Stigma and violence in dealing with madness: narratives from psychosocial care centers in Bahia and Sergipe, Northeastern Brazil.

OBJECTIVE To analyze stigmatization processes and types of violence experienced by individuals with mental disorders. METHODS A qualitative study was carried out, based on individual interviews with users and focus groups with family members and professionals at five psychosocial care centers in the municipalities of Itaberaba, Lauro de Freitas, Salvador, Vitória da Conquista, and Aracaju, Northeastern Brazil, in 2006-2007. The analysis categories were constructed based on the stigma concept proposed by Goffman, and four types of violence were systematized: interpersonal, institutional, symbolic and structural. RESULTS Users and family members recounted examples of disqualification, reprimands, embarrassment, humiliation, negligence and physical aggression that had the aims of domination, exploitation and oppression. Professionals reported that people who suffer from mental disorders remain the target of prejudice that is culturally ingrained and naturalized. The main consequence is continuation of their isolation from social life as a form of 'treatment' or as an excluding attitude manifested by discriminatory reactions in the form of rejection, indifference and verbal or physical aggressiveness. CONCLUSIONS The various ways of expressing stigma denote a sociocultural situation of violence against individuals with mental disorders. It is proposed that state monitoring bodies capable of planning and evaluating countermeasures against stigmatization should be set up.