Where does stigma come from? I’m sure there are answers and possibly more theories. I believe some stigma is the result of the assumptions we have of human behavior. To a degree in the west we believe that people have direct control over their fate and get what they deserve in life. (The Just World Hypothesis) To view poverty, hunger, oppression, illness and abuse as arbitrary is disconcerting. We have all heard the ignorant suggest that those who live in countries susceptible to famine should simply move. They assume their good fortune at being born in a democratic and wealthy nation was somehow personally determined. You are responsible for this as much as you are responsible for your height or eye colour. We like to know the cause of illness. To believe illness is indiscriminate not only goes against our worldview but it threatens our ideas of personal power and self-determination. Westerners are uncomfortable with powerlessness. Consider the lengths we go to battle male baldness. There are entire industries built to combat physical attributes. Acceptance equals defeat for some.
Westerners also value individualism. We value independence above all else. As such we assume individuals who have mental health problems can overcome their symptoms with nothing more than willpower. It’s all in your head is it not? The idea of responsibility I would argue is more pronounced in mental health than it is with physical health. We would be considered callous if we told the cancer patient to “pull up your socks.” The depressed person on the other hand is often told to snap out of it.
Is it possible that stigma is fear of a perceived threat; a threat to our person but also to our worldview. If mental illness is without cause it threatens our beliefs and elicits fear. It could be argued that as mental health consumers we are exposed to both the “flight” and “fight” responses to fear. We are avoided and segregated; even ostracized (“flight”) and we are often ridiculed (“fight”).
I am unsure of how to combat stigma but in overcoming fear, exposure is often employed. If those who have no experience with mental illness opened their hearts and minds to us they will be exposed not to a pathogen but to a human. As more people step forward, hopefully more will stand back and see us as human. As my Occupational Therapist is fond of pointing out “they” like ice cream too!
Brett Batten 
I found your use of the term “mental health consumer” interesting. I assume this is a North American phrase? I’ve never come across it in the UK (“mental health service user” tends to be more usual). To me it sounds like this very phrase might be associated with many of the concerns you address around self-determination and individualism. At any rate, it appears to express choice, agency – and, indeed, a backdrop of consumerist society – in a way that “user” does not. I’m sure terms like this are introduced to try and combat powerlessness, but perhaps they simply end up encouraging stigma in other ways (like that you suggest).
At one of my first conferences I attended, as a panel we had to introduce ourselves. During my years of hospitalization I usually referred to myself as a patient. I was aware of the term consumer and introduced myself as such. Someone in the audience gave a small chuckle knowing I was involved with forensics. I never sought out my involvement and powerlessness was as routine as my medications. I did not feel like a consumer because I was at no point able to remove myself from the service I was apparently purchasing. I sometimes wonder if using a different term for those in mental health care is helpful. If I am getting my appendix out I am a patient so why wouldn’t I be if I was being treated for a mental illness? I use the term consumer or client when I speak or write because I assume there are some who feel empowered by the terms. I think the best way to empower clients/patients is to have them involved in their treatment.
Thanks for your perspective. I’ve never been a fan of consumer, as a former mental health provider, and I’m not sure why. I prefer the term client. I never use the term patient because of its association with the medical model that takes tends to see the doctor as the expert and the “patient” as not bringing anything of value to to the service. The medical field is slowly changing to a “patient-centered model” but I don’t think is addressing the arrogance of the medical field. But I digressed.
Anyway, I don’t think I like consumer because of the association with consumerism. Words can be very powerful because of the association they have with meaning – and it is meaning that defines us. I am wondering how the word client would work to define who you are as a user of services? This is important for me because I am writing some policies for a mental health agency that provides the community mental health services in our area. I want to use language that is respectful and also accurate in describing what is involved in the providing and using of services – the helping process. Thanks for any help you can provide for me.
Thanks for your thoughtful post.
Hi Pat,
Thank you for your thought provoking comments. Being in the forensic system I was never a consumer. I did not seek out their services. I felt powerless much of the time. Every three months I would be asked into a room of a dozen health care providers and told what their plans were and the privileges I was being awarded. Forensics is not the norm but it made me realize the best way to empower clients is to have them participate in their treatment. I don’t mind client and often referred to myself as a patient possibly because I experienced some of what you describe. I have thought about what other terms could be used and sadly can only offer a couple. Partner seems to fit somehow but is awkward. As a healthcare provider you are assisting me so I chose it for the impression of cooperation. I was also treated by “Teams” so team member may offer a different perspective as well. No term works however if the process does not change. I would like to see the change then the name rather than the name then the change but possibly they follow each other.
I’m not sure if I have been helpful but I would be pleased to continue the conversation. I wish you all the best with your project and thank you for your efforts.
Kind regards,
Brett
Your response helped a lot. I am going to play around with partner because I like it. I went for mental health treatment because I was seriously depressed and met with a team. It was a horrifying experience so I can only imagine what yours was like. You had so much more riding on the decisions of your “meetings”. Thanks for your helpful perspective.
It was scary to have so many others making decisions on whether I could walk outside even. I think teams can be helpful but I find it ludicrous that the client is not a member of their own team. I trust you are in good health presently. I’m sure your experience is invaluable to your efforts.
I’m having a debate with myself on the chicken and egg thing. What comes first? Exposure or acceptance. Can’t work it out but am working on a post. Meanwhile I’m hoping the OT provides ice-cream. 🙂
Yes, if he knew I liked ice cream why did he never buy me one? I will have to pose that question to him. I have a feeling that despite being exposed there are individuals who will never arrive at acceptance.
What a beautiful post. Again, you are voicing long held beliefs of mine. If a person says I have cancer or diabetes, that person becomes almost instantly heroic and very much supported….AS IT SHOULD BE….but so should it be for those who have had any dealings with mental health illness.
Thank you for the compliment. I have often wondered if mental illness and those affected were regarded AS THEY SHOULD BE if outcomes would be better. If we held derision for cancer I suspect recovery would be more of a challenge. Thanks for your insight.
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