Of stigmas and stings


stigma (στίγμα) in Greek means sign, mark, sting.

And i brands they are the ones we often put on certain stories as well as on people. Especially if they have something that we fear may belong to us and from which we feel the urge to distance ourselves.

Lo stigma unfortunately we often meet him in the Labels psychiatric, on impetuous girls and boys, on women, on alcoholic men, on prostitutes in the street, on a miniskirt that goes against modesty, sometimes even on a man who cries.

stigma and mental health. stigma and addictions. Here is what we will focus on in the next lines.

Homelessness* and health are often like two parallel roads that don't cross, like two wheels turning in opposite directions, like two asynchronous clocks. But not always. It also takes good survival skills to withstand life on the street.

Physical and mental health problems and pathological addictions are widespread among people living on the street. Numerous national and international studies on the subject of homelessness tell us this.

Furthermore, conditions of double diagnosis are very frequent, in which mental illness is added to pathological dependence. And we can think that the abuse of alcohol and substances originates from environmental conditions, but that it can also be the manifestation of a real one circuit of addiction, in which the inability to manage impulses leads to the use of the substance to calm them and, therefore, to a continuous and increasingly massive search for alcohol or drugs (very often alcohol is the master, because it is easier to find and lower costs). The mechanism of addiction has a neurobiological substrate that feeds on reinforcements, craving and compulsions. At the base of all addictions there are complex and pathological biopsychosocial factors, made up of trauma, retraumatizations, depression, compulsive cyclicality: clumsy attempts at self-treatment and escape. The substance thus remains the only cure available. The substance replaces the drug, the bed, the reality, the relationship. As elsewhere it is the relationship that cures, often on the street alcohol and drugs are the only palliative cure to that reality otherwise too painful to bear.

Often on the street we see people who suffer for or who are trapped in a traumatized self, because basically this life on the margins represents a cumulative trauma: many events and conditions that are not necessarily striking, but which repeat themselves, like a Chinese drop, day after day, month after month, year after year. Resisting life on the street unharmed is perhaps an illusion, a very demanding request for the person involved, a denial for those who go back to sleep in their bed at night. Here then is what neoreality, the use of substances and other defenses, perhaps sometimes bizarre, represent the only escape to resist and survive marginality, pain, isolation.

"Projects" or "help yourself that God helps you"

The difficulty for some people to access the ordinary network of services is given not only by bureaucratic and network problems, but also by the fact that mental activity sometimes comes to overwhelm real life, thoughts become so pervasive that they turn into experiences acoustic, visual, sensory. Cognitive processes are affected, memory for small things decreases, the ability to orient oneself in space and time, the planning of simpler actions such as reaching an office, the desire to do anything, the sense of continuity, movements. 

How are these people labeled (why, oh, yes, who are being labeled)? Like non-collaborative. In these stereotyped social systems, terms, verbs and adjectives are often clumsily adapted that in Italian grammar are not born to be related to people: it is the example of "conversing" to talk to someone, "psychiatric users", as if psychiatric were the person and not the diagnostic label, "planning", as if the person were a phase of elaboration of a project and not the participant and involved subject. How true it is that words are important. How true it is that the relationship is made up of words and communication. How true that it is stigma it also expresses itself with these terminological stamps.

The progressive fading of the Self can be accompanied by a pervasive feeling of anxiety, agitation, terror which can also increase in contact with the other. This anxiety of annihilation, the vanishing of the Self, the disintegration of oneself (the "nameless terror"By Bion), cognitive dulling, but also flattened or impetuous affects, overwhelm the person and drag him to the relational and social margins, to withdrawal, to catatonia, to escape into a neoreality

Road and stigma

The literature teaches us that to work with homeless people you need specific training, the ability to know how to grasp the links between homeless people, mental illness and addictions, as well as the ability to move in the network of territorial services, an approach integrated multidisciplinary, case management skills (and “staying” in the path, in the case, in the stories, tolerating frustrations) and the management of countertransference responses aroused by the relationship.

Already for mental illness, but even more so for addictions, in addition to not being considered "project", the person often arouses frustration and a sense of helplessness in those who try to provide support. But very often negative, hostile, expulsion and rejection reactions also arise towards these people: especially those who abuse alcohol and substances are seen as liars, manipulative and uncooperative, "you can get out, it's you who is looking for it ". This expulsive attitude ignores the fact that addiction is not a matter of choice or willpower.

In psychology there is the defense mechanism of projective identification, through which the person removes unpleasant experiences from himself, depositing them on someone else who lends himself well to this expulsion, but remains linked to it through contemptuous thoughts, criticizing it, excluding it. I am good, you are dirty and bad. And basically that's how it works stigma.

* In English the suffix -ness is used to form nouns that indicate a condition, a state. The Anglo-Saxon term was chosen to facilitate immediate reading and because it is widely used in the international scientific panorama. 

Joanna Teti



DK Padgett, BF Henwood, SJ Tsemberis (2016). Housing First. Franco Angeli, Milan, 2018





Photo credits: © Tommaso Berretta

** Notes on the author: Giovanna Teti is a psychologist, psychotherapist and expert in psychodiagnostics. He initially worked in the territorial services for adults and with the developmental age, and then devoted himself to the sector of hospital psychology. She has been involved in adoptions for several years and is currently the contact person for the Rome office of the Regional Service for International Adoptions. For some years she has been working with homeless people as a street worker for the Municipality of Rome. Partner of PsyPlus since 2021, she is currently dedicating herself to the development of the Area dedicated to Social Inclusion and to the fight against serious adult marginalization with the aim of carrying out Housing First projects in the cities of Rome and Pescara.

addictions, Mental health, Homelessness, stigma

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