Language and Stigma
The stigma attaching to mental ilnesses is an extra distress for sufferers. We tend to internalise social values and attitudes including judgmental ones, and these we may turn against our self. This can lead to our believing we are ‘bad’ rather than ill, and stop our seeking help. Stigmas are prevalent in society. Often people use hurtful words unconsciously, unaware that they are being hurtful, and it’s widely believed that bringing more awareness and knowledge about conditions will lessen negative stereotypes, judgmentalism and discrimination.
Many big and small mental health organisations and campaigns strive to reduce stigma. In Scotland, See Me has this as their purpose. They have a big range of materials, stories, reports and resources for campaigning. Relatively little attention is paid by these organisations to addiction as a mental illness, or to the severe stigmatisation that surrounds addiction.
This lack of attention may be down to institutional stigma whereby organisations downplay the serious impacts of addiction on individuals, communities and society. It may be seen in some health settings in which patients receive less professional support than they are entitled to. It’s an odd situation given that addictions of all kinds may affect 10% of the population.
Institutional stigma may be seen at the level of policy making, funding, training and resourcing. Gambling addiction is called ‘the hidden addiction’ not only because it is not always evident that somebody has a problem, but largely because it receives little attention and interventions. Much of this, arguably, may be due to stigma.
Our website wants at the very least to draw attention to stigma surrunding gambling disorders, and hopefully contribute a little to challenging this. Because there is so much available about mental health stigma we provide below a few links to materials that dig deep into various aspects of stigma. Most researchers believe much more research is needed to understand stigma. There are also many focuses upon evaluating the best and least effective ways to tackle stigma. We begin though by reproducing a piece from our self-help section.
Dealing with Stigma
Mental health conditions generally carry stigma, the projection onto an individual of negative values such as ‘weak’, ‘irresponsible’, ‘abnormal’. The degree of stigma varies and it’s important to note that stigmatisation is often unconscious and not unkindly meant, and that by no means everybody stigmatises people with a mental health disorder. That said, it is unfortunately pervasive and adds a further burden to somebody’s suffering.
Stigma, visible in common social attitudes, is internalised by sufferers who may feel shame and all the other negative labels of stigma. This can stop people coming forward for support.
Addiction, the extreme end on a spectrum of problems associated with harmful experiences relating to substances and behaviours, is particularly strongly stigmatised. It is possible that addiction is ‘institutionally stigmatised’, that is embedded in the policies and practices and customary attitudes of staff in health and social care services. This results in a lack of resources and attention, a failure to provide support with the same values and importance as general health delivery, and an inadequate delivery of services. Of course, this is partly offset by much excellent work of staff, organisations and anti-stigma initiatives.
How can we cope with being stigmatised? Remember, stigma is not only relevant to health. Large swathes of population are stigmatised by gender, race, social status for example – and in such areas too we witness resistance, challenge and progress. Such progress does not eliminate stigma overnight and as to be ongoing. In the case of an individual, there are no once-and-for-all quick fixes to eliminate the pains of being stigmatised. But there are ways to considerably lessen it.
1. Stigma largely arises through lack of knowledge and an unconsidered adoption of prevailing stereotypes. Anti-stigma projects work on the basis that increasing knowledge and awareness is powerful in combating stigma. Hopefully this website gives some such awareness and insight into gambling harms as connected with a clear health issue. Millions suffer silently from the effects of a substance or behavioural problem, often ashamed and interpreting their suffering as their own fault, the product of weakness or immorality. The first step to handle stigma is to realise you have a common mental health disorder which needs and fully deserves empathic, sympathetic, non-judgmental and skilled support and treatment. You, like millions of others have a problem, the solution to which requires medical and other (such as debt) support.
2. Your family and people close to you may themselves feel stigmatised by association. Worse, in response to problems that have arisen, they themselves may stigmatise you as bad, weak, selfish, and so on. Where possible, and sadly it won’t be, talk to them, provide them however you can with information about gambling harms. Tell them you fully understand their pains and the ways in which they may feel stigmatised, ashamed.
3. Stigma can make you feel very isolated and reluctant to share your understanding or confusion about your suffering. It’s a tremendous relief to open up to somebody close if available. If not, and you feel that you’re capable, join in meetings at Gamblers Anonymous or SMART Recovery. With no commitment necessary at this stage to such groups, the non-judgmental sharing will help you recognise aspects of your own story, show you that you are not unique in your pain. If group attendance seems too much for you, there are plenty of telephone services. Having someone listen respectfully is of huge benefit.
4. You have a problem. You are not a problem. Well, it’s likely you’ll have several problems (being stigmatised being one of them). Perhaps with someone’s help, break down the problems and start working on them. Taking action no matter how little at first will boost confidence and commitment. You, your identity, your whole being are vastly larger than any illnesses or misfortunes that befall.
5. Try to step back and not take stigma personally. See it as a social problem, not a problem of your making.
6. Knowledge about your condition, a pervasive mental health condition that affects millions, will help remove identifying with it as a character fault. The more you learn, the more you will come to see and believe that what’s happened was largely ‘not your fault’.
7. Use such knowledge when talking to people close to you. Try to be patient with their initial ignorance.
8. Tell your story when you are ready. There are countless examples of people telling their stories about gambling. In the media, on social networks, on youtube and podcasts, talks, and focused organisations such as the Scottish Recovery Network, See Me, the Scottish Association for Mental Health and the Scottish Health and Social Care Alliance. We’ve detailed on this site some of the many organisations set up by people harmed in different ways by gambling, and they share stories.
9. Many people in recovery report that getting involved in campaigning, awareness raising and anti-stigma work has been a potent aid to their progress. Having suffered with shame and feelings of worthlessness, they have overcome these by gaining knowledge, joining conversations with others who have been through it, setting up networks and campaigns or joining those of others. Just as we see campaigns to raise the status of mental health to that of physical health, or campaigns to demand fair attention the needs of particular illnesses, or to seek alleviation of poverty and inequality, so we need to bring awareness and information about gambling and to challenge sigma. Getting involved can start with very small steps such as a letter to your MP. Hopefully this website will suggest many ways of getting involved. When you get to a place where you know for sure that you have an illness and not a fault, the energy from working to goal and helping others can be a significant factor in recovery.
What Can be Done to Reduce the Public Stigma of Gambling Disorder? Lessons from Other Stigmatised Conditions
This is a ‘read only’ paper with an Australian focus from the Journal of Gambling Studies, 2020. Although ‘academic’ it’s an easy read and covers a great deal of ground relating to stigma around gambling and illness.
Gambling harms represent a major global health concern. Issues in Australia reflect those in the UK. Another, longer piece about gambling addiction stigma is Hing-Stigma-of-problem-gambling-2015 which considers how stigma can be addressed. Despite global commonalities, in Scotland we have to locate any anti-stigma work within the national context, and also in differing community contexts.
Alex Blaszczynski, Thomas B. Swanton & Sally M. Gainsbury, again in Australia, in the short piece here Avoiding use of stigmatising descriptors in gambling studies encourages researchers and professionals to consider their own usage of language in publications.
Are mental health anti-stigma campaigns effective? Could they even be counter-productive? Danny Taggart a lecturer in clinical psychology at Essex University (UK!) discusses the major English anti-stigma work of Time to Change. He concludes:
In writing this blog and the paper that preceded it, I have been very mindful of the positive stories that I have heard from colleagues, clients and friends who have had transformative experiences through their contact with anti-stigma campaigns. For many of these people, anti-stigma events were the first time they spoke publically about their mental health and this was the first step in their recovery. There is nothing to be gained by denying how important this is for them and wider society. However, I am also reminded of other conversations I have had with the same people whereby their ‘recovery story’ was the only one that anti-stigma campaigns wanted to hear. The messier stories of abuse, poverty, and relapse were toned down or edited out. Perhaps the challenge for anti-stigma campaigns, and public debate, is to be able to listen to these more complicated stories and to ask what more do we need to do to tackle stigma than merely change our minds?
A really useful and practical toolkit from the Danya Institute looks at addiction stigma. A focus on substance addictions but the principles and strategies provide very powerful insights into tackling stigma attaching to all addictions. This toolkit is designed for people who want to engage in efforts to reduce addiction-related stigma. The toolkit can help addiction treatment professionals and community groups to create multi-component stigma prevention and stigma reduction campaigns. It includes 4 sections: an overview of the concept of stigma as it relates to substance use and addiction, a discussion of specific strategies you can use in a stigma prevention campaign, worksheets to help you plan and implement the campaign, and a list of resources with additional information. In use since 2001 it has been slightly modified in 2012 and 2020.
Evaluating the efficacy of a particular campaign (such as here). is one thing. Asking a bigger question about the value of anti-stigma campaigns in general is another. It’s a very big question and we won’t attempt an answer. However, it would be useful to hear how the voices of lived experience about how they see anti-stigma work as fitting in with what is necessary to improving mental health, including addiction, support and care.
Let’s end with a bang rather than a whimper. Here’s an expert by experience, Angela Lemus-Mogrovejo, taking a human rights approach:
…. the takeaways from anti-stigma campaigns are framed around personal responsibility and vulnerability in place of structural transformation. These campaigns often suggest that if only attitudes regarding mental health were to change, people would find themselves more receptive to mental health services and treatment as a whole.
Ignore the fact that many people experience discrimination through the lens of stigma from a variety of institutional factors such as racism, sexism, inadequate housing, poverty, and more.
Ignore the fact that much recent research has indicated that mental health issues are strongly connected to a variety of life circumstances such as child abuse, domestic violence, unemployment, loss, etc.
Ignore the fact that if healthcare services, which currently are not receiving much needed funding, receive more patients than they will be even more incapable of providing needed healthcare.
Simply change people’s attitudes and things will be just fine.
My frustration with these campaigns, at its core, comes from how infrequently they do justice to the lives and needs of those with mental health/psychiatric disabilities. To be clear, reducing stigma should be addressed as it has very real effects on people’s willingness to disclose their issues and seek treatment. However, these campaigns strike me as done by either those desiring to be saviors for “poor, mentally ill souls” or those who have experienced mental health issues without acknowledging the impact of societal factors. It is dehumanizing, pitying, and runs a very damaging risk of misinforming others on the needs of marginalized people with (mental health) disabilities without listening to us in full. We deserve better than this and it is time stigma campaigns do better by us.
We deserve anti-stigma campaigns that address the structural components of psychiatrically disabled lives, not simply attitudes towards those socially deemed mentally ill.
We deserve anti-stigma campaigns that work through political measures to address the complex needs of those with mental health issues as disabled people, not to promote a tokenizing attitude toward us that denies a normalization of our full humanity.
Yes! In the area of anti-stigma work, as in every aspect of mental health, people disagree, often strongly. Just like in life really!
Stigma can be very hurtful in the full panoply of social life, including mental health. It’s usually unconscious (where it is most pernicious), thoughtless rather than malicious. As individuals we can all choose words carefully to reduce stigma somewhat. Anti-stigma campaigns bring great benefits to individuals. Framing stigma as values-based, attitudinal, based on unexamined beliefs is a start in reducing institutional stigma which disallows a parity between mental and physical health. Stigma against addiction is to a large extent reinforced by ignoring its parity with other mental and emotional disorders.
Changing words – for instance using ‘alcohol dependence syndrome’ rather than ‘alcoholic’ – is a useful step. But consider how, for instance, in dealing with stigmas around depression and anxiety we don’t feel the need to change the words. ‘Addict’, though, is a dirty word. On this site we stick with the word addiction to represent a unique severe disorder – partly to insist on its character as separate from anything else. Secondly, for the forsseable future there will be Journals of Addiction, addiction research, and the ongoing institutional division between ‘mental health services’ and ‘addiction services’. We refer to an individual as ‘impacted by addiction’ or ‘in recovery from addiction’. There can be no justification for referring to somebody as ‘an addict’. We also emphasise that ‘gambling addiction‘ is a fairly rare, extreme state on the spectrum of gambling disorders.