topic Is Combination Stigma, Worse Than Stigma? in Multicultural experiences

Is Combination Stigma, Worse Than Stigma?

Donte — Thu, 08 Feb 2018 06:49:21 GMT

At some point in our lives we may have bad experiences by people who display negative attitudes, thoughts, beliefs and behaviours that influence us and others around us, altering the way we see things, injecting fear, prejudice, rejection, avoidance that leads to discrimination and marginalisation, simply based on our mental health. Even though, this is a common experience that transcends ethnicity, this stigma is often much greater for people of culturally and linguistically diverse backgrounds, especially if they do not 'fit' into their ethnic origins' prescribed stereotypes and if not being accepted by their own cultural or religious community.

Think of cultural and religious minorities who already confront prejudice and discrimination because of their group affiliation, and suffer double or triple or multiple stigma simultaneously, inside and outside of their communities.

For instance, consider a HIV+ married muslim or jewish man who has sex with other men but is not openly 'out' in his community, doesn't speak good English, lives in a remote or rural area, is facing family breakdown, isolation and possible homelessness, unemployment, has drug dependency and suffers from mental illness. The potency of the stigma in this scenario may lead this individual to not seek help inside their community and also not seek or adequately participate in treatment. So, I'm taking about the combination stigma and how it can impede treatment and well-being, creating otherwise preventable and treatable mortalities and morbidities.

Stereotyping various groups only adds to the stigma. I have heard people inside and outside the muslim and the jewish community for example, saying that muslims or Jews don't have alcohol or substance abuse problems, or that there are no gay muslims or jewish gays! Such stereotypes could serve as a deterrent to mental health care for the above-mentioned individuals, and place extreme ambivalence at the centre of their need to seek help.

What are your thoughts on combination stigma? Have you experienced it? Do you know of others who do? How would you effectively deal with this if you are in this situation or you want to help someone in this predicament?

Is Combination Stigma, Worse Than Stigma?

white knight — Thu, 08 Feb 2018 21:42:14 GMT

Hi Donte

I dont believe there is a lot of difference between someone with stigma for one thing than someone with stigma for multiple things. Here's why.

Say a person receives teasing at school for having frizzy hair, stutters., eats onions at lunch, is muslim and shows no interest in girls. Multiple stigma right? Now compare another guy that just has frizzy hair and feels the hurt, embarrassment of that alone.

See the guy with just one reason to suffer stigma could feel worse than the guy with multiple differences and that one thing can be just as devastating as the other fellow. Furthermore the first fellow likely has an asset...support from his fellow worshippers and from his Allah.

The comparison of stigma to multiple stigma is like the skit between Dudley Moore and John Cleese when two hypochondriacs in a pub begin talking about their health problems. One says he has cancer of the stomach, the other days he has cancer of the stomach and cancer if the brain. The other says he has cancer of that to and...cancer of not being talked about...eventually one days he has cancer of the universe. ...

Stigma is not a competition. I'd suggest sad souls with one hangup have seen their demise in life. To them that one hangup, cause them to be different, has just as much effect than multiple differences.

It depends on the individual and is a slam dunk for being subjective IMO.

Tony WK

Is Combination Stigma, Worse Than Stigma?

Donte — Thu, 08 Feb 2018 22:11:08 GMT

Thank you White Knight for this thoughtful and insightful response. I often wonder upon this and your explanation and examples have shed light on this topic.

Stigma is not a competition as you stated. Everyone’s pain feels the greatest. And it is for them, as this is their individual experience. To know that another has much greater pain than you, doesn’t minimize the actual pain you may feel.

In regards to combination stigma, my interest is to hear from people with this kind of experience in the context of how various multiple factors could perhaps make it more difficult for someone to seek help. Especially in culturally and linguistically diverse settings.

To look at your example, the person who has Allah and his fellow worshipers may be indeed more supported than an atheist who has no safety net to fall upon for help or guidance. (Even though the person who doesn’t believe in god can have multiple other supports too). However, in my example, if being gay is not accepted by this person’s religious and cultural group, then this support not only it won’t exist but in the contrary, his community will become a persecuting, discriminating, marginalizing factor that will push this individual to further isolation and despair. In this regard, this particular individual may be in worse predicament than the atheist as he may live with the fear, anxiety, despair that he will be judged, criticized, bullied, harassed and in many cases even fear for his own life as he is going against the grain, and is in conflict with the collectivist values of his group, simply due to his sexual orientation.

Additionally, his lack of language skills, social networks outside his religious or cultural group could possibly hinder his ability to access and navigate professional support systems to address his issues and the impact on his mental health.

Of course, as you mentioned, one size doesn’t fit all, and stigma, the impact and levels of complexity is an individual thing.

Finding ways to address it can be as complex as the individual himself.

Would be great to hear more on this subject. 🙂

Is Combination Stigma, Worse Than Stigma?

Hayfa — Fri, 09 Feb 2018 04:00:01 GMT

Hello Donte' and White Knight

This is certainly a very important and interesting topic.
I think it's important to ponder for a moment what stigma may mean, by actual definition we know stigma describes "a mark of disgrace that sets a person apart" (healthdirect.gov.au).
I believe the question here is what is the condition or multiple conditions that can cause stigma, stigma as we know it is the cause of social polarising but perhaps that polarising is further magnified when there are multiple reasons.

The outcomes to individuals experiencing stigma can be the same; stress, anxiety, depression and more as I think this is what White Knight was explaining. However, Donte' is correct when explaining the impact and levels of complexity is an individual characteristic.
I think that the impacts on people facing stigma is equally difficult regardless of the one or many stigmatising situations however I do believe that if it is multiple and involving a CALD person it could be worse at this time because of older, embedded cultural and traditionalist views that make acceptance difficult.

Hayfa

Is Combination Stigma, Worse Than Stigma?

Donte — Fri, 09 Feb 2018 10:57:42 GMT

Hello Hayfa,

Thank you for contributing to this discussion. I find the definition of stigma - "a mark of disgrace that sets a person apart" very accurate. Stigma is a Greek word and that is the literate meaning. I think that apart from stigma itself, the perception of what that this stigma means, the connotations it takes within various contexts, be it self-perception and internalised stigma or another individual's perception or a collective group perception, can be very damaging and often hinder the help-seeking process.

Is Combination Stigma, Worse Than Stigma?

blondguy — Fri, 09 Feb 2018 11:42:58 GMT

Hi Donte

Thankyou for your interesting thread topic

You mentioned "Stigma is not a competition. Everyone’s pain feels the greatest. And it is for them, as this is their individual experience. To know that another has much greater pain than you, doesn’t minimize the actual pain you may feel"

I have also been brought up as you have in a different cultural background which I mentioned on another post.

Just for me it can be very difficult to cope/heal from stigma no matter my race cultural background or beliefs

If you could explain Multi/Combination Stigma for the layperson in a nutshell it would benefit many. I have never heard of it before and I thought I was reasonably well read/educated

Thankyou for your understanding

My Kind thoughts

Paul

Is Combination Stigma, Worse Than Stigma?

white knight — Fri, 09 Feb 2018 13:13:04 GMT

Hi all,

I'm likely a bit confused. See, Australia is made up, in its early development, of criminals and soldiers. This penal colony was a dumping ground for prisoners from Britain. So any wonder, there was a culture of larrikinism and defiance of the law that became embedded as part of our society.

That is just one aspect of the development of the peoples of our nation. 150-200 years isn't a long time in the scheme of human change. This criminal aspect and other aspects IMO has had a negative effect on some individuals today, those 5th and 6th generation Aussies (like myself) that inherited veins of embedded difficulties like- coping with life/society/people. Is this factor lets call it Australian inherited pioneering difficulties a factor that has flown under the radar of cultural hardship?

It is mentioned above by HAYFA " however I do believe that if it is multiple and involving a CALD person it could be worse at this time because of older, embedded cultural and traditionalist views that make acceptance difficult."

So by that I take it that "embedded cultural and traditionalist views" don't include our early immigrants, only later European migrants and their cultures. That kind of undermines factors of those that are descendants of early Australians doesn't it?

Best I give one example. One of my earliest descendants came to Tasmania around 1832 as a convict. He eventually settled around Burnie and carried out the old country (Britain) tradition of leaving nothing in his will to his wife nor his daughter. For the daughters married into other families and bore their surname. Obviously this was very unfair and discriminatory. The ramifications might not compare well against cultural differences of later European migrants but that example is to demonstrate that Australian cultural traditions were not always so squeaky clean and have been overlooked in this process of attending to the problem of which we speak now.

What of our British culture? I mean many of us descendants of early convicts have no, history that we know of. Most European descendants have a vast tapped history of their background, family members and roots. That is missing in those like myself. It means we know less of who we are.

I can say that add to the above, hangups, we were poor and other issues and you have equally serious CS as recent arrivals in this country. Combination stigma isn't confined to migrants of the last 60 years.

We shouldn't be selective in support.

TonyWK

Is Combination Stigma, Worse Than Stigma?

Hayfa — Sat, 10 Feb 2018 01:13:48 GMT

Hi Tony

Thank you for your excellent and relevant perspective. First of all from me, many apologies if my post caused confusion, I was responding to Donte's original thread in which he talked about multiple stigma being difficult for members of CALD communities.
This does not mean that the sufferings of one group are worse or more legitimate than another and as I said in my earlier post, the impacts are the same and equally as difficult.

I think it should be emphasised that in my comments that you italicised above, I am referring to this current context since we are living and affected in some ways with today's events and Donte's original post was describing impacts on CALD communities of today.
I have to say though, I am a little confused with what you are saying since you are describing inherited characteristics from a way of life lived by your earlier ancestors whereas Donte's original post was talking about ethnic minority groups who affiliate in certain sub-groups but don't fit the stereotypical ethnic community and are thus shunned. For example, the Muslim man who identifies as gay (against their religious ideology), now resulting in having alcohol and substance abuse.
What you seem to be describing is a cultural idea that has grown throughout the generations as opposed to an individual who affiliates to certain groups(s) not generally regarded as a societal norm.

I think we need to not confuse the impacts of stigma that can affect anyone regardless of group/ethnicity as I have mentioned in earlier posts.
I think what we are interested in here is the outcomes of those impacts in conjunction to a person's present community/life/identification of himself or herself in their community. This certainly doesn't discount experiences of all communities experiencing mental health stigma whether they stem from past or present experiences, everyone is important and all experiences are valid and we are certainly not being selective in support.

The way individuals respond to what they may be experiencing from resulting stigma is I think what we want to ponder as everyone is affected differently and may have had different experiences. Perhaps there may be smaller or bigger impacts on different individuals resulting from their one or many personal experiences and life situations.

Hayfa

Is Combination Stigma, Worse Than Stigma?

Donte — Sat, 10 Feb 2018 08:50:01 GMT

Thank you blondguy,

Not sure if the term 'combination stigma' officially exists.

In my thread I describe stigma as a collection of negative attitudes, thoughts, beliefs, and behaviours that influence an individual, or the general public, to fear, reject, avoid, be prejudiced, and discriminate against people with mental disorders.

Some people may experience stigma in many different areas of their lives, for example, due to their ethnic background, skin colour, gender, religious beliefs, sexual orientation, age, illness etc. So they are not only discriminated due to their mental illness, but also for all the above mentioned things. This then is what I'd call 'combination stigma'.

The levels of stigma and the impact could be much more devastating than if discrimination took place only based on one thing (mental illness).

Example of 'combination stigma' -

a homeless, disabled, older, lesbian non-english speaking single mother, who is HIV+, has a substance abuse issue, is ostracised from her own community and hasn't got supports outside her cultural group. In this instance, stigma could be self-stigma, (her internalised trauma, shame, rejection etc and effect on mental health and self-esteem etc); her own community's stigma, (group rejection and discrimination/harassment from her own peers); and general public's perception and marginalization. This 'combination stigma' affecting the life of this woman at multiple levels and the impact it could have will have a detrimental effect and hinder the help-seeking process. I guess that probably sums it up.

I'm sure we could think/mention more impacts if we examine this more closely.

I'd like to hear people's experiences of 'combination stigma' and how do we live with it/manage/overcome. 🙂

Is Combination Stigma, Worse Than Stigma?

Donte — Sat, 10 Feb 2018 09:15:12 GMT

Hello White Knight and thank you for joining this very important discussion.

Your point is very relevant in my opinion and I'm glad you have raised it as it's not often heard.

I believe that ALL people experience stigma and 'combination stigma' is not limited to individuals from culturally and linguistically diverse background. Like mental health, stigma is a universal experience that transcends culture, religion, ethnicity, sexual orientation, race, gender, age etc. There are cultural responses to this universal experience, and individual responses within the cultural ones.

The way I have come to understand it is that:

the Universal experience is how ALL people experience stigma;

the Cultural experience is how SOME people within specific groups experience stigma like no other group;

the Individual experience is how NO ONE ELSE experiences stigma like this particular person.

White-anglo Australians are not excluded from experiencing stigma as you have described very accurately in your post; and in fact are part of what we call today a 'multicultural society'.

I do not believe in the 'Us' and 'Them' mentality that often is propagated in the media etc. We are ALL multicultural people as we ALL come from a variety of cultural backgrounds and English is just one of the 200 ethnic backgrounds that we have in Victoria. Similarly, Anglican and Catholic are two of the 135 religions people ascribe to in our State.

Often it is implied that only the 46% of the population who is born overseas or has at least one parent born overseas comprises the multicultural element of our society. This is false in my view. 100% of our population consists of the multicultural society we are all part of (including Aboriginals).

So with that in mind, your example is valid and I totally agree with you. Thank you once again for bringing to our attention an often neglected issue.

Wondering what others believe about this. 🙂

Is Combination Stigma, Worse Than Stigma?

Donte — Sat, 10 Feb 2018 09:18:47 GMT

Hi Hayfa,

You have summarised this very well.

Thank you

Is Combination Stigma, Worse Than Stigma?

white knight — Sat, 10 Feb 2018 09:45:09 GMT

Hi all, thankyou for your replies. This discussion is fruitful.

Perhaps I am a good example. Although a 5-6th generation Australian from British extraction (Scot, Wales and English...my family moved from Tasmania to Melbournes western Suburbs in 1962 for health reasons. When I started Technical school all other of the 30 students in my grade were either born in Europe or their parents were (no Asians then). The German kids spoke to each other in German, the Italians, Yugoslavs, Poles, Greeks etc kept amongst themselves and avoided English unless in class. I was very much ostracised. I was different.

Add to that severe emotional issues diagnosed around 42 years later as bipolar, depression, anxiety and dysthymia. Add to that an overweight body and what might seem minor, but thick hair. In the 1960's long hair of the Beatles and hippy era was fashionable...the longer I grew my hair the more I was teased. Oddly enough had I been in USA I would be ok Afro hair was "in".

So I suffered "combination stigma" in my own way. Imagine joining the RAAF at 4 days past my 17th birthday and I was elated for many reasons one of which was that I would fit in with mandatory short hair!! But alas, I was the youngest and notoriously immature emotionally. Another stack of stigmas replaced those in school..

Personally due to the above I dont feel multicultural background/experiences/cultural gaps are any worse than what Ive gone through. As I've mentioned, some families have strong ties, religious support and beliefs which helps. Some dont. If an Italian boy was the only migrant child in a class of 5th generation Aussies might he feel as I did? Yet he/she would be receiving extra focussed attention with the multicultural theme of support.

So I dont feel there is equal regard to reverse multicultural issues, those that also suffered by NOT being of ethnic background. Similar to how the indigenous were deprived compared to white Australians.

Imo all people are equal and these "combination stigmas" are everywhere and should be approached for all people and crafted for the individual. I feel a bias towards migrant families and dont agree with that.

We have support for LGBTIQ people. Imagine if we left out the transexuals in that ? Hence the best approach that covets all. Perhaps organisations are trying too hard to help various groups and in the meantime they miss some that slip through the net.

To avoid bias we should just help all individually as equals.

Tony WK

Is Combination Stigma, Worse Than Stigma?

Donte — Sat, 10 Feb 2018 10:06:36 GMT

Thanks White Knight,

Person-centred care is the best approach.When I am in need, I don't want people to respond to me as a Greek person, or as a gay person, but rather as a person. The questions we should always ask, according to my view, are:

'how is this person like all others?' (Universal issue)

'how is this person like some others?' (Cultural issue)

'how is this person like no other? (Individual issue)

These three questions combined could lead us to appropriate responses for the needs of a particular person.

Is Combination Stigma, Worse Than Stigma?

quirkywords — Sat, 10 Feb 2018 15:03:19 GMT

Donate,

What a real discussion.

I like the idea of eyeing someone as a person not their race, religion, or mental illness.

We are all different and have needs.

I have had people say very hurtful things to me because of my religion. I sometimes challenge people and find they have never met someone of my religion but base their stigma on something they have heard or read.

This is why I am open about my religious back ground and my bipolar as I feel the more honest I am, I can at least break down a few stereotypes.

I think avoiding generalisations and stereotypes is one way of reducing stigma.

Quirky

Is Combination Stigma, Worse Than Stigma?

Donte — Sun, 11 Feb 2018 00:01:57 GMT

I agree Quirkywords,

Generalisations and stereotypes can evaporate once you get to know the actual person! There are so many people who have said to me (after getting to know me), that I'm not like other Greeks or like other gays etc. Some ask 'what type of Greek are you?', to which I reply: 'the type that is me!'. Or 'Are you sure you're gay?', well yes, the last time I checked!

Is Combination Stigma, Worse Than Stigma?

Donte — Sun, 26 Aug 2018 23:20:28 GMT

I have an Egyptian neighbor with whom we have become friends.

The other day while enjoying our coffee we started discussing about how terrible it is in their country in regards to stigma if you are HIV+.

I told them that there is a global decline of HIV infections. Stigma is the last frontier when it comes to living with HIV particularly in certain countries where discrimination is legal and citizens are not protected even if they are victims of violence.

In Egypt, HIV has actually been spreading at an alarming rate contrary to global trends of decline.

Apart from the lack of funding and access to medications, social stigma hinders all efforts for prevention and treatment.

(This is not only unique to Egypt by no means.)

Majority of population doesn’t get tested for HIV on a regular basis as the assumption is that only homosexuals, prostitutes and drug addicts get the virus.

The reality is that many HIV+ people have families — husbands, wives and children — who if infected are forced to live with this disease for the rest of their lives in a society that heavily discriminates against anybody living with HIV.

To have HIV and live in Egypt is a tragedy due to discrimination from family and friends, as well as losing your job and sometimes being obliged to move around because of aggressive neighbors. Dentists can refuse treating you, people can by law refuse service and ask you to leave.

UN figures show that Egypt ranks behind only Iran, Sudan and Somalia for the rate at which the epidemic is spreading. Treating people could cost thousands of dollars per person, and there is no budget allocated to prevention and treating the virus.

The best way to reach Egyptians, my neighbor claims, is through religious leaders, due to the cultural importance Egyptians place in religion and God. The responsibility of sheikhs and priests should be not only to raise awareness, but to teach tolerance and acceptance towards those who have HIV and not exclude but rather accept one other.

This made me think that we, here in Australia, need to actively work together within the various communities and consolidate all initiatives and efforts by ethnic NGOs, civil societies and the government in order to control the epidemic within our CALD communities and change conceptions and stigmas of HIV by raising awareness at a local level.

Perhaps then, people from these communities can also offer support to loved ones and people in their homelands.