good morning Hank it's Tuesday so
there's a lot of talk these days about
ending the stigma especially when it
comes to mental illnesses but also when
it comes to other highly stigmatized
diseases and driving through Sierra
Leone a few months ago I was discussing
stigmatization with dr. Beeler berry and
he pointed out to me that we can't
really know how to end stigmatization
until we grapple with what causes it
something I'd never really thought of
before so the classic definition of
stigma is that it's a mark of disgrace
that reduces someone from a whole and
usual person to a tainted discounted one
the word comes from a Greek word that
described a mark placed on slaves to
denote that they were less valuable than
other people and of course when the
social order sees you as tainted and
discounted discrimination and isolation
become much more common especially if
you are from a group that is already
discriminated against for example
worldwide diseases that
disproportionately affect women are more
highly stigmatized as are diseases that
disproportionately affect poor people
and also stigmatization is highly
context dependent like it's easier for
me to live openly with a mental illness
because I don't have to worry about
applying for jobs where a prospective
employer might learn about and be
concerned by my mental illness I hope I
don't have to apply for any more jobs
but okay so what actually causes stigma
and why are some diseases more
stigmatized than others well this has
actually been studied and researchers do
have a few ideas first and maybe most
importantly there is perceived peril
highly stigmatized illnesses are often
seen as a threat to healthy people many
people even people who intellectually
understand that for instance HIV could
not be transmitted through hugs or
handshakes still incorrectly perceived
peril when encountering people living
with highly stigmatized diseases the
mentally ill meanwhile are often
perceived as unstable or dangerous and
so the perceived peril may be less about
contracting the illness than becoming an
indirect victim of it it does seem like
education can help reduce the stigma but
only to an extent then we have origin
and controllability diseases that are
seen to be the result of choice are more
highly stigmatized than those that
aren't like the mentally ill are often
told to buck up or snap out of it or
whatever which believe me we would like
to but we can't because we don't
actually have the control that is
ascribed to us by the stigma and
origin factors in when diseases are for
instance sexually transmitted and
therefore seen as some kind of
punishment for sin but John from the
future here just to state the obvious
that's not how biology works like
viruses do not have a moral compass and
we have long pretended as if they do
because we want life to be a story that
makes sense
this is why for instance in the middle
of the twentieth century it was commonly
believed that cancer was caused by
childhood depression and social
isolation I think this is also why
mental illness has been associated with
demon possession we want to understand
the cause and effect we want the story
to have a moral but nobody deserves
illness deserving is the wrong frame
through which to look at illness illness
isn't like some punishment from on high
it's a side effect of having a body
alright so the last cause of stigma
cited in many studies is course
instability which is to say that
illnesses that are likely to be fatal or
chronic are more highly stigmatized as
our illnesses that have an unpredictable
course and as better treatments for
diseases emerge those diseases tend to
become less stigmatized like syphilis
for instance was probably the most
stigmatized illness in the world 200
years ago but now it's curable and so
one way we can reduce stigma is by
investing in research and treatment of
highly stigmatized diseases while mental
illness treatments have gotten vastly
better over the last few decades we
still have a long way to go and the same
can be said of HIV and the availability
of antiretroviral therapy but to really
end stigma we also have to resist the
urge to see illness as part of some
moral narrative how you got sick
shouldn't determine whether you're able
to get well and the pain of illness
shouldn't be compounded by the pain of
isolation in short we need to get better
at treating illness but we also need to
get better at challenging narratives
that look for Fault in the lives of ill
people rather than looking for ways to
help Hank I'll see you on Friday