Stigma Keeps People From Seeking Help

The dictionary defines stigma is as a mark of shame or discredit, but it’s the list of synonyms that bring the point home: “blot brand onus slur smirch smudge spot stain taint”.

Alcoholism is stigmatized. So is drug addiction. So is mental illness. And that’s an important obstacle to recovery.

I learned a lot about stigma some years ago from a woman named Bertha, who was heavily dependent on alcohol and determined not to admit it. She blamed her problems on almost anything else. She didn’t much care what.

Bertha: “I’m not an alcoholic. I’m just depressed.”

Me: “But this is your third arrest. Your blood alcohol was three times the limit.”

Bertha: “That’s the depression. I think it slows my metabolism. My body doesn’t get rid of the alcohol.”

Me: “You had to have had more than one glass.”

Bertha: “I saw this show on post-traumatic stress. Maybe I have that. I fell out of a tree when I was a kid and had to go to the hospital for a week.”

Me (checking the file): “This was a long, long time ago, right?”

Bertha: “I was eight. Then a doctor told me once that I had low blood sugar. Could that show up as alcohol in your system?”

Me: “Bertha, I get the feeling you’d rather the problem be something other than drinking.”

Bertha (surprised): “Well, sure I would. There’s nothing more disgusting than a drunk woman.”

The look of revulsion on her face was unmistakable. We might regard alcoholism as a disease, but Bertha wasn’t buying it. She took it as a personal insult.

Stigma has become a popular topic in healthcare because experts have realized how much of a problem it can be in motivating people to seek help for otherwise treatable problems.

I wonder if that’s partly why some AA members announce it when they stand up to speak at meetings: “my name is Bill and I’m an alcoholic”. The First Step doesn’t require it – powerlessness and unmanageability are the terms. Perhaps the use of ‘alcoholic’ is a way of taking back power over the thing you once feared.

Mental illnesses are stigmatized, too. Note that Bertha was happy to acknowledge depression and even PTSD as long as nobody called her an alcoholic. Many men are exactly the opposite. They’ll admit to a drinking problem, but don’t go calling them depressed.