AIDS AND STIGMA G.M. Herek, 1999

AIDS-RELATED STIGMA  AIDS-related stigma refers to "prejudice, discounting, discrediting, and discrimination against people perceived to have AIDS or HIV, and the individuals, groups and communities with which they are associated" 2

AIDS STIGMA IN THE US AND BEYOND  PWAs/PWHIVs are stigmatized throughout the world to varying degrees, in different ways, e.g.,  Social ostracism and personal rejection of PWHIVs  Discrimination against PWHIVs  Laws depriving PWHIVs of basic human rights  AIDS stigma is effectively universal, but takes different forms country to country, and specific targets vary  In US, in1992, 21% of PWHIVs experienced violence in their communities because of their HIV status 3

THE SOCIAL PSYCHOLOGY OF AIDS STIGMA  Empirical studies conceptualize AIDS stigma as a psychological attitude or facet of public opinion  AIDS manifests 4 characteristics likely to evoke stigma 1) its cause is perceived to be the bearer’s responsibility 2) it is an unalterable or degenerative condition 3) it is a condition perceived to be contagious or dangerous to others 4) it is readily apparent to others, “obtrusive” (Goffman, 1963) 4

THE PERSONAL IMPACT OF AIDS STIGMA  Fear of AIDS stigma and discrimination may deter those at risk from being tested and seeking info and assistance for risk reduction  AIDS stigma affects decisions about disclosing status to others  Loved ones of PWAs are at risk for courtesy stigma (Goffman, 1963), risking ostracism and discrimination b/c of their association with a PWHIV  Caregivers and advocates for PWAs also at risk for courtesy stigma 5

AIDS STIGMA AND PUBLIC POLICY  Mass media were initially slow to report on AIDS  AIDS stigma and stigma attached to injecting drug use have prevented large-scale implementation of needle-exchange programs  Federal law and policy have prevented AIDS educators from providing clear and explicit risk reduction information to individuals at risk  AIDS exceptionalism: HIV exempted from traditional public health practices such as partner notification and contact tracing  AIDS exceptionalism has diminished over time 6

ON BEING SANE IN INSANE PLACES D. L. Rosenhan, 1973

PSEUDOPATIENTS AND THEIR SETTINGS  8 "sane" people became "pseudopatients" in 12 hospitals  varied ages, men and women, one grad student and three psychologists, a psychiatrist, a painter, a housewife  they all used pseudonyms  Pseudopatients complained of hallucinations, each with similar symptoms - hearing voices, words like "empty," 'hollow" and "thud"  Beyond alleging symptoms, falsifying name, and employment, no other alterations of person or history, no life circumstances were changed  significant life events of pseudo-patient were presented as they actually occurred  none of the pseudopatients' histories were pathological  Upon admission to psychiatric ward, pseudopatients ceased simulating symptoms 8

PSYCHIATRIC DIAGNOSIS AS SELF- FULFILLING PROPHECY  A psychiatric label has a life and influence of its own, when a sufficient amount of time has passed and no bizarre behavior is shown, patient is considered in remission and available for discharge – but the label endures beyond discharge, influencing family's friend's and patient's own understanding of self  The diagnosis acts like a self-fulfilling prophecy  eventually patient himself accepts diagnosis and acts accordingly 9

THE EXPERIENCE OF PSYCHIATRIC HOSPITALIZATION  Term "mental illness" coined by humane people who wanted psychologically disturbed people to be treated more like the physically ill, not like "witches" and "crazies"  But the mentally ill still are not treated in same way as physically ill  attitudes toward the mentally ill are characterized by fear, aloofness, hostility, suspicion and dread  the mentally ill are "society's lepers"  Negative attitudes affect general public and professionals - attendants, nurses, physicians, psychologists, and social workers  most mental health professionals would insist they are sympathetic, but there's ambivalence  such negative attitudes are product of the labels patients wear and the places they are found  Consider the structure of the typical psychiatric hospital  segregation between staff and patients  hierarchical organization, lower-level staff take cues from upper-level, and upper-level spend least time with patients 10

POWERLESSNESS AND DEPERSONALIZATION  Eye contact and verbal contact reflect concern or individuation  Continuous exposure to depersonalization creates deep sense of powerlessness among individuals in psychiatric hospital  Signs of powerlessness found everywhere  patient deprived of many legal rights due to psychiatric commitment  lacks credibility due to psychiatric label  lacks freedom of movement  cannot initiate eye contact with staff, but may only respond  personal privacy is minimal  personal history can be accessed by most anyone in facility, as they have easy access to patient files  bathroom trips monitored, bathrooms may have no doors  In extreme, patients felt invisible 11

THE SOURCES OF DEPERSONALIZATION  Attitude of all of us toward mentally ill  Hierarchical structure of hospital facilitates depersonalization  Financial constraints are common in psychiatric institutions, and usually patient contact is the first thing to go 12

CONSEQUENCES OF LABELING AND DEPERSONALIZATION  Consequences of misdiagnosis of physical & mental illness very different  you're relieved when you find out the cancer diagnosis was wrong, but the psychological diagnosis stays with you forever  people don't feel threatened by others with a broken leg, but it's different when someone is diagnosed with schizophrenia  the label sticks, a mark of inadequacy forever  How many are sane outside facility but insane in it, not because of inherent pathology, but because they are responding to the "bizarre" setting? 13

SUMMARY AND CONCLUSIONS  We can't distinguish sane from insane inside psychiatric hospital  Hospital itself imposes a special environment in which the meanings of behavior can be easily misunderstood  Consequences to people hospitalized in such an environment – powerlessness, depersonalization, segregation, mortification, and self-labeling – are counter-therapeutic  Solutions?  avoid psychiatric labels, focus on specific problems and behaviors, and retain the individual in a relatively non-perjorative environment  Treatment of patients did not derive from malice or stupidity by the staff  Staff also affected by environment, their perceptions and behavior were controlled by the situation  In a more benign environment, one less attached to global diagnosis, their behavior might have been more benign and effective 14

LABELING THEORY  Labeling theory assumes that public labeling, or branding, as deviant, has adverse consequences for further social participation and self-image  the most important drastic change is in public identity, which is a crucial step towards building a long-term “deviant career” 15