FACULTY OF HEALTH AND OCCUPATIONAL STUDIES
Department of Social Work and CriminologyExploring Perceived Stigmatization of People with
Bipolar Disorder to deepen the knowledge For Glocal
Social Work Practice by means of An Interview and
Literature Study.
Beryl Delight Yengo and Michael Swarne Noble
Simba
2020
Student thesis, Bachelor degree, 15 HE Social Work
Bachelor of Science in Social Work - Specialization International Social Work Supervisor: Komal Singh Rambaree
FACULTY OF HEALTH AND OCCUPATIONAL STUDIES
Department of Social Work and CriminologyAbstract
The aim of the research was to explore perceived stigmatization of People with Bipolar Disorder to deepen the knowledge for Glocal Social Work Practice by means of an Interview and Literature Study. The data of the research was gathered from the
perspective of people with bipolar diagnosis and a peer within the field, about whether stigma is experienced by people with bipolar disorder and how their resilience factors i.e. strength factors can be supported and enhanced. A qualitative study was conducted with the purpose of expanding the evidence-based knowledge base by exploring how people with bipolar disorder with resilience experienced stigmatization, and the factors that supported their resilience versus inhibited their resilience in their adversity. The research results were analyzed through literature reviews and interviews to gain an in-depth knowledge of the phenomena. The findings indicated that stigma was experienced by the people with bipolar disorder, and was experienced as affecting recovery
FACULTY OF HEALTH AND OCCUPATIONAL STUDIES
Department of Social Work and CriminologyKeywords
Bipolar disorders, mental illness, resilience, stigmatization, discrimination, glocal social work, social exclusion, anti-stigma, evidence based social work practice, building knowledge-base, recovery, coping, rehabilitation, destigmatization, inclusion, anti-stigma intervention,
Word count: 16 000 words
Acknowledgements
A special thanks and appreciation to all the individuals that participated by contributing their valuable experiences and knowledge to make this study a success. To the 4
FACULTY OF HEALTH AND OCCUPATIONAL STUDIES
Department of Social Work and CriminologyTABLE OF CONTENTS
CHAPTER 1 - INTRODUCTION 1
1.1 Background Information 1
1.2 Aim and Research Questions 3
1.3 Explanation of concepts 4
CHAPTER 2 - PREVIOUS RESEARCH 5
2.1 Stigmatization 5
CHAPTER 3 - THEORETICAL FRAMEWORK 7
3.1 Stigmatization theory 7 CHAPTER 4 - METHODOLOGY 9 4.1 Research Design 9 4.2 Data collection 10 4.3 Mode of Procedure 11 4.3.1 Literature choice 11 4.3.2 Selection 11 4.4 Interview procedure 13 4.4.1 Interviews 13 4.4.2 Interview guide 13 4.5 Data analysis 15
4.6 Credibility & Validity 15
4.7 Reliability 16
4.8 Generalization 17
4.9 Ethical considerations 17
5.0 Strengths and Limitations of Methodology 18
CHAPTER 5 - RESULTS 19
5.1 Perception of bipolar disorder from society 20
FACULTY OF HEALTH AND OCCUPATIONAL STUDIES
Department of Social Work and Criminology5.2.2 Medical Professionals 21
5.2.3 The Influence of media 22
5.3 Self-stigmatisation 23
5.4 Effects of Stigmatization 24
5.5 Stigma tackling strategies 25
5.6 Resilience 26
5.7 About social workers & medical professionals 27
CHAPTER 6 - ANALYSIS 28 6.1 Analysis Introduction 28 6.1.1 Creation of stigma 29 6.1.2 Peril 30 6.1.3 Concealability 32 6.1.4 Course 34 6.1.5 Disruptiveness 36 6.1.6 Aesthetics 37 6.1.7 Origin 39
CHAPTER 7 - DISCUSSION AND CONCLUSION 41
7.1 Summary of main results 41
7.2 Previous research connected to the findings and discussion 43
7.3 Theories connection to the findings 44
CHAPTER 8 - FURTHER RESEARCH 45
REFERENCES 45
APPENDIX 55
i) Consent form: 55
CHAPTER 1 - INTRODUCTION
1.1 Background Information
According to the World Health Organization (WHO) report in 2001, it was estimated that 450 million people are suffering glocally from mental illness problems. A study by Ritchie and Roser (2018) estimated 792 million people and around 46 million people with bipolar disorder globally. The bipolar disorder is a biological and medical illness that usually lasts a lifetime (Cerullo et al., 2014;). Bipolar disorder was formerly called manic depression and vary from mild to extreme severe cases of mood swings that include emotional highs (mania or hypomania) and lows (depression) that affect how they feel, think and how they act (Gooding et al., 2018; Cerullo et al., 2014; Verdiun et al., 2005).
The bipolar “highs” includes being active or hyperactive to “lows” being depressed as in being very sad, having a great sense of hopelessness and being inactive. The process is a continuous repetitive circle with usually a normal mood in between (Gooding et al., 2018; Verdiun et al., 2005; Cerullo et al., 2014). The “lows” can cause feelings of sadness as well as loss of interest in activities that were once loved or enjoyed. The mania and hypomania (less extreme mania) may cause feelings of euphoria, full of energy or unusual irritability. It can affect sleep, energy, activity, judgement, behavior, ability to think clearly and also lead to emotional and/or physical problems as well as decrease a person's ability to function in their ordinary life i.e. work, personal life, activities and various endeavors, cause damage relationships, enable bad judgement and choices, poor job or school performance, poor physical and mental health and even suicide (Verdiun et al., 2005; Cerullo et al., 2014; Gooding et al., 2018). The illness can be destructive and cause emotional, social and financial damage (for example they can make drastic financial decisions/purchases, quit their jobs of ignore their responsibilities etc.) for themselves and their loved ones (for example breaking up; ending
good quality of life and being socially included.. This contributes to a downward negative spiral that increases mental health problems and mental illness stigma and decreases resilience (Verdiun et al., 2005; Vázquezs et al., 2010; Social Exclusion Unit, 2004, Cerullo et al., 2014; Gooding et al., 2018). This is why more research is needed to deepen the knowledge and establish more effective evidence based social work practice. The causes of bipolar disorder i.e. mental illness are unclear but are suspected to be genetically related (Gooding et al., 2018). There are however effective medications and strategies (manage sleep and stress) to manage and prevent relapse of both mania and depression, and live a fully normal life with the illness (Gooding et al., 2018; Verdiun et al., 2005; Cerullo et al., 2014). However, if not treated it can lead to negative
consequences as mentioned previously (Ibid). The bipolar disorder i.e. mental illness has different levels of gravity and ranges from those that are institutionalized and in need of constant medical assistance, to fully functioning members of the society i.e. people with bipolar who have resilience (Cerullo et al., 2014; Verdiun et al., 2005). These bipolar people (i.e. professionals, students, parents etc.) with resilience choose to live in the shadows, unnoticed and silent as they live normal lives due to the stigma that is attached to mental illness (Verdiun et al., 2005; Cerullo et al., 2014).
stigmatized. Stigma is structural formed and a societal construct, that occurs on three levels; social, self and professional, impacting the stigmatized negatively through discrimination, exclusion and causing self-internalized stigma (self-stigma), inhibiting recovery and resilience, decrease mental health well-being and create public reluctance to seek treatment needed due to fear of getting stamped (crazy, dangerous, unstable) and being stigmatized (Lee et al., 2006; Hansson et al., 2011; Pinfold et al., 2005). The US Surgeon General report on mental illness found in 1999 that stigma was the most significant obstacle in mental disorders treatment (Pinfold et al., 2005). Raising awareness and highlighting the existence of resilience in people with bipolar disorder i.e. mental illness disorders may publicly change the image portrayed by the general media and create acceptance and awareness, establishing public knowledge based on facts, that mental illness disorders (bipolar disorder) are a biological and medical illness that need medical attention. Therefore, exploring the factors that promote resilience helps in creating effective anti-stigma strategies and deepen the knowledge for effective and qualitative evidence-based glocal social work practice within the field. So that people with bipolar disorder i.e. mental health problems can live destigmatized as well as get the needed help and live ordinary happy lives as members of society. Jones et al. (1984) six dimensions of stigma will be the main theory in this research to explore the results. Establishing the factors that contribute to stigmatization of mental illness crucial in to establish effective glocal social work practice.
1.2 Aim and Research Questions
The Aim of the research was to Explore Perceived Stigmatization of People with
Bipolar Disorder to deepen the knowledge for Glocal Social Work Practice by means of an Interview and Literature Study.
Research questions:
1. What are the perceived causes of stigmatization of people with bipolar disorder? 2. What are the perceived impacts of stigmatization on people with bipolar
disorder?
3. What are the resilience factors from bipolar individuals in overcoming stigmatization?
1.3 Explanation of concepts
Stigma: An attribute, behavior, or reputation which is socially discrediting in a
particular way: it causes individuals to be mentally marked and classified by others as tainted, undesirable, a disgrace, stained, shameful, rejected stereotypes rather than in an accepted, normal person or people.
Stigmatization: Shaming, disgracing or disapproval of individuals or discrimination
against individuals based on social characteristics that distinguish them from other members of a society.
Anti-stigmatization: Acceptance and inclusion of all people as members of society no
matter their conditions. It is the opposite of stigmatization and counteracts shaming, disgracing and discrimination.
Anti-stigma: Opposite of stigma, against shaming, disgracing and discrimination.
Advocating accepetance, inclusion, anti-discrimination, dignity for all members of society no matter their conditions.
Destigmatize: Removing associations of shame or disgrace and discrimination. Anti-stigma interventions; Strategies to eradicate stigma with the goal of correcting
misinformation or contradicting negative attitudes and beliefs. Counteracting inaccurate stereotypes or the myths by replacing them with factual knowledge i.e. information.
Resilience: The ability to recover from or adjust easily to misfortune and adversities. Recovery: The act and process of recovering for example combating a disorder (such as
bipolarity) or a real or perceived problem.
Glocal: Reflecting or characterized by both local and global considerations.
Glocal social work practice: Social work practice in the field in both local and glocal practice.
RBP: People with Bipolar Disorder with resilience (that have been stable for at least 5
years without visiting the psychiatric ward. That worked, studied and lived normal lives or are parents and so on managing their lives. Members of society that handled their stress levels and had full control of their medications in order to lead independent lives).
BP: was used to refer to the people with bipolar disorder
In this study, the words “interviewees” and “participants” will be used interchangeably. The same principle will apply to “mental illness” and “bipolarity”.
CHAPTER 2 - PREVIOUS RESEARCH
This section presents previous research about stigmatization regarding people with mental illnesses. The previous research selection process for the study was based on the purpose of exploring the findings i.e. data results in alignment with the theory. The selected previous research was specifically chosen and utilized in the purpose of
exploring the aim of the study. This study will cross reference various studies within the context of the research study. These studies explore, show or link the relation between mental illness i.e bipolar disorder stigmas status, the impact of stigmatization and current effective anti-stigma strategies.
2.1 Stigmatization
A cross-sectional research study conducted by Hansson et al. (2011) of 140
professionals (e.g. social workers) and 141 and mental illness outpatients and in-patients in Sweden was about the attitudes and beliefs of devaluation i.e. stigma and
mentally illness lose job opportunities, and which affects them negatively i.e. devalued and create self-stigma.
Lee et al., (2005) study reported that family members were ashamed of the mentally ill i.e. bipolar people, even as family members and could stigmatize the mentally ill. The family members’ fears of social contamination (losing face) motivated stigmatizing the mentally ill, and could hide or abandon them to maintain their social status (Ibid). Porter, 2002; Lee et al. 2005 and Foucault (1992; 2001) describe historically how the mentally ill were deemed mad, cursed, crazy and dangerous people and abandoning or hiding and imprisoning them in dungeons, madhouses and prisons. And unfortunately according to research by Crisp et al. 2000; Angermeyer & Schulze, 2001a; Wahl, 2003; Foucault, 2001, p. 109; Foucault, 1992 and Thompson et al. 2002 state that people still perceive the mental illness as “dangerous” and “unpredictable”. Ericson et al. (1987; 1989) shows that the Media i.e. the News depict itself as the main source of truth, while Philo, 1996; Foucault, 2001, p.109; Wilson et al. 2000 and Goffman, 1963 state the mentally ill are not portray in a positive light in the Media, but as dangerous and killers. Sirey et al. 2001; Jones et al., 1984; Davey & Gordon, 2017 and Goffman, 1963 state that mental illness with resilience can if possible choose to conceal (hide) and avoid exposure in order to avoid stigmatization and discrimination. Lundberg et al., 2007, Angermeyer and Matschinger, 2005 and Lee et al., 2005 talk about the unnoticed that remain silently in the shadows.
Research about the direct correlation between public (including professional) mental illness stigma and recovery i.e. resilience will be explored and cross referenced based on the studies of Vázquezs et al., 2010; Social Exclusion Unit., 2004; Hansson et al., 2011; Lee et al., 2006; Pinfold et al., 2005; Corrigan., 2004; Nosek et al., 2009; Sirey et al., 2001. According to the studies of Hansson et al. (2011), Royal College Psychiatrists. (2001), Pinfold et al. (2005), Lee et al. (2006) and the Social Exclusion Unit (2004) stigma has negative implications for recovery, treatment and development of people. Lundberg et al., (2007) explores if mental illness is manageable with treatment. Pinfold et al., (2005) also explores the means of effective anti-stigma in order to enable
and described. Davey & Gordons (2017) study explores the need to promote and raise awareness as their study showed that knowledge about mental illness i.e. diagnoses was lacking and limited. The studies of Corrigan et al., (2001a); Corrigan & Watson, (2002) and Pinfold et al., 2005 explores the emphasis of anti-stigma interventions, exploring both personal contact, education and empowerment.
CHAPTER 3 - THEORETICAL FRAMEWORK
This section presents the selected theory for the study and the process of selecting the theory. The researchers selected specifically jone et al., (1984) six dimensions of stigma based on the purpose of exploring and emphasizing on the aim and purpose of the study i.e. in order to explore the phenomenon in multifaceted depth and gain in-depth
knowledge from the results in association with explored research. The theoretical framework was utilized i.e. cross referenced in a deductive manner. The will be explored and linked specifically in the context of mental illness i.e bipolar disorder stigma, the impact of stigma on mental illness, the status and current effective anti-stigma strategies. There was very little research done in resilience and coping from the perspective of people with mental illness i.e. bipolar disorder in adversities. The theory will be utilized in association with previous research in the analysis of bipolar disorder i.e. mental illness stigma.
3.1 Stigmatization theory
The origin of the stigmatization theory is defined by Erving Goffman (1963, p. 3) as a deeply discrediting attribute that diminishes people from perceived as normal i.e. whole, tainted and insignificant. Stigma is a social construct (Goffman, 1963, p. 4) and occurs because there is an inconsistency between characterization of a person and the person's actual attributes (Goffman, 1963, p. 2). A criticism of Goffman’s stigma theory is that the theory accredits a helpless role to the stigmatized disregard to mention that the stigmatized can achieve beneficial improvements to their communities (Fine and Asch, 1988;). Jewkes (2006) and Sayce (1998) deemed the theory narrow and unsuitable for constructing stigma intervention strategies and programs. However, despite the
identified three forms of stigma; i) the physical; can be deformities one has on the body, ii) the group identity stigma; stemming from a certain race, religion, nationality or social class etc. and iii) the character traits stigma such as “blemishes of individual character perceived as weak will, domineering, or unnatural passions, treacherous and rigid beliefs, and dishonesty, these being inferred from a known record of for example mental disorder, imprisonment, addiction, homosexuality, unemployment, suicidal attempts, and radical political behavior. Link and Phelan (2001) state that those facing stigma experience structural discrimination or institutionalized disadvantages followed by Michalak et al. (2013) stating that structural, social and self-stigma were the main societal stigmas while Martinez & Hinshaw (2016) state the forms of stigma
discrimination as social, economic, political.
Expanding on Goffman's work Jones et al., (1984) identified six dimensions of stigma; (i) peril, (ii) concealability, (iii) course, (iv) disruptiveness, (v) aesthetics and (vi) origin. The first dimension, peril, is known as dangerousness and entails for example the
general public perceives people with mental illness i.e. bipolar disorder as
unpredictable, strange and frightening (Ibid). The concealability dimension talks about how visible versus invisible the illness might be, in this instance people with
stigmatization. The origin dimension of stigma is the origin of the illness, and within this context it is believed that bipolar disorder i.e. mental illness is to a certain extent developed from biological and genetic factors hence origin.
CHAPTER 4 - METHODOLOGY
The methodology section will primarily focus on why preferred research methods were chosen and how they relate to the study. There are subsections formed clearly to show the topics that are relevant such as; prior understanding, information on the research design, the means in which articles and relevant research material for the study was obtained, the sampling methods applied to select the participants, analysis of data and through what medium validity and reliability was created in this study. Furthermore, the ethical considerations are presented, and limitations experienced during this study are also discussed.
4.1 Research Design
Considering the aim of the research, this study used a deductive qualitative research method for empirical data collection, with focus on descriptive and explanatory information about the subject. In methodology, literature study was done for the
framework and the interview study for analysis to deepen the knowledge. The literature reviews and interviews were both chosen in a deductive method. The researcher’s authors had a hypothesis that people with bipolar disorder are stigmatized in the society and experience themselves as stigmatized. The reason the deductive approach was chosen was because it was most suitable for this qualitative research to gain a deeper insight and awareness of the topic (Robson, 2007). Keeping in mind that the study only had a handful of participants, which is a rather limited number of participants, to gather and analyze qualitative data. Forms such as sounds, words or images, can be considered as forms of qualitative information (Kvale & Brinkmann, 2009). According to Grinnell & Unrau (2005), qualitative research method concentrates on the interpretive
and descriptive in nature and focuses on personal meanings and perceptions (Kvale & Brinkmann, 2009), using methods such as observation and interviews were the focal points in order to let the researchers in this study explore perceived stigmatization of people with bipolar disorder.
4.2 Data collection
The data in the research was collected in-depth with semi-structured open-ended interviews through telephone calls, which according to Kvale & Brinkmann (2015) are questions asked during an interview that are malleable in order to get the interviewee's view of their world by opening, talking and addressing the focus topic. Open-ended questions also enable asking follow-up questions for clarifications so the participants could give us more detailed accounts of their experiences (Babbie, 2006). This assisted in interpreting the meaning of the phenomena being described. An advantage of an interview is that it helps you obtain detailed and specialized information from selected individuals for the interview. Moreover, Halperin & Heath (2017, pg. 286-288) argued that interviews prioritize validity since it allows one to gain an in-depth knowledge of the phenomena. As mentioned earlier, data collection was done through telephone interviews. The researchers chose to conduct telephone interviews for this study due to the convenience of our participants. In addition, telephone interviews helped the researchers gather information rapidly and get access to interviewees in a wider geographical area, considering distance was also a factor in this study. Although telephone interviews were chosen as the form of data collection, the researchers were also aware of its limitations. An example of this is that the interviewees could have been biased, since it was not face-to-face (Halperin & Heath, 2017, pg. 286-288).
4.3 Mode of Procedure
4.3.1 Literature choice
interest for several decades. However, regarding stigmatization of people with bipolar disorder, the researchers found the research from 1999 to 2019 the most relevant. The keywords in this study that assisted in finding the relevant articles were “bipolar”, “stigmatization”, “discrimination”, “social work”, “social exclusion”,
“destigmatization” and “inclusion”. Furthermore, keywords were restricted to articles with peer reviews, texts that had full links and textbooks and literature from the years between 1960 to 2019 that were relevant to the study. In total, the search from the main search sources Google scholar and Researchgate generated around 182 articles, all of which were deemed to be suitable for the study and they are therefore included in the reference list.
4.3.2 Selection
Considering the aim of the research, the authors in this study wanted to find people with bipolar disorder who could share their experiences on the topic of stigmatization. There were a total of four participants who were gathered through purposeful sampling. Three of the participants were diagnosed with the disorder and were working or studying members of society. The bipolar participants were chosen because they had insightful knowledge on how people with bipolar perceived stigmatization. However, one of the three bipolar participants was also an stigma social advocate working with the anti-stigmatization intervention organization Hjärnkollen in Sweden. The last participant was a doctor working within psychiatry. The doctor was chosen because he had knowledge about mental illness, in this case bipolar disorder, from a medical
perspective and he is also an anti-stigmatization advocate because he generally informs and educates other doctors and the public (who have relatives with the diagnosis) on new updated information about the disorder. Agreeing to the interview was his way of combating stigma by spreading information about the disorder. Therefore in this study, there were two anti-stigmatization advocates and they were chosen because they had intervention strategies that could be used to help build resilience. The participants were sought out from different bipolar associations/institutions and chosen from different locations in Sweden with participants from 25 - 50 years old.
understanding of the anti-stigmatization strategies used in Sweden, we interviewed a doctor working within the field of mental illness, that to be clear was not bipolar. This technique was preferable because as Palinkas et al. (2015) states, it requires indicating and choosing specific people that are knowledgeable and skilled of the research phenomena. Based on that and purposeful sampling we sought out experts i.e.
professionals within the field mental illness in healthcare clinics, social service and anti-stigma advocates in mental illness and bipolar associations to find interviewees.
To deduce if the participants with bipolar disorder were qualified for the study, they were asked beforehand if they had been diagnosed with bipolar disorder, and their last year of being hospitalized, if they were working or studying and if they were
independently managing their medication and stress levels to be able to fit the
requirements to participate in the study. Furthermore, the participants were contacted mainly through telephone calls because of their location distance. They received information about the study and asked about their willingness and availability to participate in the study, since they were living normal working, studying and family lives. The participants agreed immediately during the first contact to participate, and time and date for the interview was established. Additionally, the participants were given the option of language preference, English or Swedish in the interview process. The main purpose was to promote comfort, boost articulateness and expression for depth and qualitative data.
4.4 Interview procedure
How the interviews were carried out and a description of the interview-guide are presented in this section.
4.4.1 Interviews
As mentioned earlier, data in the research was collected through in-depth
for several reasons, the main reasons was that it was the convenient and logical method due to location distance between participants and researchers, other reasons were expenses, schedule problems with work or studying etcetera.
Even though both researchers are fluent in Swedish and English, one took the role of the interviewer while the other listened and assisted in follow-up questions during the interview. “TapeACall: Call Recorder” was the phone application used to record the interviews and later on used during transcription. Before the interview began, all the participants were given information about the aim of the study, that they would be recorded, how their recordings would be handled and confirmation of informed consent through the telephone to accept to participate in the study. Some technical issues
regarding volume in the phone recording application appeared in the beginning, which was solved by asking the participants to speak louder to improve audibility. With about 14 to 15 questions, each interview took about 40-60 minutes.
4.4.2 Interview guide
Before the interview, questionnaires were created to be used to regulate the course of the interview to not get out of topic. Since the study interviewed both bipolar people and anti-stigmatization advocates, there were two sets of questionnaires that were created with a bit of alteration to fit the two categories. The questionnaires were generated with the aim of the research being to explore perceived stigmatization of people with Bipolar Disorder to deepen the knowledge for Glocal Social Work Practice by means of an interview and literature study, to gain insight and deeper understanding into how people with bipolar disorder and anti-stigmatization activists perceived stigmatization. During the interviews, the participants were asked to mention what resilience factors they had and what suggestions they could provide to decrease stigmatization of bipolar people.
To answer the research questions, major questions were created with sub-questions under them, to limit them to distinct questions. As stated before, the interviews were open-ended and because of this the participants were able to extensively express their experiences in detail regarding the issue of stigmatization in people with bipolar
The participants were asked about their life occupations and if they were bipolar, they were either working or studying and were therefore put into a table for clarity. For confidentiality, the participants names were omitted from the transcripts and labelled I1, I2, I3 and I4.
Table 1. Participant list Present status of participants in the study
Participant 1 I1 Diagnosed bipolar
Studying
Participant 2 I2 Diagnosed bipolar
Working
Participant 3 I3 Doctor within Psychiatry & Anti-stigmatization advocate Working
Participant 4 I4 Diagnosed bipolar & Anti-stigmatization advocate Working
4.5 Data analysis
The participants’ responses were transcribed in order to find recurring themes within the data and in turn the data was analyzed through literature reviews in order to explore the data in depth and extensively to understand the phenomena by both researchers in this study. The research questions plus the stigmatization theory was used as a framework during the analysis to find themes. The themes were then color-coded regarding recurring experiences that the participants had. This was important to answering the research questions by finding similarities, contrasts and patterns to draw pertinent conclusions on the way the research assisted in the knowledge about the focus topic (D’cruz and Jones, 2014). The results from the study were presented and discussed in the results and analysis sections. The stigmatization theory was used for the analysis of the data.
4.6 Credibility & Validity
credibility in this study. This complemented the trustworthiness by focusing on
addressing exact information from the participants’ perspectives, which is what Grinell and Unrau (2018) strongly advised on. The interviews in this study were transcribed with concentration on writing down explicitly what the participants expressed about their experiences, in order to meticulously represent their perspectives and to form objectivity. According to Kvale and Brinkmann (2009), validity is crucial when
conducting a qualitative study because it ensures that there is consistency in the findings and controls the research’s quality from start to finish through the different stages (thematizing, designing, interviewing, transcribing, analyzing, validating and reporting). To strengthen the validity of the research, the researchers analyzed the collected data individually and later compared their findings before writing the result.
Since one of the researchers is diagnosed with bipolar disorder and the other is not, researcher bias had to be avoided. For this, both researchers had the questionnaires used for the interviews approved by a supervisor, in order to make sure that the questions were not leading the participants to specific answers. The data from the interviews was coded and analyzed first individually and then together to avert affecting the results and strengthen the analysis. Other peers were also asked to review the
conclusions several times to make sure that there was no researcher bias present. In order to strengthen validity and credibility, corroboration from multiple researchers was used to support the findings from this study. Validity and credibility of an interview research counts on “equivalence of stimulus”, which means that one has to “rely on the interviewer’s skill to approach as nearly as possible the notion that every respondent has been asked the same questions with the same meaning, in the same words, same
4.7 Reliability
Reliability points out the importance of trustworthiness and consistency (Kvale and Brinkmann, 2009). It builds upon the ability of the researchers to deflect from influencing the participants’ answers regarding being bipolar, their perception of
stigmatization and their resilience factors (Grinnell and Unrau, 2018). To strengthen the reliability of the study, the researchers used in-depth open-ended semi-structured questionnaires that were approved by a supervisor so that the participants chose what they wanted to share and so that the interviewers were not guiding the answers given by the participants. The participant’s availability, whether they were studying or working, was taken into consideration considering that the only way to conduct the interview was through telephone calls. This was because of location distance which made telephone calls the most convenient method for them. Reviewing previous research about stigmatization of bipolar people and resilience in Sweden was another way the researchers used to increase reliability in this study which assisted in aiding how the research questions were formulated.
4.8 Generalization
The aim with generalization is to achieve representativeness, meaning that the claims made about a population should not only sample represent the population but that the findings are also significant whether in a large or small number (May, 2001). However, in this study, generalization to a greater scale is not recommended, keeping in mind that this study only involved four participants; three bipolar individuals and one doctor working in psychiatry (not bipolar) talking about their personal experiences with stigmatization of people with bipolar disorder. Furthermore, the focus of the study was to get an in-depth knowledge and understanding from a small group which was
4.9 Ethical considerations
Both international and national social work principles from the National Association of Social Work, the Swedish Union for Social Sciences Professionals
(Akademikerförbundet SSR) and by the Swedish Research Council and values such as informed consent, confidentiality and integrity were paid keen attention to in this research (Swedish Research Council, 2017; Akademikerförbundet, n.d.). As Banks (2001) talks about, regarding ethics and values in social work, this was an important part of the research because it aims at protecting the participant's confidentiality and anonymity. Considering people with bipolar disorder are vulnerable to stigmatization, they were labelled I1, I2, I3 and I4 instead of using their names and not disclosing their location, age or private information which is one of the principles and values that was crucial in this study. This is so that they cannot be traced (Smith, 2010; Kvale and Brinkmann, 2009). Preceding the interviews, the participant received informed consent through the telephone about the aim and purpose of the study to them in detail. After an agreement, a verbal consent at the end since the researchers and the participants could not meet up for a physically signed informed consent (D’cruz and Jones, 2004). They were also informed that the interview will be audio recorded for data analysis, but they are free to quit at any time with no explanation requirement. Additionally, they would be sent a copy of the data analysis if they asked for any misunderstandings from the research on what their statements meant. The recordings from the interviews were stored with a secure password on the phone recording application and after transcribing, the recordings were deleted for precaution as not to land in anyone else's hands for the participant’s integrity, both mentally and socially.
abstain from questions that are sensitive. Instead, for ethical concerns, the questionnaires were centered on the research questions.
5.0 Strengths and Limitations of Methodology
The aim of the research was to explore perceived stigmatization of people with Bipolar Disorder to deepen the knowledge for Glocal Social Work Practice by means of an interview and literature study, specifically in Sweden. In order to obtain an in-depth understanding of the experiences that the participants shared on this phenomenon, using a qualitative research method was suitable to collect empirical data and explore the aim of this study. Both researchers kept in mind the importance of trustworthiness in the study by following ethical principles and values of research, formulating the research design and meticulously analyzing the data from the participants. Open-ended
questionnaires were used, which allowed the participants to share their experiences in detail and for the interviewers to follow-up for clarification on statements by the participants. This aided in high quality data for the study. The convenience of using a qualitative research method also made it easier for the participants to share their experiences about stigmatization.
Limitations were also to be expected using the method. Firstly, that the interview was based on individual perceptions and their recollections of experiences. It can be challenging to trust in memory if the participants themselves have undergone negative traumatic encounters regarding stigmatization (Dudley, 2011). According to Echterhoff et al. (2005)’s study, memory can be reconstructed while trying to recall an event, adding or taking away information in the process. Therefore, if an individual is asked to recall a particular event that they have a bias on, it could lead to an audience-tuning effect. In this study, since the participants were asked if they experienced themselves to be stigmatized, they might have answered the questions in line with what the
Keeping in mind that this is a small qualitative study with just four participants,
generalizing the results was a concern to pay attention to as supported by Patton (2015).
CHAPTER 5 - RESULTS
This section will present the data obtained from semi-structured open-ended interviews from the participants and will put in subsections for clarity. These subsections are organised according to the research questions of the study in relation to stigmatisation of people with bipolar disorder. The accounts from the participants will be presented here on their perceived stigmatisation, causes of it, the effects of stigmatization, strategies to tackle stigmatization, what resilience factors they had to overcome stigmatisation and lastly their suggestions on what could be done by professionals to diminish stigmatization and promote resilience will also be presented.
5.1 Perception of bipolar disorder from society
All the interviewees stated that stigma, negative attitudes, stereotypes and
discrimination against mental illness still exist despite the development within the field of psychiatry. When asked if they had experienced stigmatization, I1, I2 and I4 with bipolar disorder strongly expressed that they had experienced stigma. I3, a doctor working in psychiatry, also agrees that people with bipolar disorder do experience stigmatization. When asked if they had a challenging time accepting their diagnosis, I1, I2 and I4 agreed that they did not. I1 said it was because she had confirmation from 3 different doctors. I2 and I4 stated that it was because a close family member also had the diagnosis.
experience that partially contradicts the others experience as I4 did not experience stigma within her surroundings even though she aligned with the existence of stigma. I4 stated:
I have never experienced discrimination publicly for being bipolar because I’m open about it and for me it has never been a problem.
5.2 Stigma Attitudes and Causes
The research data shows the causes of stigma is lack of knowledge i.e. unaware of what bipolar disorder is, lack of public information and education about bipolarity. Three main themes as causes of stigma that arose from the data research were; (i) lack of knowledge i.e. unawareness of what bipolar disorder was; lack of public information and education about bipolarity, (ii) medical professionals and (iii) negative media influence.
5.2.1 Unawareness of bipolar
All the interviewees expressed that unawareness, lack of factual knowledge about bipolar disorder being an illness along with factual knowledge about actual effects of the illness was experienced as a cause of stigmatization. All the interviewees stated that most people lack knowledge about the types of bipolar disorder that exist, including the fact that it is a biological medical problem. Stating that the general public is unaware of the different levels of severity of bipolarity and what the illness really entails.
Additionally, I1 and I2 stated that it is difficult to deal with the illness on a day to day basis alone, that the stigma that accompanies the illness does not help with dealing, healing or coping with the illness. I3 stated that:
I don’t think it's very well understood. I think generally people may have heard about bipolar, but they don't understand what it may encompass, and I don’t think they fully
understand that there are different types of bipolar disorder.
5.2.2 Medical Professionals
I2 stated that younger generations of doctors and people that work within the field of mental illness are more aware of the illness and have great knowledge and competence. I3 stated that the reason why the younger generation is more knowledgeable is “because of the recent progress and the knowledgeable new generation of professionals within the field of
education and the profession”. All interviewees agreed that older generations working within
the field have outdated knowledge because of the recent progress made within the field, especially in Sweden where mental illness awareness is increasing according to I3. All the interviewees within this research study asserted that the professionals incompetency could also be part of the causes for the stigmatization, especially the older generation or any professionals with outdated information about bipolar illness. I2 stated that her first experience seeking professional help was a traumatic experience because I2 got
wrongly diagnosed, suffered for many years, before an experienced and competent professional finally discovered that I2 had been wrongly diagnosed and wrongly medicated. I2 got better shortly after the new treatment from a competent professional. I3, a Psychiatric Doctor by profession stated;
I think it very much depends on the generation of health professionals, the younger health professionals because they all do an internship where it is compulsory of three months of Psychiatric placement, I think they have a pretty good idea of bipolar disorder and what it means to have bipolar disorder and also different types of bipolar disorder. The older generation, they have, they may have an idea of what bipolar disorder is but a lot of the older generation, a lot has happened in the field of Psychiatry the last couple of years, that may, or it resulting into that their knowledge may be outdated, like a lot of [the younger generation] healthcare professionals have between different subjects and specialties.
5.2.3 The Influence of media
I1 stated that the media has had a huge influence on how people in society today interpret issues and topics, especially mental health. I1, I2 and I4 mentioned that the media projects people with mental illness as mad, untrustworthy and unstable individuals. I4 also agreed that mental illness is associated with insanity and mental institutions, in turn mental institutions are associated with psychopaths and therefore bipolar people along with the mentally ill are generally associated with being
years, there has been a steady increase in positive discourse about mental illness in general. That how the media chooses to report on cases with people with mental illness is crucial because it impacts how people in society view mental illness as a whole and the people who have it, bipolar, for instance. It is important because people generalize, and this can be socially harmful for people with mental illness. I2 explained that.
The generalization of mental illness in the media and a lot of people who are living normal lives are never represented, in my opinion, in the media. But the media definitely associates mentally challenged people with being dangerous. So they paint people with mental illness in a bad way. I would also say the media affects people in the sense that they don’t want to be associated with bipolar illness.
I4 agreed that if someone was to commit a crime and they know that the person is bipolar, that is definitely going to be in the papers and then people generalize and associate that everyone with bipolar is capable of doing such and such crimes. Even though I2 has the perception that the media hasn’t helped much in reducing stigma, she also added that at least good and correct information also comes out. Which is
supported by I1 who states that with the increase of awareness on social media, there has been more progress in terms of discourse because people are forcing the
conversation to happen. This statement is also backed by I3 who said,
I think the Media plays a big part in how people seek help for really any disorder whether it’s for somatic diseases or psychiatric disorders. It's now highlighted in the Media and I think that is helping people to accept mental illness in a way it wasn’t accepted before and also it educates people. So Media plays a big part in that. The awareness is increasing.
I4 supported this by expressing that on social media, if people know more about the diagnosis and understand what it entails, then they won’t have the same perception, which in turn affects those who have the diagnosis in a positive way and want to get help. And not just any help, to find assistance in getting the right kind of help.
5.3 Self-stigmatisation
shared that she probably used words like crazy on herself because she self-stigmatized. She believed that sometimes people do put themselves in the stigma because it feels like a taboo to talk about it, and even not to talk about it feels weird. I1 mentions,
I know that I’m not going to climb the career ladder, the pressure is going to break me. Maybe that is self-stigma or internalized stigma, but I feel that I won’t be able to be a CEO.
5.4 Effects of Stigmatization
I3 pointed out that stigmatization related to mental illnesses has been described as having worse consequences than the conditions of the mental illnesses themselves. I2 mentioned that even with therapy, shaming is the hardest part to deal with and some of the effects it has on a person generally in life are that one becomes reserved by not telling people, she isolated herself, she didn’t go out to parties and felt ashamed of being around friends or at work. I3 confirmed this statement by adding.
In general I think as a society, there is a lot of shame in any psychiatric disease not only Bipolar disorder. Reluctance to seek help if you may be experiencing Psychiatric problems is one huge issue, especially in certain communities that are not as accepting with any psychiatric disorder including bipolar disorder.
All interviewees agreed that by not seeking help, people with bipolar disorder do a disservice, not only to themselves but to those that care for them because bipolar illness is a biological illness that needs medical and psychiatric attention even though people in society might not perceive it as so. I2 mentioned that people with bipolar disorder are perceived as irrational, unstable and crazy because some people do not understand the illness, and even though they may not use or say those words out publicly.
They believe that if I get mania, I’m just sick in the head or that I don’t have a handle on the situation or that one is crazy. They won’t call you crazy out loud but the way they behave says a lot.” I4 concurs by adding, “I think the community sometimes perceives me as intense, isolated, non-participative, just unstable in general.
though a promotion was out of the question if they tell an employer that they are bipolar. I2 added that,
You become afraid to work because suddenly you have to be away for a month, and you have to explain to your boss then it feels more like a problem than being helpful.
I4 confirmed this by stating,
I also think that a lot of people that are prone to the illness and they don’t take care of themselves have been forced to stop working. That they cannot come back after for example getting a new job that has a trial period for 6 months and they have to be on sick leave for a while.
5.5 Stigma tackling strategies
I1, I2 and I4 mentioned that in recent years, progress has been made within the field of mental illness and the subject has been highlighted and talked about more than it used to be, so the awareness and knowledge in Sweden is increasing and acceptance is
becoming the norm. However, they still believe that stigma still exists, and people are still reluctant to seek help or associate themselves with the label of mentally ill in fear of being labelled or stamped, but is actually changing. I1, I2 and I4, were also in consensus that the progress made in Sweden is profoundly better compared to many countries or cultures where talking about mental illness is considered a taboo subject, and mental illness is perceived as anything from insane individuals, broken individuals, cursed individuals, possessed individuals and/or dangerous. All the interviewees agreed that spreading awareness of mental illness in general through educating the public was the best way to reduce stigmatization. I2 suggested that.
Educating people about this is very important, especially in the work environment to talk about psychiatric illness. Just to inform the people because people with mental illness sometimes have had it all their lives and they keep it a secret because they are embarrassed to talk about it. So giving people information and educating them is a huge plus to work against stigmatization. My suggestion to help take down stigmatization is to just talk about it, even if it’s just for 10-15 minutes, is extremely important. And that is what I like about Hjärnkollen, they inform, they educate and definitely raise awareness.
eradicating any stigma is a good idea, especially when it comes to diseases, it would lead to more people seeking help, if so need be.
5.6 Resilience
All the interviewees concurred on the importance of family support as a major factor that influenced resilience. I3 shared that family, adequate professionals and activities were important external factors. He added,
Generally speaking, sure goals and activities are important, to set up reasonable goals and to accept the disease as well, and to understand it.
I1 mentions her mother and best friend as two of the most important people in her life that assisted her to get through the tough times. That having contact through phone conversations with her friends and family that can last for hours helped her to deal with stigmatization. In regards to hobbies, the I1 shared that painting, writing, dancing or any manual work was a great tool for her to clear her mind. Having a routine was also another external factor that was significant to I1 in helping her find a life purpose.
I have to have a routine, something that gives me a sense of obligation, like studies, or work, something on the outside that will give me a solid feeling of gratification.
I2 on the other hand expressed that;
I have a lot of assignments from my work that I do which helps me. And my husband too is my support, and my sister is my biggest support. So I would pretty much say my family because I know that they love me.
I4 also shared the same perspective when it comes to family, especially her
grandparents, as a strong external factor because they understood and accepted her. That she could count on then when she’s had a bad day, hasn't slept well or when she’s not feeling well. They understood that she needed to rest in order to recharge so it doesn’t get worse. Additionally, I4 shared that having another family member who was also diagnosed bipolar only served to bring them closer.
I2 and I4 added that hope and faith were additionally crucial internal resilience factors that they had. I2’s belief in God and Jesus even though she doesn’t go to church often helps a lot too. She added:
Just hope in itself, that someday in the future everything is going to go well. I would save each day to see that day.
I1 also attributed her boss at work as a resilience factor and her pets too who indirectly engaged her in social activities.
I take care of pets. So that means I have to go out very often and I have to go to the park and I have to see people and people see me and we recognize each other and say hello politely. And that creates a cohesive atmosphere.
I4 on the other hand shared that the organisation she works for always brings
excitement , a sense of purpose and fulfillment because she gets assignments to present information to people about bipolar disorder.
5.7 About social workers & medical professionals
All the interviewees were in consensus about the importance of having a competent approach, empathy, awareness and knowledge about the illness, especially since
bipolarity has different levels, different individuals with different personalities, different medication, different receptivity to treatment and medication, support factors and resilience levels. I1 and I4 confirmed that they did not receive any assistance from social workers, rather they dealt primarily with medical professionals. All the
interviewees in this study suggested their personal opinions on ways in which resiliency can be promoted through professionals that work with people with bipolar disorder. I4 advised social workers is to,
See us as individuals because everyone is different…see how the person wants to be approached. I had a doctor once that was telling me that he felt sorry for me and talking a bit in a degrading manner, and that doesn’t work for me. But I can understand that for someone else that works perfectly.
Sometimes it’s better with someone who is not a professional, someone who is themselves a bipolar who just sits down and talks about how things can be. Sometimes people just need someone who has empathy and humane towards others. Not someone sitting on a high horse.
CHAPTER 6 - ANALYSIS
This section aims to explore the correlation between the term stigma in an attempt to understand the phenomena, gain knowledge and establish evidence based social work practice and expand the knowledge base. The results will be analysed using
stigmatization theory and previous research. The researchers will attempt to analyze stigmatization and explore the discourse through the lenses of the conducted study, through previous research and theory chosen in this study. The analysis will include psychosocial authors and stigma researchers in purpose of increasing evidence-based knowledge within glocal social work practice.
6.1 Analysis Introduction
As the results show, three of the participants agreed that people with mental illness i.e. bipolar disorder are stigmatized and experience themselves as stigmatized, which correlates with previous research within the field (Nilsson et al., 2016; Svensson & Hansson, 2015; Hawke and Parikh, 2014; Goffman, 1963; 1999; Hansson et al., 2011; Link et al., 1989; 2001; 2004). However, one of the participants said that she did not perceive herself as stigmatized because she has been open about her mental condition for a long time. Though this could be because she has been working with an anti-stigmatization organization “Hjärkollen” and so she has a blind spot for stigmatizing actions from others.
Stigmatization of people with mental illness i.e. bipolar disorder exists on different levels. It can be found among the public, within healthcare, among friends and family as well as internalized by the affected individuals themselves (Hawke and Parikh, 2014). Heatherton (2000) proposed that stigmatization could be a result of “people’s limited cognitive resources, and of the social information and experiences to which they are exposed”. Both the stigmatizer and the target have different perspectives that are
affected by the significance of their own personal and collective identities in the society. This is intertwined with their cognitive, behavioral and emotional processes. However, degrees of resilience in addition to other factors such as physical, biological,
psychological, social, cultural and environmental sub-spheres are important in combating stigmatization and vitally correlated to the quality of life of people with bipolar disorder (Lee et al., 2017).
As mentioned earlier, even though stigmatization of people with mental illness i.e. bipolar disorder still exists and the impacts; which will be mentioned later on,
stigmatization has on their lives are known, Jones et al. (1984) writes that stigmatization does not just occur, there is a process that it follows.
6.1.1 Creation of stigma
Jones et al. (1984) following on Goffman's work used the term "mark" describing the conditions that initiate the stigmatizing process, stating that stigma happens when the mark/process links the identified person or group through attributional processes to undesirable characteristics that discredits the person or group in the eyes of others e.g. bipolar disorder. This is what all participants of the study were in consensus about, stating the discrediting attribute is that of having mental illness i.e. bipolar disorder. Based on the results of the study, it is clear that Jones et al. (1984) dimensions of stigma are evident in the study, by utilizing Jones et al., (1984) theoretical framework we can explore the dimensions of stigma, previous research and the inter-relation of stigma and resilience.
important to remember that stigma can be created by the presence of these dimensions working either independently or simultaneously.
6.1.2 Peril
The first dimension of stigma is peril known as dangerousness, often considered a critical perspective in stigma development, and often cited in most research (Corrigan et al., 2001). In the peril dimension, the general public perceives those with bipolar
disorder i.e. mental illness as strange, unpredictable, dangerous and frightening (Crisp et al., 2000; Lundberg et al., 2007) which is in consensus with the study results. When the participants were asked how the public perceived bipolar disorder, all the participants agreed that most of the public is unaware of bipolar disorder and those that had some information got it from media sources which have not always had correct information. The participants mentioned that the media has had a huge influence on how bipolar disorder is portrayed, especially in movies and on the news. Although the results show that there has been a steady increase in positive discourse about mental illness over the years, the media play an important role in how people with mental illnesses are
portrayed, since this impacts the society’s view of people with mental illnesses, such as bipolar disorder. There is supporting research studies, personal testimonies and
campaign groups that can all identify sources of stigma, for example, generally negative portrayal of people with bipolar disorder i.e. mental health problems in opera dramas through time, in media, movies, tv shows and unfortunately in modern tabloid as well as newspaper headlines (Ross et al,. 2019; Wahl, 2003; Philo, 1996; Wilson et al., 2000) as shown in the conducted study results, that people with mental illness are dangerous and unpredictable. One of the participants mentioned that if there has been an individual with mental illness that has committed a crime, this is broadcasted even more, giving mental illness and those suffering from it a horrible reputation.
Even when some of the general public and professionals can have a relative
and those that suffer from it because people generalize, and this can be socially harmful for people with mental illness. Combined with unawareness of what mental illness entails, stigmatization of people with mental disorders continues to persist in society. According to Corrigan (2004; 2007) fear and discomfort happens as a result of attributed characteristics to people or groups, in this case, that people with bipolar disorder are dangerous and unpredictable. Therefore, according to the participants, most people in public react negatively to mental illness and those suffering from it and opt to reject them, leaving those with mental illness to feel unwanted and isolated.
Therefore, people with mental illness who are stigmatized can also struggle with social support, adjustments and difficulties building, maintaining concrete and trustworthy relationships when they are labelled as dangerous because people would want to stay away from them (Michalak et al., 2013; Lee et al., 2017; Svedberg et al., 2013). The results from the study found this to be accurate. The participants for instance mentioned that they isolated themselves, had low self-esteem at some point and this can affect the quality of life they have. Therefore, educating the public and talking about bipolar disorder more at the workplace so that not just the employers, but even co-workers understand the illness and what they can do in order to make the workplace a
comfortable environment for those suffering from mental illness i.e. bipolar disorder is important.
There are a multitude of factors that influence resilience however, ecological factors such as family and friends are the most important protective factors for people facing stigmatization (Garmezy, 1991). In order to deal with the stigma, Heatherton (2000) mentioned that the person on the receiving end of the stigmatization finds a way to deal with their situation by creating “positive group identities”, which correlates to
Goffman's (1963) perspective. The participants did not mention that they created “positive group identities”. Instead, they had other protective resilience factors, both internal and external that helped them overcome stigmatization; Family, Supportive Network, Competent Doctors, Passion in Craft or Work, Faith, Goals, Hobbies,
observed to influence resilience and they operate both indirectly and directly (Werner, 2000). However, these resilience factors adjust during the course of life (Kim-Cohen & Turkewitz, 2012).
6.1.3 Concealability
The second dimension of stigma is Concealability (Corrigan et al., 2001; Jones, et al., 1984). It describes how detectable a characteristic is and in bipolarity, it depends on the severity of the illness, but people with bipolar disorder who with resilience are able to hide their illness often choose to do so (Jones et al., 1984). Unlike race, a physically noticeable attribute, bipolar is a mental illness, which is not physically detectable and so people’s understanding of the condition can be limited. For this reason, the invisibility of the diagnosis makes it easier to conceal for people with bipolar disorder that have resilience factors to help them overcome stigmatization (Davey & Gordon, 2017). As mentioned earlier, participants with bipolar disorder mentioned that they had to conceal their mental health status from their employers because of job security purposes. They did not want to put their jobs in any risk by asking for time off from work, because it was uncertain if they would be able to get it back. They concealed if they had been hospitalized before too because that would add to the perceived
stigmatization of the illness. This is why demolishing stigma through anti-stigma intervention in workplaces is important according to one of the participants who suffers from bipolar disorder and also works with anti-stigmatization strategies. This would help in understanding the reluctance of people with bipolar disorder to share their condition (Jones et al., 1984) and become publicly associated with stigmatizing attributes.
social behavior to avoid exposure to stigmatization, rejection or discrimination. This can be confirmed by two of the participants suffering from bipolar disorder, one who shared that she avoided asking for a promotion because she believed she would not get the position if she revealed her mental health status and another who shared that she isolated herself and avoided going to parties because she was ashamed of the illness. This is why the unnoticed people with bipolar disorder with resilience that are living normal lives choose to remain in the shadows and remain silent about their condition due to stigma (Lundberg et al., 2007; Angermeyer and Matschinger, 2005; Lee et al., 2005). One participant shared that even with therapy, shaming is the hardest part to deal with and so she must hide the illness from other people. However, the participants said that they did not have to conceal their diagnosis from their family and friends because they were their support system.
The participants mentioned purpose, self-acceptance and perseverance when talking about their resilience to overcome adversity (Wagnild, 2010). When asked how if they had a challenging time accepting their diagnosis, they all agreed that they did not. This, according to the participants, was because they either had confirmations from different doctors or that a close family member also had the diagnosis. The results showed that even though there are challenges that come with having bipolar disorder for example depression and stigma, the participants with bipolar disorder had accepted that it is an illness that they would be dealing with their entire lives and they developed self-reliance techniques such as controlling their stress levels and medication to be able to manage the illness without medical or psychiatric help. One of the participants found her purpose while working with an anti-stigmatization organization in Sweden called Hjärnkollen to help others that are bipolar and educate the public on what bipolar disorder is. From the findings in the study, the participants shared equanimity; a trait that describes optimistic individuals (ibid) because they shared hopes of the future that mental illness will not be as stigmatized as it still is today.
6.1.4 Course
Course (Jones et al, 1984) is the third dimension and it explores the likelihood the
on mental illness found that stigma was the most significant obstacle to the treatment of mental disorders (Pinfold et al., 2005). Public stigma disadvantages people with bipolar disorder i.e. mental illness with respect to many important life circumstances, thereby hindering recovery, employment, income, social network ties, quality of life, mastery, self-esteem, depressive symptoms, and access to and quality of medical and mental health services (Hansson et al, 2013; Hansson et al, 2011; Druss & Bornemann, 2010; Serafini et al., 2011; Link et al., 2008; Sirey et al., 2007; Pinfold, 2005). Stigmatizing actions and behaviors against bipolar disorder and those suffering from it are reversible over time (Ibid), this is why bipolar disorder initiatives and interventions are made in the spirit of recovery, betterment and managing the illness. These initiatives and interventions are not only made primarily for medical purposes but also for public purposes through anti-stigma interventions. A study by Cerit et al (2012) showed that the significant correlation with functioning were severity of depression, internalized stigmatization, and perceived social support. As a biological illness that affect cognitive functions and social behavior and therefore an illness with medical treatment it is reversible and manageable, especially by eliminating stressing factors i.e. stigma, rejection and discrimination (Lundberg et al, 2007; Angermeyer and Matschinger, 2005; Lee et al., 2005). Stigma may have a strong negative impact on the recovery of the individual’s social functioning (Corrigan 2004; Nosek et al., 2009; Sirey et al., 2001). Considering the participants in the study confirmed that they had not been hospitalized the past 5 years, it is safe to say that the illness is treatable. This can be confirmed by one of the participants who is a doctor working within psychiatry who stated that bipolar disorder is treatable. The results support the statement that stigmatization does not help in the recovery process, it only slows it down and can even be a hindrance to seeking help.
Rehabilitation of people with bipolar disorder aided resilience and improved their self-formulated goals and quality of life regarding employment/ job training and the number of individuals depending on disability pensions also lessened (Lee et al., 2017). That is why anti-stigma interventions contribute in creating stigma free environments that boosts resilience (Hansson et al, 2013; Hansson et al, 2011; Druss & Bornemann, 2010; Serafini et al., 2011; Link et al., 2008; Sirey et al., 2007; Pinfold, 2005). And the
employ multi-faceted and multi-level strategies that focus upon personal contact, education and empowerment (Alexander & Link, 2003; Link; 2001; Corrigan et al., 2001a; Couture & Penn, 2003; Corrigan & Watson, 2002).
Anti-stigmatization interventions on the other hand enhance resilience and recovery. The participants in the study who have bipolar disorder shared that treatment works but that requires the use of updated information by professionals about the illness. Even though the participants did not experience stigmatization directly from medical professionals, they experienced that professionals used outdated information that resulted in years of suffering according to one of the participants. As one of the participants with bipolar disorder shared, she suffered for some years with the illness because the doctor she has used outdated information for her treatment, but it got better when she received new medication from another doctor that helped in her recovery. If a patient suffering from bipolar doesn't know that they are receiving outdated medication, it is a possibility that they could resort to having stigmatization perceptions about their medication, does not work and stops taking them instead of blaming the medical professional that gave them the wrong medication. The results have shown that even though the participants who have bipolar disorder in this study experience
stigmatization, they are living more fulfilling lives because they are able to either work or study. For them to be able to do this without the help of professionals, it means that they can control their own stress levels and medications which has helped them feel some control of their lives.
