The stages of change model

Projection: Attributing one’s unacceptable feelings or desires to someone else. For example, if a bully constantly ridicules a peer about insecurities, the bully might be projecting his own struggle with self-esteem onto the other person.

Denial: Refusing to recognize or acknowledge real facts or experiences that would lead to anxiety. For instance, someone with substance use disorder might not be able to clearly see his problem.

Repression: Blocking difficult thoughts from entering into consciousness, such as a trauma survivor shutting out a tragic experience.

Regression: Reverting to the behaviour or emotions of an earlier developmental stage.

Rationalization: Justifying a mistake or problematic feeling with seemingly logical reasons or explanations.

Displacement: Redirecting an emotional reaction from the rightful recipient to another person altogether. For example, if a manager screams at an employee, the employee doesn’t scream back—but the employee may yell at her partner later that night.

Reaction Formation: Behaving or expressing the opposite of one’s true feelings. For instance, a man who feels insecure about his masculinity might act overly aggressive.

Sublimation: Channelling sexual or unacceptable urges into a productive outlet, such as work or a hobby.

Intellectualization: Focusing on the intellectual rather than emotional consequences of a situation. For example, if a roommate unexpectedly moved out, the other person might conduct a detailed financial analysis rather than discussing their hurt feelings.

Compartmentalization: Separating components of one’s life into different categories to prevent conflicting emotions.

Historical Context

Historically, mental illness and addiction have been misunderstood and stigmatized. For much of history, these conditions were seen as moral failings or character flaws rather than medical issues. This has led to a persistent stigma that continues to influence societal attitudes.

Lack of Awareness and Education

There is still a significant lack of awareness and education about mental health and addiction. Many people do not understand that these conditions are medical issues that require treatment, just like physical illnesses. This lack of understanding contributes to negative attitudes and discrimination.

Media Representation

Media often portrays mental illness and addiction in a negative light, reinforcing stereotypes and misconceptions. These portrayals can shape public perception and contribute to the stigma surrounding these conditions.

Criminalization

Addiction, in particular, has been heavily criminalised. This has led to a perception of addiction as a criminal issue rather than a health issue, further entrenching stigma and discrimination.

Internalised Stigma

Individuals with mental illness or addiction often internalise the stigma they experience, leading to feelings of shame and low self-worth. This can prevent them from seeking help and support, perpetuating the cycle of stigma and discrimination.

Healthcare System

Even within the healthcare system, biases and stigma can affect the quality of care provided to individuals with mental illness or addiction. This can lead to inadequate treatment and support, further exacerbating the issue.

Social and Cultural Factors

Social and cultural factors also play a role in how mental illness and addiction are perceived. Different cultures have varying attitudes towards these conditions, which can influence how they are treated and supported.

The differential treatment of treatment-resistant substance use disorder (SUD) and treatment-resistant cancer by society can be attributed to several factors:

1. Perception of Control

Substance use disorders are often perceived as a result of personal choices or moral failings, whereas cancer is seen as an uncontrollable disease. This perception leads to stigma and blame towards individuals with SUD, while those with cancer are more likely to receive sympathy and support.

2. Historical Stigma

Historically, substance use has been stigmatised and criminalised, leading to a societal view that addiction is a choice rather than a medical condition. In contrast, cancer has been recognized as a medical condition requiring treatment and compassion.

3. Media Representation

Media often portrays substance use in a negative light, emphasising criminality and moral failure. Cancer, on the other hand, is often depicted with empathy and urgency, highlighting the need for medical intervention and support.

4. Healthcare System

The healthcare system has historically been more equipped to handle cancer treatment, with extensive research, funding, and specialized care. SUD treatment has lagged behind, with fewer resources and less comprehensive care options.

5. Complexity of Treatment

Treatment-resistant SUD involves complex psychological, social, and biological factors, making it challenging to treat effectively. Cancer treatment resistance, while also complex, has seen significant advancements in research and technology, leading to more effective treatments.

6. Social and Cultural Factors

Cultural attitudes towards substance use and addiction vary widely, with some societies viewing it as a personal failing. Cancer is generally viewed more universally as a disease that requires medical intervention.

REFERENCES

Substance Use Disorder and Stigma

Australian Government Department of Health and Aged Care. (2024). Initiatives and programs. Retrieved from https://www.health.gov.au/about-us/what-we-do/initiatives-and-programs

Morrison, A. P., Birchwood, M., Pyle, M., Flach, C., Stewart, S. L. K., Byrne, R., Patterson, P., Jones, P. B., Fowler, D., & Gumley, A. I. (2013). Impact of cognitive therapy on internalised stigma in people with at-risk mental states. The British Journal of Psychiatry, 203(2), 140-145. https://doi.org/10.1192/bjp.bp.112.112110

Wood, L., Byrne, R., Burke, E., Enache, G., & Morrison, A. P. (2017). The impact of stigma on emotional distress and recovery from psychosis: The mediatory role of internalised shame and self-esteem. Retrieved from https://repository.essex.ac.uk/21927/1/woodpr2017.pdf

Cancer Treatment and Stigma

American Cancer Society. (2023). Cancer treatment and survivorship. Retrieved from https://www.cancer.org/treatment/treatments-and-side-effects.html

National Cancer Institute. (2022). Cancer treatment (PDQ)–Patient version. Retrieved from https://www.cancer.gov/types/treatment-pdq/patient/cancer-treatment-pdq

World Health Organization. (2021). Cancer treatment and palliative care. Retrieved from https://www.who.int/cancer/prevention/diagnosis-screening/cancer-treatment-palliative-care/en/

I would infer that you may be depleted in some area of your life. Generally, when I am having any of these experiences I can recognise that my basic needs, and possibly even transformative, needs are not met. My basic needs are food and water, adequate sleep, shelter and safety, social connection (belonging), and esteem needs (e.g., self-respect, self-worth, self-competence, mastery and achievement, integrity, sense of freedom and independence etc.). Perhaps only when all my deficiency needs are met, and I’m experiencing dissatisfaction with my growth needs, do I feel Restless, Irritable, and Discontent in this area of my life – however I assume some would argue that if I am feeling that way when attending to my growth needs, then I may have slipped back to Esteem Needs. You can look up Maslow’s Hierarchy of Needs for a visual representation if you like, using a search engine. Below is a GIF that I created to educate people on how we can buffer ourselves to vulnerabilities. It’s very telling to go into the body when we haven’t eat for a while, may be we’re running on caffeine, and you can feel the restlessness in the body. We have to fuel up when we’re hungry to buffer ourselves from becoming irritable and restless. If you’re feeling discontent with life, I would suggest a social activity, play time with friends, working on a project of some kind, or getting involved in your community.