Essay on Assess the Role of Stigma in Everyday Society

Widely heralded and researched in the field of psychology, stigma represents a social process whereby people are being marginalised (or stereotyped) based upon certain attributes which make them stand out from the rest of society in a supposedly unacceptable manner. Goffman (1963) perceives stigma as a response to the need of the society to categorise people as “normal” or “deviant” with the use of normative expectations (i.e. everyone should conform to a certain way of being). The outcome is the transformation of an individual “from a whole and usual person to a tainted and discredited one”, which is certainly anathema towards embracing individuality and the uniqueness which exists in society (Goffman, 1963:3). Goffman makes the vital distinction between ‘actual’ social identity and ‘virtual’ social identity. The latter is the opinion we make about an individual, based upon our first impressions of them and the assumptions we make about the character of that individual (traits etc.), which then mutate into normative expectations which then translate into demands (or societal conventions depending on the terminology which one is using). Until the moment these expectations are validated or refuted, the virtual social identity is what individuals comprehend. Only after the person overtly expresses their attributes, does the actual social identity become noticeable.

How the stigmatised individual interprets the manner in which they are perceived is relevant, as they could potentially conform to societal conventions in their presentation of themselves in everyday life (Goffman, 1959). When individuals believe that they are singled out from others obviously, “discredited stigma” is present. Conversely, when an individual feels that they are not immediately disparate from society as a whole, they possess “discreditable stigma”, should others become aware of what makes them different (Goffman, 1963).

Stigma and epilepsy

Although stigma can have significant psychological impacts on an individual, stigma associated with medical conditions represents further stressors and complications.

One medical diagnosis that is frequently associated with stigma is epilepsy. Scambler (1989) developed a “hidden distress model of epilepsy” which purportedly stated that “felt stigma” can generate more anxiety than “enacted stigma”, which reaffirms Goffman’s beliefs on this matter”. The social perception (and expected stigmatisation) of being diagnosed with epilepsy exerts such an influence over an individual that they have self-induced episodes of anxiety because of this belief of themselves as marginalised. Perhaps unsurprisingly, an individual will be affected by this perception, as it can often be self-perpetuating: if individuals consider themselves to be inferior or ‘labeled’, this can make this more obvious to others and leave them open to ridicule and hostility from others. Felt stigma usually emanates from compulsory education received in one’s formative years and the ‘need’ to conform and comply with the norms elucidated in the initial section of this essay. This can lead individuals to hide information about a condition present in a family in the not completely unjustified belief that people cannot discriminate if they are not aware of the diagnosis (Scambler, 2010).

Mental health

In nursing practice, the implications of stigma can lead to medical consequences being sustained in addition to the social and psychological implication. As is so often the case for mental health patients,they do not seek help if they have faced stigmatisation in the past in their relationship withhealth care professionals. Research shows that health care professionals are not completely aware of the effects of their demeanor and communication with patients who have a mental illness, perhaps due to the ambiguity of verbal/non-verbal communication (West et al., 2010). The behaviours identified in research which are contributory to mental health patients being stigmatised are: “diagnostic overshadowing”, which refers to the incorrect attribution of certain physical symptoms to the mental condition of the patient, “prognostic negativity”, which entails a pessimistic outlook over the likely recovery of the patient and “marginalisation”, which refers to being reticent and unwilling to treat psychiatric symptoms whilst in a medical setting (While and Clark, 2009).

Mechanical ventilation and stigma

Carnevale (2007) underwent research which revealed that when children require mechanical ventilation, both parents and children are or feel stigmatised. Using mechanical ventilation to aid respiratory and breathing capacities (such as in a child that has severe asthma difficulties) is correlated to stigma due to people’s perceptions (or misconceptions in some cases) about disability and the societal beliefs/consensus about what constitutes a ‘normal healthy lifestyle’. The general public, in addition to healthcare practitioners (who are presumably eschewing the medical advantages of a procedure) perceive mechanical ventilation as an intrusive method through which a form of life support is provided in order to compensate for pathology, with connotations and images of being disabled coming to the forefront of one’s mind, such as the image of a wheelchair (Carnevale, 2007).

Age and stigma

Throughout history, elderly people are either categorised in an ameliorative fashion as being wise and active or denigrated for being dependent and senile. Due to the world financing an increasingly elderly population (due to the oft-mentioned reasons of improved healthcare and increasing life expectancy), the perceptions of the elderly need to be changed in order to create positive societal change. Older people tend to be marginalised in society, being considered as different from the general public, whose opinions can be disregarded at will and pale in comparison to the rest of society (Walker, 2015). On occasion, elderly people sometimes stigmatise themselves and and mistakenly believe that they are not deserving of appropriate healthcare and support as the younger generation. Walker’s research illustrates that an aging population is perceived to be an onus or burden on society, which really does inhibit elderly individuals (tending to be those in retirement) from being active citizens in society (instead of being confined to their home environment) which could allow them to access a greater quality of life (Walker, 2015).

Implications of stigma for nursing practice

In nursing practice stigma impacts both the effectiveness of the treatment provided and on the entire care process. For nurses at least, they have to become aware of how the messages they relay to patients are received, taking care to ensure that they are not being discriminatory or offensive in any aspect (Anderson and Funnell, 2010). Due to the proliferation of modern media and the normative beliefs held in society, the instances of stigmatisation are abundant to the extent that it is considered to be ‘normal’ behaviour (Larsson et al., 2011). Empathy and compassion can eliminate stigma, and promulgate a culture of patient empowerment (Henderson, 2003). Research has demonstrated that if a patient is involved in their care process, then they can become intrinsically motivated to partake in their treatment (Coon and Mitterer, 2010) subsequently generating better treatment results and an enhanced sense of satisfaction with the care that is received (Larsson et al., 2011).

Conclusion

Stigmatisation is undoubtedly a complex process. Whilst research has shown a commendable moral commitment to others who are stigmatised (Hughey, 2012), for some academics, the return for acceptance by others has been fuelled by a quest to categorise others and find labels that define conditions or behaviours (Carnevale, 2007). With regards to nurses, the need to challenge any preconceptions and assumptions whilst simultaneously being aware of practices that might inherently erode a patient’s sense of security about themselves and their belief about themselves should be at the forefront of our clinical practice, in addition to respecting the opinions of patients.

References

Anderson, R. and Funnell, M. (2010) ‘Patient empowerment: Myths and misconceptions.’ Patient Education & Counselling. 79, 277-282.

Carnevale, F.A. (2007) ‘Revisiting Goffman’s Stigma: the social experience of families with children requiring mechanical ventilation at home.’ Journal of Child Healthcare. 11(1), 7-18.

Goffman, E. (1959) The Presentation of the Self in Everyday Life. New York: Penguin Psychology.

Goffman, E. (1963) Theory about stigma. New Jersey: Prentice Hall.

Henderson, S. (2003) ‘Power imbalances between nurses and patients: a potential inhibitor of partnership in care.’ Journal of Clinical Nursing. 12, 501-508.

Larsson, I., Sahlsten, M., Segesten, K., Plos, K. (2011). ‘Patients’ perceptions of nurses’ behaviour that influence patient participation in nursing care: a critical incident study.’ Nursing Research and Practice. 1-8.

Scambler, G. (1989) Epilepsy & Stigma. London: Routledge.

Scambler, G. (2010). The Stigma of Epilepsy and it’s impact. [Online]. Available at: http://www.epilepsyaustralia.net/userData/docs/The%20Stigma%20of%20

Epilepsy%20and%20its%20Impact_Professor%20Graham%20Scambler.pdf. (Accessed: 27th May 2015).

Walker, A. (2015). ‘Active Aging: Realising its potential.’ Australian Journal on Aging.34(1), 2-8.

West, K., Hewstone, M. and Holmes, E. A. (2010) ‘Rethinking ‘mental health stigma’. The European Journal of Public Health.20(2), 131-132.

While, A. and Clark, L. (2010) ‘Overcoming ignorance and stigma relating to intellectual disability in healthcare: a potential solution.’ Journal of Nursing Management. 18, 166-172.