by Monica Ross
I’d like to talk a little bit about stigma. And I’ll apologize in advance for the length of this post as it is a topic that is near and dear to me and I have a lot to say. As an undergraduate student at The University of Texas at Austin I read a book called Stigma: Notes on the Management of a Spoiled Identity written by Irving Goffman. The book really spoke to me for several reasons. For one I was dealing with my own issues of identity at the time as a twenty-something. But two, it hit on so many things that I felt I had personally witnessed in life up until that time that had really bothered me in terms of observing people coming into conflict with social standards and how those individuals were treated by others.
A few key things that the book points out are that sometimes when a person has a stigma they often have to go through layers of discrimination that reduce their life chances. Those were Goffman’s words...”layers of discrimination” and “reduce their life chances.”
I’m thinking of the former felon who is now back in society who then has to find employment and gets discriminated everywhere she goes when trying to find work. By the way, if you yourself are dealing with this issue or know someone who is there is this resource.
It’s as though once a person has a stigma they also have an associated inferiority or it is as though we as a society place a kind of inferiority status on them. Then comes the labeling often—queer, crazy, criminal, pedophile, prostitute.
When a person gets defensive and resists the label, for example in the case of mental illness, and says something like “I’m not crazy.” Sometimes the response from society is--well of course they’re going to deny it it’s part of their illness.
But what is the metatext of what is being said in that exchange? The label thrown is an attempt at delegitimizing someone’s experience and the response is the human outpouring equivalent of—you can’t take away my ownership to my feelings.
For the population that I work with, for the mentally ill, who also by the way may have had a criminal past or may identify as LGBTQ+, or may have some other form of stigmatized social identity, how maddening do you think it is to be told that their experiencing of things is not legitimate or is called into question somehow by way of their stigmatized identity?
And then add to that, that we’re talking about something that could possibly be beyond a person’s ability to control on the one hand and on the other hand may be something that is within a person’s control but that is either part of past behavior or current workings through. Either way, it’s not good.
Let’s the take the first instance, the case of something being beyond one’s control. I’m thinking of the person who may have persistent and severe mental illness that may include things like paranoia and delusions. Let’s put this person in a situation.
Let’s say they go to the grocery store and let’s make this person male. They are walking through the grocery store with their spouse who is female and they have the persistent feeling that they are being followed. They always get this feeling. One response the wife could have is to turn to her partner and argue with him that that is not the case.
She could turn and say, you are not being followed, up to and including getting into a heated argument in the store about the persistence of this particular problem for him like “you always do this, why can’t we ever go out, why can’t you let this go, etc.” The wife is expressing what for her may be the culmination of years of frustration and she has every right to her feelings.
But for the husband who is experiencing these issues, the paranoia and the delusions, they are very real things. And to argue with a person who is experiencing something like this often doesn’t get very far. Anyone who has lived or worked or interacted with someone with this particular issue can understand what I mean.
Okay, so if the paranoia and delusions are a given and possibly treatment resistant, what then? I’ve seen people laugh at those with this issue, I’ve seen people respond with a patronizing attitude, I’ve seen people shake their heads and do a tsk tsk, I’ve seen a wide range of responses that I would all lump into the category of delegitimization.
For the party who is doing the delegitimizing it’s a means of defense in a way. It’s a kind of a well if I can’t change these things about this person I can at least exert my authority and power over the situation and minimize someone else. Perhaps the person does this in an effort to bolster their stance and to feel better about their position.
I have even seen this amongst mental health professionals themselves and despite clinicians’ best efforts to guard against it. For some maybe it’s a means at bringing humor into what can sometimes be a stressful interaction with clients. These responses that I’ve witnessed though, they irk me to no end because I care so much about my clients.
But let’s go back to the word itself—delegitimize or delegitimization. What does it mean? It means to somehow take the value away from, to invalidate, even to make unacceptable.
Remember we’re talking about people, human beings here who have a right to their experience, to their feelings, to being accepted. My point is that we all have inherent worth and dignity.
For a person who has a stigmatized identity and may have a qualified disability in addition to that and who is struggling with issues that are beyond their control, I think it’s best to work with the person and within the context of the person’s experience instead of against them and to join them as it were instead of pathologizing.
There is famous story of a well-known psychiatrist named Milton Erikson who was working with a mental patient in a hospital who had the delusion he was Jesus Christ. Instead of arguing with the man that he wasn’t Jesus Christ he approached the man asking about his carpentry work.
I like this approach to therapy because it’s about meeting a person where they are at and once again validating a person’s experience while at the same time gently introducing an alternative way of looking at things, not from a position of authority or with a tie-in to morality or some objective and fixed definition of Truth with a capital “T” or even necessarily with the end goal of changing or fixing something that for some may not ever possibly be able to be changed or fixed.
It’s about holding the space for alternative and possibly preferred behavior while at the same time allowing for the possibility that the preferred behavior may never come. One of the things that I love about the city that I live in is that it makes an effort or attempt at embracing differences in its hallmark slogan “Keep Austin Weird.”
Okay, so that was beyond a person’s control, and now what about within a person’s control and working through? I'm always using analogies. So here's another. If I were a dancer and I was building up my skills to be able to dance with grace and there was a particular movement I was doing that my teacher was correcting for, which approach do you think would work better in the long run?
Would it be better that my teacher shout every time I made a wrong move, laugh, scoff, come across as critical or superior? It may be get me to change the behavior but it’s a pretty rough approach. I’d forever hear my teacher’s voice in my head if I made a mistake.
What if they could empathize and understand the tendency for me to lean in a certain direction but try to gently curb and guide in a different way? I would say the later. And I would say the later only in the instance where the movement that the dancer is trying to perform could lead to long-term physical injury or wasn’t representative of the style of dance they had come to the teacher to try to learn.
So in other words if the movement they were trying to perform was harmful to them in some way and they desired to go in a self-identified direction with their dance movements and style, which was the very reason for their coming to the teacher for guidance in the first place. They wanted help with something.
So the analogy for the mental health professional would be a client who comes in with problems in behavior that are causing harm to themselves or others. The harm it is causing may not even be within the client’s awareness yet. It’s the therapist’s job to guide with the client as the lead.
Also it would mean targeting behavior that isn’t reflective of the client’s long-term goals, which again isn’t the therapist’s long-term goals for the client, and isn’t anyone else’s goals for the client, but is the client’s goals and reasons for themselves, their reason for coming into therapy in the first place.
Why does the client come? Because they hold out the hope that there may be a way of being in the world that works better for them in the long-run and they need assistance in discovering that.
This is what I mean when I say I am a humanistic and holistic therapist. I’m humanistic in the sense that I focus on a person’s individual nature and strengths to find healing. I value my client’s experiences and inner wisdom. And I am holistic in the sense that I work within the context of the whole person with an eye towards empowerment and a clear sense of the society in which we live which would attempt at times to take that power away.
Often this means working with the client to accept the things that cannot be changed; having courage, compassion, and respect for the client's process of changing the things that can; and developing the wisdom alongside the client to know the difference.