Get your hands off my stigma.

Today, when people talk about stigma, they’re usually referring to social stigma, which denotes the disapproval of a group of people who are different from the social norms. The word stigma flies out of my mouth a lot—I’m always blabbering on about how we need to do something to eliminate stigma associated with mental illness, rape stigma, female stigma, addiction stigma, poverty stigma, etc.—but what am I really talking about?

 

The word stigma originates from Latin words that signify a mark or brand that was possibly used to identify a criminal or slave. Current definitions include:

  1. A physical scar
  2. A mark of shame or disgrace
  3. A sign or characteristic of a disease
  4. The female part of the flower that receives pollen
  5. The area of the mammalian ovary where a follicle emerges during ovulation

 

Wait a minute, how did we go from shame, disgrace, and disease to female reproductive parts?  Sigh. It probably has to do with the Greek origin of the word stigma meaning “a mark or tattoo made by a pointed instrument or stick (i.e. phallus),” so apparently female parts = the permanently-branded object of male parts. While the female part of a flower is its stigma, the male part of a flower—its anther—is derived from the Latin word that means, appropriately, flower. Similarly, the word penis is derived from the Latin word for tail, which describes the way the organ looks. But the word vagina is derived from the Latin word for scabbard, which is a sheath for a sword or dagger (another phallic object). So in both cases, males are described by what they are, but females are described by what they are in relation to men/what men do to them. Women never had a chance. Is this evidence of centuries-old rape stigma? I don’t know—maybe I’m just an etymology nerd and like to attribute grand implications to the origins of words.

 

But after I was raped, my rapist made me go to the county health clinic with him to get the morning-after pill. I will never forget his statement in the lobby of that clinic—in front of me and the nurses and the other distraught girls there:

 

“I just like to leave my mark wherever I go.”

 

It became my mission to destroy whatever mark he may have left on me, but in doing so, I ended up destroying my entire being.

 

This view of rape victims as permanently-scarred “damaged goods” contributes to the pervasive rape stigma in our society. Victim-blaming doesn’t help either. A couple years ago, I was at a routine gynecological appointment, and upon seeing the PTSD diagnosis on my medical record, the doctor asked if I had been in the military. I told her no, that I had been raped. She acknowledged my history of drug abuse and alcoholism and asked if it was my drug use that caused me to get raped. No. It was a rapist that caused me to get raped. Rape is the fault of the rapist, and you are not permanently-damaged even after such a horribly damaging experience.

 

Rape is a crime, and I wish we could see it as one. I wish we could view rape the same way we view getting shot in the stomach. If you were walking home and somebody came up to you, stole your wallet, and shot you in the stomach, you probably wouldn’t hesitate to call the police. And the police would ask, “What did he look like?” “What was he wearing?” “Was he alone?” Even if you were drunk and wearing a short skirt. But the opposite is true with rape: “What where you wearing?” “Were you drinking?” “Were you alone?” because people believe that rape is somehow the woman’s fault. When victims do report rape, they are often asked to testify about details of their current and past sexual activity—as if that matters. Rape is stigmatized, in part, because it’s sexualized. If you had to testify after getting shot in the street, nobody would ask about the details of your current and past activity walking down the street because the crime doesn’t really have anything to do with walking down the street—in the same way, rape is not sex. Male rape also has a particularly strong stigma. If a man is raped by a man, he is considered to be weak. He is asked if he is gay and if he had an erection, as if that constitutes consent. If a man is raped by a woman, he is, again, asked if he is gay because that’s the only reason a man wouldn’t want to have sex with a woman, right? When reporters write about violent crimes, they will report that the victim was stabbed, beaten, robbed, etc. but they will leave out that the person was raped. While this is generally done out of protection of the victim, it highlights that rape is universally thought to be more shameful that any other kind of violence.

 

Now I’m not saying that getting raped is the same as getting shot–especially because the rapist is usually someone the victim knows, which is precisely what really contributes to this stigma and victim-blaming. We’re taught that if somebody you know and trust violates and betrays you, you must have done something to deserve it. We are taught, “Don’t get raped” rather than “don’t rape.”

 

It’s clear how the meaning of social stigma was derived from the original usage of the word. Visible evidence of a disease. A tattoo used to identify criminals and slaves. The outcasts, the unworthy, the people who are avoided and ridiculed and spat upon. Belonging to a stigmatized group can be treacherous—not only can it destroy one’s self-worth, but it can cost a person their friends, job, and respect. This is why people who find themselves in one of these groups may try to keep it a secret. I have been told countless times not to tell anybody that I was raped, that I had a substance abuse problem, that I’m gay, that I have a mental illness—because I would be “jeopardizing my future.”

 

People with illnesses like depression or PTSD are often seen as weak, inadequate, or that they are just fabricating their symptoms to get out of their responsibilities. This is partially due to the fact that we can’t (yet) see a brain injury like we can see a broken bone or a tumor. Mental illnesses really are brain injuries, but because the function of the brain affects so much of a person’s behavior and personality, these kinds of problems are thought to be within the person’s control. People like to think we are in control of our brain, but it’s more accurate to say that our brains are in control of us. And if there is something wrong with that central operating system, we can’t control our behaviors, moods, and thoughts. One of my responsibilities as a neuroscientist is to understand how mental illness affects the brain, not only to provide better diagnoses and treatments, but—just as importantly—to encourage people to see mental illness like any other physical illness. Nobody would tell a cancer patient to “just get over it.”

 

Unfortunately, this is battle is far from won. Studies around the word have consistently shown that evidence of a biological basis for mental illnesses does not reduce stigma, and, in fact, may even promote it 1-5. People who believe that mental illnesses have a biological or genetic cause tend to fear and avoid people with mental disorders even more because they think they are more dangerous and more hopeless than if the disorder was just “all in their heads.” This could be due to the belief that a genetic defect indicates a defect of the whole person, a defect of the family, and the risk of such a defect in future children. This is the crux of stigma. This summer, an editorial in Psychiatric Bulletin 6 proposed that stigma is dominated by fear and blame, and when one attitude is decreased, the other increases (e.g. decreasing the blame stigma by providing genetic evidence increases fear, and vice versa). Substance abuse/addiction is doubly stigmatized—many people don’t see addiction as a mental illness, and because a person can’t become an addict/alcoholic without choosing to use the substance in the first place, we may never get away from the blame stigma there.

 

It doesn’t seem that attributing a cause (or re-directing blame) to stigmatized issues is helping much. We need to do more than view rape as a violent crime and mental illness as a physical illness. We need to see that regardless of how a person got to the place they are at, they deserve freedom and respect. What do we need to do in order to see past a person’s sexual orientation, abuse history, brain state, physical state, income level, and social status? We need to create a better platform for stigmatized people to share their stories. Maybe science de-humanizes these issues too much, and if we can add real experiences and faces and names to stigmatized people, we’ll see that they aren’t much different from anyone else—and the differences that are there aren’t so scary after all. We need to see people as just that: people.

 

References

  1. Pescosolido, B. a, Medina, T. R., Martin, J. K., & Long, J. S. (2013). The “backbone” of stigma: identifying the global core of public prejudice associated with mental illness. American Journal of Public Health, 103(5), 853–60.
  1. Read, J., Haslam, N., Sayce, L., & Davies, E. (2006). Prejudice and schizophrenia: a review of the “mental illness is an illness like any other” approach. Acta Psychiatrica Scandinavica, 114(5), 303–18.
  1. Dietrich, S., Beck, M., Bujantugs, B., Kenzine, D., Matschinger, H., & Angermeyer, M. C. (2004). The relationship between public causal beliefs and social distance toward mentally ill people. Australian and New Zealand Journal of Psychiatry, 38, 348–354.
  1. Phelan, J. C. (2002). Genetic bases of mental illness – a cure for stigma? Trends in Neurosciences, 25(8), 430–431.
  1. Walker, I., & Read, J. (2002). The differential effectiveness of psychosocial and biogenetic causal explanations in reducing negative attitudes toward “mental illness.” Psychiatry, 65(4).
  1. Gergel, T. L. (2014). Too similar, too different: the paradoxical dualism of psychiatric stigma. The Psychiatric Bulletin, 38(4), 148–51.

 

 

 

 

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