al., 2020; Gavin et al., 2020; Kola, 2020; Pfefferbaum & North, 2020).