Philosophy Department, Vanderbilt University, Nashville, Tennessee, USA.
J Eval Clin Pract. 2022 Oct;28(5):883-889. doi: 10.1111/jep.13735. Epub 2022 Jul 9.
When we face an equation with an unknown variable, we 'solve for x', using methods that allow us to isolate and identify the unknown. Stigma is a known variable in health care equations, but remains impactful in a variety of ways that are not fully mapped or understood. In other words, stigma is a known unknown: it presents potential obstacles to the delivery of effective health care, but what kind of obstacles, of what size and significance, and for whom is often unclear. This paper investigates what Erving Goffman called the 'stigma situation': 'the situation of the individual who is disqualified from full social acceptance.' The core argument is that to successfully incorporate the experiential knowledge of mental health care service users, we must first solve for stigma-that is, we must determine the nature and scope of its significance, and then mitigate its effects. The present paper begins by demonstrating that stigma in mental health care remains an obstacle worthy of sustained attention. It then discusses typical methods taken in efforts to destigmatize mental illness, and suggests that additional work is needed in the clinical context of mental health care. The pervasiveness and complexity of stigma requires diligence in clinical settings to integrate the experience of mental health care service users and work towards an adequate model of recovery.
当我们面对一个含有未知数的方程时，我们会通过一些方法来“求解 x”，这些方法可以帮助我们隔离并确定未知数。污名是医疗保健方程中的一个已知变量，但它仍然以各种未被充分描绘或理解的方式产生影响。换句话说，污名是一个已知的未知：它为有效医疗保健的提供带来了潜在的障碍，但什么样的障碍、规模和意义，以及针对谁，往往并不清楚。本文探讨了欧文·戈夫曼所称的“污名情境”：“个体被剥夺完全社会认可的情境”。核心论点是，要成功地纳入心理健康服务使用者的经验知识，我们必须首先解决污名问题，也就是说，我们必须确定其意义的性质和范围，然后减轻其影响。本文首先表明，心理健康领域的污名仍然是一个值得持续关注的障碍。然后讨论了在消除精神疾病污名化方面的典型方法，并提出了在精神卫生保健的临床环境中需要做更多的工作。污名的普遍性和复杂性要求在临床环境中勤奋工作，整合心理健康服务使用者的经验，并努力建立一个充分的康复模式。
