Zimbabwe: Stigma in Mental Health Must Stop!

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The word stigma referred originally to a mark or brand on Greek slaves, clearly separating them from free men. In common usage the word signifies a disgrace or defect placed on another human. There are two ways stigma is expressed:

1. Felt stigma: Also known as internal stigma or self-stigmatisation. This refers to the shame and expectation of discrimination that prevents people from talking about their psychiatric or psychological issue and stops them seeking help.

2. Enacted stigma: Also known as external stigma or discrimination. This refers to the experience of unfair treatment by others.

Both types of stigma can be as damaging since it leads to withdrawal and restriction of social support. Many psychiatric disorders can be hidden once the person has recovered. Goffman in his book written in the 1960s describes two states of Stigma as a whole, these are:

Discreditable -This allows people to pass as normal so long as no one finds out their conditions or have condition that are not obvious to the naked eye or not expressed to the public.

Discredited -This where people with psychiatric conditions that cannot be hidden from the public and are obvious to the naked eye and to the general public.

People with a discreditable condition like bipolar disorder in remission, anxiety disorders, sleep disorders, and sexual dysfunctions as examples must decide how much to tell and to whom. By careful information management they can minimise social rejection and enacted stigma.

Those who live with a discrediting condition such as schizophrenia with tardive dyskinesia, intellectual disability, and movement disorders will have serious difficulties with information management and are at highest risk of experiencing enacted stigma.

At its worst stigma leads to discrimination, isolation, labeling worsening of simple conditions, unorthodox management of psychiatric patients, hiding of patients by relatives, physical abuse and denial and defaulting of treatment.

Mental health discrimination stems from structures in society and from individuals' attitudes and behaviors; both individuals and structures need to be changed by legal reform, public education , protests and grassroots activities to increase activities of Mental Health Days.

This is best done by both the public and private sector. Mental health must be given the attention it deserves. We must channel more funding to awareness activities in schools, colleges and work places. The time to stop STIGMA IS NOW!!!!!!

Dr Sacrifice Chirisa is a passionate mental health specialist at Parirenyatwa Hospital, one of the country's major referral centresrent.

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