Stigma Against Stigma

March 9, 2014

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Whenever a word gains universal appeal we have grounds for suspicion. We have all seen what words like ‘democracy’ mean in the mouths of neoliberal governments and what ‘equality’ becomes when it is spoken by members of the financial class, and how these redefinitions get naturalised. The appeal to words laden with connotations of good and evil attempt to short-circuit critical thought; all too often they become retrofitted as euphemisms that obscure the intentions of ruling class formations. Stigma, a word deployed by many survivors (a term used by people who identify as ex-mental health patients in an avowedly political manner), is now routinely spoken by those systems they survived. What happens to meaning when the abused and the abuser use the same language to speak of, for example, their love?

Few words are as popular in the world of mental health as ‘stigma’. Spoken by psychiatrists, psychologists, nurses, survivors, service-users and patients alike, it enjoys a ubiquity across competing and antagonistic subject-groups. Campaigning against stigma has become the dominant focus of most charities. This industry is exemplified by ‘Time to Change’, an anti-stigma campaign in England.

The idea behind campaigns like ‘Time to Change’ is to raise consciousness by drawing attention to mental suffering by starting a ‘conversation’ about it in the attempt to normalise it. This is done via TV adverts, posters on public transport, websites and celebrity tell-alls. The avowed aim is to make the public more aware and better equipped to deal with such suffering. After £20m spent and four surveys of its effectiveness, the British Journal of Psychiatry reports that the campaign has had only a negligible impact in changing public attitudes. Furthermore, several studies have failed to show that educating people that mental suffering is an illness makes any significant difference – except insofar as it justifies medicalisation and obscures the socio-economic mediators of that suffering. For instance, long-term unemployment leads to depression and doubles suicide risk, whilst life under late capitalism forces people into positions that are depressogenic and neurotoxic; it is unsurprising that Rethink (one of the charities behind the ‘Time to Change’ campaign) employ people on zero hours contracts, and sees this as an unfortunate necessity.

In his radical formulation of stigma, sociologist Erving Goffman presents the concept as an expression of a dynamic relationship between attributes and stereotypes. Using the example of racism, Goffman’s formula states that the attribute of black skin interacts with a series of stereotypes about black skin (i.e. black people are more primitive and/or more criminal). In this way, the question of stigma refers to a structural relationship between physical and semiotic signifiers relating to one another in such a way that they mutually reinforce their reciprocal attachment. Thus, within societies in which racism is rife, black skin can no longer appear without being attached to a series of racist meanings, while those meanings become naturalised as partly constitutive of blackness.

For Goffman, mental suffering may be invisible but its stigmatisation is all the more insidious as it becomes part of a self-reflexive subjectivity that manages itself to prevent exposure. In other words, self-stigmatisation results in subjects who police themselves so as to appear normal: the depressed person must put on a cheery face; the person with eating problems must be seen to eat normally and vomit later, in private; the mother who can’t cope with her new baby has to pretend to feel a love she does not. It is not hard to see how this theory could be made to serve the purposes of responsibilisation, a species of victim-blaming linked to economic moralism.

Originally, stigma meant a mark of shame, often a branding of the flesh that denoted dishonour usually found on ancient Greek slaves and criminals. Today when organisations speak about stigma they tend to be referring to a mixture of attitudes and beliefs that populations and individuals hold about individuals and populations with mental suffering. All too often the idea is that changing people’s hearts and minds will result in a better world for sufferers. As such, anti-stigma campaigns amount to little more than a liberal version of ideology critique aimed at overcoming mystification. The problem here is that of linguistic idealism: by changing what people know about ‘schizophrenics’ or ‘schizophrenia’ nothing is necessarily altered in the structural relationship between ‘schizophrenia’ and the person’s experience.

These campaigns rarely discuss the very real problem of visible mental suffering. Schizophrenia and manic psychoses are regularly embodied in seemingly bizarre behaviour and speech, and psychiatric medications often result in strange movement or postures, hyper-salivation, tremors, to the point that the woman on the bus mistaken for a drug addict might simply be on prescribed medications. There are a host of visible markers of mental suffering that act as somatic attributes coupled to semiotic worlds that end in avoidance, exclusion, fear and violence being directed to the sufferer.

As with racism, or patriarchy, this problem is not erased by a mere changing of attitudes because we are talking about a section of society that is systematically excluded and subject to violence on the basis of somatic-semiotic couplings that justify a material exclusion that intersects with many others (transsexuality is pathologised; black men are disproportionately diagnosed as schizophrenic; the working class are “resistant” or “difficult to engage”).

The mentally ill form a historically invariant section of society that embodies the dissolution of society. People experiencing mental suffering are the sufferers of a generalised proletarianisation resulting from specific stigmatisation. This stigma operates in the same way that these other forms of exclusion do, and their intersections prop up capital and the state. The liberal deployment of terms like stigma and discrimination ultimately work to obscure and perpetuate these structural and impersonal aspects of suffering. A critique of stigma-talk demands a materialist praxis that is able to realise its lost radicalism, organised by and in solidarity with sufferers. Repeating the Sozialistisches Patientenkollektiv: turn the idea of stigma into a weapon!

By Arran James | @dronemodule