Economou M, Bechraki A, Charitsi M
First Department of Psychiatry, National and Kapodistrian University of Athens, Eginition Hospital, Athens.
University Mental Health, Neuroscience and Precision Medicine Research Institute "Costas Stefanis" (UMHRI), Athens, Greece.
Psychiatriki. 2020 Jan-Mar;31(1):36-46. doi: 10.22365/jpsych.2020.311.36.
The present article explores the concept of stigma from a historical and theoretical perspective. At first, the conceptual origin of the term "stigma" is presented as well as its subsequent course and incorporation in the scientific field. The term stigma originates from ancient Greek language and in particular from the verb «στίζω», which means "to carve, to mark as a sign of shame, punishment or disgrace". In contemporary thinking about stigma, the work of Erving Goffman is seminal. According to him, stigmatization is elicited by the presence of a socially undesirable characteristic, which signals otherness. When this characteristic becomes conspicuous during a social interaction, it may act in a disqualifying manner for the identity of the person who bears it. One of the first theories on social stigma which attracted increased scientific attention is labeling theory by Thomas Scheff. Later on, the conceptual model of Corrigan and Watson underscored the main constituents of stigma, namely stereotypes, prejudices and discrimination; whereas the theoretical framework of Link and Phelan stressed labeling, stereotyping, separation, status loss and discrimination as interconnected components in a power situation. During the last half of the previous century, the concept of stigma came to the fore and gained growing research attention, especially due to shedding light on the ways whereby people with mental disorders were treated socially. Most of the literature has focused on recording the general population's level of knowledge and lay beliefs about mental illness as well as on exploring social attitudes and desired social distance from people with mental disorders. Converging evidence indicates that stereotypical beliefs and discriminatory attitudes against people with mental illness prevail worldwide; while illness severity, poor therapeutic outcome, disturbances in patients' emotional expression during a social interaction, incidents of violent or dangerous behaviours and labeling have all been shown to influence public stigma. Regarding lay respondents' correlates of public stigma; male gender, older age, lower socio-economic status, lower educational attainment and residence in semi-urban or rural areas have been linked to unfavourable attitudes towards people with mental disorders; while of outmost importance is personal experience/ familiarity with mental illness.
本文从历史和理论角度探讨了污名的概念。首先,介绍了“污名”一词的概念起源及其后续发展历程以及在科学领域中的纳入情况。“污名”一词源于古希腊语,尤其源自动词“στίζω”,意为“雕刻、标记为羞耻、惩罚或耻辱的标志”。在当代对污名的思考中,欧文·戈夫曼的著作具有开创性意义。据他所言,污名化是由一种社会上不受欢迎的特征引发的,这种特征标志着差异。当这种特征在社会互动中变得明显时,它可能会对具有该特征的人的身份产生否定作用。最早引起科学界更多关注的社会污名理论之一是托马斯·谢夫的标签理论。后来,科里根和沃森的概念模型强调了污名的主要构成要素,即刻板印象、偏见和歧视;而林克和费兰的理论框架则强调标签化、刻板印象、隔离、地位丧失和歧视是权力情境中相互关联的组成部分。在上个世纪的后半叶,污名的概念开始受到关注并获得越来越多的研究关注,特别是因为它揭示了精神障碍患者在社会中受到对待的方式。大多数文献都集中记录普通人群对精神疾病的认知水平和外行观念,以及探索社会态度和与精神障碍患者期望的社会距离。越来越多的证据表明,对精神疾病患者的刻板信念和歧视性态度在全球普遍存在;而疾病严重程度、治疗效果不佳、患者在社会互动中的情绪表达障碍、暴力或危险行为事件以及标签化都已被证明会影响公众污名。关于外行受访者的公众污名相关因素;男性、年龄较大、社会经济地位较低、教育程度较低以及居住在半城市或农村地区都与对精神障碍患者的不利态度有关;而最重要的是个人对精神疾病的经历/熟悉程度。