Transcript Sinning and sinned against: The stigmatisation of problem

Stigmatisation and Barriers to
Recovery
Charlie Lloyd
Health Sciences
University of York
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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’
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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 stigma
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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 users
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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 activity
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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 manipulative
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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?
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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 avoidence
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Policing
 JRF 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 recovery
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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 disgust
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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 use
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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
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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.
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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.
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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.
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Conclusions
 Stigmatisation matters – felt exquisitely due to deeply social
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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