Continuing stigmatisation by psychiatrists

In response to the Royal College of Psychiatrists' anti-stigma campaign, Chaplin (2000) emphasises the role psychiatrists can have in both creating and perpetuating stigma. Chaplin particularly focuses on people with alcohol problems and on those with learning disabilities. However, she omits a third and important group: those with personality disorders.

Lewis & Appleby (1988) showed that such patients are readily stigmatised by psychiatrists. They found that the introduction of the term personality disorder produced marked levels of negative attributions in psychiatrists when comparing otherwise similar clinical vignettes. The reasons for this are complex but there is little evidence that such attitudes have changed. Hinshelwood (1999) has discussed some of the problems this group of patients can present.

The Government's proposed reforms of the Mental Health Act (Department of Health, 2001) present major challenges to forensic psychiatry in relation to the proposals concerning those with ‘dangerous severe personality disorder’. In the controversy surrounding these proposals it should not be forgotten that they redefine ‘mental disorder’ in its broadest sense, specifically including personality disorder within its scope. Any clinical separation that existed between personality disorder and mental illness may thus be consigned to history. In the light of psychiatry's stigmatisation of those with personality disorders, the proposals present a very clear challenge to present services.

The Government's proposed reforms are also contributing to further stigmatisation of those with personality disorders, via the routine newspaper equation of ‘dangerous severe personality disorder’ with personality disorder and the false generalisation of risks from one group to the other that this entails (Gillan & Campbell, 1998). This demonstrates again that stigmatisation is an active and continuing process. The profession of psychiatry itself needs to recognise when it contributes to this process, as well as addressing the contributions of others.