EDITORIAL: Stigma in Medicine

West Afr J Med. November 2023; 40 (11): 1137-1138 PMID: 38035823

Abstract

Stigma in Medicine

Despite the increasing attention and focus that has been placed on recognizing and combating stigma in medicine particularly regarding mental illnesses, stigma in medicine is still very rampant and remains a top priority in research (Bos, Pryor, Reeder, & Stutterheim, 2013). The word stigma originates from ancient Greeks who burned marks into the skin of criminals, slaves, or traitors as a way of identifying them as traitors or people to be avoided (Goffman, 1963).

In contemporary times, stigma is said to occur when a person or group is labeled in a pejorative way that sets them apart from others and, as a result, is treated in ways that mark the person as socially unacceptable (Penn et al., 2005). Stigma is a complex social process that has negative implications for people living with specific health challenges and their health-seeking behavior (Nyblade et al., 2019). Stigma can lead to reduced interaction, social isolation, social rejection, discrimination, and dehumanization (Bos et al., 2013)

Stigma can influence the health of a population leading to worsening outcomes by, undermining, or impeding a number of processes, including social relationships, resource availability, stress, and psychological and behavioral responses, exacerbating poor health(Hatzenbuehler, Phelan, & Link, 2013). Stigma can act as a barrier to preventing people from seeking services for disease prevention, treatment of acute or chronic conditions, or to maintain a healthy quality of life.

Numerous health conditions have been stigmatized in the past, including HIV/AIDS, Leprosy, certain types of cancers, Mental illnesses, etc.(Stangl et al., 2019). One such health condition is epilepsy which is often stigmatized due to its unpredictable and often uncontrollable symptoms.   The paper by Durodami, Kanu & Russel (2023) in this issue with its focus on the stigma of epilepsy in Sierra Leone is very timely. In their paper, the authors investigated 128 patients, out of which 9 were below the age of 18. Majority of participants experience seizures outside their homes, had suffered burns/serious injuries as a result of epilepsy and had used traditional treatments as non-medical treatments for their epilepsy. Majority of participants experienced perceived stigma, such as people avoiding them, people being uncomfortable around them, and people looking down on them due to their having epilepsy. The level of perceived stigma was higher in those with a longer duration of epilepsy and increased seizure frequency.

Further research considerations should include the use of a standardized and validated stigma scales which would enable ease of comparison with other studies as well as ensuring reliability of research findings. The design was cross-sectional in nature which means causality cannot be inferred. Future studies can use prospective approaches. The study was also hospital-based, as such the prevalence of the condition could not be calculated. A cohort design would be better for tis purpose such as a birth cohort who would be followed up over time. Despite these limitations, this study has highlighted factors associated with perceived stigma which could pave way for interventions in reducing stigma in the community.

References

1. Bos, A. E., Pryor, J. B., Reeder, G. D., & Stutterheim, S. E. (2013). Stigma: Advances in theory and research. Basic and applied social psychology, 35(1), 1-9.
2. Goffman, I. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.
3. Hatzenbuehler, M. L., Phelan, J. C., & Link, B. G. (2013). Stigma as a fundamental cause of population health inequalities. American journal of public health, 103(5), 813-821.
4. Nyblade, L., Stockton, M. A., Giger, K., Bond, V., Ekstrand, M. L., Lean, R. M., . . . Siraprapasiri, T. (2019). Stigma in health facilities: why it matters and how we can change it. BMC medicine, 17, 1-15.
5. Penn, D. L., Judge, A., Jamieson, P., Garczynski, J., Hennessy, M., & Romer, D. (2005). Stigma.
6. Stangl, A. L., Earnshaw, V. A., Logie, C. H., Van Brakel, W., C. Simbayi, L., Barré, I., & Dovidio, J. F. (2019). The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC medicine, 17, 1-13.