In March this year, Professor John Swinton game a thought-provoking seminar on “Spirituality and Mental Health Challenges” for Faith in Older People (FIOP). A specific challenge for all of us is how we address stigma. “It is not who I am, its how you see me” was highlighted in his presentation.
To take this forward Professor Swinton has kindly agreed to FIOP publishing an extract from his book Finding Jesus in the Storm – The Spiritual Lives of Christians with mental health Challenges which address this issue.
The Rev Professor John Swinton BD, PhD (Aberdeen), RMN (Registered Mental Nurse), RNMD (Registered Nurse for People with Learning Disabilities); Professor in Practical Theology and Pastoral Care with the University of Aberdeen and Theological Advisory to Faith in Older People.
John Swinton is Professor in Practical Theology and Pastoral Care and Chair in Divinity and Religious Studies at the University of Aberdeen. For more than a decade John worked as a registered mental health nurse. He also worked for a number of years as a hospital chaplain, and as a community mental health Chaplain. In 2004, he founded the University of Aberdeen’s Centre for Spirituality, Health and Disability. He has published widely within the area of mental health, dementia, disability theology, spirituality and healthcare, qualitative research and pastoral care. In 2016 his book Dementia: Living in the memories of God won the Archbishop of Canterbury’s Ramsey Prize for excellence in theological writing.
EXTRACT from Finding Jesus in the Storm – The Spiritual Lives of Christians
The Problem of Thin Descriptions
There are different kinds of descriptions, depending on the angle from which one looks at a phenomenon, but there are also different types of descriptions. In his book The Interpretation of Cultures, the anthropologist Clifford Geertz presents us with the idea of thick and thin descriptions. A thin description provides us with the minimum amount of information necessary to describe a situation or context. A survey, for example, provides a thin account of a phenomenon insofar as it captures only certain statistical aspects and provides no contextual, relational, experiential, or cultural information. Statistics also provide thin descriptions. So, for example, we might note that one in four people will experience mental health challenges over a lifetime. This emphasizes at a general level the fact that mental health challenges are a significant issue in the population. However, this statistic tells us very little about the particularities of either the one or the four. Thin descriptions provide us with high-level insights but no low-level details. Another example might be Google Translate, a web-based program that translates typed words into a different language. Through this process you do get a rough understanding of what words mean in other languages, but that understanding is extremely limited and can even be quite badly skewed. It is an understanding of language stripped of culture, experience, history, or linguistic subtleties and idioms. It is too thin to provide more than a very basic level of insight into the language.
As we enter the world of mental health, it will quickly become clear that thin descriptions abound, both within public conceptions of people’s experiences and within the mental health professions. In what follows, I examine four key areas where thin descriptions have become particularly problematic.
Stigma as Thin Description
We find a particularly powerful and devastating example of a thin description and its dangers in the phenomenon of stigma. Stigma is one of the most destructive aspects of living with unconventional mental health experiences and one of the most painful experiences that people have to endure. Stigma occurs when a person is reduced from being a whole to being a mere part; from being a full human being to being the sum of a single part. The sociologist Erving Goffman informs us that the concept of stigma originated in the Greek slave trade. After a slave was purchased, the slave was branded and, in branding, was reduced (or thinned down) to the size of the brand. The slave was no longer described as a person, a citizen, a friend, or a family member but was now simply property. Stigma functions in the area of mental health in a very similar way. Stigma reduces people living with unconventional mental health problems to the shape and form of their diagnosis, or more accurately, to people’s perceptions and caricatures of the implications of their diagnosis. In this way stigma thins down or reduces people’s descriptions to impersonal caricatures based on the connotations of their diagnoses. People cease to be perceived as persons and become “schizophrenics”, “depressives”, “neurotics”, or any other thin diagnostic façade that people choose to project when they don’t want to engage with read individuals.
A Spoiled Identity
Goffman describes stigma as a phenomenon that occurs when an individual with an attribute deeply discredited by his or her society is rejected as a result of that attribute. “While a stranger is present before us, evidence can arise of his possessing an attribute that makes him different from others in the category of persons available for him to be, and of a less desirable kind – in the extreme, a person who is quite thoroughly bad, or dangerous, or weak. He is thus reduced in our minds from a whole and usual person to a tainted, discounted one. Such an attribute is a stigma, especially when its discrediting effect is very extensive.” Stigma is most powerful when it urges us to “reclassify an individual from one socially anticipated category to a different but equally well-anticipated one, and the kind that causes us to alter our estimation of the individual downward.” Such a powerful stigma redescribes individuals in negative ways that mov them from one socially anticipated category to a difference and lesser social category. Stigma is thus a malignant mode of social description that is very often aimed at some of the most vulnerable people within society.
One of the problems with mental health diagnoses is that they are highly stigmatized categories that take their meaning not only from their clinical descriptions but also and sometimes primarily from the negative cultural accretions that accompany such descriptions. This is particularly true in the Western world, which as a preoccupation with intellect, reason, and clarity of thinking. In such a cultural milieu, mental health challenges can easily be perceived as challenging each of these socially valued attributes and, in so doing, challenging our conceptions of what it means to be fully human.
Tanya Luhrmann notices this particularly in the diagnosis of schizophrenia in America: “One of the challenges of living schizophrenia in the United States is the clear identity conferred by the diagnostic label itself. To receive care in a society so acutely aware of individual rights is to receive an explicit diagnosis. A patient has the right to know. But the label ‘schizophrenia’ is often toxic for those who acquire it. It creates not only what Erving Goffman called a ‘spoiled identity’ but an identity framed in opposition to the nonlabelled social world.” Describing someone as having schizophrenia or being a ‘schizophrenic’ has significant social and relational consequences, at least in Western cultures. As Esme Weijun Wang put it in relation to her personal experience of living schizoaffective disorder: “Giving someone a diagnosis of schizophrenia will impact how they see themselves. It will change how they interact with friends and family. The diagnosis will affect how they are seen by the medical community, the legal system, the Transportation Security Administration, and so on.”
Importantly, this “spoiled identity” stands in direct opposition to those claiming to bear witness to “normality.” This is why schizophrenia can be so alienating. Built into the description is an assumption of distance and presumed Otherness. However, this is not true in all cultures, as we will see. Indeed, in certain cultures it is not possible to be “a schizophrenic”; constructing people in this way is just not what such cultures do. A question we will explore in various ways as we move on is this: What is it about Western culture that constructs schizophrenia (and other forms of mental health challenge) in such a way as to make it so dehumanizingly stigmatic?
Professor John Swinton
 John Swinton (2020) Finding Jesus in the Storm – The spiritual lives of Christians with mental health Challenges which address this issue.
 Clifford Geertz, The interpretation of Cultures (New York: Basic Books, 1973), 33-35.
 Erving Goffman, Stigma: Notes on the Management of Spoiled Identity (Englewood Cliffs, NJ: Prentice-Hall, 1963), 3.
 Goffman, Stigma, 3.
 Goffman, Stigma, 3.
T. M. Luhrmann and Jocelyn Marrow, eds., Our Most Troubling Madness: Case Studies in Schizophrenia across Cultures (Berkeley: University of California Press, 2016), 27.
 Wang, The Collected Schizophrenias, Kindle locations 225-227.