Prof. Dr. Kemal Arıkan
Psikiyatrist

Stigmatization in Psychiatry

Besides being a concept that was used in ancient times as a method to brand the bodies of slaves and criminals with a red-hot iron in order to exhibit those people, stigmatization appears as an attempt to marginalize or to classify people due to specific characteristics they have, despite having the same logical grounds in social sciences, primarily in sociology and psychology. Throughout the history, individuals, who were marginalized or considered as people to be kept away from, were always stigmatized through the opinions of the people, and not always necessarily with a red-hot iron, in many societies. The categorization and classification of people appear to be a pattern of behavior that the majority, consciously or unconsciously, have.

When considered from a psychological perspective, stigmatization, also known as branding, which is a concept that can be described as an individual being biased against by other individuals or cliques due to the mental problems that individual is having, or because of some aspects of theirs that are not compatible with social norms, is a mistake to be paid utmost attention on at psychiatry clinics. The fact that a person, who’s coming for treatment, is branded by those whom they expect treatment from, and the fact that the treatment started with prejudice are mistakes that are made right at the beginning of the road for the patient.

Who’s Healthy, Who’s Not?

Those, who work on the field of mental disorders, know very well that it is not as easy as it looks to determine whether a person is normal or abnormal. Dr. David Rosenhan of Stanford University, who has doubts on stigmatization and on how healthy the patients are observed in terms of diagnosis, showed this issue through his sensational experiment in the psychiatry circles.

Carried out in 1969, the Rosenhan Experiment, although its original name is “the Thud Experiment”, took the world by storm when it was published in the Science magazine in 1973.

Rosenhan and seven of his down-to-earth friends hid in different psychiatry hospitals and expected to be noticed by the doctors, and yet the doctors failed to notice this situation. These eight healthy individuals, who were engaged in different occupations, dispersed to different hospitals in different states of America, and said they only heard voices, such as “thud”, “empty”, and “hollow”, and then proceeded to act normal, but they were all admitted to psychiatry hospitals. Although it is hard to believe, all but one of these eight people were diagnosed with schizophrenia despite having only mentioned auditory hallucinations.

While those healthy individuals, who took part in this experiment, were thinking that they would get caught and fall into disgrace, the exact opposite happened. The doctors did not back away from the diagnosis/branding they made although these participants, who were diagnosed and admitted to hospitals through a single symptom, acted quite healthily following their admissions and stated that the initial symptoms they told about disappeared. The hospital personnel, who observed their normal behaviors during the day, always provided the doctors with negative reports, which was the exact opposite of the situation.

At the end of the experiment, Rosenhan put forward that the failure to diagnose an unhealthy person is worse than a healthy person getting falsely diagnosed, and as a consequence of this finding of his, the American Psychiatric Association rearranged the patient diagnosis criteria (DSM; Diagnostic and Statistical Manual of Mental Disorders) in a more detailed manner in 1980.

What Could be the Solution?

Brain scanning systems (EEG, fMRI, fNIRS, etc.) facilitating the diagnosis of psychiatric disorders are of the opportunities the developing technology provides us with on the field of medicine. Using such technological methods in order to make healthier diagnoses within the opportunities will prevent all mental health employees from making mistakes, such as being biased against, labeling, branding the individual who’s there for treatment.

Epilogue

As it is clearly seen, the sensitivity must be at utmost levels during the diagnosis in order to avoid making psychological disorders a victim to stigmatization. These disorders are not as easy as diagnosing a fracture/dislocation, and making use of technological progresses, in addition to theoretical and experimental approaches, during the diagnosis process is a principle to be applied both ethically and conscientiously by the mental health employees, regardless of their positions. We must all remember that an unbiased life is possible.

Psikiyatride Stigmatizasyon

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