Is Combination Stigma, Worse Than Stigma?

[Donte]

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?

[white knight]

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

[Donte]

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. 🙂

[Hayfa]

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

[Donte]

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.

[blondguy]

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

[white knight]

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

[Hayfa]

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

[Donte]

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. 🙂

[Donte]

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. 🙂