Mind Moves: Sitting in a crowded sexually transmitted infection (STI) clinic can be an unsettling experience. It's something that later you may not care to disclose to friends over, say, dinner.
But recently I found myself in precisely such a context. With my credibility on the line and my ego at risk of being gravely misunderstood, I had a brief glimpse of what it was like to be on the receiving end of stigma.
The details are hardly important. Okay, they are. I had contracted an infectious "tick bite" disease while exploring bush country in South Africa.
On my return home, I was gripped by an impressive fever, which rendered me like one of those GIs who lay shivering and sweating in M*A*S*H tents with malaria. I accepted, with relief, a referral to the infectious diseases clinic at the Mater hospital.
It was not an easy place to locate on the hospital campus, with dreadful signage and a bland grey door which, even as you entered it, gave little reassurance that you were in the right place. As I walked in I made a mental note to complain to someone, until I realised that the clinic's low profile was deliberate.
Signage inside the clinic left little doubt about the reasons for choosing discretion. Its principal users are people with STIs, HIV and Aids - people who probably don't need neon announcements of their plight displayed outside the building.
Sitting there, I found myself entertaining the fantasy of addressing the assembled congregation and explaining why I was there. Or more to the point, what I wasn't there for.
In moments like this, one realises that one's mind leaves a lot to be desired. There was only one person in the room judging me: myself. I was looking at myself through the eyes of a stigmatised attitude I held about people with STIs.
Stigma occurs when we label a person or a particular group of people in a pejorative way that sets them apart from others. On the basis of some particular attribute, be it mental illness, sexuality, lifestyle or religious belief, we deem them to be undesirable in a variety of ways.
Misinformation is added to some particular feature of their behaviour which generates a global negative impression of their personality and character.
In a recent study, people with mental illness were regarded as different to other people. More than half of those interviewed viewed people with depression as having lower intelligence than the general population and people who experienced psychosis as being prone to violence.
In reality, there is no evidence for these views, but when we are afraid of something, we are inclined to "add in" lots of false assumptions that grow into the stigma we inflict on those who seem different to us.
The damaging effects of stigma can be considerable. People with severe mental illness find it harder to avail of job opportunities, to gain access to adequate physical care, and to secure appropriate accommodation. As a result, they experience a poorer quality of life, lowered self-esteem and increased stress. To cope with stigma, they avoid other people, engage in secrecy and experience reduced social support. Inevitably, these coping mechanisms increase their likelihood of relapse.
The stigma among the general public surrounding those who experience mental disorders is familiar. It is perpetuated by misinformation, fear and lack of contact with real people who experience and recover from these difficulties.
This is why it is important that people have been able to come forward and tell their personal stories of struggle and recovery, and help to counter the misinformation that abounds in the public mind.
A common reaction from psychology students, heard repeatedly after their first week of placement in a psychiatric hospital, is: "I never realised these patients would be so normal".
More surprising perhaps is the recent finding that a wide variety of seasoned mental health professionals hold stigmatising beliefs about those with mental disorders.
Some of this reflects fears about their own vulnerability to emotional crises and their desire to distance themselves from those who are not managing to cope with life. But a major reason is their pessimism about the possibility of recovery from mental illness.
It seems our fear of engaging with people in severe distress can only be overcome when we believe that their pain can be resolved.
When it comes to stigmatising people, we are all guilty. It's comforting in some perverse way to look down on others, to lump them into a stereotype and assume we are better than them. Rather than get to know more about what makes them different, we label them as inferior, stupid, childish, and even dangerous.
If we were to get close to them we would experience them as having much more in common with us than we imagined. In rejecting them, we exile a part of ourselves. And when our illusion of being superior cracks, we are unable to welcome difficult experiences that reveal the ways in which we are as yet unformed, unresolved and deeply human.
• Tony Bates is a clinical psychologist.
