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'end the stigma'

2019-09-17 · explainer · John · 4:00 · watch on YouTube

Topic: Health · mode: Explainer · tags: heavy topic

Prompted by Dr. Bailor Barrie, John explains what causes the stigma of illnesses such as mental illness and HIV (perceived peril, origin and controllability, course instability) and argues that ending it needs better treatment and rejecting moral narratives about illness.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — 'End the stigma' talk, Dr. Barrie's point, and what stigma is and how it varies by context

  • ★★★ Amid talk of ending the stigma of mental and other illnesses, Dr. Bailor Barrie told John in Sierra Leone that we can't know how to end stigma until we grapple with its causes. — 00:00:00 · Sierra Leone, mental disorder
  • ★★ Stigma is classically a mark of disgrace reducing a whole person to a tainted, discounted one; the word comes from a Greek term for a mark placed on slaves to denote lesser value. — 00:00:29
  • ★★ When the social order sees someone as tainted and discounted, discrimination and isolation become much more common, especially for already discriminated groups. — 00:00:29 · the social order
  • ★★ Worldwide, diseases that disproportionately affect women or poor people are more highly stigmatized; stigmatization is highly context-dependent. — 00:00:29

00:00:58 — Causes of stigma (perceived peril, origin and controllability, course instability) and how to reduce it

  • ★★ John says it is easier for him to live openly with a mental illness because he doesn't have to apply for jobs where an employer might be concerned by it. — 00:00:58 · mental disorder
  • ★★★ The first, maybe most important, researched cause of stigma is perceived peril: highly stigmatized illnesses are often seen as a threat to healthy people. (hedged) — 00:00:58
  • ★★ Even people who know HIV can't be transmitted through hugs or handshakes still wrongly perceive peril around people with highly stigmatized diseases. — 00:01:27
  • ★★ The mentally ill are often seen as unstable or dangerous, so the perceived peril may be less about catching the illness than becoming its indirect victim. (hedged) — 00:01:27 · mental disorder
  • ★★ Education seems to help reduce this stigma, but only to an extent. (hedged) — 00:01:27
  • ★★★ Second cause, origin and controllability: diseases seen as the result of choice are more highly stigmatized than those that aren't. — 00:01:56
  • ★★ The mentally ill are told to buck up or snap out of it; John says they would like to but lack the control the stigma ascribes to them. — 00:01:56 · mental disorder
  • ★★ Origin matters when diseases are, for instance, sexually transmitted and so seen as punishment for sin. — 00:01:56

  • ★★★ In an inserted 'John from the future' aside, John says biology doesn't work that way: viruses have no moral compass, and we pretend they do because we want life to be a story that makes sense. — 00:01:56

    “viruses do not have a moral compass”

  • ★★ In the mid-20th century it was commonly believed that cancer was caused by childhood depression and social isolation. — 00:02:26 · cancer

  • ★★ John thinks the same wish for a moral story explains why mental illness has been associated with demon possession. — 00:02:26 · mental disorder
  • ★★★ Nobody deserves illness: deserving is the wrong frame, and illness is not a punishment from on high but a side effect of having a body. — 00:02:26 · just-world hypothesis
  • ★★★ The last cause cited in many studies is course instability: likely fatal or chronic illnesses, and those with unpredictable courses, are more highly stigmatized. — 00:02:55
  • ★★★ As better treatments for diseases emerge, those diseases tend to become less stigmatized. — 00:02:55
  • ★★ Syphilis was probably the world's most stigmatized illness 200 years ago, but it is now curable. (hedged) — 00:02:55
  • ★★★ One way to reduce stigma is investing in research and treatment of highly stigmatized diseases. — 00:02:55
  • ★★ Mental illness treatments have improved vastly over recent decades but have a long way to go, as does HIV and access to antiretroviral therapy. — 00:03:24 · mental disorder

  • ★★★ To end stigma we must resist seeing illness as a moral narrative: how you got sick shouldn't decide whether you can get well, nor should isolation compound illness's pain. — 00:03:24

    “How you got sick shouldn't determine whether you're able to get well”

In the description and comments

  • ★★ In a comment John clarifies that education and 'end the stigma' campaigns work only to an extent; better treatment reduces stigma much more dramatically. — creator comment
  • ★ In a comment John says his sabbatical lasts four more weeks, until October 15th, and he hopes to extend it a bit. — creator comment
  • ★ In a comment John says the four-minute rule constrains videos like this one; the brothers have been reluctant to propose eliminating it. — creator comment · Four-minute rule

Threads in this video

Mentioned

Central: mental disorder · social stigma

Also: Concepts: cancer · depression · Greek language · HIV/AIDS · just-world hypothesis · narrative fallacy · sexually transmitted infection · syphilis

Places: Sierra Leone

Only in the description or credits: Bailor Barrie · Four-minute rule

Also centred on social stigma: My Physicalmental Illness · TAKE IT UP A NOTCH · Talking Tuberculosis, GeneXpert, J&J, and more with MY HEROES · Why Can't I Take My Meds? · I've Been Pooping All Wrong

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