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​在生活中如何受污名化的影響

污名不但會形響大眾如何與有精神病的人交往 [1],更會影響社會資源分配 [2],以及造成精神健康不對等(mental health disparity) [3]。以下是一些有精神病經歷的人因污名而面對的困難:

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1. 被群體孤立

有精神病經歷的人往往不願意透露自己曾患病之事實,就算有意開口,亦覺得極之窘迫,難以啟齒,因為他們懼怕他人負面的反應。往往當他們終於鼓起勇氣向身邊信任的人開口,絕大部份人表示他們總是面對誤解﹑避開和無視等反應,身邊其他人的行為其實已間接構成孤立。在香港,超過一半受訪者亦不希望跟精神病歷的人居住在同一個社區[4],可見人們普遍對他們接納程度甚低。由於被同事﹑鄰居,甚至是至親的家人﹑朋友誤解和疏離,他們會因此對社交失去信心,情緒更為低落,亦會對自身施加更大壓力。

2. 難以求職或求學

在香港,294個受訪者中,有一半感到被僱主和同事歧視[5];另一研究顯示七成人不認同融合教育對有精神病的學童為理想之策 [6] ,種種證據均讓我們看到復元人士在工作和學業上都遇上重重困難,在社會不同的政策上,復元人士的平權路還很遠。

3. 求助過程受阻

你可能很驚訝,精神健康服務提供者(例如社工、心理學家、醫生)對復元人士的污名其實十分嚴重,外國甚至有數據顯示復元人士有四分一的污名經歷是來至精神健康服務提供者的 [7][8]。在香港,在300多位受訪者指出在精神健康服務中,有一半曾被當作是小朋友、對他們無禮以及無視他們的需要,有三成更指服務提供者曾拿精神病開玩笑 [9];另外在2006亦有研究指出有一半的受訪者認為入院經歷不愉快,當中包括沒有人向他們解釋藥物副作用以及有過多的身體限制 (physical restraint) [10]

4. 延誤治療

有不少人發現自己出現精神病症狀的時候,在危機發生後才向精神健康機構聯絡。在香港,有精神健康問題的人當中只有若26%的人有尋求專業協助[11]。這是因為精神病污名,人們對其誤解極深,害怕自己一旦求助就會被裁定為「不正常」,恐懼別人對自己的歧視和疏離,外國有不少研究都顯示污名對治療有負面形響[12][13]。

在這個精神疾病被污名化的時代,我們應該拒絕讓無知擴大污名範圍,摒除有色眼鏡,而用理性和包容的態度去面對復元人士,其實我們都一樣,有權享受有意義的生活。

參考文獻:

[1] Blascovich, J., Mendes, W. b., Hunter, S. B., & Lickel, B. (2000). Stigma, threat, and social interactions. The Social Psychology of Stigma, 307-333.

[2] Link, B. G., & Phelan, J. C. (2006). Stigma and its public health implications. Lancet, 367, 528-529.

[3] Hatzenbuehler, M. L., Phelan, J. C., & Link, B. G. (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health, 103(5), 813-821.

[4]Equal Opportunities Commission, 2011. Baseline Survey on Public Attitudes towards Person with a Disability 2010. 2011 (full report), Hong Kong SAR Government.

[5] Mak, W. W., Chong, E. S., & Wong, C. C. (2014). Beyond attributions: Understanding public stigma of mental illness with the common sense model. American Journal of Orthopsychiatry, 84(2), 173-181.
[6] Young, D. & Ng, P. (2016). The Prevalence and Predictors of Self-stigma of Individuals with Mental Illness in Two Chinese Cities. The International Journal of Social Psychiatry, 62(2), 176-185

[7] Corrigan, P., Thompson, V., Lambert, D., Sangster, Y., Noel, J. G., & Campbell, J. (2003). Perceptions of discrimination among persons with serious mental illness. Psychiatric Services, 54(8), 1105-1110.
[8] Schulze, B., & Angermeyer, M. C. (2003). Subjective experiences of stigma. A focus group study of schizophrenic patients, their relatives and mental health professionals. Social science & medicine, 56(2), 299-312.
[9] Mak, W.W.S., Cheung, F.M.C., Wong, S.Y.S., Tang, Y. K., Lau, J.T.F., Woo, J., & Lee, D.T.F. (2014) Understanding and reducing professional stigma of psychiatric disorders: Perspectives of professionals and people with psychiatric disorders. Commissioned Research on Mental Health Policy and Services. Food and Health Bureau, HKSAR.
[10] Lee, S., Chiu, M. Y., Tsang, A., Chui, H., & Kleinman, A. (2006). Stigmatizing experience and structural discrimination associated with the treatment of schizophrenia in Hong Kong. Social Science & Medicine, 62(7), 1685-1696.

[11] Lam, L. C. W., Wong, C. S. M., Wang, M. J., Chan, W. C., Chen, E. Y. H., Ng, R. M. K., & Lam, M. (2015). Prevalence, psychosocial correlates and service utilization of depressive and anxiety disorders in Hong Kong: the Hong Kong Mental Morbidity Survey (HKMMS). Social Psychiatry and Psychiatric Epidemiology, 50(9), 1379-1388.
[12] Fung, K. M., Tsang, H. W., & Corrigan, P. W. (2008). Self-stigma of people with schizophrenia as predictor of their adherence to psychosocial treatment. Psychiatric Rehabilitation Journal, 32(2), 95-104.
[13] Sirey, J. A., Bruce, M. L., Alexopoulos, G. S., Perlick, D. A., Friedman, S. J., & Meyers, B. S. (2001). Stigma as a barrier to recovery: Perceived stigma and patient-rated severity of illness as predictors of antidepressant drug adherence. Psychiatric Services, 52(12), 1615-1620.
 

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