Psychosocial Effects Of Stigma Towards Mental Disorders in Rural Communities

Mental health disorders are rarely on the frontline of health regulations. Previous research has shown that there are several barriers that have been blocking the improvement of mental health care. These include civil society support, the cultural perspectives, mental health gap as a human rights issue and the inherence of beliefs and attitudes towards the mentally ill. Family burden has also been indicated, as relatives of the mentally ill face challenges when caring for loved ones at home and within rural community settings.

The social identity theory originated from two social psychologists, Henri Tajfel and John Turner, in 1979 (McLeod, 2008). A social identity is a person’s sense of who they are, based on their group membership. The theory proposes that a threatened social identity can have an impact on well-being and self-concept. Tajfel and Turner further conceded that individuals do not have just one personal selfhood, but rather multiple selves and identities that are associated with their affiliated groups.

People might act differently in varying social contexts according to the groups that they belong to, which might include their families, race or their country of nationality.

According to one of the social identity contributors, Tajfel, members of all societies engage in social categorization, social identification and social comparison (McLeod, 2008). Tajfel proposed that the different social classes which individuals identify themselves by, are an important source of one’s pride and self-esteem. Therefore, grouping oneself gives individuals a sense of belonging to the social world. When societies are divided into “us” and “them”, it puts people into different groups, where the “us” are in-groups whilst the “them” are the out-groups.

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The social identity theory states that ‘in-groups’ will discriminate and find negative aspects against the ‘out-groups’ to enhance their own self-image. Individuals with mental disorders are ‘out-groups’ within societies as they are discriminated and are associated with many other negative labels such as being called ‘mad people’. Individuals with mental disorders end up losing their sense of belonging because of the negative treatments that they endure within their communities.

Erikson’s Psychosocial Theory of Development

Erik Erikson (1959) proposed the psychoanalytical theory of psychosocial development, comprising of eight stages from infancy to adulthood. With each stage, an individual experiences a psychosocial crisis that could either have a positive or negative outcome to one’s personality development. Erikson is also an ego psychologist who emphasized the role of culture, society and conflicts that take place within the ego. According to Erikson, an ego develops through successfully resolving crises that are social in nature. These crises involve establishing a sense of trust in others, in the form of building relationships with other people. It also consists of developing a sense of identity and belonging in societies. In application to the study, individuals with mental disorders may feel alienated from their societies and so they will not be exposed to the various ways of viewing the self. As a result, individuals may end up defining themselves as mentally ill or unwanted lunatics that are possessed by demons, and this self-definition could represent the greatest component of their identity, contributing to their stigma.

Stigma and Discrimination

Mental health stigma has always left a distasteful demeanor in the face of mental health care systems across the world. Lund et al. (2011) posits that there is agreement that public attitudes towards mental disorders remain negative, with widespread misconceptions surrounding mental disorders as well as those that are affected. People with mental disorders are believed to be weak, lazy, insane, not capable of doing anything as they cannot think for themselves and they are also generalized as violent or aggressive people. The research conducted by Lund et al. (2011) further states that the continuous widespread of stigma attributes to the spread of fearful and discriminatory information within the public domains, leading to inadequate treatment services for the mentally ill. The lack of family and community support could have an impact on treatment plans and promoting recovery amongst the mentally ill.

In addition to Lund et al. (2011), Nxumalo and Mchunu (2017) concede that families of persons living with mental disorders are often subjected to stigma by their association with such individuals. It is also highlighted that the stigma of families is seen in the form of social isolation and rejection. The perpetuation of stigma leads to a lack of motivation in helping individuals with mental disorders during the recovery process, thus resulting in prolonged sicknesses which have financial and emotional implications on families that are affected. The findings of both authors give a clear indication of what stigma is, ways in which it perpetuates and how it affects the mentally ill. As a researcher, it is important for family to act against the stigma, support individuals living with mental illnesses and not fall victim to isolation or any form of negativity within communities.

Mental Health gap as a Human Rights Issue

According to Burns (2011), the gap existing between the burden of mental disorders and the lack of mental health resources in South Africa is a human rights issue. The state has an obligation to provide services for the health needs of its people. Kohrt et al. (2018) further emphasizes the outreach to communities as a crucial component for the human rights protection because in many community platforms such as homes, traditional healing centers or other religious institutions, individuals with mental disorders may be kept in forced seclusion and suffering from many other forms of exploitation, leading to the violation of basic human rights. Mental illness sufferers face multiple forms of inequity and discrimination in their lives, within health systems. The discrimination and prejudice that is encountered by the mentally ill is in the form of reduced social opportunities and social stigma.

As a researcher, one would associate the mental health gap to statistics that prove that the South African health care system advances physical health facilities more than the psychological facilities. This further perpetuates the stigma around mental disorders, especially if the system is failing to provide the necessary health care education and treatment for mental illnesses. Burns’ idea of reduced social opportunities and social stigma also needs to be looked further into, in terms of its effect to an individual who is mentally ill. Concerning the human rights issue, it could also be important to consider the different racial groups in the case of violated human rights because what could possibly be a violation of a human right to one racial group, could be something completely normal to another race group.

Cultural Perspective on Mental Disorders

A large proportion of the population in South Africa hold the traditional explanatory model of illness that mental health care users with severe mental disorders often utilize both Western healthcare facilities and traditional healing systems. Peterson and Lund (2011) conducted research which posits that mentally ill individuals seek help from alternative healers and advisors in the hope that individuals are not judged or looked down upon (Peterson & Lund, 2011). Tilolo (2015) also mentioned in his research that the African society tends to consult traditional healers when individuals manifest certain changes in behavior (Tilolo, 2015). Tilolo also argues that many religious practices interfere with the use of conventional treatment, as religious practices often delay mental healthcare users in consulting mental healthcare providers.

The research findings both state that there is little or close to none co-operation between the two systems of healing, although the systems share the individuals with mental disorders. To promote a form of cultural congruence, there needs to be an increased amount of training to promote mental health literary (Peterson & Lund, 2011). Another theme that is brought up from this discussion is the importance of educating everyone within communities, especially traditional healers and religious institutions because of the large proportion of individuals that would rather not consult with Western healthcare service providers.

Mental Healthcare Workers and Stigma

According to Schulze’s (2007), there are three positions that healthcare workers such as nurses may assume in relation to the stigma of mental disorders. Healthcare professionals are either the ‘stigmatizers’, the ‘stigmatized’ or the ‘de-stigmatizers. Ross and Goldner (2009) conceded that mental healthcare workers hold beliefs that mental illnesses are caused by factors such as weakness of morals, malingering and a lack of self-discipline. The same misconceptions lead to the difficulty in distinguishing behavioral symptoms from ill-mannered or uncouth behavior. Health care workers often make implicit assumptions that an individual who has enacted self-harming behaviors did so from a volition to die. Therefore, healthcare workers believe that no healthcare resources should be wasted on those who ‘wish’ to die. On the other hand, there is also healthcare workers who fear, not based on stereotypes, but because of the lack of resources to provide safety in workplaces to assist with management of aggressive behavior by the mentally ill individuals.

An online article by McIntosh (2017) specifies the role of mental healthcare professionals, which is to lead in the fight to de-stigmatize mental disorders. The article states that even doctors continue to foster stigma through their words and actions when consulting with mentally ill individuals. Patients become irreparably harmed due to mental health professionals who do not read, listen to or care about mental illnesses. One would have to be extra cautious when consulting with health professionals in general as it has been revealed that they often do not look deeper into mental issues unless an individual’s behavior is starting to be a threat to others. The literature review has revealed that there are many areas that need to be considered to elicit the psychosocial effects of stigmatization within mental disorders.

CONCEPTUALISATION

Psychosocial The interrelations of social factors and individual thoughts and behavior. The research study seeks to identify the social and psychological factors that affect people living with mental disorders. Effects The changes which are a result or consequence of an action or other causes. The effects of the study are the outcomes that will be drawn from the stigma towards the different types of mental disorders. Stigmatization. When someone or something is stigmatized, they are unfairly regarded by many people as being bad or having something to be ashamed of. In the study, stigma is referred to as any attitude, behavior or label places on a mentally ill person, that is negative or demeaning to them. Mental Disorder Any of the various psychiatric disorders or diseases, usually characterized by impairment of thought, mood or behavior. In this study, mental disorders could be any illness such as depression, bipolar disorder, schizophrenia or any other mental health disorder which has been diagnosed by mental health professionals using the Diagnostic and Statistical Manual of Mental Disorders (dsm-5) classification.

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