Destigmatization

of psychiatric patients
 Objectives
• Understand the notion (stigma) & appraise
its consequences
• Define the role of culture & religion in
promoting/combating mental illness
• Refute myths about psychiatric illness,
patients, & treatments
• Discuss scientific basis of diagnosis and
treatment of mental illness
 What is Stigma?
• Stigma represents a complex interaction
between social science, politics, history,
psychology, medicine and anthropology.
• The key step in the generation of stigma
is the perception of difference. For
stigmatization to occur, such difference
must be linked to undesirable traits.
 Psychiatry History
• Psychotic disorders were thought to be
supernatural in origin.
• In 4th century BC, Hippocrates theorized their
physiological basis
• Religious leaders used exorcism to treat mental
disorders which often used cruel, harsh, and
other barbarous methods
• First psychiatric hospital built in Baghdad in 705
• Psychiatric disorders classified in 20th century
 Why psychiatric
patients?
• Chronically ill or less treatable
• One type of treatment for all
problems
• Behaviour unpredictable
• Loss of social skills
• Safety concerns.
• ? Drug addiction (iatrogenic).
• Probably all of the above, and
more.
 Psychiatry and religion
• Like all Arab communities, Kuwaitis too believe in
spiritual (jinni) possession, envy by others’ evil
eyes, and sorcery; which not uncommonly are
invoked to explain changes in human behavior

• Obsessional ruminations attributed to devil

• Evidence based practice beneficial for your patients

• The patients’ religious believes should be respected

at all times.
Cycle of stigma (Sartorius
2001)
Psychiatry in Media
 What should we do?
• Acceptance of difference, not normalization
or denial of difference.
• Encourage people to believe their own
experience, rather than rely on stereotypes
portrayed in the media and elsewhere.
• Emphasize validity of diagnosis
• Demonstrate efficacy of treatment
 What to say
• Start from what people know, not
from what you want them to think.
Their beliefs, understanding and
concerns are taken into account.
• They are not schizophrenic patients,
they are patients who have
schizophrenia. (i.e. they have same
needs and persona of the rest of us)
 Culture-Bound
Syndromes
• Behavioural disturbances presenting
themselves preferentially in particular
sociocultural context
• Readily recognized as “illness”
participants in that culture.
• Usually associated with sanctioned
explanations and spiritual healing rituals
• Psychopathology includes dissociation,
acute stress, depression, and paranoia
 Amok
• The word was in use in India during the
British Empire, originally to describe an
elephant gone mad.
• Dissociative episode characterized by
Sudden outburst of violent, aggressive, or
homicidal behavior. Precipitated by by a
perceived insult. Usually affects men and
associated with amnesia.
• Reported first in Malaysia. Similar cases
reported in Philippines and Laos.
 Koro
• Episode of sudden and intense
anxiety that the penis or vulva is
retracting into that body and will
possibly cause death.
• Occurs in South and East Asia.
• At times, occurs in localized
epidemic form.
 Latah
• Episode of hypersensitivity to
sudden fright, often echopraxia
and echolalia, dissociation and
command obedience.
• Occurs in many parts of the
world.
 Useful questions
• What do you think has caused
your problem?
• What do you think your sickness
does to you?
• Do you think you were able to
avoid it?
• What kind of treatment do you
think you should receive?