Health Sciences University of York Stigmatisation and Barriers to Recovery 2 What is stigmatisation Stigma Gk tattoo or puncture mark branding Modern meanings among others a mark or sign of disgrace or discredit ID: 559904
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Charlie LloydHealth SciencesUniversity of York
Stigmatisation and Barriers to RecoverySlide2
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What is stigmatisation?
Stigma = Gk - tattoo or puncture mark – branding
Modern meanings (among others):
‘a mark or sign of disgrace or discredit’
Erving
Goffman
: a discrediting attribute that can make person ‘not quite human’
Stigma hangs over personal interactions between the stigmatised and the ‘normal’Slide3
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Other features of stigmatisation
Universal in human (and other?) societies.
Stigmas vary across time and place
Perceived blame crucial: the more responsible, the greater the stigmaSlide4
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Who are the ‘stigmatised groups’?
Currently: the mentally ill, the disabled, BME groups. Stigma as an unfair process that needs to be combated
But most stigmatised groups are child murderers, paedophiles, rapists, drug dealers – not described as ‘stigmatised’
Stigma literature has tended to focus on groups that are perceived as blameless
Important implications for drug usersSlide5
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Problem drug users: public attitudes
Dangerous, deceitful, unreliable, unpredictable, hard to talk with and to blame for their predicament
More stigmatised than other groups such as mentally ill
Family members also stigmatised: carry blame for addiction
Small study on empathy for pain – video clips of people experiencing pain, 3 groups – healthy, AIDS thru blood transfusion; AIDS thru
idu
. Self-reported empathy significantly greater for non
idu
groups. Matched by levels of brain activitySlide6
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Health professionals
2 studies of treatment of PDUs in hospital setting (US)
Conflict on pain relief
Hospital staff can be distrustful and judgmental but drug users can be aggressive and manipulativeSlide7
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The pharmacy
Unique setting where drug users cannot hide their identity
Half of the users in two UK studies reported feeling stigmatised.
‘They will make you wait around the corner and serve all other people first…like we are scum.’
Shop design – separate doors/space – more or less stigmatising?Slide8
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Addiction services
Potential to increase stigmatisation by cementing an ‘addict’ or ‘junkie’ identity.
Can conflict with conventional lifestyle -
esp
MM
Can lead to further rejection from family and friends
Issues can lead to treatment
avoidenceSlide9
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PolicingJRF study of 62 users
Contact – coercive, adversarial, ‘
unjusified
’
‘…they’re collaring you and they’re
PNCing
you and they’re stopping you, and they’re embarrassing you in the street by making you
spreadeagle
on the car…just trying to belittle you in public...’
Particularly problematic for ex-users in recoverySlide10
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Impact of stigmatisation
‘They look down on me as the scum of the earth…’ PDUs often feel profound sense of social rejection and isolation
High self blame; low self-esteem
Study: recognition of facial expressions. 6 basic expressions – happiness, sadness, fear, anger, surprise and disgust. PDUs generally slow – but
signif
more likely to accurately
recognise
disgustSlide11
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Stigma as a barrier to recovery
Focus on ‘ex-users’ who must be given chance to ‘reform’
Discriminated against in employment and accommodation
Majority of employers will not employ someone with history of heroin or crack cocaine useSlide12
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Issues: medicalisation v criminalisation
Medicalisation
vs
criminalisation
However, a disease with many social origins. Also many diseases
stigmatised
: leprosy, AIDS…
But criminal perspective more
stigmatising
. Illegality and ‘war on drugs’ – talking tough Slide13
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Issues: media and language
Media – crucial influence. ‘Junkie’ frequently used word. Invective.
Language important. Study of 728 mental health profs – vignettes – ‘
Mr
Williams is a substance abuser/has a substance use disorder’ –
s.a
. group more likely to see him as personally culpable, requiring a punitive response
‘Drug abuser’ – NIDA, DSM IV. Misleading term – users treat their substances with great devotion. May contribute to stigma. Slide14
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Issues: blame
Lies at heart of the strong stigma attached to PDU
2 elements: 1) took illicit drugs in first place 2) ‘choose’ to continue to take drugs
But risk factors genetic and early family, so blame? Also users clearly do not feel that they have a choice.Slide15
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What can be done?
Stigmatisation
involves complex social interaction between individuals – hard to influence. But…
Protest – user/advocacy groups. Campaign to ban use of ‘junkie’ in the media? Celebrities.
Education and training. Public education on addiction; training for health care, treatment and pharmacy staff, police.
Contact – personal experiences of PDUs in town
centres
.
The Big Issue
. Other approaches? Volunteering.
Arnold Schwarzenegger.Slide16
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Conclusions
Stigmatisation
matters – felt exquisitely due to deeply social make-up.
Serious impact on lives of those it affects.
PDUs highly
stigmatised
group
However, unlike disabled and mentally ill, not perceived as a blameless, unfairly
stigmatised
group
Major aim of those wishing to decrease
stigmatisation
of PDUs should be to challenge the widespread sense that they have only themselves to blame.
Must be a priority for any Government setting its sights on social reintegration and recovery