Chapter 1

The Mark of Shame

Historical and Social Background

People normally try to conform to the standards established by

societies to fulfill the various expectations attached to their social roles.

When a certain person fails to conform to these standards, he falls outside

the social norms of acceptable behavior. However, if that person does so

unwillingly; because he/she is ill, compassion and sympathy soon arise.

Then, all the social confinements seize to exist. Yet the case is different

with Mentally Ill Patients (MIPs)1. As, according to their social circle,

they are either pretending to be ill or they are severely ill. Each

assumption serves as a very good reason to be easily banished and

avoided. Thus, the fear of being alien to those who they most cherish

drives the MIPs to deny or conceal their illness and/or failure. Deranged

as they are, they seek to hide in order to avoid being stamped with a mark

of shame.

Lisa Appignanesi explains, in her book Mad, Bad, and Sad:

Women and the Mind Doctors: “The fear that our minds have grown alien

to us. The shame that our acts, words or emotions can slip from our

control, are often combined with a wish to disguise both states if at all

1
Throughout the thesis, the abbreviated form MIP signifies mentally ill patients.

1
possible.”(2) In order to avoid prejudice and social rejection, MIPs and

their families tend to hide the fact of their illness. Concealment has been a

typical means of avoiding stigma. If a patient seeks treatment, he is

branded as socially deranged and personally disabled. Throughout

history, different terms have been used to describe mental illness, such as

insanity, madness, and lunacy. Such terms imply a permanent loss of the

capacity of reason. Lacking the fundamental quality of humanity, MIPs

have been branded as sub-humans.

Once the subhuman status is presumed, harsh consequences

typically follow: stigmatization, discrimination, stereotyping, oppression,

banishment, and even genocide. This situation raises some critical

questions, such as: Why MIPs are usually victims of social stigma2,

prejudice, and misconceptions? Does a community’s attitude towards

MIPs have anything to do with seeking treatment and rehabilitation? Is

mental illness an everlasting mark of shame that can never be removed?

Is decency to our fellow man conditional on his sickness; being it

physical or mental? To provide clear answers for these questions, one

should realize what mental illness is.

2
In his book the Mentally Ill in Contemporary Society, Agnes Miles defines stigma
as: "a social reaction which singles out certain attributes, evaluates them as
undesirable and devalues the persons who possess them." (70)

2
 Mental Illness as a Concept:

In his book What is Mental Illness? Mcnally implies that "Mental

disorders are diseases of the brain, on a par with diseases of the

circulatory system or the immune system. As the National Alliance for

the Mentally Ill put it, just as diabetes is a disorder of the pancreas,

mental illnesses are brain disorders" (128). Then, to Mcnally, a mentally

ill patient is simply an ill person who suffers from a brain disorder. But is

a brain disease patient ill in the same sense as a patient who has diabetes?

Freidson, the American sociologist, makes a distinction between illness

as a 'bio-physical state' and illness as a 'social state.' The former occurs

when there are abnormalities in the biological functioning of the human

body. A social state illness, however, is bounded up with people’s beliefs,

evaluations and actions. (qtd. in Miles 1)

Psychiatry is mainly about the study of the human behavior.

Consequently, it involves not only the study of the brain damages but also

the study of the social, cultural, religious and even personal background

of each patient. In his book The Myth of Mental Illness, Szasz asserts that

“Although there are certain biological invariants in behavior, the

precise pattern of human actions is determined largely by roles and

rules. Accordingly, anthropology, ethics, and sociology are the

3
 basic sciences of human action, since they are concerned with the

values, goals, and rules of the human behavior” (13).

In other words, man’s behavior and actions are determined by the

social rules he follows and by the roles he practices. A man’s mind then

is nothing but a product of his social environment. That's why mental

illnesses are as unique as the very nature of each human being. The

psychiatrist Mchugh divides mental health conditions into four clusters:

One cluster includes patients who have disturbances in the structural and

functional pathology of the brain. This brings about changes in

perception, cognition, and emotion. In other words, what patients 'have'?

Alzheimer’s disease, bipolar disorder3, and schizophrenia are examples.

(Check structure) The second cluster has much to do with who these

patients really are? Due to his temperament, a patient falls at extreme

points on psychological dimensions of traits. The person concerned is

vulnerable to deal with the challenges of everyday life. If a person is very

shy, for example, he does not always have a social phobia; the social

interactions he/she perceives may turn this shyness into mental illness.

The third cluster includes problems related to what those persons are

3
According to the National Institute of Mental Health: "Bipolar disorder is a serious
brain illness. It is also called manic- depressive illness. People with bipolar disorder
go through unusual mood changes. When they feel very happy and 'up,' this is called a
manic episode, but if people with bipolar disorder feel very sad and 'down,' this is
called a depressive episode." (U.S. Department of Health and Human Services)

4
doing? This applies mainly to drugs and alcohol abuse. Those persons

seek the immediate positive consequences and neglect the delayed

negative consequences of addiction. These people only seek to attain a

false happiness to escape their misery regardless of the devastating

consequences. Finally, the forth cluster includes problems that arise from

something the patients have encountered in their life; post-traumatic

stress disorders (PTSD) (qtd. in Mcnally 213:214).

MIPs might be persons who have certain brain damage that causes

temporary or permanent loss of memory. They might be sensitive, shy, or

simply angry persons who easily lose their temper; They might be

(remove) persons who turn to drugs or alcohol abuse to escape from

reality. Their past might be troubling or full of cruel incidents that make

them behave differently out of being shocked or traumatic. They are

humans who are too fragile to deal with reality. Surprisingly, many forget

the fact of MIPs’ humanity, but only remember their current status of

madness. People tend to judge MIPs and brand them as abnormal and

disabled, regardless of the nature of their disease. An MIP is a mad

person who deserves to be excluded and/or discriminated.

Accordingly, the variety of mental diseases results from their

subjectivity. Despite the fact that some MIPs may suffer from the same

symptoms, their treatment methods and the way each patient responds to

the treatment totally differs. As Agnes Miles illustrates:

5
 “Doctors concerned with physical illnesses are dealing with

objective, biological, value-free categories: a broken bone is a

broken bone everywhere. By contrast, when it comes to what is

generally called ‘mental illness,’ Szasz holds that it is not possible

to state in the terms of anatomy and physiology how the mind

functions when 'normal.'… It is only possible to state that the way

a person behaves, or feels, seems abnormal to him or to his

fellows” (Miles 6). (Detect documentation)

A person cannot be held mad and shunned away simply because

(just for) he changes his behavior and/or feelings. Change is an ultimate

truth that each individual has to experience; societies change and so do

people. So, even deciding on whether someone is mad or not from his

behavior only is impalpable. (check semantic structure). However, it is

only human to reject and fear what we do not know. Szasz implies in his

book The Manufacture of Madness that “The principal problem in

psychiatry has always been, and still is, violence: the threatened and

feared violence of the 'madman,'… The result is the dehumanization,

oppression, and persecution of the citizen branded 'mentally ill'” (xvii).

Crucially, MIPs have always been victims of social stigma,

prejudice, and misconceptions. Despite the major advances regarding

mental disorders, emotional reactions towards mental patients are still

dominated by fear, pity, and scorn. Unfortunately, media usually portrays

6
them as unpredictable, violent, and dangerous; neglecting the fact that

very few cases render violent behavior, while the majority does not. The

Indian psychologist Ashima Kanwar clarifies that “stigma against MIPs

has diverse reasons ranging from, lack of awareness, fear of a dimly-

comprehended and much-misunderstood illness, illogical generalizations;

and disrespect for the heterogeneity of life” (181).

Due to a general lack of knowledge MIPs and their families' are

often seen as somehow responsible for their illness, and are shunned out

of fear. Thus, to Kanwar, media stereotypes of violence, ignorance, and

fear are the main reasons for the social stigma, discrimination, and

banishment that have branded MIPs throughout ages. What is shocking,

however, is that even in modern societies MIPs still receive negative

interactions. This is the case in the USA where jails and prisons have

become the largest mental facilities. This was (no past tense) the result of

an increasing tendency to stereotype and criminalize MIPs (Hinshaw ⅺⅰ).

Stigma, discrimination, and banishment are social injustices that

deprive MIPs of their humanity, and rob them of their rightful

opportunities. According to Patrick W. Corrigan, “the general public tend

to infer mental illness from four signals: psychiatric symptoms, social

skill deficits, physical appearance, and labels” (13). For many people,

symptoms of severe mental illness such as inappropriate behavior,

language irregularities, and talking to self-aloud are common indicators

7
of madness. Moreover, poor social skills might lead to stigmatizing

reactions. So, deficiency in maintaining eye contact, choosing inadequate

discussion topics, and showing improper body language also produce

stigma. Physical appearance and personal hygiene may be manifest

indicators of mental illness as well. The final and most crucial signal is

labeling. The fact that a person is mentally ill is more than a good reason

to be socially stigmatized, stereotype and shunned away (Corrigan

13:16).

Emotionally deprived as they are, many MIPs seek the church to

attain some sort of spiritual contentment. As faith plays a crucial role in

achieving treatment, the researcher Matthew S. Stanford has conducted a

survey in 2007 in the United States of America (US) to assess the

attitudes mentally ill Christians encountered upon seeking counsel from

the church. Analysis of the results found that: (you can also use your own

words instead of this long qt.)

“while a majority of the mentally ill participants were accepted by

the church, approximately 30% reported a negative interaction.

Negative interactions included abandonment of the church,

equating mental illness with the work of demons, and suggesting

that the mental disorder was the result of personal sin” (Stanford

445).

8
 These results show that even in a society as modern as the United

States (US), MIPs are stigmatized. Despite the major shifts in conceptions

of the human behavior along with the recognition that mental illness is

not rare, stigma towards MIPs is still so rampant amongst their relatives,

their fellow society members, and even the religious entities they belong

to. Unlike physical illness, mental illness is not personal. The social

context and the emotional interactions of a mentally ill patient play a vital

role in his recovery.

Kawanishi signifies that:

“Mental illness is often expressed in the context of the patient’s

interactions with the environment and other human beings through

language use, attitudes, and behaviors that range from eccentric to

bizarre. Therefore, mental illness is seldom a solely individual

experience, but rather a phenomenon that extends beyond the sick

person and involves others both in his or her close circle and

beyond in the outside world of neighborhood, work, and school”

(ⅺ). (try to paraphrase; thinks it is better)

Though not all mental diseases are socially constructed, the

distancing and rejection that MIPs encounter in their social circle make

them more vulnerable and isolated. The emotional, social and religious

supports are crucial in rehabilitation and treatment seeking.

9
 Mental Illness throughout History

Over history, MIPs were starving for care and acceptance but they

were only persecuted. The plight that MIPs have suffered from for

centuries proves that mental illness is a mark of shame, but hopefully not

an everlasting one. Mental illness has persisted in many cultures as a

form of religious punishment or demonic possession. In the Greek and

Roman times, a mentally ill person was viewed as strange and deranged.

His illness was believed to be the doing of some evil spirits that might

suddenly fly out and possess others. Consequently, such individuals were

avoided and shunned. If that person had no family, his town might either

assign a caretaker or have the person held in a jail or dungeon.

By the fifth century, there were clear records of the Christian

Church helping the mentally ill. One of the first hospitals devoted to

treating those with mental illness was established in Jerusalem in 490. In

the sixth century, the mentally ill were cared for in monasteries run by the

Christian church. In the Middle Ages in Europe, people with mental

disorders were labeled as witches and assumed to be inhabited by

demons. Muslim Arabs, who establish asylums4 as early as the 8th

century, carry on the quasi-scientific approach of the Greeks. According

to the historical record, the earliest hospital providing care to the insane

4
According to Cambridge Advanced Learner’s Dictionary & Thesaurus: "asylum "is a
hospital for people with mental illnesses: a lunatic asylum, old use.

10
was in Cairo. It was built in 872 by Ahmed ibn Tulun, the governor of

Egypt in that time. These hospitals were called ‘maristans’. Muslim

physicians and,

“[The Arab rulers] believed that caring for the mentally ill was one

way to fulfill their religious obligation of charity to the needy,

based on Sura 4:5 in the Qur'an, which states, 'Do not give to the

incompetent [mentally ill] their property that God has assigned to

you to manage; provide for them and clothe them out of it; and

speak to them honorable words” (Koeing 29: 30).

However, the case was rather different with the church. The

Christian church was compassionate with MIPs, but not always. This was

mainly due to the popular myth that MIPs were possessed by demons. So,

help was provided for the needy, the poor, and sometimes the insane

people. The attitude of the church totally changed in 1487 as the Christian

church's persecution of sorcerers, witches, and sometimes mentally ill

became widespread. As Stephen P. Hinshaw mentions in his book The

Mark of Shame:

“Hundreds of thousands of women in Europe were branded as

witches from the late 1400s through the next several centuries.

Many appear to have been suffering from mental disorder,… they

were tortured and burned at the stake in order to expel the devil

from their bodies and save their souls” (ⅺⅰ).

11
 In his book Madness and Civilization, Michel Foucault argues that

up to the seventeenth century in Western Europe, the mad experienced

little opprobrium from the sane. But they were not singled out for special

treatment. However, according to Foucault, somewhere in the

seventeenth century received severe stigmatization and lost their freedom

to move freely through society. The confinement of MIPs was associated

by the demands of this age’s economic behavior. As madness become an

equivalent to non-productivity, and thus the insane were banished from

the larger societies (qtd. in Jimenez 2).

As the scientific revolution of the late seventeenth gained

momentum, physicians argued forcefully against the notion that mental

disorders were caused by witchcraft or possession. During the

seventeenth and eighteenth centuries, madness had many manifestations

and meanings. It could be seen as medical, moral, religious, or satanic. It

could be sited in the mind or the soul, in the brain or the body. In his

book Mind Forg’d Manacles, Roy Porter implies that “No clear cut and

rigid boundaries were generally recognized between what we might call

clinical insanity proper and a variety of other, possibly less severe,

12
peculiarities of thought and behavior, such as melancholy or

hypochondria5, or just being ‘cracked’ ” (ⅹ).

Generalization and lack of knowledge lead to blur the reality about

mental illness. Any change in an individual’s behavior could be simply

considered a symbol of his madness. In 1785, Jean Colombier, Inspector

–general of French hospitals and prisons, summed up the situation of the

mentally ill in a very devastating statement. He implies that:

“Thousands of lunatics are locked up in prisons without anyone

even thinking of administering the slightest remedy. The half-mad

are mingled with those who are totally deranged, those who rage

with those who are quiet; some are in chains, while others are free

in their prison. Finally, unless nature comes to their aid by curing

them, the duration of their misery is life-long, for unfortunately the

illness does not improve but only grows worse” (Rosen 151).

Thus, up to the end of the eighteenth century, there were no real

hospitals for the care and treatment of the mentally ill. However, Andrew

T. Scull has argued, in Museums of Madness: The Social Organization of

Insanity in Nineteenth Century England, that:

5
According to Cambridge Advanced learners Dictionary: Hypochondria is “a state in
which a person continuously worries about their health without having any reason to
do so.”

13
 “A dramatic change overtook the social reaction to the mad in

England in the early nineteenth century. During this period, the

insane were ‘incarcerated’ in a state supported asylum system

where their condition was newly defined as a medical problem and

their lives were under the jurisdiction of the medical profession”

(qtd. in Jimenez 4).

The case is not different in the American history of insanity. In his

Mentally Ill in America, Albert Deutsch explains that the colonists were

largely ignorant and sometimes cruel in treating the insane. He argues

that the establishment of asylums rescued the mad from the inhumane

treatment, and that the recognition of madness as a disease gave new

hope to its victims (qtd. in Jimenez 5).

During the nineteenth century, a dramatic change in the nature of

medicine as a whole took place. This change is a result of the recurrence

of a spate of diseases that has much to do with redefining this century

medically and socially, especially for women. Examples of these diseases

or illnesses are tuberculosis6 and a variety of mental illnesses including

neurasthenia. The majority of tuberculosis victims were women, and the

same applies for neurasthenia from which women, in particular, both

6
Tuberculosis: a deadly airbome disease that attacks the lungs, tuberculosis was
known in the nineteenth century as a consumption and was closely associated with
writers and artists because it was believed to produce bursts of creativity in its
victims.

14
fictional and real suffer. Women in the nineteenth century were perceived

as dolls and roses. (what does it mean)They are too fragile to pursue a

career or to attain a proper education, as this might end up in damaging or

even unsexing them.

“The American physician Dr. Edward H. Clarke argued in his

1873 treatise Sex in Education that any kind of formal schooling

was inappropriate for girls after they entered puberty, because

intellectual activity, especially during menstruation, caused atrophy

of the uterus and ovaries, sterilization, masculinization, and

insanity” (qtd. in Darrow 3). (it is better to be paraphrased)

Thus women in the nineteenth century were denied the right to

attain proper education and to have a profession. Most, if not all, of them

were only allowed to attain a little education in order to perform their

domestic duties properly. Thus, they are rather dependent on men, and

merely have a say in their own lives. Even those who sought to escape

this notion and bring about change were only met by rejection. Kathy D.

Darrow explains in her article “Women and Medicine” that:

“[women were]Unable to fulfill the Angel in the House expectation

or to escape the notion that they were ruled by their biology, some

women did simply collapse into depression, while others may have

been pushed into it by well-meaning but misguided male

15
 physicians who prescribed a regimen of complete cessation of

physical and intellectual activity” (4).

Throughout the nineteenth century different standards existed for

freedom. Despite the Civil Rights Bill, the social and legal oppression of

the Blacks persisted. Moreover, the social and legal status of the women

in the nineteenth century was the same, as it has been in the colonial

period. Women were only expected to take care of the home and the

family. They were only mothers, wives, or to be wives. The fixed gender

roles assigned by a male dominant society in the nineteenth century, as

well as the economic, political, social, and even educational restraints

imposed upon women lead to the rise of many feminist movements.

The first wave of feminism began in the mid nineteenth century to

confront the ideology of the cult of true womanhood that can be

summarized in four key tenets: piety, purity, submission and domesticity.

Led by Elizabeth Cady Stanton and Susan B. Anthony, the first feminist

wave primarily focused on women’s suffrage (the right to vote), and

gaining access to education and employment. The fact that this age was

called the golden age of hysteria, which was mostly attached to women

rather than men, adds insult to injury. Being one of the leading feminists

in her age, Gilman asks for the same demands of the first feminist wave

in most of her works. However, being not only a female writer but an ex

mental patient as well, she entitles herself with the authority to describe

16
the suffering of a nineteenth century mentally ill female writer depending

on her own experience. In her book Questions of power: The Politics of

Women’s Madness Narratives, Susan J. Hubert explains that psychology

in the late nineteenth and early twentieth centuries was greatly based on

how women used to rely mainly on men and especially their physicians.

They saw themselves as prisoners to their mental illness, and the

only key to their escape and freedom lies in the hands of their physicians

(qtd. in Hume 4). It is worth mentioning here that, during the late

eighteenth and early nineteenth centuries, a rash of so called hysteria

cases occurred. Because of the rise of this type of mental illness, this

period became known as ‘the golden age of hysteria’. Authorities of the

time defined the malady in terms of femininity and female sexuality.

Rooted in the Greek term ‘hysteron’, meaning womb, hysteria was known

as a strictly female illness that was caused by women’s delicate

constitutions and emotionality. Many doctors, in fact, believed it to be

caused by the uterus, which was why they concluded that men could not

become hysterical. (‫)ال وهللا‬

Hysteria was assumed to be a largely self-created or imagined

illness. People did not generally take it (or mental illness) seriously,

though hysteria became a focal point of study by physicians throughout

the world (leading, in fact, to Sigmund Freud's development of

psychoanalysis). Symptoms include: fainting, vomiting, choking,

17
sobbing, laughing, paralysis, and temperamental fits. Reflecting the belief

that women were prone to hysteria, because they were less rational and

stable than men. Dr. Edward Tilt, in a typical Victorian textbook

definition, wrote: “mutability [changeability] is characteristic of hysteria,

because it is characteristic of women” (Showalter, 129).

As more studies were conducted, however, some doctors began to

link hysteria with restricted activity and sexual repression. In her book

The Female Malady Showalter clarifies that:

“the range of activity of women is so limited, and their available

paths of work in life so few, compared with those which men have

in the present social arrangements, that they have not, like men,

vicarious outlets for feelings in a variety of healthy aims and

pursuits” (130) .

F. C. Skey, a Victorian age physician, pinpoints that strong women

who exhibited more than the usual amount of forceful, confident, and

fearless behavior were particularly prone to hysteria. In fact, strong and

creative women, forbidden from exercising their minds and bodies, often

struck out with fits of hysteria or became exceedingly depressed, because

they could not find constructive outlets for their energy. In addition,

motherhood brings significant hormonal and other changes that require

psychological adjustment. After giving birth, some women become

extremely depressed. Postpartum depression, coupled with the stifling

18
social constraints of the Victorian era, drove some women mad, causing

serious mental illness and even suicide.

Cures and remedies for mental illness were limited during the

golden age of hysteria. The most accepted ‘cure’ was Dr. Silas Weir

Mitchell's ‘Rest Cure,’ which required complete isolation from family

and friends, forbade any type of mental or physical exertion, and required

a milk-fed diet and total bed rest. In effect, the cure was as much a

punishment for hysterical women as an attempt at a cure.(check

preposition)

“When they are bidden to stay in bed a month,” Mitchell wrote,

“and neither to read, write, nor sew ... then rest becomes for some

women a rather bitter medicine, and they are glad enough to accept

the order to rise and go about when the doctor issues a mandate

which has become pleasantly welcome and eagerly looked for”

(Showalter, p. 139). (no need to be a qt. try to paraphrase)

Mitchell’s attitude illustrated the general belief that women feigned

hysteria, and that they could stop their outbursts at will.The ‘Rest Cure’

had devastating effects on many women. Female writers, such as:

Charlotte Perkins Gilman, Jane Addams and Edith Wharton experienced

the same devastating results from Mitchell's treatment. Only when they

resumed writing and active participation in their lives did they emerge

from their depressed states. The short story The Yellow Wallpaper was

19
Gilman's attempt to show the detrimental effects of the Rest Cure, (she

specifically wrote it to convince Mitchell that his treatment was flawed)

(better to write it as a footnote) and the vital importance of mental and

physical stimulation for all human beings, including women. Her story

vividly illustrated the emotional torture that women suffered when denied

the right to fully express themselves through meaningful work.

While the United States of America is now one of the leading

countries in treating mental disorders, the situation was rather different in

the nineteenth century. After the Declaration of Independence in the

fourth of July, 1776, the thirteen American colonies have become free

and independent states. If the eighteenth century witnessed the birth of

the American Nation, it is the nineteenth century that marked its actual

growth and development. After many wars, civil rights and equality

movements the American nation has ended up being one of the strongest

and most established nations worldwide. The war of 1812 or the Second

Revolutionary war, took place in the beginning of the century between

Britain and America. The Civil War broke out in April 1861 between the

Confederacy and the Union or the south and the north. The bloodiest war

in the American history lasts for four years, and the toll reaches 260000, a

number that exceeds the nation’s loss in all its other wars. Thus this

period is one of the most turbulent and creative times in the American

history. Undergoing major industrial inventions, extensive westward

20
expansion, as well as the Civil War, nineteenth century authors turn to the

real life to articulate the tension and complex events of the time. The age

of realism includes many great writers who were able to crystalize not

only the lives of mentally ill people but also the stigma and rejection from

which they suffered. The researcher, in this study, has chosen three of the

most prominent writers of this age, namely Edgar Allan Poe, Charlotte

Perkins Gilman, and Sarah Orne Jewett. In their works, they clearly

reflect the life of MIPs and how they faced stigma during the nineteenth

century.

Erving Goffman’s Theory of Social Stigma

Stigma as a concept is often used nowadays to express

discrimination and oppression. According to Oxford Advanced Learners

Dictionary, stigma refers to “the feelings of disapproval that people have

about particular illnesses or ways of behaving” (Oxford Learner’s

Dictionaries Online). However, the term stigma itself emanates from the

historical literally branding of the members of a certain castigated group

with a bodily visible mark as a sign of disgrace. The Greeks used to burn

marks into the skin of their criminals, slaves, and traitors as a sign of

rejection. Yet the plural term ‘stigmata’ has been used to refer to the

marks of crucifixion on the body of Jesus.

In his book The Mark of Shame, Stephen Hinshaw defines Stigma

as “a term conveying a deep, shameful mark or flaw related to being a

21
member of a group that is devalued by the societal mainstream” (ⅺ).

Hinshaw explains that racial minorities, as well as many other outgroups

have been stigmatized throughout history. Thus mainly stigma connotes

the feelings of rejection and disgrace that society conveys towards certain

groups or outgroups of people. It represents more than just disapproving a

person. Surprisingly, it evolves into some sort of rejection and

punishment of those concerned which often results in hurting the

stigmatized persons.

The main concern here is mental health stigma. In this type of

stigma, societies tend to view the symptoms of psychopathology as

threatening which fosters attitudes of discrimination and rejection

towards people with mental health problems. Mental health stigma can be

divided into two types: social stigma and perceived or self-stigma. Social

stigma refers to the social exclusion of MIPs. While self-stigma refers to

the internal feelings of the MIPs themselves; how they perceive stigma.

(documentation needed)

In his book Stigma: Notes on the Management of Spoiled Identity,

Erving Goffman, the twentieth century’s most remarkable practitioner of

social science states his Stigma Theory (1963). (check structure)

According to Goffman, stigma is a “deeply discrediting attribute.” It

causes an individual to be classified mentally by others in an undesirable,

rejected stereotype. This eventually results in creating some sort of a gap

22
 between what he calls ‘the virtual social identity’ and ‘the actual social

identity.’ (2) Due to Goffman, understanding the concept of stigma lies in

perceiving three notions of identity which are ‘social identity,’ ‘personal

identity,’ ‘ego or felt identity.’ Goffman explains the three notions from a

social point of view, clarifying that each of these notions is associated

with a set of social processes.

Goffman’s Stigma
Theory

Social Identity Personal Identity Ego or Felt Identity

Virtual Social Actual Social

Identity Identity

(Figure 1) Goffman’s Identity Notions

Goffman begins by social identity which is usually based on the

first impressions that we have upon encountering a stranger. These

impressions depend mainly on the first appearance. Then, he developed

this identity concept further by distinguishing between ‘virtual’ and

‘actual social identity.’ Each society establishes certain standards and

23
social roles for its members. These standards and roles are often

accompanied with specific expectations and attributes that need to be

fulfilled. Thus when we first encounter a stranger, we assign to him some

expectations and attributes that we socially assume to be part of his social

role, status, and or identity. These attributes are mainly based only on his

or her appearance. We simply stereotype him and enforce him to confine

to the demands of this stereotype which Goffman defines as ‘virtual

social identity.’

Wherein, in fact, he might possess different attributes, and he

might belong to another social category, which Goffman called ‘actual

social identity.’ If both the virtual and actual social identities match, the

social interaction goes smoothly. However, if not, a disruption might

appear. This disruption though does not necessitate stigma. Stigma only

occurs when the differences between virtual and actual identities work to

discredit or downgrade our social expectations of the person concerned

rather than to elevate them. Then if the first impression lasts or developed

into a higher degree the virtual identity becomes part of the actual

identity. However, if the first impression descends into a lower degree,

the virtual identity then stands as an opposite to the actual identity. This

results in establishing a kind of social distance between those concerned,

and leads later to rejecting or even stigmatizing those people. (Smith 85)

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 People in society

The The Sympathetic Normal

Stigmatized other People

Discredited Discreditable

The Own The Wise

Figure (2) The three categories of the people in society according

to Goffman

Goffman divides the individuals in any society into two broad

categories: the normal and the stigmatized. The normal people

stigmatize those who fail to fulfill their social expectations only if they

encounter them or know about their status. Thus, the stigmatized people

are mainly two types: the discredited and the discreditable. The

discredited are already stigmatized and rejected, while the discreditable

are those who might be stigmatized if they reveal themselves. The

discreditable, then, refers to those who choose to hide and conceal

themselves in order not to be rejected. Information control plays a crucial

role for the discreditable. They are struggling to take a decision of either

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to keep pretending in order to maintain their virtual identity, or to reveal

their actual self. They keep asking themselves whether “to display or not

to display; to tell or not to tell; to let or not to let on; to lie or not to lie;

and in each case, to whom, how, and where.” (Goffman 42)

It seems as if those people have to change what they really are to

be accepted. This raises a rather critical notion; that of personal identity.

Personal Identity, to Goffman, is the one’s sense of uniqueness and

individuality, his distinctive positive and negative marks, and his life

history information are the factors that determine who he really is. If a

person discloses any of these factors, his personal identity becomes at the

verge of destruction. Each member of a society has certain roles. These

roles require specific qualifications and behaviors that distinguish each

member from another. In other words though the members of every

society might have common roles, it is how each member fulfills his or

her role that distinguishes him/her from others. The individual’s attitudes,

manners, and actions form his personal identity. Whenever he changes

any of those factors to attain the social acceptance, he might be lacking,

or to become part of a certain social circle he ends up losing his/her

personal identity.

Goffman’s third and final notion is Ego or felt identity. ‘Ego’ or

‘felt identity’ is “the subjective sense of his own situation and own

continuity and character that an individual comes to obtain as a result of

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his various social experiences” (Goffman 105). Simply, it is the

individual’s personal feelings about being stigmatized, and what he

encounters in dealing with this status. It is the individual’s inner conflict

about being stigmatized or normal, discredited or discreditable. Being in

the group or out becomes a highly essential choice that the individual has

to make in order to decide what his ego identity ought to be.

To Goffman, people in general are normal, stigmatized, or

sympathetic. He argues about those who sympathize with the stigmatized

whom he approaches as ‘the sympathetic other.’ Those who understand

the feelings of the stigmatized and help them in overcoming the rejection

they face are either ‘own’ or ‘wise.’ The own possess the same stigma as

the discredited person while the wise are those who are aware of the

discredited person’s predicament. One of Goffman’s main aims in

developing his stigma theory is to assure that difference is not deviance.

Goffman’s argument shows how stigma dynamics are part of a

very general social process, experienced by everyone at some point of

their lives. He explains that sociologists use the term ‘deviance’ to label

any different manner of human conduct. For him, this is unacceptable; so,

he replaces it with a rather more specific term ‘social deviant.’ Those

who are socially deviants are those who are engaged in some kind of

collective denial of the social order such as prostitutes, drug addicts,

criminals, etc. Thus the stigmatized person is nothing but a normal

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deviant. As society norms of grading individuals do not apply to all the

members of that society, which results in producing so many stigmatized

individuals. The deviations from identity norms are, therefore, very

common.

Consequently, it is pointless to count the number of stigmatized or

to divide them into types. For almost everyone has encountered a

personal experience of stigma at some point of his life. Stigma

management is thus a very general social process, not one restricted to a

certain outcast class. Goffman suggests that there is no such thing as

normal and stigmatized; for normal and stigmatized “are not persons but

rather perspectives.” (138) Stigma insists Goffman concerns matters of

difference not deviance. Then, why would an inherently social species

reject members of its own kind and stigmatize them. According to

Goffman, stigmatization is a process of devaluation of an individual who

possesses a socially deviant attribute. When an individual’s actual social

identity fails to meet his society’s normative expectations, he becomes

liable to perceive stigma. He, then, could either be discredited or

discreditable, based on his own choice. If he maintains his identity he

loses his social circle and becomes discredited, and if he conceals his

status, his identity is spoiled and he loses himself. This is the case with

MIPs.

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 Although mental illness is a quite recent genre in medicine, the

diseases of the brain are as old as the human existence. However, it is

only with Freud’s theories of psychoanalysis in the early twentieth

century that new techniques for understanding human behavior are

provided. This thesis shows that different types of mental disorders

persisted in the nineteenth century literature. Before the publication of

The Interpretation of Dreams (1900) and Psychopathology of Everyday

Life (1901), disorders, such as bipolar disorder, hypochondria, hysteria,

and neurasthenia were common.

Interestingly enough, the researcher has been able to detect

different types of mental illnesses in specific works for three nineteenth

century writers: Sarah Orne Jewett’s "A Sorrowful Guest" (1879),

Charlotte Perkins Gilman’s "The Yellow Wallpaper" (1892), and Edgar

Allan Poe’s "The Raven," "Annable Lee," "Ulalume," and others.

Through which stigma and social rejection for MIPs exist both inside

these works, as well as in the real lives of their authors. Each writer

provides a rather solitary case of mental disorders that took place during

the nineteenth century.

While both Gilman and Poe examine stigma very intimately,

Jewett’s view is more relevant to what the researcher argue for in this

thesis. Both Gilman and Poe were mental patients. Gilman experienced a

case of post-partum depression, and was about to lose her mind; due to

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the rest cure. She was mainly concerned with asserting the failure of the

rest cure as a treatment for depression. Her main purpose in writing her

story was to change perceptions of the treatment by highlighting its

cruelty and revealing its potential damaging effects on the mental state of

patients. Poe’s poems, on the other hand, were not meant to deliver any

message. His very existence as a great writer and poet defies all what

Psychiatrists claimed to be true about mental illness. Since Poe suffered

not only from Bipolar disorder, but he was addicted to alcohol as well. He

was supposed to lose his mind gradually; as he is a mentally ill patient.

Yet his great works marked him as a genius.

Jewett’s story, however, provides the third person vision of the

mentally ill patient. She began to follow the scientific method in treating

the patient; affected by her father who was a physician. Through applying

the flash back technique in her story, she was able to produce some sort

of a case history for the patient who is portrayed by the guest. She then

presented a definition for his illness. Finally, she asserts that seeking

treatment requires compassion as well as care, which the female

protagonist and her brother showed towards the patient, were major

elements for the patient.

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