Psychiatric Mental Health Nurses: Stigma Issues We Fail to See

Abstract

From the Rush College of Nursing, Chicago, IL. Corresponding Author: Kathleen R. Delaney, PhD, PMH-NP, Professor, Rush College of Nursing, Department of CommunityMental Health and Systems, 600 S Paulina St., Chicago, IL. E–mail address: Kathleen_R_Delaney@rush.edu © 2012 Elsevier Inc. All rights reserved. 0883-9417/1801-0005$34.00/0 doi:10.1016/j.apnu.2012.04.006 W hile mulling over the issue of stigma and its ubiquitous presence in mental health, I came upon a public service advertisement that spoke to one aspect of the core issue, it read “Hard to see a solution until you let yourself see the problem.” Of course, most psychiatric mental health (PMH) nurses are aware of the issue of stigma and the damage wrought to patients through its associated stereotyping. But what PMH nurses may not let themselves “see” are the ways stigma extends into their own behaviors, fundamentally impacting the treatment they provide, particularly recovery-oriented services. Thus, what PMH nurses need to see is, first, why stigma cuts into the heart of recovery and, then, how stigma permeates into and undermines the fidelity of nursing's person-centered approach. Stigma cuts into the core of recovery because it oppresses the very spirit that is essential to the recovery process. For instance, recovery is intimately connected to hope, an individual's reawakening, rediscovering of personal strengths, and finding purpose and meaning in life (Onken, Craig, Ridgway, Ralph, & Cook, 2007). Recovery is a personal journey seen to involve the individual's experiences of self-determination, autonomy, and freedom of action. The oppression of stigma erodes the selfesteem, creativity, and empowerment that fuel this journey (Finfgeld, 2004). Moreover, stigma carries with it marginalization, placing distance between a person and the resources he or she needs for social connection and basic survival (Perese, 2007). Stigma's ubiquitous reach also threatens PMH nurses' person-centered approach. Stigma is associated with the proclivity to bring entrenched stereotypes into relationships and interact with individuals based on assumptions, thus treating the person less than whole (Horsfall, Cleary, & Hunt, 2010). Such repressive interactions are compounded in psychiatry by a tradition of paternalistic attitudes and low expectation for improvement (Hinshaw, 2007; Ross & Goldner, 2009). In this instance, via