|Year : 2020 | Volume
| Issue : 5 | Page : 46-48
The stigma story of COVID-19 in India
Astha1, Vinay Kumar2
1 Department of Psychiatry, Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
2 Consultant Psychiatrist, Manoved Mind Hospital, Patna, Bihar, India
|Date of Submission||22-Aug-2020|
|Date of Acceptance||24-Aug-2020|
|Date of Web Publication||02-Oct-2020|
Dr. Vinay Kumar
Manoved Mind Hospital, Patna, Bihar
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Astha, Kumar V. The stigma story of COVID-19 in India. Indian J Soc Psychiatry 2020;36, Suppl S1:46-8
The word stigma means “tattoo or brand” and it has come from the Greek culture which is used to put a permanent punitive mark on some members of the society to devalue and discriminate them. With time, the act of physical stigmatization went out of practice but remained as a meaningful metaphor across cultures, languages, and disciplines to express human behavior of demeaning others. Arboleda-Florez has discussed stigma at length and tried to understand its three dimensions, namely perspectives, identities, and reactions. He argues that stigma has a different meaning for the person who stigmatizes (perceiver) and the target. The dimension of identities can be understood as labeling a person or group of persons with certain identities. This dimension facilitates stereotyping. The impact of stigma depends considerably on reactions which may remain contained at the level of cognition and affect or may get expressed through behavior. Now, we need to answer one more question to understand the stigma related to COVID-19 and that is “why.” Stangor and Crandall have tried to understand this as a three-step process: initial perception of tangible or symbolic threat, perceptual distortions that amplify group differences, and consensual sharing of threats and perceptions.
| The COVID-19 Stigma|| |
In the case of COVID-19, an element of stigma became visible when the virus crossed Chinese boundaries. Apart from news of transmissibility, treatment-refractoriness, and lethality of the disease, an intellectual rumor of conspiracy theory also crept in. As the disease entered nation after nation, the stigma related to COVID-19 took its first step because there was a tangible or symbolic threat and there was a theory for “othering,” the conspiracy. “Blame game” has always been part of social construction of illness. European history and Indian newspapers can be referred for existence and persistence of witchcraft and witch-hunt. Sontag  has discussed the theory of social construction of illness as a foreign invasion in the context of human immunodeficiency virus and acquired immune deficiency syndrome. In the USA, Budhwani and Sun  recently studied the behavior of a social media platform called Twitter after the presidential reference of COVID-19 as Chinese virus. They found a significant rise in tweets and retweets. Observing the rise in tweets referencing “Chinese virus” or “China virus,” along with their contents, they concluded – “The rise in tweets referencing “Chinese virus” or “China virus,” along with the content of these tweets, indicate that knowledge translation may be occurring online and COVID-19 stigma is likely being perpetuated on Twitter.” The Centers for Disease Control and Prevention (CDC) advisory  categorically underlines that some groups of people who may experience stigma during the COVID-19 pandemic include: “certain racial and ethnic minority groups, including Asian Americans, Pacific Islanders, and African Americans.” Prioritizing Asian Americans in the advisory clearly indicates toward control of the damage done by geopolitical emphasis on the conspiracy theory.
| The Safety Concerns|| |
Concern for personal safety is part of human nature. However, there is a difference between feeling safe and being safe. Being safe depends on correct information and its application to life situations, but feeling safe depends on lots of personal and sociopolitical factors which may include rumor and misinformation and social interpretation of correct/incorrect information. Anthropologically, the process of stigmatizing a person or a group of persons has its roots in the psychology of feeling safe. The act of ostracizing sick people goes back to antiquity. To save the herd from untreatable sick persons, even scriptures, which are otherwise treatise of human values, advocate discriminatory attitude. It is quite understandable that perception of threat must have played a role in silencing the ethical voice. If we look back at the story of COVID-19, we find “perceptual distortions that amplify group differences.” Like the past, this pandemic has also generated a huge amount of fear and uncertainty due to possible lethality and lack of effective treatment and a preventive vaccine. It is an unfortunate situation that personal immunity has appeared as the most effective protection. Reports of poor prognosis and bad outcome, in cases of medical comorbidity, has justifiably frightened families who have members with high risk. No country was ready to handle the pandemic. Being a developing and densely populated country, India has also experienced a resource crunch. People have suffered due to insufficient number of hospital beds and limited availability of life support systems. Understandably, these factors have also played a role in heightening the level of perceived threat which has resulted in activation of psychosocial mechanism of othering people with illness. The Chinese conspiracy theory entered the Indian mental space as well and TV channels irresponsibly kept airing this unverified news as unavoidable noise. In the middle of March 2020, there came a religious angle of viral spread which led to construction of theories around conspiracy and persecutory politics. The members of a community who attended a religious conclave were considered corona-vendors because many of them were found COVID positive. The arrest of some foreign members who were found allegedly hiding fueled the suspicion to the next level. “Consensual sharing of threats and perceptions” in the social media took rounds. This led to hatred and animosity, and in several parts of the country, acts of violence against medical and law enforcing teams were reported in media which got reflected on the scientific platform also. Similar reports from other countries can also be found on the same scientific platform. The WHO highlighted this in their statement issued on March 18, 2020: “some healthcare workers may unfortunately experience avoidance by their family or community owing to stigma or fear. This can make an already challenging situation far more difficult,” an aspect highlighted by Murthy too.
| The Human Angle|| |
Humanity needs proximity, freedom, trust, compassion, and love to survive. However, at the level of governments and health organizations, the management of COVID-19 crisis began with the advisory of social distancing which means personal safety at one hand and suspicion and mistrust on the other. In India, the COVID-19 period began with masked personnel at the airports screening incoming international passengers at the airports. Travel history became a caution for public health. Almost all the governments, including India, put a ban on international travel, and this meant othering rest of the world. Although this was a desperate but unavoidable administrative measure, it obviously contributed to stigma. Soon social proximities were banned, and the word “meeting” became an official and cyberspace phenomenon. The travel ban was imposed inside the country also, and people with a history of domestic travel also became an object of suspicion. The Government of India kept evacuating Indian nationals from foreign lands, and on arrival, they were stamped with indelible ink and quarantined at designated centers or at their own home which was declared a risky place by sticking posters of warning. Another step was lockdowns which is continuing as a preventive measure with varied strictness. In some parts of the country, the nature of lockdown mimicked curfew and citizens were beaten by the police if found not adhering to it. Due to the lockdown, a large number of migrant laborers were forced to return home on foot and many of them suffered due to disproportionate amount of suspicion. The media reported sanitizing of their bodies with hypochlorite solution and ill-treatment on their return back home. Chaturvedi and Sharma  have also mentioned some of these factors. The process of disease control, if not properly blended with proper social education, care, and compassion, leads to widespread stigma which adds to the suffering of these sick people. This prevents new and potential cases from seeking health care. On the contrary, kind behavior facilitates familiarity which helps in reducing the stigma. In a pandemic like this, the health-care workers get caught between exposure to infection and the associated stigma. This leads to higher rates of stress and burnout.
| Conclusion|| |
Discriminatory attitude and behavior are most explicitly communicated through language. It is unfortunate that COVID-19 has been labeled as a war. 24 × 7 outpourings from the media have almost established it. Experts and research materials have always advised to refrain from creating such disease constructs and using military terminologies which include words such as “victims” and “warriors.” “We are not being invaded. The body is not a battlefield. The ill are neither unavoidable casualties nor the enemy. We – medicine, society – are not authorized to fight back by any means whatever.” The WHO, CDC USA, and MoHFW, Government of India, have also come out with prudent advisory to educate and empower people for minimizing the social stigma which has got associated with patients and health-care workers.
The pandemic is not over, and the issue of mitigating the stigma remains a challenge. Society needs to invoke love and compassion, the hallmark of humanity. Leaders, opinion makers, and all forms of media need to play a proactive role in mitigation of stigma.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Arboleda-Florez J. In: Arboleda-Flórez J, Sartorius N, editors. Understanding the Stigma of Mental Illness: Theory and Interventions. West Sussex, England: John Wiley & Sons; 2008. p. 3.
Stangor C, Crandall, CS. Threat and the social construction of stigma. In Heatherton TF, Kleck RE, Hebl MR, Hull JG, editors. The Social Psychology of Stigma. New York: The Guilford Press; 2000. p. 73.
Sontag S. AIDS and its metaphors. New York: Farrar, Straus, and Giroux; 1989.
Budhwani H, Sun R. Creating COVID-19 Stigma by referencing the novel coronavirus as the “Chinese virus” on Twitter: Quantitative analysis of social media data. J Med Internet Res 2020;22:e19301.
Bagcchi S. Stigma during the COVID-19 pandemic. Lancet Infect Dis 2020;20:782.
Lancet T. India under COVID-19 lockdown. Lancet 2020;395:1315.
Murthy RS. COVID-19 pandemic and emotional health- social psychiatry perspective. Indian J Soc Psychiatry 2020;36 (Suppl);S24-S42.
Chaturvedi SK, Sharma MK. Psychosocial aspects of Covid-19, the Indian way. World Soc Psychiatry 2020;2:129. [Full text]
Lyndon AE, Crowe A, Wuensch KL, McCammon SL, Davis KB. College students' stigmatization of people with mental illness: Familiarity, implicit person theory, and attribution. J Ment Health 2019;28:255-9.
Kannampallil TG, Goss CW, Evanoff BA, Strickland JR, McAlister RP, Duncan J. Exposure to COVID-19 patients increases physician trainee stress and burnout. PLoS One 2020;15:e0237301.