Sport, Mental Illness and Sociology

Michael Atkinson

• Publisher: Emerald Publishing Limited
• Year: 2018
• ISBN:
  9781787439559
• Topic: Sozialwissenschaften
• Subtopic: Soziologie

At a timewhen the public discussion of mental illness in society is reaching a highpoint, athletes and other sports insiders remain curiously silent about theirprivate battles with a range of mental illnesses. While a series ofprofessional athletes have exposed the deep, dark secret related to thepervasiveness of mental illness in high performance sport, relatively little isknown, sociologically, about what mental illness culturally means inside sport.
This editedcollection showcases research on how sport, as a social institution, mayactually produce dangerous cultural practices and contexts that foster thedevelopment of mental illness within athlete groups. Further, chapters alsoillustrate how sport, when organized with sensitivity and care, may serve tohelp manage mental illnesses. Rather than analyzing mental illness as anindividual phenomenon, contributors to this volume equally attest to how mentalillness is socially developed, constructed, managed, and culturally understoodwithin sport settings. The book highlights the relevance of a range of theoriespertinent to the social study of mental illness including dramaturgy, culturalstudies, learning theory, symbolic interaction, existentialism, and total paintheory. Chapters range from the discussion of depression, anxiety, eatingdisorders, drug addiction, epilepsy, mental trauma, stigma, the mass mediationof mental illness, and the promise of sport as a vehicle for personal andcollective recovery.

CHAPTER 1

MENTAL ILLNESS STIGMA

Elizabeth C. J. Pike

ABSTRACT

Purpose – This chapter responds to calls to “reclaim” the work of Erving Goffman, and specifically his conceptualization of stigma, arguing that Goffman’s ideas can inform a critical social theory of mental illness in sport. The analysis pays particular attention to the challenges to social identity for those experiencing mental illness stigma, the role of personal identity in negotiating mental illness stigma, and strategies for stigma reduction including the adoption of stigma symbols.

Approach – The first section of the chapter revisits the concept of stigma, before proceeding to relate this to mental illness stigma as applied to sport. The second section overviews several high-profile cases of mental illness stigma of elite athletes, before presenting some examples of campaigns to address the perceived stigma related to mental health issues in sport.

Findings – The chapter proposes that Goffman’s work maintains relevance when related to social contexts other than those directly observed by him, and that the conceptualization of stigma helps understanding of, and challenges to, mental illness stigma in sport.

Implications – While sport continues to be proposed as an arena for positive character development, analysis informed by the work of Erving Goffman demonstrates that the culture of sport provides a context within which athletes experiencing mental health issues may be stigmatized. This, in turn, undermines the potential for them to secure the health care that they need, with participation and performance often taking precedence over well-being, even in the campaigns ostensibly designed to address mental illness stigma.

Keywords: Character; Goffman; identity; stigma; total institution; dramaturgy

This chapter focuses on the stigmatization of sports people experiencing mental illness, and the implications of mental illness stigma for athlete well-being and health care. There is substantial research evidence that elite athletes are vulnerable to a range of mental health problems. In a systematic search of the evidence base regarding mental illness in sports, Rice et al. (2016) concluded that, while the quality of research evidence was weak, it appears that elite athletes experience a broadly comparable risk of high-prevalence mental disorders relative to the general population. However, these experiences do appear to be nuanced due to the uniquely intensive mental and physical demands of a sporting career. The main mental illness issues identified in the literature relate to aggression, anger, anxiety, depression, eating disorders, stress, and substance misuse. The elite athletes at particularly high risk of mental ill-health include those who are retiring/retired, injured, experiencing performance failure and/or career dissatisfaction, exposed to media pressure, and/or have low social support (see also Foskett & Longstaff, 2017). Furthermore, the evidence suggests that elite athletes tend not to seek support for mental health problems because of a lack of understanding about mental illness and its potential influence on performance. Of particular concern is evidence that there remains considerable stigma attached to mental illness in sport, which includes a perception that seeking help is a sign of weakness and so to be avoided:

Mental health has a stigma that is tied into weakness and is absolutely the antithesis of what athletes want to portray. (Dr Thelma Dye Holmes, in Rhoden, 2012)

In this chapter, I respond to calls to “reclaim” the work of Erving Goffman, whose work has relevance to a critical social theory of sport (see Birrell & Donnelly, 2004), with particular attention to his conceptualization of stigma. Following Scambler (2006) “it is relevant to engage in theoretical elaborations and extensions of Goffman’s original concept (of stigma) in relation to other social and cultural contexts than those observed by Goffman” (see Jacobsen & Kristiansen, 2015, p. 103), and I identify elite sport as one of those contexts. Specifically, I outline the concept of stigma as part of what Goffman (1963) describes as a person’s social identity, the evidence regarding mental illness stigma, and the ways in which Goffman’s work contributes to an understanding of experiences of mental illness stigma in sport. I then consider how the personal identity of the athlete with mental illness may impact on their negotiation of the stigma through forms of information control, and their health care options. The chapter concludes with some examples of campaigns to reduce the stigma of mental illness in sport and future recommendations. It should be acknowledged from the outset that this chapter is complicit in the common method of framing discussions of athletes’ mental health in the language of mental illness (Hughes & Leavey, 2012), using language that is argued in itself to contribute to stigmatization, denial, and the prevention of effective care for athletes (Uphill et al., 2016).

STIGMA: THE SOCIAL IDENTITY

Stigma is sociologically defined as a sign of disgrace or discredit, which arises when an individual lacks the attributes required to be an acceptable member of a group and so disqualifies them from full social acceptance (Byrne, 2000; Elias & Scotson, 1994; Goffman, 1963). In order to understand how a person may become stigmatized within a cultural context, we should first consider Goffman’s most familiar theoretical model of self-presentation and audience reception/interaction that of, dramaturgy.

Goffman’s (1959) dramaturgical model uses the language of theater to characterize social interactions as performances by the participants. People are seen to select the most appropriate role for any given situation, which they perform in public on what Goffman calls the front stage, while they prepare for their performances in the private back stage areas away from their audience. In these social interactions, individuals are displaying their social identity, the one that is presented to, and available for scrutiny by, others. One of the earliest applications of this model to understanding the subcultures of athletes is Alan Ingham’s (1975) exploration of the ways that athletes are socialized into the sporting subculture and learn to perform different normative roles for a variety of audiences:

The athlete is often confronted with a fundamental dilemma, whether to conform to the expectations of his peers, the expectations of the management, or the expectations of the public. Since each of these audiences may use different criteria for evaluation, the athlete becomes adept as the art of impression management. He is “cool” for his peers, demeaned for management, and dramatic for the fans. (p. 369)

Ingham’s (1975) analysis helps illustrate how athletes engage in impression management; or, the deliberate act of maintaining their credibility as they perform the role of an athlete for their different audiences, which, in turn, may be compromised if some aspect of their performance fails. Specifically, this may be the case for an athlete who experiences mental illness which undermines their credibility as an athlete, as high-level sport assumes mental toughness which athletes with mental illness are assumed to lack to some extent.

According to Goffman (1963), stigma arises where there is a discrepancy between a person’s virtual social identity (what they ought or appear to be) and their actual social identity (what they privately experience themselves to be), with the gap between the two resulting in what he calls a spoiled identity which sets a person apart from others. For Goffman (1963), the concept of stigma helps us to understand situations in which we do not grant people the deference that they deserve because they deviate from the role expected in any given social context. Goffman (1963, p. 123) frames this within what he calls the “politics of identity” which enables a conceptualization of the “normals” (those who meet the expectations of their particular role) who are differentiated from the “stigmatized.” As I explore below, the “normal” athlete is one without any apparent mental illness, whereas an athlete who appears to, or discloses that they have mental health problems may be stigmatized.

Goffman also suggests two types of stigmatizing conditions: the discredited/discrediting stigma, which is an evident stigma that is impossible to disguise, such as a person with a physical disability that they feel stigmatizes them in some social situations; and the discreditable stigma, which is hidden but vulnerable to exposure at any moment. In the latter definition, Goffman (1963, p. 125) presents the example of a homosexual acting straight (the coping strategy of “covering” one’s true identity to avoid discrimination). However, the athlete hiding mental illness is also experiencing a discreditable stigma, as the illness may be regarded as inconsistent with their virtual social identity as an athlete and, while it is possible to conceal mental illness, it may be exposed at any time with consequences that the athlete may find embarrassing. Goffman’s (1963) explanation of this is that the stigmatized individual is likely to hold the same beliefs about the ideal identity as others, and so will be alive to their perceived failings and recognize that they are unlikely to be accepted on equal terms as those without mental illness. It is this that leads to a sense of shame in the experience of mental illness, which creates further challenges for the stigmatized individual.

Scambler and Hopkins (1986) identify two further subtypes of stigma: the enacted and the felt stigma. The enacted stigma is when a person experiences some actual hostility, discrimination, and/or ridicule (see also Scott, 2009). This type of stigma is generally based on three dimensions: stereotypes or beliefs about a person based on their particular characteristics; prejudice which arises when people accept the stereotypes and have a negative emotional reaction to the person; and discrimination which are the negative actions that people take based on the stereotypes and prejudice (see Corrigan, 2000; Rusch, Angermeyer, & Corrigan, 2005). Felt stigma occurs when the individual anticipates that there may be an enacted stigma and fears the consequences of the stereotyping and discrimination, leading to constant self-management, worry, and hidden distress (Scambler & Hopkins, 1986). While there may not be any actual hostility, this does not make the discomfort any less consequential. Goffman (1952, p. 463) describes such processes as a means by which the “socially dead” are “sorted but not segregated and continue to walk among the living,” or those deemed “successful.”

Mental Illness Stigma

There are significant difficulties in understanding mental illness stigma. Unlike other social groups which may experience stigma, there is no universally accepted term for stigmatization grounded in mental illness; so, while we may be familiar with discussing sexism, racism, ageism, homophobia, and discrimination based on other social categories, there is no similarly recognized term for the stigmatization of people with mental illness. In addition, there is no clear demarcation between “mental health” and “mental illness” to enable a simple labeling process of those who have mental illness and those who do not.

As outlined above, psychologists have tended to focus on the cognitive and behavioral features of mental illness stigma: stereotypes (the cognitive knowledge structures), prejudice (the cognitive and emotional consequence of stereotypes), and discrimination (the behavioral consequence of prejudice) (see Corrigan, 2000). Sociological interest in the stigma of mental illness developed significantly following the publication of Stigma – Notes on the Management of Spoiled Identity by Erving Goffman, and provides the framework for this chapter. In his text, Goffman (1963) comments that the difference between a normal and a stigmatized person is a question of social perspective (how they are seen by self and others), rather than reality. Sociologists such as Link and Phelan (2001) extend the psychological understanding of stigma to identify that, as a precondition of stigma, differences between persons have to be noticed by others and regarded as relevant and labeled accordingly. Furthermore, they suggest that the stigmatizing group has to be in a more powerful position than the stigmatized group: “stigma is entirely dependent on social, economic, and political power – it takes power to stigmatise” (Link & Phelan, 2001, p. 375). With respect to mental illness, Goffman’s (1961, p. 316) work on Asylums defines mental illness as a specifically social phenomenon because it relates to a condition or conduct which is defined as “inappropriate to the situation.”

Goffman (1963) ultimately links stigma with the notion of social deviancy, where a person may not adhere to the norms of conduct and personal attributes of a group (or may not be able to adhere to these norms and attributes due to their mental illness). Goffman (1969) explains this in terms of his face theory – this is the term used to distinguish a person’s self-image in particular social situations. A person will have face when they effectively present an image of themselves, have wrong face when some information about a person is inconsistent with their self-image, or be out of face when the self-image is not that expected of a person in a particular situation, which may then require saving face to reform their identity.

I now consider how Goffm...