Stigma

I read an article recently titled 'Neutralizing Stigma', by Jackson Rainer, PhD, In the magazine Arthritis Self-Management. Dr. Rainer defines stigma as “an unfavorable assessment of a person that is based on a particular attribute, usually one that marks the person as different from others”. In other words, it stereotypes people who are different as not 'normal'. It can take the form of rejection or discrimination, based on fears and prejudice arising from that sense of difference.

I usually think of stigma as related to metal health. Many people still think of mental illness as voluntarily being lazy (depression), or crazy (schizophrenia). Mental illness is as real as physical illness, caused by imbalance of chemicals in the brain. I often tell my patients at the hospital that they have the opportunity to educate people, if they choose. People with mental illness are not 'those crazies out there', they are us, people like any other people, who happen to have an illness.

This article is about the stigma against people with arthritis. My first reaction was 'What stigma?” The first anecdote was about a woman with hands deformed by rheumatoid arthritis being called 'lobster lady'. That is one form of stigma, being called names because of one's differentness. The second anecdote in the article tells of a woman being assisted from the car to her wheelchair by her home health aide. A passerby talked about her with the aide as if she were invisible. This depersonalization is another form stigma can take. Those of us with invisible illness may be subject to a variant of stigma. People may assume we are lazy, or are faking our illness to get out of work or social obligations.

Stigma hurts by making the person feel inferior or inadequate. Chronic illness or pain can make us less able and independent, and this can make us feel inferior or inadequate in our own mind. When we hear others say or imply it, it only confirms it to us. It can be a challenge to maintain high self esteem when living with illness. With lower self esteem, one is more likely to listen to and believe what others say about them.

Stigma needs to be dealt with on two levels. The first is learning to cope well with illness and with your own feelings of being stigmatized. This can include educating yourself and those close to you, finding support groups and community resources, and counseling if needed. Develop your self esteem based on who you are and what you can do, rather than what you can't do. Remember that just because someone says something to you or about you, you don't have to believe it.

This leads me to the second level of dealing with stigma. Stigma comes from ignorance, prejudice and fear of 'other'. The key to eliminating stigma is education. People are less afraid and more accepting of things they understand. Think out how you can explain your illness/disability briefly, in easy to understand terms. Humor can help to diffuse discomfort on both sides. Be aware that not everyone wants to be educated, and there are people who will be hostile to your efforts. When confronted with this, accept it for what it is. Don't take it personally, it is them, not you.

People with handicapped parking stickers who don't have obvious disabilities often get rude looks or remarks from people who see them getting in or out of their cars. This article quotes a man who knows 'the look' all too well. When he sees it, he just laughs and says “Arthritis. Can't walk as far as you. I can see you're jealous because I have a closer parking space to the door, but don't be. It's really not worth it.”