It’ s become a commonplace that stigma is A-Very-Bad-Thing.


It is. It makes people reluctant to seek help. It makes people feel ashamed. It adds an extra layer of suffering. Self-stigma, the internalisation of social attitudes is very hard to uproot. Many of us report stigma in health and social care services where anything connected with ‘addiction’ is kept at arms length. Yes, we need to challenge stigma. We can, for instance, amplify the voices of people with lived experience of severe health distress. to help people understand that those suffering are not bad, weak, responsible for their own pain but are enduring a severe mental health disorder like any other. But it’s not straightforward.

Stigma is a six-letter word, and like its shorter four-letter linguistic cousins it is also a dirty word – and numerous other dirty words, behaviours and actions are encompassed in its scope. Such a small word in the grand scheme of things – but such a big impact on so many people.

Stigma is also a buzzword – one of those go-to words wheeled out in cycles when we are forced to face the reality of the damage that people experience when they are desperate yet met with hostility and scorn. Things happen, we talk a lot, but it is still there – insidious – and so it is not long before we go through yet another round of actions to tackle it.

The danger of this is that the term stigma itself starts to lose its real meaning, the word becomes divorced from its impact, ennui sets in and professionals see tackling stigma as yet another training hoop – like health and safety – that has to be jumped through in order to get on with the real business of doing their job.

Check out Michaela Jones’ brilliant short piece here.

Astract knowledge about stigma is common. Fifteen year olds preparing for examinations in subjects like sociology and psychology learn about it. School students will come across it through mental health awareness programmes. Generations of professionals will have covered it, many academics making aspects of stigma a central focus. (If you want to refresh your basic abstract knowledge, Wikipedia has a surprisingly thorough page. Good basis for exam revision!)

The NHS Addictions Provider Alliance runs a campaign, Stigma Kills. There is a great new organisation led by people with lived experience of harms from their own gambling or affected by someone else’s, Tackling Gambling Stigma. There is relevant work from other sectors involved with alcohol and other drugs recovery such as The Scottish Drugs Forum. Many Scottish third sector mental health organisations raise stigma as a major mental health issue. It should be noted that sometimes the latter do not give much emphasis to addiction as a mental health disorder, still less to gambling disorders. Some exclude it entirely from the area of mental health.

The Wound Man (right) appeared in the fourteenth century in a guide for surgeons. It could equally well represent the pain of stigma which pierces and wounds and can kill.

The word stigma comes from ancient Greek stigme which referred to a pointed stick. Variations of a stick include swords, spears and brands. People suffering stigma are branded by others with a mark of shame.

We can easily forget that the moment of branding itself can be intensely painful and traumatic, this trauma then the source of enduring distress later on. It is well known that a child suffering trauma has a very high risk of addiction and other severe disorders. Often, this trauma includes being pierced by a branding of stigma.

In the Christian tradition the stigmata of Christ refers to the wounds in his hands and feet left by the nails that pierced his body and pinned him to the cross. Christian or not, we still refer to being shamed and stigmatised as ‘being crucified’. It feels like we have been pierced and ‘hung out to dry’. For all the words and ideas about stigma, nothing is more important than the feelings an individual endures. It is here that the need for safe and supportive companionship is so clear, a place where those who ‘really know’ share each other’s pain.

The pen in the picture above is also a stick, a potential weapon of stigma. A person can be ‘written off’. They can be ‘signed off’ by services long before their need for suport ends. They can be written into predesigned frameworks or diagnoses which totally miss an individual’s life.

The picture on the right also reminds us that a person often suffers from multiple stigma. Poverty, age, gender, educational level, involvement with the justice system, the wrong accent…. stigma is rife.