This study explores experiences of stigma and discrimination amongst people diagnosed with bipolar disorder (BD) or borderline personality disorder (BPD). Inspired by Margaret Archer's morphogenetic sequence and the ontological depth of critical realism, a temporal framework for stigmatisation, incorporating structure and agency, is developed and used to situate these experiences. A literature review found very little existing research on the subjective experience of stigma amongst these diagnostic groups. Indeed, most mental illness stigma research is quantitative and focussed on schizophrenia and depression. In-depth interviews were conducted with twenty-nine people diagnosed with BD or BPD, along with five ‘friendship’ mini-focus groups within the UK. Participants were recruited via charities and participant networking. Using thematic analysis, along with abductive and retroductive inference, experiences and anticipation of stigma and discrimination for participants with one of the two diagnoses in various contexts of social interaction were found to coincide with ‘four faces’ of oppression: cultural imperialism (pathologisation, normalisation and stereotyping), powerlessness, marginalisation and violence. Such experiences implied a range of antecedent social and cultural structures. Implications for the stigma concept are discussed.
Fifty years ago Goffman (1963) emphasised that human attributes, characteristics or traits were not shameful in themselves, but could have discrediting effects if they were considered incongruous with cultural expectations placed on their bearers in social interaction. It was these discrediting effects, he argued, that made a particular feature a stigma.
Since then, the stigma concept has developed considerably. Scambler and Hopkins (1986), for example, made the distinction between stigma as an ontological deficit (i.e. implying bearers are ‘imperfect beings’) and deviance as a moral deficit relating to ‘doing wrong’. Within the context of mental illness stigma, both the labelling of mental distress ( Link et al., 1987, Link et al., 1989 and Scheff, 1966) and the cognitive, affective and behavioural responses to behaviour indicative of mental disorder ( Corrigan et al., 2000, Crocker et al., 1998, Hinshaw, 2007, Jones, 1984 and Thornicroft, 2006) are considered germane ( Link et al., 1999, Pescosolido, 2013, Pescosolido and Martin, 2007 and Silton et al., 2011). Moreover, during the last decade or so, attempts have been made to expand and reorient stigma's theoretical lens to focus on meso and macro socio-cultural structures and power ( Link and Phelan, 2001, Link et al., 2004, Parker and Aggleton, 2003, Pescosolido et al., 2008, Scambler, 2006a, Scambler, 2006b and Schulze and Angermeyer, 2003). Link and Phelan, 2001 and Link et al., 2004 stigma concept, for instance, consists in the co-occurrence of labelling, stereotyping, separating ‘us’ from ‘them’, negative emotional reactions of others and those labelled, status loss, and discrimination, within a power situation that allows these processes to unfold. Power was incorporated into the stigma concept in response to criticism from disability theorists who argued that stigma was not about ‘personal tragedy’, but rather the social oppression of difference ( Oliver, 1992). And oppression, as one of the functions of stigma ( Phelan et al., 2008), is conceived by Young as having ‘five faces’: exploitation, marginalisation, powerlessness, violence and cultural imperialism ( 1992). Although Young's idea of oppression has been regarded as theoretically important to stigma ( Scambler, 2011), empirical data linking the two are so far lacking.
Whilst recent advances in the general theory of stigma discuss the processual importance of ‘structures’, some theorists in the mental illness stigma field appear to treat ‘structure’ as synonymous with ‘institution’ (e.g. Corrigan et al., 2004), rather than see it as a variety of relatively enduring relational elements of the social world, emergent at different social levels ( Archer, 1995). Consequently, there is perhaps a need to consider more fully the effects on stigmatisation from multiple structural elements such as social roles, social positions, institutions, and the systemic relations between them, alongside their intertwining with cultural/ideational forms. This requires a conception of the temporal interplay between structure and agency hitherto lacking in the stigma field. When referring to agency, a useful distinction can be made between actors (individual people), primary agents (collectivities of individuals similarly placed in a socio-cultural system without their choosing) and corporate agents (groups organised around shared concerns) as distinctive ways of being human which are constrained and enabled by structures ( Archer, 2000). And to understand the structure-agency interplay, Archer's morphogenetic sequence can help explain how structure and agency “emerge, intertwine and redefine one another” over three stages of structural conditioning, social interaction, structural elaboration/reproduction ( Archer, 2011, p. 68). A turn to Archer's work, which utilises Bhaskar's (1989) critical realist social ontology, also helps to provide a metatheoretical corrective in the mental illness stigma field which is largely situated in the positivist-empiricist tradition.
