One of the most uncomfortable things that individuals with substance use and mental health conditions face in their recovery journeys is the impact of bias and stigma. Although the professional world and society at large have come a long way in understanding behavioral health disorders, emotional and social responses in society have not necessarily kept pace with the intellectual understanding within the clinical world.
In any culture, the mainstream group set the standard and decides the ranges of what is considered “normal”. For much of recorded history, individuals with mental health conditions, were considered to fall outside of that range. Often, families denied a mental health condition for fear it would bring shame to the rest of the family. In modern times, particularly since the temperance movements and prohibition, people with substance use disorders were also considered to be outside the range of normal when their substance-influenced behaviors were unacceptable.
Some of the negative perception of individuals with behavioral health disorders is rooted in fear or ignorance and some in rooted in moral judgement. Whatever the root, the experience of such judgment can cause significant distress to our clients and their families. It is likely that you experienced some of the same distress when confronted with those negative attitudes.
In general people with perceived difference internalize the dominant cultural perception. This is true of persons with behavioral conditions in the same way it is true of racial and ethnic minorities. The result of this internalized stigma may be feelings of helplessness, hopelessness and worthlessness.
The Difference Between Bias and Stigma
Two terms that are often used interchangeably are “bias” and “stigma.” Actually these two terms have quite different meanings. Bias merely refers to a preference for one thing over another or an inclination to avoid something, rather than to seek it out. On the other hand, stigma is a term that is associated with more than preference – stigma refers to a negative judgment about something or someone and the social rejection associated with that judgment. When a quality, characteristic or condition carries a stigma, the individual who has that condition may internalize the negative judgment and feel shame or worthlessness. Simply put—bias is a question of either/or, while stigma is a distinction between acceptable and unacceptable.
Language provides a clue as to whether someone is expressing a bias or assigning a stigmatizing label to another individual. But, according to the U.S. Department of Health and Human Services:
“Stigma is not simply the use of negative labels or wrong words: it is disrespectful to the individual who has a mental illness. It further discourages the individual from seeking the help they need for fear of discrimination. Furthermore, stigma encourages fear, mistrust, and violence against people with mental illness.”
Stigma is often expressed through labels. All of us have probably experienced name-calling of one type or another at some time in our lives. Sometimes those names are not hurtful because they do not have much to do with our identity or they are used only by a small number of individuals. Sometimes, labels are even used as terms of endearment, such as when they are a nickname that signifies belonging. Labels are different from nicknames because they tend to put people into groups, rather than to regard them as individuals. When we see a person’s label, rather than their true selves, it is easier to exclude, dismiss or devalue them. Use of labels is not consistent with a strengths-based, recovery-oriented culture.
Peer Specialists and Stigma
Peer specialists deal with stigma on three fronts:
- in their own recovery journeys
- with the clients and in helping clients to avoid internalized stigma
- in the workplace, as they are seen as ambassadors and representatives for persons in recovery.
Dealing with stigma on all three fronts requires a strong sense of self, an ability to resist stigma without becoming angry and bitter and the ability to remain calm in the face of labels, negative attitudes. Since some stigma comes from fear and lack of information, the peer specialist’s skill in forming relationships and communicating effectively with others can go a long way in helping to overcome stigma. There is a great deal of misinformation about behavioral health conditions that contributes to stigma. When the peer specialist can calmly and respectfully dispel that information, they are serving themselves, their clients, their employers and the community.