At the DGPPN (German Association for Psychiatry, Psychotherapy and Psychosomatics) in 2019, I took part in a symposium entitled “Antistigma – children of mentally ill parents”.
To say it straight away: I didn’t take away much enlightening information from the speakers. But it did lead to a brief exchange with one of the speakers afterwards, Prof. Dr. Hans-Henning Flechtner. He spoke about antistigma in child and adolescent psychiatry. Unfortunately, in my opinion, his presentation remained more in the realm of probing the role of professional care institutions in the interplay of forces when it comes to stigmatization. Because Prof. Flechtner rather focused on the difference in the communicability of physical illnesses on the one hand and mental illnesses on the other, i.e. why the term makes communicative clarity in dealing with mental illnesses more difficult.
But his presentation inspired me to think about naming the same thing in a professional context.
Stigma goes hand in hand with taboo
Stigmatization goes hand in hand with children of mentally ill parents – in my opinion generally in the context of “Psychosis” – always accompanied by taboo, even and especially when the aim is to destigmatize.
If the topic in question cannot be discussed, the stigma cannot be reduced because it cannot be “demystified”.
At the same time, efforts to educate the public remain ineffective, which in turn encourages the attribution of characteristics. This is because everyone then has to form their own, prejudiced picture of “the illness” and “the sufferer” and therefore also “the relatives/children”.
Professionals are also affected
What follows from this for the organizational side of the “healthcare system” is the question: To what extent can employees of the “healthcare system” identify themselves as children of mentally ill people – and thus as those affected?
n my experience, this is not the case, or only with difficulty, because the possible negative sanctions (to be determined more precisely) seem too powerful. One of them is the undermining of one’s own professionalism or the status of being perceived as a specialist because one fears being dismissed as “ONLY a person affected”.
In this sense – and I mean all this with the highest esteem – the care system indirectly contributes to the stigmatization of those affected by tabooing, because they also convey the view “as if nothing were wrong”.
At the same time, this factor has a much greater impact than the dimensional/contextual diagnosis, which is diffuse and difficult to grasp, especially for laypeople. This is because the care system tends to treat the affected person in a distanced manner, especially at the relationship level “professional – affected person/patient”, which does not establish a feeling of “being understood”.
After all, why should the Gaussian normal distribution not apply in care facilities? It is estimated that almost four million children per generation have a parent with a mental illness. That makes up to 16 million people in Germany across all generations. It would be surprising if this were not also the case for nurses, administrators and doctors.
Sensitivity
I believe that I am somewhat aware of the implications of such a form of “disclosure” to the patient and that this also touches on questions of professional ethics. For surely “the healthcare system” would not (yet) be ready for this step. In addition, it would be worthwhile to think through the consequences of this step – beyond the pure “patient-professional” context, because a system that presents itself as “not affected” is indirectly contributing to the taboo.
This means that the mechanism I mentioned, which has only been outlined in outline, remains in place.
A social science research assignment?
In my opinion, it would be worth taking a closer (social) scientific look at this connection. Without having done any further research at this point, I can think of various approaches that would need to be considered with regard to this question.
But what would the question actually be?
Theses
First of all, the following theses were put forward:
Thesis 1: Care systems participate in stigmatization because they hinder a communicative treatment of the topic by making it taboo.
Thesis 2: Only by breaking taboos can myths and fears be dispelled.
Questions of principle
Then the fundamental questions concerning stigma and taboo and their relationship should be addressed. A fundamental description or definition of the term is required:
- What is stigmatization? What does it consist of? How does it manifest itself?
- Is there empirical evidence of how the stigma is expressed?
- What sanctions are there?
- What exactly is the correlation between stigmatization and taboo?
- Does tabooing encourage stigmatization?
- Or does tabooing at least prevent the stigma from being dismantled because it is not possible to discuss what is actually to be dismantled?
And more specifically in relation to the topic in question:
- Is there any stigmatization at all with regard to mental illness? And what does it consist of?
- Why are children of mentally ill people also affected by stigmatization, even though or if they are not mentally ill themselves?
Further questions
- Which actors are involved in stigmatization?
- • Is stigmatization essentially an attribution? Is it an organizationally supported Attribution process?
- Which organizations would be interested in stigmatization? Which actor/organization would have the power of attribution and definition here?
Empirical approaches
From which empirical perspectives can the topic of stigmatization be viewed?
- The group of those directly affected (the mentally ill)
- The group of those indirectly affected: Children
- The healthcare system (hospitals vs. outpatient facilities, professionals as a group vs. individuals (therapists etc.))
To what extent can an employee in the healthcare system describe him/herself as a child of mentally ill parents?
- How are colleagues perceived by each other between the role as an affected person on the one hand and the role as a professional on the other? Do tensions arise here because you may no longer be accepted as a professional as an affected person?
- Why, or why not, do professionals reveal themselves as #COPMI? What do they fear if they do?
And to what extent does the “healthcare/hospital” system have an interest in their staff/members not acknowledging their role as #COPMI, should they also have this role?
- Is there a negative sanction in the event of recognizability/outing?
- Are there official or easily comprehensible expectations on the part of the “hospital” or “chamber of therapists” organization that employees do not make such self-disclosures?
Theoretical questions
Is “stigmatizing” an action in the Weberian sense or is it a category of actions or even an institution?
In short, I would be delighted if researchers felt invited to pursue these questions.
