Stress and stigma are known drivers or contributors to poor health outcomes. Decreases in physical and mental positive health outcomes are recognized because of stress and or stigma, and is documented both in the clinical arena and in the data. Are we held accountable for our actions, personally or externally, well intentioned or not? How can we work to decrease stress and stigma in our daily lives?
So much is happening in the world today that no matter what socioeconomic, ethnic, regional, and or identifying group¹ you are from, you are facing more daily stressors, either from your environment, your work, your family, your own centralized world. How can we handle these stressors? Is speaking out for an individual or group who you see is being targeted, good for your physical and mental health? I believe so, I believe there is some data to back this as well, self activation and positive action autonomy. Overall though, one might feel that their voice does not matter or they are ‘shushed’ ~ so not heard, or cultural norms do not translate easily when trying to express oneself to another identifying group or group member. The Golden Rule is beautiful though very few actually practice it. Stigma happens and gets in the way of individuals every day lives, it exists in their living rooms, classrooms, just about rooms of any kind, including the great outdoors rooms of nature.
Stigma has been at the forefront of my mind these last few weeks, after hearing Dr. Daniel Goldberg JD PhD² @prof_goldberg speak on this subject at the Behavioral Health and Social Justice Global Alliance conference in Denver at Anschutz, and then too hearing on stigma again at the University of Washington from Dr. Deepa Rao³ PhD MA at the Lancet Commissions US roll out on Action on Global Mental Health .
In light of what has happened in America over the last few days, I have found myself reflecting on Martin Niemöllers famous words that are so often recited when unexpected horrors hit our communities once again. I would like to posit that silence is still the more common action that exists in most communities, exception for the activists and some advocates. The activists and advocates cannot be the only voices from either side, whether left or right, people waving signs, marching, attending rallies and we have people that will remain silent because of perceived or real necessity for self protection. Many individuals simply do not feel comfortable, and some do not feel safe going out to marches or rallies, and some have just quit outward actions due to the apathy they feel after seeing so little positive movement or because of the railroading of the issue by people whose interests might be self serving and or appear to not really be for the common good. When an individual might depart from the front line issue group, they are usually left to be alone, ignored and even ostracized, not comforted nor embraced after they try and share why they have left.
First they came for the socialists, and I did not speak out—
Because I was not a socialist.
Then they came for the trade unionists, and I did not speak out—
Because I was not a trade unionist.
Then they came for the Jews, and I did not speak out—
Because I was not a Jew.
Then they came for me—and there was no one left to speak for me.
Stigma against individuals and groups can occur after speaking out, after utilizing ones Amendments rights, hate can occur from and within both sides, there are wrongs and rights according to social and cultural norms. It is my understanding though that violating anyone’s personal space, harming them through thefts, destruction of property and or physical actions is illegal and should be addressed if known about before the action happens so hopefully the harm never manifests itself in the first place.
Transparency and personal accountability are lacking it seems to me, and there really is too much silence against stigma and hate speech that is too common place in the rhetoric of todays world. Are we afraid of stigma from our peers if we speak out? Is there stress from retaliation and or is the retaliation ignored by ones neighbors? Why is there so much hate speech and actions currently existing in our neighborhoods, is it because we are stressed and afraid of the Stigma if we do speak out, is our future going to turn out similar to Niemöller’s era and later to his famous quote? Just some thoughts.
More Reading and References:
- Stigma as a Fundamental Cause of Population Health Inequalities https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3682466/ https://www.ncbi.nlm.nih.gov/pmc/about/copyright/
- Dr Daniel Goldberg ‘Pain, objectivity and history: understanding pain stigma’ https://mh.bmj.com/content/43/4/238 https://blogs.bmj.com/medical-humanities/2017/12/21/daniel-goldberg-shame-stigma-medicine/
- Dr. Deepa Rao’s UW Global Health Project on Stigma https://globalhealth.washington.edu/interactive-map/projects/1006/Reducing-HIV-Stigma-to-Improve-Health-Outcomes-for-African-American-Women