The Deep Roots of Stigma: 6 Weeks Of Cultural Immersion and Mental Health Advocacy in Argentina
Mental illness and the associated stigma is not just one group’s issue, but , human issue globally. Stigma is deeply rooted in the historical mistreatment of the mentally ill, varying from culture to culture, gender to gender, class to class. It is an umbrella issue to dissect a variety of systemic inequalities that pervade borders. Although the scope of my knowledge is limited to my experiences in the United States and my brief stint in Argentina, I can unreservedly say that the greatest disservice we do to others is to typecast them. When we encounter people in life, we are all at some unique in our own psychosocial development. None of us exists at a stationary point, yet we’re often trying to pin people and their identities down to a series of attributes;, trying to make sense of how and why and what and where this person came from. But identity cannot be distilled into the vacancy of labels. Identities are dynamic works in progress, ongoing, ever-changing, and paradoxical.
In the world of mental health care, a false dichotomy arises between pharmacological approaches and therapeutic approaches to care. My experience working alongside mental health professionals for six weeks in Argentina demonstrated that in a quest to ameliorate stigma, the key ingredients are a marriage of the natural science and the humanities. Empiricism and humanism, in harmony, create the shared empathy necessary between care-taker and patient to break down the barriers of stigma.
No matter how disparately cultures conceptualize mental illness, there is a common process of labeling that leads to prejudices that leads to discriminatory behavior. Stigma can arise both as self-stigma and public stigma. Each occurs in similar series of steps, perpetuating a cycle of stigmatizing thoughts, beliefs and actions. Public stigma begins with cues that mark a person as ‘Other’ –some mark or indicator of being mentally ill. Such a cue stirs up stigmatizing beliefs, and these beliefs become ingrained in our cultural narratives as stereotypes. Stereotypes are the foundation upon which prejudicial attitudes manifest as outright discrimination. With or without overt acts of discrimination, individuals suffering from a mental illness can internalize stigma, leading to self-discriminatory behaviors.
For six weeks over the past summer, I worked intensely with questions of my own identity and the positioning of others through an internship I had working with a community of sufferers of mental illness in an organization called Proyecto Sumo in Buenos Aires, Argentina. As an active participant in the workshops my patients participated in as rehabilitation, I was able to better understand my patients as people with distinct identities outside of their diagnosis. My days were spent engaged in a variety activities, including occupational therapy, music therapy, art therapy, movement therapy, expressive writing, and yoga. In these activities I made my largest contribution to the group of patients. As a member in their experience, their activities, my patients grew to know me on a deeper evel through self-expression in nonverbal ways. This disruption of any hierarchy between patient and character allowed us to learn about each other, forging open communication through fundamental human interactions.
While my organization provided a space with a vast amount of support and resources for the patients, I couldn’t help but feel frustrated that the mutual empathy occurring between those walls could not be so effectively woven in the fabric of society outside. Despite our efforts, the larger society labeled these individuals as “unintelligent”, “violent”, or “defective” due to their diagnosis of mental illness. Could these patients progress in terms of their well-being, autonomy, occupational liberty, familial connections and friendships if the society at large refused to include them? Serious mental illness (SMI) requires serious caretaking and resources to manage. Most of the patients I encountered, though perhaps having unconventional personalities by societal standards, are so full of life, creativity, and intelligence. But our approach to mental health in a global sense is such that no truly dignified well-organized, well-funded space exists to for these merits to be appreciated.
I was encouraged to see in the work of my colleagues the beginnings of a space that honored each of these individual’s capacity for creativity and intelligence. Seeing my boss Raquel in action during admissions interviews for new patients was, for me, a cornerstone of understanding how patient and practitioner begin to forge a relationship of mutual understanding. Etched permanently in my memory is one interviewee, a young woman, close to my own age. She had attempted to end her life by overdosing on pills. In no way, shape, or form did Raquel push this young woman into divulging details about the underlying causes of her suffering. She tactfully pursed out the details of the young woman’s short and long term history–an estranged relationship with her father, taking care of her mother through a rough divorce, feelings of pressure and inadequacy about her appearance and professional life. Raquel, without a touch of haste, slowly, methodically, unraveled the complexities with no secret formula or tools, just the power of a nod, active listening, and a warm aura of safety. It was as if each patient is the chain of a necklace that had coiled endlessly in upon itself at the bottom of a jewelry box.
Raquel’s expertise and training was in essence the culmination of disciplines, humanistic and scientific. Her professional but compassionate bedside manner and ability to immediately establish a report with the patients was clearly the product of years of interacting, her intelligence, and her expertise. Proficiency in interpersonal interactions, like Raquel, is the best way to formulate methods of recovery that optimally engages the advantages of both psychopharmacology and psychotherapy. An alliance between the benefits of psychotherapy and psychopharmacology integrated multiple spheres of a person; the physiological selves and their notions of identity. But what does this idea have to do with stigma?
Stigma itself feeds off of lack of information. Lack of understanding. Lack of empathy. Closed-mindedness that has the power to insert people into unfounded labels. Through six weeks of participation in the day hospital, I saw the compassion and care each professional at the organization took for each of their patients. A balance that had to be struck between connection to their patients, being a figure that could be confided in and empathetic without breaching patient/caretaker boundaries, something that is often times muddy or unavoidable with the kind of disorders patients suffered from. Herein lies the kind of work that amounts to a tangible shift in people’s lives, and subsequently in the campaign against stigma. Between both patient and practitioner, the daily practice of patience, empathy, and listening is what it takes.
Since my return to Haverford campus this fall, I have more actutely witnessed a similar internalization of emotion. Internalization of shame, fear, bearing the burden of anguish without an outlet. Our national and community culture is one that tells us to pick ourselves up by the bootstraps, to fix our problems by slapping a smile on our faces. We are taught from a young age to feign stoicism over vulnerability. I am struck how vastly people suffer from the constant sublimation of emotion, the constant battle against our fear of being stigmatized.
Although not many of us find ourselves in the position of being an arbiter of change as a legislator in mental health policy or a psychologist, we can empower ourselves to shift our own paradigms away from such rigid interpretations of others. The power I witnessed in action, the power we each carry, is our capacity for the same things I saw my colleagues practice so readily: patience, empathy, and refraining from judgment. Truly examining the depths of my own prejudices in the company of my patients left me with an encouraging realization. There is still a space in the hustle and bustle of the modern working world, full of compartmentalized emotion, productivity, and ambition that honors the simplicity of face to face, human interaction. No cutting-edge technology is needed, just the frame of mind to listen and to be heard and to learn about each other.