A Psychoanalytic Interpretation of the Phenomenon of Stigmatization of People with Mental Disorders

Social stratification, or the segregation of society, consists in the “structuring of social inequality” – the division of society into classes according to certain characteristics (gender, age, ethnicity, etc.) and the discrimination of individual social segments / classes / groups [1]. The process of stratification is an “unintentional consequence of social relations and is reproduced in each successive generation” [1, p. 957]. Thus, the existence of social groups with low social status – “pariahs” and “outsiders” rejected and despised by other members of society on the basis of various characteristics – is inherent to human society as such, that is, to a community of people engaged in social relations. The process of segregation and simultaneous distancing of society from its own devalued segments can also be designated by the term “stigmatization,” introduced into scholarly discourse in the 1960s by American sociologist E. Goffman [2]. The objects of stigmatization can be very diverse social groups, whose members differ in one way or another from society’s expectations of an average citizen. In this article, we examine stigmatization through the example of attitudes toward mentally ill persons, considering the chronological and geographical perspectives of stigmatization. The relevance of this problem is linked to a range of negative consequences caused by stigmatization and self-stigmatization – the individual’s own maintenance of a negative social identity. Overcoming these processes requires primarily educational efforts; however, segregation and stigmatization mechanisms have such deep-seated determinants that they render such efforts ineffective. As A. Finzen notes, “ultimately, what is at stake are fears, irrational fears, that sustain stigmatization. And irrationality cannot be overcome through education and increased knowledge” [3, p. 43]. In view of the above, this article is devoted to investigating the unconscious causes underlying stigmatization processes in society.

The Concept of Stigma

Stigma is simultaneously an ancient and a very new concept. In its original meaning, it denotes a “brand” used to mark slaves or criminals in antiquity. Its modern resonance – as an immaterial symbol of the psychological and social alienation of specific persons or groups from other members of society – was acquired in the second half of the twentieth century. The term was introduced into scholarly discourse by E. Goffman in his book Stigma: Notes on the Management of Spoiled Identity (1963) [2]. The author draws attention to the fact that universal processes of social structuring, including the devaluation of certain classes, are widely described at the phenomenological level but have not been analyzed from the perspective of their preconditions and internal mechanisms. Goffman proposes understanding “stigma” as a mark that reveals a particular disgraceful feature of an individual, whereby the “disgraceful” quality of the mark is conditional, locally conventional – recognized within a given society as negative and potentially quite neutral or even positive in other contexts. Goffman emphasizes the ambivalence of stigma: it persistently draws attention to the bearer of the “brand” while repelling interlocutors; the stigmatized individual is simultaneously attributed negative traits and “magical,” “supernatural” properties that provoke fear and envy. For Goffman, stigma functions in the worldview of conventionally “normal” people as an ideology – a system of beliefs about stigmatized others – diffusely spreading to the evaluation of all the stigmatized individual’s characteristics, even those that in a given culture are assessed as positive and in other circumstances would command respect [2, pp. 15-25]. The stigmatized individual cannot inspire respect or admiration – his entire image is colored by the shameful tinge of a single trait. Moreover, he himself largely concurs with this state of affairs as self-evident, comprehensible, expected, and logical: “the individual responds to this rejection by acknowledging that it is due to some of his characteristics” [2, p. 31].

Stigma and Mental Illness: Finkzen, Foucault, Dugin

A. Finzen, analyzing in detail various aspects of stigma through the example of schizophrenia, aptly notes that this diagnosis plays the role of a stigmatizing metaphor and multiplies the difficulties of the patient and his family. For beyond the symptoms of the illness itself – from which both the patient and his loved ones directly suffer – relatives experience feelings of guilt and helplessness, the social isolation of the entire family gradually intensifies, and all parties to the situation must live in constant tension, concealing the truth about themselves or their loved ones. “Rejection, discrimination, accusation – this is what relatives of people with schizophrenia must reckon with” [3, p. 193]. The author calls the social consequences of stigmatization the “second illness,” and the consequences of accusation and stigmatization of the patient’s relatives the “third.” Finzen inclines to the view that stigma has the character of an insurmountable social tendency; as a phenomenon of social life, it constitutes a social necessity. “The symbolic content of schizophrenia – and of other stigmatizing illnesses – has become generally accepted; it has integrated itself into the irrational; it has penetrated deeply into our sensory world” [3, p. 190]. Thus, anti-stigma awareness campaigns are ineffective; moreover, they are powerless against the force of mass media, which methodically constructs and sustains the stigma of mental illness. Finzen, drawing on Goffman’s approach, recommends relying on the concept of “stigma management” rather than “destigmatization.”

In the context of studying stigma, mention must also be made of the sweeping study of the history of madness conducted by French philosopher M. Foucault. In a series of works (Mental Illness and Personality, 1954 [4]; Madness and Civilization, 1961 [5]; Madness, the Absence of Work, 1964 [6]; Abnormal, 1974-75 [7]), the author examines both mental illness itself and the ways in which madness was understood and the mad were treated in different eras. As A.A. Gritsanov notes, the concept of madness acquired its own philosophical and cultural-historical meaning precisely through Foucault’s work [8].

Exploring the philosophical dimensions of madness, Russian philosopher A. Dugin builds his reflections on the classical Cartesian thesis cogito, ergo sum, according to which madness – as the impossibility of thought – together with death constitutes the two ultimate boundaries of the human being as a “thinking animal,” beyond which it does not exist. The experience of physical finitude – death – brings humans closer to and assimilates them with animals; but the possession of “reason” and its loss constitute the specific species “passport” of the human being – what cardinally distinguishes it from animals. And if in the age of Traditional philosophy and ontology, which organically incorporated a dualistic vision of the world and operated with the category of the sacred, madness was regarded as the highest form of reason, in modern times – the era of “fresh, rosy capitalism” – madness elicits a single desire: to cure the person, to return them within the framework of a rationalist, non-contradictory, and non-dualistic world [9]. Mental illness, even the very idea of it, scientific or colloquial, provokes fear; its associative chains, through the symbolism of loss (of reason, of capacity), lead to the actualization of the fear of death [10]. To lose one’s mind is to die psychologically – to remain within one’s world while never again being included in it as one was before the illness [3]. Mental illness poses a threat to all of Maslow’s basic psychological needs [11] – from safety, belonging, and esteem through to the highest needs of self-actualization. An ill person – including a mentally ill one – is a living reminder that any of us, at any moment in life, may find ourselves in their position, irreversibly and irremediably.

Anti-psychiatry as one direction of research into the socio-psychological dimensions of madness (R.D. Laing, D.G. Cooper, T.S. Szasz, F. Basaglia) “overturns the schema of the classical era, endowing madness with existential reality and revealing the existential falsehood of society,” and “madness becomes one of the questions of the human sciences, an instrument of philosophical inquiry” [12]. Diagnosis is viewed as an instrument of coercion and a means of isolating and alienating those who refuse to experience themselves and reality in the manner convenient to society. Thus, from an anti-psychiatric standpoint, mental illness is an experience of authenticity, a liberation from one’s own conformism and the pressure of social stereotypes.

The study of the stigmatization phenomenon continues within the context of contemporary psychiatric research on nosogenic reactions (A.B. Smulevich [13], M.Yu. Drobizhev [14]), including nosogenies as a form of reaction to the semantics of diagnosis (O.O. Filts [15]).

Self-Stigmatization

Attempts to reduce alienation, fear, and negative attitudes toward mental illness in society have prompted numerous projects and studies on “destigmatization.” In the course of these efforts, it has become clear that the phenomenon of stigmatization is not merely a one-way negative influence of society upon individuals. Patients “marked” by illness also adopt a certain stance toward their disorder, its symptoms, and their own status. These processes have been designated self-stigmatization (A. Finzen [3], L.Ya. Serebeiskaya [16], O.A. Gonzhal [17], and others), and several varieties have been described, including [18]: autopsychic (justifying one’s own incapacity by reference to mental illness), compensatory (ignoring signs of mental illness in oneself, emphasizing one’s difference from “the mentally ill,” and intensively accentuating the incapacity of mentally ill people), and socioreversive (changing social identity, joining the social group of the mentally ill, and interpreting society’s attitude toward oneself as prejudiced). Thus, self-stigmatization is reinforced both by society’s actual attitudes toward the patient and toward mental illness as such, and by the patient’s own subjective representations of mental illness and its bearers, and by the patient’s attitudes toward “the mentally ill.” Every patient simultaneously sustains stigmatization, is both its victim and its “stigmatizer.”

Historical Overview of Attitudes Toward the Mentally Ill

The question of the particular treatment of mentally ill persons – the “different” – has a very long history. As Yu.V. Kannabikh notes, members of primitive human communities, like contemporary people, suffered from schizophrenia, exhibited hysterical reactions, and experienced mental disorders linked to purely organic causes: epilepsy, sequelae of traumatic brain injury, atherosclerotic vascular damage and stroke, and genetic mutations. In prehistoric times, the treatment of aggressive and dangerous madmen was harsh, but ultimately comprehensible and expedient from the perspective of survival: they were expelled from the tribe as beings “abandoned” by the gods or punished by them. Toward non-aggressive persons with mental disorders, the attitude was one of special regard – they were not harmed but, on the contrary, were cared for and heeded, as they were considered favorites of the gods [19]. Without precise data, we may surmise with some probability that among primitive shamans there were also people with exceptional mental characteristics. In any case, shamans differed from ordinary members of the tribe not only in their knowledge and social role, but also in a distinctive character composition that enabled them to perform very specific functions.

In ancient Greece and Rome, the “different” were treated as ill – it was a time of flourishing medicine, so ideas of “spirit possession” and “divine punishment” had somewhat lost their currency. In ancient literature we find descriptions of mental disorders presented precisely as histories of people who were ill, not merely victims of divine intervention. Moreover, some of these “different” people could find for themselves an honorable and respected place in society as oracular priests or Pythia – seers of the future and mediators of divine will. These individuals, like primitive shamans, were capable of entering trance states in which they prophesied. According to contemporary scientific understanding, this capacity correlates with certain pathological states of morbid or psychopathic (associated with severe personality disorders) origin [20].

The Christian era – the age of “Galenism” in medicine – was a period of stagnation and religious dogmatism, which is destructive for any science, and especially for medicine. It is precisely to these times that the beginnings of the “witch hunts” belong, sparked by ideological conflicts between Christianity and paganism. In the twelfth and thirteenth centuries there was a particular intensification of the Roman Catholic Church’s struggle against newly formed sects (Cathars, Waldensians). Members of these sects accused church ministers of dishonesty and failure to uphold the moral imperatives of the Christian faith, thereby provoking fierce persecution and annihilation in 1223. From that time, all manner of “heresy” was conceptualized by the Church as the devil’s interference with God’s plan and ruthlessly suppressed. In 1231-32, a special institution was established – the Holy Inquisition – tasked with exposing and neutralizing malefactors who were instruments in the hands of the unclean spirit. In 1252, special rules of interrogation were introduced, officially permitting torture; the tools of the Inquisition were refined, their range and cruelty expanded. In 1484, Pope Innocent VIII issued the Summis desiderantes affectibus (“Bull on Witchcraft”), and in 1487 the Malleus Maleficarum (“Hammer of Witches”) was authored by Dominican friars Heinrich Kramer (Henricus Institoris) and Jacob Sprenger. According to the beliefs of that time, witches were attributed the most fantastic crimes – the bringing of epidemics, natural disasters, the pestilence of livestock, the murder of infants, and deviant sexual relations with the devil. The very confession of a crime, obtained under torture, was deemed proof of a witch’s guilt. The Inquisition and secular courts pursued even pregnant women and young children suspected of dealings with dark forces. It is evident that among those destroyed during these centuries as witches were many mentally ill people – those unlike others, incomprehensible to their surroundings, whose guilt may have consisted solely in strange behavior or utterances, mood fluctuations, and the like [21, 22].

Mental disorders in some European countries continued to be regarded as possession by evil spirits or a pact with the devil until the end of the eighteenth century. At the same time, from the sixteenth century onward, voices began to be raised in defense of the mentally ill (J. Weyer, F. Spee in Germany; R. Scot in England). At the turn of the seventeenth and eighteenth centuries, the Prussian philosopher and jurist Christian Thomasius actively opposed “witch” trials. In the 1730s-40s, England, Prussia, and Austria – followed eventually by other countries – reformed their legislation, abolishing the witch laws [23].

Social alienation and isolation from society of the mad – stigma in a sense approaching the modern one – appears only in the era of the High Renaissance. Drawing on the historical-philosophical work of M. Foucault, Madness and Civilization [5], we can briefly summarize the tendencies in European attitudes toward the “different” from the fifteenth and sixteenth centuries onward, together with its prehistory – the appearance of leprosy in Europe. Having returned from the Crusades of the late Middle Ages, many knights of Jesus contracted leprosy. The appearance of large numbers of lepers caused new infections and the spread of this incurable disease across all of Europe. Society isolated lepers in leprosaria, and the dominant Christian paradigm helped process the widespread fear of personal contagion in the following way: God had not, in fact, abandoned the lepers; their role consisted precisely in remaining excluded from society, reminding it simultaneously of divine wrath and mercy. Lepers were “marked by a sacred illness; they find their salvation in their very condition of outcasts and even through it: by the law of that strange reward, opposite to the reward of prayer and merit, they are saved by the hand not extended toward them. The sinner who does not let the leper across the threshold opens his way to the Kingdom of God” [5, p. 26]. In time, quarantine measures bore fruit: the lepers gradually died out, and the leprosaria were filled for a time with venereal patients, who did not remain there long, since society “accepted” them back, giving them places in ordinary hospitals. Meanwhile, the niche of social alienation in the Age of Enlightenment began to be occupied by the mad, who assumed the role of rejected outcasts – despised but, by divine design, necessary for some purpose. From that time onward, the stereotype of the mentally ill person – someone on the boundary between reason and its absence – began to crystallize in the collective consciousness.

Mental illness, according to Foucault, beginning from the seventeenth century, begins to occupy in social consciousness the position formerly belonging to leprosy – the mad become the same outcasts as those afflicted with leprosy, inspiring the same horror and awe as those “marked by God’s grace” in a terrible and unimaginably absurd way [5, p. 28]. This period is preceded by an almost two-century “latent period,” during which a reorientation of existential anxiety in Europe takes place – from the fear of death, induced by epidemics and wars, to the fear of madness. “Having discovered the fatal inevitability by which man is transformed into nothing, the Western world shifted to the contemptuous contemplation of that nothingness which is human existence itself… Non-being in death is now nothing, for death is already everywhere, for life was a vain self-deception, vanity, the rattling of a jester’s bells” [5, p. 35]. Society attempts to isolate itself from the mad as it had formerly done with lepers. If the latter were locked in leprosaria, the former are driven from cities, dispatched on voyages aboard “ships of fools,” in order to rid itself of them and protect itself from a living reminder of its own insignificance and folly. Foucault also notes that the theme of death had not in this way been “dispatched.” Rather, the opposite – it received new impetus in its development and a more differentiated semantic content. Death ceased to be only the ultimate limit that both frightens and liberates the human being from the vanity of life. Death, kindred and intertwined with madness, becomes permanent, perpetually present, and ruinous of human life from within. The mad, as the living embodiment of “the death of reason,” inspire fear – existentially significant, irrational, and therefore insurmountable.

In the nineteenth century, psychiatry developed actively as a separate medical discipline, and a process of “desacralization” of mental illness took place: “the ‘unreasonable person’ was transferred to the psychiatric hospital, and isolation became a therapeutic measure” [8]. As Yu. Nuller notes [24], psychiatry itself until the end of the nineteenth century continued to be at a “pre-paradigmatic” stage of development, when different approaches to understanding and classifying mental illnesses were applied in different countries. The greatest influence on the development of clinical thought in psychiatry was exerted by the concept of mental illness as a manifestation of degeneration, developed by French psychiatrist B.A. Morel. Our study is not concerned with scientific paradigms as such, but we may suggest the following: the degeneration concept simultaneously articulated, accentuated, and reinforced the irrational components of the attitude toward mental illness as something deficient, deficit-laden, and degenerate. The degeneration concept “fits” the irrational sense of fear and intuitive premonition of threat, and effectively rationalizes society’s desire to distance itself from the mentally ill person.

The twentieth century – an era of great discoveries and wars – generated two entirely opposite approaches in the treatment of psychological norm and pathology. Within the framework of Sigmund Freud’s psychoanalytic theory and a whole constellation of related psychotherapeutic concepts, the functioning of the psyche of a specific individual is examined through the prism of its adaptation to specific environmental conditions. The psychoanalytic paradigm does not presuppose a clear-cut norm/pathology evaluation; thus, the pathological in the human psyche is brought closer to the normal. Moreover, the study of the functioning of the conventionally normal psyche proceeds through the investigation of pathological phenomena. Thus, to generalize, it may be stated that the healthy psyche contains pathological experiences “in small doses,” as very mildly expressed disturbances or as a readiness for pathological perception of reality. Consequently, psychoanalytic theory and the psychotherapeutic practice built upon it “normalize” psychic pathology and “pathologize” the norm, bringing the two closer together.

A diametrically opposite attitude toward psychic pathology and its bearers prevailed in totalitarian states. The most striking examples concern the functioning of psychiatry in Nazi Germany. Germany’s “Law for the Prevention of Hereditarily Diseased Offspring” (1933) and the “Euthanasia Decree” (1939) legalized the sterilization and physical destruction of the mentally ill and intellectually disabled. As a result, 90% of all psychiatric patients were physically annihilated, and 350,000 were sterilized [25]. A particularly significant place in this negative roster is occupied by instances of so-called “punitive psychiatry.” By this is generally understood the use by authorities of the mental health care system for the purpose of neutralizing persons who pose a threat to the regime. In this way, a psychiatric diagnosis becomes the formal basis for the isolation of “dissidents,” their exclusion from the public process, and the devaluation and discrediting of everything they have created.

In the context of the humanization of attitudes toward persons with mental disorders, the movement of “anti-psychiatry,” developed in the 1960s by a group of psychiatrists (Franco Basaglia, Ronald Laing, David Cooper, Thomas Szasz), deserves particular attention. The principal slogan of the anti-psychiatric movement was the assessment of psychiatric treatment exclusively as an instrument of coercion and social isolation – excessive, degrading, and destructive for those subjected to it. Basaglia succeeded several times in realizing a project for the closure of psychiatric hospitals, but each time with unfortunate consequences: released patients committed crimes, which only reinforced negative public attitudes toward them and demonstrated the necessity of isolation.

As the experience of the past fifty to sixty years attests, neither the full toleration of persons with mental disorders in the anti-psychiatric convention, nor harsh restriction in the style of totalitarian states, has produced the desired outcomes. The current situation in the sphere of official attitudes toward mental illness can be assessed as a search for a “golden mean.” Beginning in 1975, EU Council resolutions, Council of Europe recommendations, and WHO resolutions have emphasized the important role of activities aimed at strengthening mental health, providing quality treatment services, and reintegrating persons with mental disorders into society. Among the most significant recent decisions is the adoption in 2005 by the European Commission of the document “Green Paper” on mental health, which sets out priorities for the development of mental health protection – in particular, the need to activate non-governmental and community programs supporting mental health, to minimize differences between the psychiatric services of EU member states, to modernize them, and to integrate mental health into the general healthcare context, which should contribute to the destigmatization of mental illness as such. In 2007, the 10th Conference of European National Coordinators of the WHO Mental Health Programme was held (Edinburgh, Scotland), with participation from Ukrainian representatives. The conference presented results of research on the effectiveness of psychiatric care systems in EU member states; the WHO and the World Psychiatric Association planned to include Ukraine in similar studies. In 2008, the “Merano Declaration of the WHO” was adopted in Merano, Italy, defining key directions for reform in mental health care systems in post-Soviet countries and calling on the governments of those countries, together with the EU, to undertake measures for reforming national mental health systems [26].

Despite numerous steps toward improving the quality of psychiatric care, changing public opinion about mental health and psychiatric treatment, and advancing destigmatization and resocialization of persons with mental disorders (current or past), society continues to remain wary, distrustful, and hostile toward individuals who have come within the purview of psychiatry. This applies above all to the countries of the former Soviet Union. In particular, a content analysis of media publications for the period 1995-2002, conducted by a group of Russian researchers, attests to the presence of negative stigma in attitudes toward both mentally ill persons and psychiatrists, psychiatric institutions, and pharmacological treatment [27].

An equally important indicator of society’s attitude toward the mentally ill is the official regulatory framework governing disability determination and social protection of persons with disabilities. An analysis of Ukrainian legislation reveals unfavorable tendencies in this domain. Thus, in 2011, the Verkhovna Rada of Ukraine adopted the Law “On Measures for the Legislative Implementation of Pension System Reform” [28], which increases the required work record for receiving a disability pension from 5 to 15 years and deprives working persons with disabilities of groups II and III of the right to receive an old-age pension. If we compare the average disability pension in Ukraine as of 2011 with the cost of at minimum medications alone (without even accounting for ordinary day-to-day living expenses), we can see the quite obvious absurdity of this ratio. According to data from the State Statistics Committee of Ukraine, the average old-age pension amounted to 1,514.9 hryvnias, and the disability pension to 1,160.2 hryvnias – an amount that exceeds the subsistence minimum established in December 2011 (953 hryvnias), but falls far short of guaranteeing adequate financial provision for basic needs [29].

Psychoanalytic Framework: Mechanisms of Defense and Social Maturity

As the review presented above shows, the phenomenon of stigmatization manifests with varying intensity in different eras and in different societies. The psychoanalytic theory – in particular, the concepts of defense mechanisms and the diagnostic assessment of personal and social maturity – can serve as an effective instrument for its comprehension. Psychoanalytic theory posits the existence of three levels of the psyche – the conscious, the unconscious, and the preconscious – and three personal structures: the Id, the Ego, and the Superego. In order to ensure its own integrity, perpetually threatened by the conflict between the desires of the Id and the prohibitions/prescriptions of the Superego, the Ego employs defense mechanisms. The latter are divided into mature (neurotic), immature (psychotic), and borderline (intermediate in terms of maturity). An analogous gradation applies to the maturity of personality structure, which is assessed on the basis of three parameters: the degree of personal integration, the type of predominant defense mechanisms, and the adequacy of reality testing. The neurotic level of personality organization presupposes the use of mature defenses, the presence of a sufficiently differentiated and integrated identity, and adequate reality testing. The psychotic level is diagnosed when immature defenses predominate (mature defenses remain inaccessible or very poorly represented), identity is diffuse (blurred) or fragmented (disintegrated, hypersensitive), and reality testing is inadequate. The borderline level of organization is characterized by the predominance of insufficiently mature defenses, a fragmented and polarized identity, but, on the whole, adequate reality testing. If human societies are classified in terms of developmental level, they too can be divided into three groups – mature, borderline, and immature. Postulating the presence of unconscious experiences in any society, it may be expected that, depending upon the level of development, each will employ one or another set of defenses for its adaptation [30].

In the context of studying the phenomenon of stigmatization as, above all, a social phenomenon, particular significance belongs to the group of projective defense mechanisms (neurotic and psychotic projection, projective identification), whose defining feature is the perception of traits internally characteristic of the personality as external with respect to the person’s psyche [31]. This group of mechanisms can be viewed as a continuum, at whose healthy pole lies neurotic projection and at whose pathological pole lies psychotic projection. In their mature forms, projection is the basis for empathy and compassion; at the pathological pole, it poses the threat of distorting the world and producing gross violations of interpersonal relations. Projective identification involves not merely attributing one’s own traits to another, but also preserved reality testing, which complicates the simple distancing from negative experiences by “assigning” them to another. The capacity for reality testing in projective identification initiates and sustains a very specific unconscious manipulation – provocative behavior aimed at altering external reality, making it genuinely conform to the negative content projected outward [32]. The maturity of defense mechanisms is in direct proportion to the individual’s capacity for containment (the more or less conscious living-through of feelings, per W. Bion [33]) of experiences that cause psychological discomfort. The greater this capacity, the more adequate is the individual’s representation of his own inner world, and the lesser is the need for projection and subjective distortion of the picture of reality (as in psychotic projection) or unconscious manipulative correction of reality (as in projective identification).

Neurotic projection is employed by comparatively mature societies – and here we are not speaking of the level of material culture. As the historical overview shows, both primitive communities and European countries of the Enlightenment era, and contemporary Europe are fully prepared, in accordance with their own understandings of the nature and methods of treating mental disorders, to care for the mentally ill, to support them, and to contain the negative aspects of their own identity without “offloading” them onto external protagonists. Psychotic projection is employed by immature societies – these are ideological systems of intolerance and totalitarianism that cannot tolerate within their ranks the “different.” In this respect, the “witch hunts” and the restrictive psychiatry of Nazi Germany are no different from each other; in both cases, bearers of psychiatric stigma were subject not merely to condemnation or ostracism, but to direct physical annihilation.

Projective identification is employed by so-called “borderline societies,” which have a limited capacity for containing the negative aspects of their own identity – for experiencing negative emotions (shame, aggression, guilt, feelings of inferiority, etc.) as a component of their own inner world. Consequently, they project these experiences onto others – onto the mentally ill, who in the subjective perception of society become the bearers of negative traits, embodying defectiveness in every possible sense of the concept. Preserved reality testing does not permit such a society to rid itself entirely of the “enemy” (to physically destroy the “different” and begin seeking a new object for projection); rather, it requires that the objects of projective identification confirm by their behavior the prejudiced attitude toward them. The borderline society unconsciously provokes, compelling its “different” citizens toward behavior that is antisocial and inadequate. This permits the safe experiencing of negative emotions in relation to them, effectively legitimizing stigmatization, and providing grounds for the isolation and control of the “different.”

The analysis presented above of attitudes toward the mentally ill in post-Soviet countries, and the brief overview of contemporary Ukrainian legislation in the sphere of social protection of persons with disabilities (in the context of this study – those disabled by mental illness), allow us to diagnose the type of attitude toward the “different” in our state as typical of a society at the borderline level of maturity, determined by projective identification. As follows from simple arithmetic calculations, persons who have developed mental disorders are so socially unprotected in Ukraine that an antisocial way of life is separated from them by only a highly symbolic margin of funds / time / circumstances.

Conclusions

Stigmatization (in the context of this study – the stigmatization of the mentally ill) has existed at various stages of societal development and continues to exist in various societies today. The level of intolerance and alienation, and the stereotyped negative attitudes toward the mentally ill, depend upon the maturity of society, which can be assessed with the aid of psychoanalytic concepts of defense mechanisms and levels of personality / social organization (maturity). Attitudes toward the mentally ill, legally established norms of social provision for persons with disabilities – including those disabled by mental illness – allow us to assess the unconscious mechanisms of the stigmatization of mental illness as projective-identificatory in nature, which testifies to the borderline level of maturity of Ukrainian society.

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