The Stigma Of Mental Illness
- depression and anxiety
- neuroses and psychoses
- addiction
- antisocial disorders
Many people with serious mental illness are challenged doubly.
- On one hand, they struggle with the symptoms and disabilities that result from the disease.
- On the other, they are challenged by the stereotypes and prejudice that result from misconceptions about mental illness.
- As a result of both, people with mental illness are robbed of the opportunities that define a quality life: good jobs, safe housing, satisfactory health care, and affiliation with a diverse group of people.
The impact of stigma is twofold, as outlined in Table Table1.1.
- Public stigma is the reaction that the general population has to people with mental illness.
- Self-stigma is the prejudice which people with mental illness turn against themselves.
- Both public and self-stigma may be understood in terms of three components: stereotypes, prejudice, and discrimination.
- Social psychologists view stereotypes as especially efficient, social knowledge structures that are learned by most members of a social group (1-3).
- Stereotypes are considered "social" because they represent collectively agreed upon notions of groups of persons.
- They are "efficient" because people can quickly generate impressions and expectations of individuals who belong to a stereotyped group (4).
Table 1
Comparing and contrasting the definitions of public stigma and self-stigma
| Public stigma | |
| Stereotype | Negative belief about a group (e.g., dangerousness, incompetence, character weakness) |
| Prejudice | Agreement with belief and/or negative emotional reaction (e.g., anger, fear) |
| Discrimination | Behavior response to prejudice (e.g., avoidance, withhold employment and housing opportunities, withhold help) |
| Self-stigma | |
| Stereotype | Negative belief about the self (e.g., character weakness, incompetence) |
| Prejudice | Agreement with belief, negative emotional reaction (e.g., low self-esteem, low self-efficacy) |
| Discrimination | Behavior response to prejudice (e.g., fails to pursue work and housing opportunities) |
- People who are prejudiced, on the other hand, endorse these negative stereotypes ("That's right; all persons with mental illness are violent!") and generate negative emotional reactions as a result ("They all scare me!") (1,3,6).
- In contrast to stereotypes, which are beliefs, prejudicial attitudes involve an evaluative (generally negative) component (7,8). Prejudice also yields emotional responses (e.g., anger or fear) to stigmatized groups.
- Prejudice, which is fundamentally a cognitive and affective response, leads to discrimination, the behavioral reaction (9).
- Prejudice that yields anger can lead to hostile behavior (e.g., physically harming a minority group) (10).
- In terms of mental illness, angry prejudice may lead to withholding help or replacing health care with services provided by the criminal justice system (11).
- Fear leads to avoidance; e.g., employers do not want persons with mental illness nearby so they do not hire them (12).
- Alternatively, prejudice turned inward leads to self-discrimination.
PUBLIC STIGMA
Stigmas about mental illness are common in the Western world. Studies suggest that the majority of citizens in the United States (13,15-17) and many Western European nations (18-21) have stigmatizing attitudes about mental illness. Furthermore, stigmatizing views about mental illness are not limited to uninformed members of the general public; even well-trained professionals from most mental health disciplines subscribe to stereotypes about mental illness (22-25).
The available research indicates that, while attitudes toward mental illness vary among non-Western cultures (26,27), the stigma of mental illness may be less severe than in Western cultures.
- Fabrega (26) suggests that the lack of differentiation between psychiatric and non-psychiatric illness in the three great non-Western medical traditions is an important factor.
- While the potential for stigmatization of psychiatric illness certainly exists in non-Western cultures, it seems to primarily attach to the more chronic forms of illness that fail to respond to traditional treatments.
- Notably, stigma seems almost nonexistent in Islamic societies (26-28).
Several themes describe misconceptions about mental illness and corresponding stigmatizing attitudes.
- Media analyses of film and print have identified three:
- people with mental illness are homicidal maniacs who need to be feared;
- they have childlike perceptions of the world that should be marveled;
- or they are responsible for their illness because they have weak character (29-32).
- Fear and exclusion: persons with severe mental illness should be feared and, therefore, be kept out of most communities;
- authoritarianism: persons with severe mental illness are irresponsible, so life decisions should be made by others;
- benevolence: persons with severe mental illness are childlike and need to be cared for.
Although stigmatizing attitudes are not limited to mental illness, the public seems to disapprove persons with psychiatric disabilities significantly more than persons with related conditions such as physical illness (34-36).
- Severe mental illness has been likened to drug addiction, prostitution, and criminality (37,38).
- Unlike physical disabilities, persons with mental illness are perceived by the public to be in control of their disabilities and responsible for causing them (34,36).
The behavioral impact (or discrimination) that results from public stigma may take four forms:
- withholding help, avoidance, coercive treatment, and segregated institutions.
- Previous studies have shown that the public will withhold help to some minority groups because of corresponding stigma (36,40).
- A more extreme form of this behavior is social avoidance, where the public strives to not interact with people with mental illness altogether.
- Discrimination can also appear in public opinion about how to treat people with mental illness.
- more than 40% of the 1996 GSS sample agreed that people with schizophrenia should be forced into treatment (50).
- Additionally, the public endorses segregation in institutions as the best service for people with serious psychiatric disorders (19,51).
STRATEGIES FOR CHANGING PUBLIC STIGMA
Change strategies for public stigma have been grouped into three approaches:
- protest, education, and contact (12).
- Groups protest inaccurate and hostile representations of mental illness as a way to challenge the stigmas they represent. These efforts send two messages.
- To the media: STOP reporting inaccurate representations of mental illness.
- To the public: STOP believing negative views about mental illness.
- Anecdotal evidence suggests that protest campaigns have been effective in getting stigmatizing images of mental illness withdrawn.
Protest is a reactive strategy; it attempts to diminish negative attitudes about mental illness, but fails to promote more positive attitudes that are supported by facts.
- Education provides information so that the public can make more informed decisions about mental illness.
- persons who evince a better understanding of mental illness are less likely to endorse stigma and discrimination (17,19,52).
- Several studies have shown that participation in education programs on mental illness led to improved attitudes about persons with these problems (22,53-56).
- Education programs are effective for a wide variety of participants, including college undergraduates, graduate students, adolescents, community residents, and persons with mental illness.
- Stigma is further diminished when members of the general public meet persons with mental illness who are able to hold down jobs or live as good neighbors in the community.
SELF-STIGMA
Low self-esteem versus righteous anger describes a fundamental paradox in self-stigma (64). Models that explain the experience of self-stigma need to account for some persons whose sense of self is harmed by social stigma versus others who are energized by, and forcefully react to, the injustice. The sense of self for many persons with mental illness is neither hurt, nor energized, by social stigma, instead showing a seeming indifference to it altogether.
- Important factors that affect a situational response to stigma include
- collective representations that are primed in that situation,
- the person's perception of the legitimacy of stigma in the situation,
- and the person's identification with the larger group of individuals with mental illness.
CONCLUSIONS
All of the research discussed in this paper examines stigma at the individual psychological level. For the most part, these studies have ignored the fact that stigma is inherent in the social structures that make up society.
- Stigma is evident in the way laws, social services,
- and the justice system are structured
- as well as ways in which resources are allocated.
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