Numerous scientific studies around the world indicate that a significant proportion of people carry an outdated, negative picture of psychiatry and mental illness. Still, the mentally ill is seen as a failure, unable to cope with the challenges of life; which is inherited as such. Social reasons are often neglected, which make some people unsuccessful and therefore develop mental disorder. Poorly informed people put patients under a common denominator. They do not distinguish mentally ill from psychosis from the one with weakness or severe depression, not to mention the many patients with functional, neurotic disorders. All mentally ill cause are feared, so they are avoided. All over the world, everyone would prefer to be physically ill, but no-mentally ill.

    The problem identified has existed for centuries. For our country it is no different than for many other, even highly developed countries. We know little about the way of life and the experiences of the mentally ill. There is not enough Bulgarian, widely popular and yet sufficiently scientific literature about the mental illness, its variants and ways of treatment.

     All of these reasons, each separately and taken together, provoked the emergence of this study. To see the two points of view on the problem - that of the mentally healthy and the mentally ill - means to show once again the significance of the problem and the position of the specialists - doctors and psychologists.

   Key words: stigma, mental illness, social opinion


Importance of the problem

   Stigma and discrimination as phenomena are present in every society (Hans Kurt, 2011). Stigmatization is the process of "piercing; of the placement of a stamp "(Greek) - a well-known, practical phenomenon in animals, and in olden times and in slaves. H. Hinterhuber (2002) mentions that in the new era, the term is borrowed from medicine to reflect the fact that certain diseases are subject to prejudices, the severe consequences of which are not only for people subject to social exclusion and discrimination but also for society as a whole.

    Especially undesirable is the difference in people when it leads to reduced social realization and incorporation. It is precisely because of this fact that stigmatization is not only a one-off negative assessment but a persistent process of lasting negative attitude. Once this process has sprung up, it is fed by people because of lack of knowledge about the subject because of disinformation, or because the authorities and opinion leaders do not address the problem and in this sense tolerate its existence (C.Lauber, C. Nordt, L. Falcato , W. Rössler, 2002, 2003).

     Each culture builds long-lasting attitudes toward certain unwanted features. In sociology this is called a "negative stereotype" (openthedoors / 2002). The more solid, the one-sided and the ultimate is a public opinion, the more definite it becomes a belief that stigmatizes.

     Individuals considered under the general denominator of the negative stereotype begin to lose their individuality. They are united in a category other than the category of other people, so that society suddenly turns out to be "us" and "them". The non-stigmatized retreat to avoid being accidentally included in the group of already stigmatized ones. The stigmatized, in turn, also withdraw in order not to be injured anymore.

    The ultimate result of the behavior of both social groups is only a deepening of the "stigma" phenomenon.

     The Global World Burden of Diseases (2000) report of the World Bank, WHO and Havard University found that among the 10 most commonly debilitating diseases in the world, 4 are mental illnesses. First of all, depressive states are placed in importance, with only 30% being actively treated. With respect to sickness retirement, mental illnesses are leading the list.

     The stigmatization as a phenomenon is equally fed by the group of the mentally healthy and the group of the patients.

     For healthy stigmatization it has its protective function. According to H. Meller (2000), the different scares; the more that different, which makes us powerless. The fear of not being ill is especially strong when the nature of the mental disorder is not known, and when the belief that "the mentally ill is guilty of his own, that he is a failure. "

     For S. Bailey (1999) one's fear of being denied by a social group does not "allow" (psychologically) to have the readiness to know the different (mental illness). A. Finzen (2011) argues that society through stigma takes care of its prosperity, forgetting individuals.

    The mentally ill, in turn, in order to keep himself and his family in particular, prefers not to expose his suffering, and thus allows false views to emerge and erupt.

     Only in recent years have appeared scientific screening methods such as those reported by B. Schulze, Angermeyer MC (2003); Link BG, Yang LH, Phelan JC et al. (2004); Pinfold V, Byrne P, Toulmin H. (2005); Buizza C, Schulze B, Bertocchi E. et al. (2007), which make it possible to conceptualize stigma through the eyes of the sick. Since 2009, according to Beate Schulze, Heather Stuart, Steffi G. Riedel-Heller, ISE has been the world's first ISE questionnaire for double tracking of sufferer's experience of staging treatment. As reported by Christian Horvath (2000), the way of survival of stigma is essential for the healing process and the outbreak of the disease. He talked about the "secondary mental illness" resulting from a stigmatization experience. It is treated as the cause of recently reported high suicidality among mentally ill (

M. C. Angermeyer (2003) provides numerous, over the years, examples of unconscious reinforcement of stigmatization by mass media, literature, and film production.

   Last but not least, a number of scientific developments address the issue of the stigma-induced mental suffering of the relatives of the mentally ill ( They themselves develop mental disorders once because they have to take care of the patient and ignore their other social commitments; on the other, due to the negative impact of the negative public opinion, also carried on themselves.

    A lasting change of public consciousness is the path to destigmatization. For this change, it is necessary to work continuously rather than campaign (C. Lauber, C. Nordt, L. Falcato, W. Rössler, 2004) in the following two strands: a / The Society accepts that the deliberate struggle with stigma is the ongoing task of every individual and society as a whole - from policy makers and the mass media to mental health professionals and employers; b) along with the medical treatment of the patient, to introduce a system of psychological support (psychotherapeutic activity) of the patient himself and his relatives.

Organization of the study

    We set ourselves to examine the parameters of the stigma of "mental illness" in Bulgaria based on a random survey of representatives of the two groups - mentally healthy and mentally ill people.

    The mentally ill are patients from the clinics and the daily station of the University Hospital "St. Marina "- Varna, and the healthy ones - visitors of dental practices.

     40 people diagnosed by a psychiatrist as psychiatric patients and 40 healthy persons who have not been in contact with a psychiatrist (psychiatrist, clinical psychologist, psychotherapist) have been interviewed. The average age of respondents: for the group of mentally ill - 45 years; for the group of healthy - 46 years. By gender the distribution is as follows: mentally ill - 11 men and 29 women; mentally healthy - 15 men and 25 women.

     An author's questionnaire was used (Jacqueline Frick, 2008), consisting of 19 questions. Each of the questions is evaluated in 4 steps: two on the acceptance or rejection of the claim. The questionnaire is self-assessing and is filled in once within a maximum of 15 minutes.

    The map results are processed statistically - each question in percentage; each group for themselves and in comparison to the two groups


 Opinion of the mentally ill respondents

     89% of the mentally ill respondents reported that they had a "personal impression of a mentally ill". 11% of them, respondents with No, show that they would not want to see themselves as "mentally ill".

     Why this is so is understood by the answers given on questions concerning their self-assessment as people treated in psychiatry:

     In a psychological defense style, 82.5% of respondents said they had a positive attitude towards the mentally ill. In fact, they carry a negative self-esteem because they find themselves "suppressed and blocked" (35%); "Inconclusive" (57.5%); "Unable to show their abilities, with rights withdrawn" (new 18%); "With negative traits in behavior" (new 5%); "Dangerous for society" (57.5%).

     The patient's opinion on the "blame for his own condition", "the thought and the unpleasant feeling of being mentally ill" is polar; "The danger of their disease to society" (50%: 50%).

    The self-assessment of the patients for their own transmission as an individual among others is too ambivalent, although 82.5% of the patients reflect their need for positive attitude towards the mentally ill.

      The lack of official awareness of mental illness and psychiatry is even reported by the mentally ill. They only know their illness from contact with treating staff and through conversations with other patients and their relatives (87%). 12% of them said they knew psychiatric illness and psychiatry, and the mass media - rather from news and films about mentally ill, in negative terms.

Assessing the Picture of Society:


     The mental illnesses themselves share - 88% of the definitive and 10% - with the wisdom that "society is dealing with disregard for mental illness and disorder." 90% of them strongly share the view that "society has a negative picture of psychiatry and mentally ill." Ambiguously, as a group, they reflected that "society looks skeptical to those in psychiatry," probably based not only on other people's opinions but also on their personal experience gained during their stay in the hospital.


The needs of the mentally ill


     Mentally ill need a stay in psychiatry. Most (62%) are aware of the need for tranquillizers, but an even greater percentage (85%) show the need to deploy a wider range of alternative methods of psychiatric treatment (relaxation techniques, phytotherapy, psychotherapy). A considerable part (38%) also reported other, non-medical positive effects of the stay in psychiatry; i. realize and seek social psychiatry in their help.


     Not a small number of mentally ill (63%) would like to "be treated in other, not in psychiatric clinics." This percentage suggests that their need, and perhaps their relatives, may be treated like all other patients, ie. without the stigma of psychiatry. In this sense, 75% of the patients should also be considered that "mental illness should not be made to a more serious problem than a disease of the body."


     The mentally ill wants to see herself in the light of any other somatic illness - of the same importance to society, without the burden of feeling guilty of having a mental illness rather than a bodily disease. At the same time, they are too ambivalent and ambivalent regarding the statement that "Mentally ill people should not be left free in society. Their place is in specialized institutions "and the statement" Mentally ill people are more dangerous and carry out more associal actions than the healthy ones. "37% are of the opinion that they are not left free in society. The same percentage of respondents think it is better to be there (in institutions).


      This ambivalence reads not only the perceived opinion of the community, but also their own fear that they are not perceived on the outside.


Opinion of the respondents mentally healthy


Assessment for people treated in psychiatry


     65% of respondents fall into the group of non-knowledgeable mentally ill - neither directly nor indirectly. Half of them still claim to know what complaints should be sought for psychiatric help. The attitude towards the mentally ill with little difference is rather positive. 13% of all can not engage definitively with respect to the mentally ill, as if they did not exist for them.


On this basis, the healthy respondents build the following picture of the assessment of the mentally ill:

- He has negative personality qualities, even "dangerous and aggressive" (cited by 37% of respondents). Only 8% of them are noted that the mentally ill is "hardworking". - "Mentally ill are guilty of their condition" - they think so

73% of the healthy.

    In 65%, they say that "the thought of a mentally ill person calls up unpleasant feelings." These feelings, if shown to a mentally ill, would provoke the appearance of the already mentioned secondary psychiatric illness.

     75% of respondents look skeptically on people treated in psychiatry. It can be said that these respondents reflect a relationship, respectively, for a small part of chronic psychiatric disorders, which may be psychoses. Regarding all mentally ill, such an attitude is rather scaring because it feeds a public opinion of "rejecting" anyone who has been treated in psychiatry, even though he has healed and possibly healed.

     The attitude of the respondents to the appearance of the mentally ill again brings the characteristics of ambivalence. This can be considered a positive sign, which probably contains the understanding that a small part of the mentally ill are lonely and abandoned. Such mental illnesses would be inconclusive. Anyone else cared for would not have an unobtrusive look. At least that should be the opinion of the respondents.

     The lack of formal awareness of mental illness and psychiatry is based on the following facts in the survey: 77% have knowledge of mental illness and psychiatry by random people, the mass media - mainly news and negative images for the mentally ill and only 8% - of scientific literature .

     Picture of society

     Healthy people are ambivalent about the view that "society is dealing with disregard for mental illness and disorder," although 72% say it really "has a negative picture of psychiatric and mentally ill."

       Respondents respond positively to the question whether this negative image is outdated or not. " Again, we meet the same ambivalence as with all other public opinion issues. From a number of sociopsychological studies, ambiguous attitude is an expression of indifference. Such attitude is much more painful than perceiving it than negative. Taking into account the shared mental illnesses themselves, it is clear why they are so disillusioned and with low self-esteem.

         82% of respondents are of the opinion that psychiatry can only help with medication. This fact again reflects the misunderstanding of the healthy of the nature of mental disorders and their likelihood of being the most severe mental illness, where the treatment is the only drug. There is a lack of knowledge among the respondents about the wide range of psychiatric disorders and the possibilities of the so- social psychiatry. It is delighted that 65% of respondents have the need to see alternative treatment methods in psychiatry. This fact, however, reiterates the idea that they do not know the real possibilities for the treatment of mental disorders, including the possibilities of psychological psychotherapy.

     Evidence of misunderstanding of the psychiatric illness by respondents is also the fact that 62% strongly believe that mentally ill can not be treated in other clinics (neurological, somatic). On the one hand, there is a lack of knowledge that a mental disorder may lead to functional, somatoform (but not somatic) manifestations; on the other - it is evident that the treatment of a mental disorder means isolation.

     Still more explicit is the opinion of 82% of respondents that "mental illness should not be made to a more important problem than a disease of the body." This fact suggests that the majority are likely to share the maxima "In a healthy body - a healthy spirit," not to think that there is also the feedback that has been explored since the early 20th century - the psychosomatic dependence. Public sources of information often comment on another fact - the impact of stress on physical and mental health. However, respondents, through their answers, show that their understanding of mental illness is far from the broad understanding that mental illness is largely the result of a person's lacking adaptive capacity to cope with situations of stress and frustration.

     77% of respondents are of the opinion that "the mentally ill is dangerous to society". Once again, the respondents are transferred to all mentally ill, which could be the smallest part of the mentally ill. Some acute psychotic states, as well as people with personality disorder, can actually be dangerous to society. And if respondents carry this vision on all mentally ill, it again shows that the institutions.

the behavior of the relatives of the sick and the sick, who, in order to preserve their personal social dignity, leave society in ignorance.

     In the two social groups we studied, those of the mentally ill and the mentally healthy, facts can be found that fuel all three reasons.

     The responses of mentally healthy people to mental illness and psychiatry as an institution are based on their own assessment of the fact that most of them do not know representatives of those suffering from mental illness. In many issues, such as the appearance and psychological qualities of the patients, as well as public opinion about them, healthy respondents show an ambivalent attitude. Such a view should indicate that either there is a serious information deficit or in the psychological defense of one's own, they push the thought of the mentally ill, so they do not engage in unambiguous opinion on the issues.

    On a rational level, they share that they know for what reasons psychiatric help should be sought. At the same time, there is evidence of an information deficit about the importance of mental illness (that it is not more important than the physical); ways of treatment (with medication only). Even with regard to the negative picture of the mentally ill they are not aware whether it is an expression of an ominous or not.

     Against the backdrop of this information deficit, it impresses the negative attitude of the healthy towards the mentally ill, demonstrated in statements of the genus: "Mentally ill are themselves guilty of the disease" and "Mentally sick is dangerous to society" or "Mentally ill are more dangerous and carry out more associal action than the healthy ones. "

     The majority share that "the thought of a mentally ill person calls up unpleasant feelings"; that they are "too skeptical of people treated in psychiatry"; accepting them as status; for causa per dutta.

      Through the opinions of mental health and psychiatric patients reflected by the respondents, they unambiguously, without realizing this fact, support the stigmatization of mentally ill. Since it is not the result of immediate contact with a mentally ill, the most likely reason for this would be to look for the role of public opinion. Apparently in their minds there are attitudes towards the mentally ill, built, as they share more often, on the basis of a foreign opinion of people who have had contact with a mentally ill - visibly negative or on a radio / TV basis (everyone is of the opinion that there the picture is only negative).

        Their own results, reflecting the opinion of the healthy, unambiguously say that in our country, at least in our city, there is a lack of clear public policy for combating the discrimination of the mentally ill. There is a confirmation that the first two reasons for the persistence of the stigma of "mental illness" are also here in Bulgaria.

     The third reason shows the results of the mentally ill respondents.

is noteworthy that only 11% of all respondents in a psychiatric clinic do not want to call themselves mentally ill. This could be due to the nature of their mental illness, but also to the same credibility of their attitude towards them (in the good sense, they have experienced a real psychotherapeutic respect for their personality, in the worst they have felt neglected). On a large scale, the mentally ill reflect the view that they need a positive attitude and respect for their personality and rights.

   How do they experience themselves as mentally ill themselves?

   The negative picture prevails - the inferior self-esteem of people who are insignificant and with rights withdrawn; inconclusive and dangerous to society; with feelings of anxiety, blockage, insularity and guilt. Such a patient's experience suggests that the medical community (mostly psychiatrists) are in debt to their patients. By treating the actual illness, they seemed to have pushed the probability of experiencing psychiatry as an institution to bring "secondary illness" to each of the patients. As the data show, about 90% of the patients surveyed are the fingerprint of the negative picture of society towards the mentally ill. They experience it as a "disregard for mental disorders / diseases" by society. In the measures for their treatment, they "read" the experience of society to isolate them; "Attachments" (ie stigmatized).

    The other side in the conflicting experience of the patient is the desire to be treated like the other patients who have a bodily problem. In favor of this view, he wants to be treated not only in psychiatry but also in other clinics; not only with tranquillizers, but also through a wider range of alternative methods of psychiatric treatment (relaxation techniques, phytotherapy, psychotherapy).

     The mentally ill wants to see herself in the light of any other somatic illness - of equal significance to society, without the burden of feeling guilty of having a mental illness rather than a bodily disease. Such a desire is understandable, but apparently contradicts reality, because also mentally ill share their inadequate awareness of mental health issues. They, in a very large percentage (82%), know this on the basis of personal contacts with a psychiatrist and a stay in psychiatry. About general information, only 12% of them said they knew psychiatric illness and psychiatry from the mass media. Probably in the same negative plan as the healthy ones.


     According to our study it can be said that the stigmatization of the mentally ill in our country is fed by:

 1 / Existing information deficit on the nature of mental illnesses, psychiatric treatment and psychiatry as a treatment base in the broad scope of understanding of mental illness and response measures;

2) The archaic crises of mental illness (perhaps unreasonably fed by the mass media);

3 / Insufficient association of society with people suffering from mental illness.

Christ. Kozhuharov, K. Taskov, Iv. Boncheva "',

 The Openly about Mental Disorders Project is funded under the BG 07 Public Health Initiatives under the Financial Mechanism of the European Economic Area 2009-2014 "

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