NURS3325 Discussion Mental Health Holistic Care of Older Adults

Far more than any other type of illness, mental disorders are subject to negative judgements and stigmatization. Many patients not only have to cope with the often devastating effects of their illness, but also suffer from social exclusion and prejudices. Stigmatization of the mentally ill has a long tradition, and the word “stigmatization” itself indicates the negative connotations: in ancient Greece, a “stigma” was a brand to mark slaves or criminals.

For millennia, society did not treat persons suffering from depression, autism, schizophrenia and other mental illnesses much better than slaves or criminals: they were imprisoned, tortured or killed. During the Middle Ages, mental illness was regarded as a punishment from God: sufferers were thought to be possessed by the devil and were burned at the stake, or thrown in penitentiaries and madhouses where they were chained to the walls or their beds. During the Enlightenment, the mentally ill were finally freed from their chains and institutions were established to help sufferers of mental illness. However, stigmatization and discrimination reached an unfortunate peak during the Nazi reign in Germany when hundreds of thousands of mentally ill people were murdered or sterilized.

Structural discrimination of the mentally ill is still pervasive, whether in legislation or in rehabilitation efforts.

The stigmatization of mental illness is still an important societal problem. The general population is largely ignorant about this problem, and fear of the mentally ill remains prevalent. Although we no longer imprison, burn or kill the mentally ill as in the Middle Ages or in Nazi Germany, our social standards and attitudes are nonetheless unworthy of modern welfare states. Structural discrimination of the mentally ill is still pervasive, whether in legislation or in rehabilitation efforts.

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A comprehensive concept of stigma

Stigma can be described on three conceptual levels: cognitive, emotional and behavioural, which allows us to separate mere stereotypes from prejudice and discrimination. Stereotypes refer to prefabricated opinions and attitudes towards members of certain groups, such as ethnic or religious groups, whites and blacks, Europeans and Latin Americans, Jews and Muslims, and the mentally ill. The most prominent stereotypes surrounding the mentally ill presume dangerousness, unpredictability and unreliability; patients with schizophrenia are most affected by such views.

Stereotypes are not necessarily wrong or negative, as they can help us make quick judgements about persons who share specific characteristics. Stereotypes thereby allow us to deal with or adapt to a specific situation without needing more information about the persons involved. If we asked for directions, we would approach a police officer in a different way than an old lady; our stereotypes of police officers and old ladies would help us to adopt the appropriate behaviour.