Widely heralded and researched in the field of psychology, stigma represents a social process whereby people are being marginalised (or stereotyped) based upon certain attributes which make them stand out from the rest of society in a supposedly unacceptable manner. Goffman (1963) perceives stigma as a response to the need of the society to categorise people as “normal” or “deviant” with the use of normative expectations (i.e. everyone should conform to a certain way of being). The outcome is the transformation of an individual “from a whole and usual person to a tainted and discredited one”, which is certainly anathema towards embracing individuality and the uniqueness which exists in society (Goffman, 1963:3). Goffman makes the vital distinction between ‘actual’ social identity and ‘virtual’ social identity. The latter is the opinion we make about an individual, based upon our first impressions of them and the assumptions we make about the character of that individual (traits etc.), which then mutate into normative expectations which then translate into demands (or societal conventions depending on the terminology which one is using). Until the moment these expectations are validated or refuted, the virtual social identity is what individuals comprehend. Only after the person overtly expresses their attributes, does the actual social identity become noticeable.
How the stigmatised individual interprets the manner in which they are perceived is relevant, as they could potentially conform to societal conventions in their presentation of themselves in everyday life (Goffman, 1959). When individuals believe that they are singled out from others obviously, “discredited stigma” is present. Conversely, when an individual feels that they are not immediately disparate from society as a whole, they possess “discreditable stigma”, should others become aware of what makes them different (Goffman, 1963).
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Stigma and epilepsy
Although stigma can have significant psychological impacts on an individual, stigma associated with medical conditions represents further stressors and complications.
One medical diagnosis that is frequently associated with stigma is epilepsy. Scambler (1989) developed a “hidden distress model of epilepsy” which purportedly stated that “felt stigma” can generate more anxiety than “enacted stigma”, which reaffirms Goffman’s beliefs on this matter”. The social perception (and expected stigmatisation) of being diagnosed with epilepsy exerts such an influence over an individual that they have self-induced episodes of anxiety because of this belief of themselves as marginalised. Perhaps unsurprisingly, an individual will be affected by this perception, as it can often be self-perpetuating: if individuals consider themselves to be inferior or ‘labeled’, this can make this more obvious to others and leave them open to ridicule and hostility from others. Felt stigma usually emanates from compulsory education received in one’s formative years and the ‘need’ to conform and comply with the norms elucidated in the initial section of this essay. This can lead individuals to hide information about a condition present in a family in the not completely unjustified belief that people cannot discriminate if they are not aware of the diagnosis (Scambler, 2010).
Mental health
In nursing practice, the implications of stigma can lead to medical consequences being sustained in addition to the social and psychological implication. As is so often the case for mental health patients,they do not seek help if they have faced stigmatisation in the past in their relationship withhealth care professionals. Research shows that health care professionals are not completely aware of the effects of their demeanor and communication with patients who have a mental illness, perhaps due to the ambiguity of verbal/non-verbal communication (West et al., 2010). The behaviours identified in research which are contributory to mental health patients being stigmatised are: “diagnostic overshadowing”, which refers to the incorrect attribution of certain physical symptoms to the mental condition of the patient, “prognostic negativity”, which entails a pessimistic outlook over the likely recovery of the patient and “marginalisation”, which refers to being reticent and unwilling to treat psychiatric symptoms whilst in a medical setting (While and Clark, 2009).
Mechanical ventilation and stigma
Carnevale (2007) underwent r
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