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The Consequences of Labeling Mental Illnesses on the Self-concept: A Review of the Literature and Future Directions
Abstract
Diagnosis of mental illness has become increasingly reified. People are being labeled; they are seen as being mentally ill instead of having a mental illness. Unfortunately, negative stereotypes are associated with mental illness. According to labeling theory, the stigma of being labeled mentally ill actually causes one to be mentally ill as a result of effects described as self-fulfilling prophecy. According to a modified version of the theory, assumptions about causation are omitted, and only the negative impact on self-concept is addressed. This impact is described in later research about stigma and self-stigma. Stigma can have negative consequences for selfconcept by lowering self-efficacy, which fosters dysfunctional coping styles and ultimately reduces quality of self-concept. Also, stigma can be internalized and create self-stigma, in which the label predominates selfconcept and reduces self-esteem. Thus, eventually, the reification of diagnosis leads to lowered self-concept through stigmatization effects. In spite of these negative effects, it is reasonable to believe that positive effects also exist. A label could foster self-acceptance, causing one to seek treatment, and can also foster interpersonal understanding. It is argued that these effects should be investigated. On the basis of outcomes, it should bedecided whether diagnosis should or should not be reported to the patient.
... Research has found that individuals labeled as mentally ill are less likely to be employed 5 and employers often assume that people with a mental illness may be more likely to be absent, dangerous or unpredictable 6 . Once people have been labeled as mentally ill, they are more likely to be underemployed or earn less than people with the same psychiatric difficulties who have not been labeled as mentally ill 7 . These findings show that labeling alone can affect employment opportunities without taking a person's ability, knowledge, education, or qualifications for a particular job into account 7 . ...
... Once people have been labeled as mentally ill, they are more likely to be underemployed or earn less than people with the same psychiatric difficulties who have not been labeled as mentally ill 7 . These findings show that labeling alone can affect employment opportunities without taking a person's ability, knowledge, education, or qualifications for a particular job into account 7 . ...
... This result could be explained by the fact that when the true nature of the illness is known, people feel more comfortable and rather sympathise towards the mentally ill person, and thus show more positive attitudes 12 . However, contrarily another study found increased negative attitudes when an illness label was mentioned 7 31 . However, one interesting observation was that a higher biological stigma was seen towards the illnesses in both presence and absence of label however this observation is only due to a visual inspection of the means rather than through an results of inferential statistics. ...
Background: Despite growing awareness, stigma against mentally ill individuals is still prevalent in society. Different labels attached to mental illnesses receive varying amounts of stigma. Moreover, materialistic societies have been shown to display a more negative outlook towards mentally ill individuals while compulsive disorders in general, elicit more negative attitudes. However, there has been only little research on the impact of materialism and the use of labels attached to mental illnesses, in relation to mental illness stigma. The current study focused on effects of materialism and label attachment on mental illness stigma in relation to perception of two compulsive disorders: oniomania (compulsive shopping) and kleptomania (compulsive stealing). Materials & Methods: A multicultural sample of 120 participants was recruited from Knowledge Village, Dubai. Participants were randomly assigned to one of four conditions; oniomania labeled or oniomania non-labeled (questionnaire depicting oniomania with either illness name present or absent), kleptomania labeled or kleptomania non-labeled (questionnaire depicting kleptomania with either illness name present or absent). Materialism and attitudes towards mentally ill individuals were assessed in two self-report questionnaires and participants were requested to watch a video depicting the illness between filling the questionnaires. Results: No significant influence of materialism or labels on mental illness stigma was found, as ps > .05. However, this study found that illness type appeared to be a stronger predictor of mental illness stigma than the other predictors of materialism and label attachment. Conclusion: This study suggests that stigma can be reduced more effectively by creating awareness of mental illnesses.
... By applying the stereotypical attitudes to the own person, the resulting self-stigma probably influences self-esteem and also self-efficacy (Corrigan et al., 2009). A current literature review on labeling mental illnesses relates the labeling effect to individual's self-concept (Pasman, 2011). By lowering self-efficacy which fosters dysfunctional coping styles, the label of a mental illness by clinical diagnosis can ultimately reduce the quality of one's selfconcept (Pasman, 2011). ...
... A current literature review on labeling mental illnesses relates the labeling effect to individual's self-concept (Pasman, 2011). By lowering self-efficacy which fosters dysfunctional coping styles, the label of a mental illness by clinical diagnosis can ultimately reduce the quality of one's selfconcept (Pasman, 2011). Taken together, labeling individuals can initiate a process including a negative self-labeling or (self-)stigma leading to damages in individual's self-efficacy and finally might have negative consequences on one's self-concept. ...
... Thus, Briken et al. (2014) comprehensibly concluded that attributing oneself as having a sexual preference for children unable to change might have negative effects on specific self-efficacy beliefs and thereby might harm the possibility to actually change behaviors and interests. According to this, literature on the labeling theory (e.g., Link, Struening, Cullen, Shrout, & Dohrenwend, 1989), the effects of a self-labeling process (e.g., Walters, 2002) or of a self-stigma (Pasman, 2011) gives rise to justifiable doubts whether diagnosing individuals with an unchangeable sexual preference for children has positive results both on the progress of treatment and for the individual's quality of life. Individuals receiving the diagnosis of pedophilia or pedophilic disorder might label themselves with the implied characteristics of this diagnosis leading to a self-efficacy impaired by the belief that they are not able to change their sexual interest in children. ...
Today's competing positions regarding the flexibility of pedophilic sexual interest are of increasing relevance. Besides empirical research on this specific topic, theoretical work grounded on scientifically sound research is equally needed. From a theoretical perspective, this paper aims to deduce if self-efficacy to change sexual interest in children may influence men with a risk to sexually abuse children in a positive way. We focus on research literature on (1) self-efficacy and (2) sexual interest in children in order to (3) link both. By this, we provide a framework within which sexual interest in children may also be seen as flexible and changeable due to specific therapeutic interventions. By addressing the individuals' conviction of being able to alter their sexual interest in children, the required motivation for change might be enhanced and help the individuals in changing and developing. Finally, both research and clinical implications are given.
... For example, modified labeling theory predicts that individuals who self-label are more likely to engage in avoidant coping in response to stigma (Corrigan et al., 2009;Moses, 2009;Pasman, 2011). Coping with emotional distress in avoidant ways is associated with negative outcomes in depression (Kasch et al., 2002;Nolen-Hoeksema, 1991;Seiffge-Krenke & Klessinger, 2000). ...
... These results provide early, non-causal evidence that self-labeling for depression is associated with reduced perceived control over depression, more maladaptive emotion regulation strategies, and more positive attitudes towards medication (but not therapy) in U.S. college students. In some ways, this mirrors prior research on modified labeling theory, which has found that self-labeling with stigmatized mental illness labels is associated with lower levels of self-efficacy and avoidant strategies for coping with stigma (Corrigan et al., 2009;Moses, 2009;Pasman, 2011) along with more help-seeking from professional sources (Corrigan et al., 2014;Horsfield et al., 2020;Stolzenburg et al., 2017). The present study, however, constitutes one of the first empirical attempts to apply modified labeling theory to how individuals manage the emotional distress that accompanies depression, rather than its stigma. ...
... However, evidence indicates that reified diagnosis leads to stigma and especially selfstigma and experienced as well as expected stigma then leads to maladaptive coping responses (Madsen et al., 2013). Thus, the reification of diagnosis may ultimately result in lowered self-concept amongst mental health patients (Pasman, 2011). This implies that a diagnosis might not only be statistically and conceptually invalid (as shown earlier) but even harmful to therapeutic progress since it builds a seemingly inescapable and limiting construct around the individual. ...
... Consequently, the patient's perceived sense of self undergoes drastic changes likely resulting in devastation and hopelessness about future decrease of psychological distress (Pasman, 2011). This implies that the negative preconceptions communicated through negative terminology associated with the diagnosis substantially create the negative affect in the patient's prediction of future changes. ...
The paper at hand aims at exploring clinical implications following the application of the
network conceptualization, as proposed by Borsboom and colleagues, to therapeutic interventions targeting schizophrenia. The central research question to be addressed is the following: What does the network approach of psychopathology imply for therapeutic interventions treating schizophrenia? In the first part, the network approach is outlined, including evidence for the notion that it is indeed a fundamentally novel, yet valid conceptualization of psychopathology and more specifically, schizophrenia. Schizophrenia is hereafter discussed taking two stances, the neuroscientific as well as the DSM’s and is then approached by the network conceptualization. Thereafter follows an examination of the influential power that the altered conceptualization could exert on the theoretical ground of diagnosis and therapeutic methods typical for schizophrenia (such as CBT). In correspondence, the examination is continued by identifying ways to integrate the network- based theoretical frame into the common therapeutic ground, potentially creating the birthplace for more effective therapeutic interventions. Finally, a conclusive discourse aspires to provoke critical thoughts regarding the controversial claim that schizophrenia in fact is nothing more than a limiting label, hinting towards treatment approaches that conceptualize interacting symptoms as dysbalanced networks (potentially mindfulness-based interventions).
Keywords: network conceptualization, network approach, schizophrenia, mindfulness
... Scheff's original work on labeling theory and mental health invoked harsh criticisms from other sociological theorists. As a result, Link and colleagues (1989) modified Scheff's theory (Pasman, 2011). The fundamental difference between these two theoretical approaches to mental illness is that the modified labeling theory removed indications relating to causation, such that it was no longer argued that labeling or diagnosis causes mental illness, but that it is related to how an individual's behaviours are understood by themselves and others. ...
... Mental illness labels create a dichotomous 'us' ('normal' people) versus 'them' ('mentally ill' people) relationship. The 'mentally ill' out-group is perceived as homogenous and is socially defined as a whole by negative stereotypes (e.g., unpredictability, dangerousness, laziness) that lead to discrimination and social exclusion (Pasman, 2011). These visions of the mentally healthy/ill dichotomy and the social exclusion of mentally ill individuals are supported by research conducted by Pat Caplan (1995). ...
Ashley Smith, who is typically presented in the media as mentally ill, was nineteen years old when she died from self-strangulation in an Ontario women’s prison on October 19th, 2007. In this paper, I explore how Ashley Smith’s actions and death were portrayed in four mainstream Canadian newspapers (Globe and Mail, Telegraph-Journal, Toronto Star and National Post). My aims in this paper are to critically analyze depictions of mental illness presented by these news articles and connect these portrayals to labeling theories. Two variables—the timing of the news coverage and newspaper political affiliation—emerged as being influential in how newspapers depicted Ashley Smith as mentally ill, through their use of generic and/or negative terminology and vulnerability stereotypes. I also discuss ‘alternative’ stories of Ashley Smith and examine their potential to challenge typical conceptualizations of mental illness, gender and carceral environments.
... Scheff's original work on labeling theory and mental health invoked harsh criticisms from other sociological theorists. As a result, Link and colleagues (1989) modified Scheff's theory (Pasman, 2011). The fundamental difference between these two theoretical approaches to mental illness is that the modified labeling theory removed indications relating to causation, such that it was no longer argued that labeling or diagnosis causes mental illness, but that it is related to how an individual's behaviours are understood by themselves and others. ...
... Mental illness labels create a dichotomous 'us' ('normal' people) versus 'them' ('mentally ill' people) relationship. The 'mentally ill' out-group is perceived as homogenous and is socially defined as a whole by negative stereotypes (e.g., unpredictability, dangerousness, laziness) that lead to discrimination and social exclusion (Pasman, 2011). These visions of the mentally healthy/ill dichotomy and the social exclusion of mentally ill individuals are supported by research conducted by Pat Caplan (1995). ...
... Therefore, individuals should use personality assessments as tools for self-awareness, interpreting results rationally rather than definitively. Recent research on self-labeling has focused on stigmatization [14], mental health discrimination [15], and cultural differences [16,17], with limited exploration of self-labeling from online personality assessments. Other studies have analyzed text features or used longitudinal tracking to examine labels' impact on mental health [18,19]. ...
The rise of online personality assessments has drawn widespread attention, but their impact on adolescents' interpersonal relationships and mental health remains unclear. This study investigates how self-labeling from these assessments affects mental health through interpersonal relationships. This study explores the mediating role of interpersonal relationships between online personality labeling and mental health based on the usage of online personality assessments among adolescents. A questionnaire survey was conducted among 575 internet users aged 14-25 (135 males, 440 females). Online personality self-labeling, interpersonal relationships, and mental health were measured using three questionnaires. Through statistical analysis, a simple mediation model with interpersonal relationships as the mediating variable was constructed to analyze the relationship between self-labeling and mental health. The results show that interpersonal relationships significantly mediate the relationship between the cognitive-affective aspect of self-labeling and mental health, while the social performance aspect of self-labeling has a direct effect on the suppression aspect of mental health. This provides new directions for future research on self-labeling phenomena and the development of adolescent interpersonal relationships and mental health.
... Previous studies have demonstrated the impact of labeling, stigma, and self-stigma on the self-concept, self-efficacy, and subsequent behavior of individuals with mental illness (Pasman, 2011). It has been proposed that self-stigma, in which individuals internalize negative stereotypes held by others, negatively impacts outcomes; such effects may be compounded by the "insight paradox" in which the negative effects of self-stigma are compounded by better insight. ...
... Terror management theory [42] suggests that uncertainty triggers the defense response which results in individuals targeting on things that are considered as the threat to life. Similarly, labeling theory [43] proposes that stigmatization provides a sense of relief when labeling uncertainty [44] because stigmatizing others can be considered as a strategy to avoid the danger and protect the community, which generates psychological comfort [45]. Therefore, the uncertainty of COVID-19 could have caused the public to have stigmatizing thoughts about healthcare workers because medical work contains the risk of infection [44]. ...
Background
COVID-19-related stigmatization refers to COVID-19-related judgements by others that devalue the individual. Such stigmatization towards healthcare workers may cause psychological burden and negative consequences. Such stigmatization may have particularly overwhelmed allied health trainees (AHTs) and post-graduate year doctors (PGYDs) because they just started their medical career. Social support and resource support have been reported to benefit psychological health and reduce stigmatization. Therefore, the present study used a cross-sectional study design to investigate the association between perceived stigma, self-stigma, psychological distress, and negative outcomes (including emotional exhaustion, insomnia and suicidal ideation) among AHTs and PGYDs in Taiwan.
Methods
An online survey distributed between July and December, 2022 received 522 responses. Variables were assessed using the 21-item Depression, Anxiety and Stress Scale, Insomnia Severity Index and a series of self-designed questions to assess social support, resource support, perceived stigma, self-stigma, emotional exhaustion, and suicidal ideation.
Results
Structural equation modeling showed that perceived stigma was associated with self-stigma (standardized coefficient [β] = 0.428, p < 0.001), and self-stigma was associated with psychological distress (β = 0.197, p < 0.001), as well as being associated with emotional exhaustion, insomnia, and suicidal ideation (β = 0.349, 0.556 and 0.212, all p-values < 0.001). While social support and resource support were negatively associated with perceived stigma (β= − 0.175 and − 0.152, p < 0.01), additional associations were found between social support and emotional exhaustion (β= − 0.093, p < 0.001), as well as between resource support and insomnia (β= − 0.120, p < 0.001).
Conclusions
The results showed that COVID-19 related stigmatization was correlated to the detrimental consequences of emotional exhaustion, insomnia and suicidal ideation. Clear paths regarding the associations of social support and resource support with the three negative associations were found as the possible solutions. Strategies to reduce the stigmatization and these negative outcomes, or improve the psychological health will benefit AHTs and PGYDs in maintaining a healthy mental status.
... Psychiatric diagnoses classify behavioral patterns by evaluating patients and placing them on a medical continuum, which resonates with social, cultural, and moral implications (Gaines 1992;Jutel 2009:278). Medical, in particular psychiatric, categories thus reflect and reproduce biocultural scripts with which patients are expected to align (Kleinman 1988;Mizrachi 2001;Pasman 2011;Perry 2011). ...
According to psychiatry, Attention-Deficit/Hyperactivity Disorder (ADHD) is a chronic condition beginning in early life. Psychiatry advocates for early diagnosis to prevent comorbidities that may emerge in untreated cases. “Late”-diagnosis is associated with various hazards that might harm patients’ lives and society. Drawing on fieldwork in Israel, we found that ‘midlife-ADHDers,’ as our informants refer to themselves, express diverse experiences including some advantages of being diagnosed as adults rather than as children. They share what it means to experience “otherness” without an ADHD diagnosis and articulate how being diagnosed “late” detached them from medical and social expectations and allowed some to nurture a unique ill-subjectivity, develop personal knowledge, and invent therapeutic interventions. The timeframe that psychiatry conceives as harmful has been, for some, a springboard to find their own way. This case allows us to rethink ‘experiential time’—the meanings of timing and time when psychiatric discourse and subjective narratives intertwine.
... Of note is that there has been some attention by sociologists (Scheff, 1966) on labeling of mental illness which is an inherent topic of the fields of psychology and psychiatry. Namely, it has been argued whether when an individual is labeled as "mentally ill, " these individuals adapt their behaviors to fulfill the expectations of such a label (Pasman, 2011;Scheff, 1966). Here we apply the same reasoning to the label of stereotypical "risk-taker. ...
Adolescents are stereotypically viewed as risk-takers (“stereotypical risk-takers”) in science, mainstream media, fictional literature and in everyday life. However, increasing research suggests that adolescents do not always engage in “heightened” risk-taking, and adolescents’ own perspectives (motives) on risk-taking are largely neglected in research. Hence, this paper is a commentary and review with two aims. First, taking a cross-national perspective, we discuss the definition of adolescence and risk behavior. We argue that much of the research on what drives adolescent risk behavior (e.g., substance use) focuses on the harms that this behavior promotes rather than on the need to explore and grow into adulthood. Thereafter we summarize the dominant approach to studying motives behind substance use, which has mostly considered young adults, and which has typically not focused on adolescents’ own self-generated motives. The few empirical studies (including one of our qualitative studies) on adolescents’ own motivations for engaging in risk behavior (i.e., cannabis use, alcohol use, and tobacco smoking) show that the most frequently mentioned motives by adolescents were being cool/tough, enjoyment, belonging, having fun and experimenting and coping. Interestingly, the “cool/tough identity” motive is virtually overlooked in research on adolescent risk-taking. The above-mentioned motives, however, generally support newer theories, such as the Developmental Neuro-Ecological Risk-taking Model (DNERM) and the Life-span Wisdom Model that suggest that adolescents’ motivations to engage in risk-taking include experimentation, identity development, explorative behavior, and sensation seeking, all of which run counter to the stereotype of adolescents engaging in risk-taking due to “storm and stress.” Hence, we also briefly consider additional recent attempts to study positive forms of risk taking. Second, extrapolating from sociological/criminological theories on labeling, we suggest that caution is warranted when (inaccurately) labeling adolescents as the “stereotypical risk-takers,” because this can instigate a risk-taking identity in adolescents and/or motivate them to associate with risk-taking peers, which could in turn lead to maladaptive forms of risk-taking. Empirical research testing these hypotheses is needed. To conclude we argue that research on adolescent risk-taking could further benefit from considering adolescent’s own motivations, which is also in line with the participatory approach advocated by international children’s rights standards.
... The diagnosis itself helps patients to cope and further allows for a brief period of self-reliance before further intervention is required. Yet, it is important to note that some might perceive a diagnosis as unhelpful, given that negative stereotypes might lead to self-stigmatisation and lowered self-esteem, which can facilitate self-fulfilling effects in the form of worsening symptoms [53]. Additionally, the waiting list was still too long for Lucy, suggesting that prompt treatment should still be prioritised. ...
Waiting lists in mental health services are currently considered too long. Lengthy waits of up to 18 weeks are commonly reported in the UK. Waiting lists have long been associated with a variety of negative psychological responses, however there is little understanding behind young adults’ personal experiences of such delays within mental health services. The current study aimed to explore young adults’ experiences of waiting lists in mental healthcare in the UK. Seven young adults were interviewed in the current study (aged 19–22). Interpretive phenomenological analysis was utilised to explore participant accounts. Three super-ordinate themes were generated: Reliance on Alternative Methods of Support; Inability to Function Sufficiently; and Emergence of Negative Beliefs, Emotions and Thoughts. Participants primarily reported a variety of negative psychological and behavioural consequences associated with waiting lists in mental health services, as well as exacerbated existing physical and psychological health issues. In accordance with the limited number of previous studies, waiting lists are considered by patients to be barriers to mental health support and intervention. Future direction is advised.
... This second implications brings about a discussion of reification, which is the process of treating certain abstract constructs as real, meaningful objects. The process of reification is a concern from both a labeling perspective, as well as a scientific perspective (see Duster, 2005;Pasman, 2011). From a labeling perspective, there is a concern of assigning an individual a label (e.g., offender, criminal, felon, delinquent) that does not truly belong to that individual, as it may result in the individual taking on the label and experiencing negative outcomes (e.g., lowering of self-esteem; Pasmnan, 2011). ...
The goal of this study was to identify distinct and meaningful profiles of the seven criminogenic risk and need domains included on the Ohio Youth Assessment System—Disposition Tool (OYAS-DIS). This goal was accomplished by conducting a latent profile analysis (LPA) on a sample of 4,383 formally processed justice-involved youth assessed by the OYAS-DIS. The LPA determined there were six distinct profiles: (1) Low risk and need, (2) Low/moderate risk and need, (3) Low risk/need with high juvenile justice history, (4) Academic, mental health, and substance use needs, (5) Prosocial skills and decision making, and (6) High risk and need. Results may help juvenile justice practitioners to identify and address specific intervention needs of adjudicated youth.
... According to Pasman [25] , labels can function as a person's self-justification if their behavior is not socially acceptable. ...
Aims:
Nurses are one of the health workers who face a high risk of contracting a disease at their workplace. The officers who are inconsistent in maintaining standard precautions when treating patients render nurses to be exposed to infectious disease.
Settings and design:
This was an analytic observational study with a longitudinal design.
Materials and methods:
This study was carried out in two Provincial B Type Government Hospitals, namely, Labuang Baji Provincial Regional Hospital and Makassar Haji Regional General Hospital, in Makassar City, with a sample size of 104 respondents. The data were subjected to ANOVA test to determine the effect of organizational factors on reducing the risk of AIDS risk reduction model-based disease transmission.
Results:
The results of this study indicate that the organizational factors do not affect the labeling of nurses related to the reduction of the risk of disease transmission (b = 0.086, ρ = 0.379). The organizational factors influence nurses commitment related to the reduction of the risk of disease transmission (b = 0.328, ρ = <0.001) and also their enactment related to the reduction of the risk of disease transmission (b = 0.199, ρ = 0.030).
Conclusions:
The organizational factors related to the reduction of the risk of disease transmission affect the action of nurses to reduce the risk (enactment) through the commitment. These organizational factors also affect the labeling of nurses as individuals who are at a risk of contracting a disease so as to facilitate the adoption of a behavior to reduce the risk of disease transmission in hospital.
... Or vice versa, one's self-beliefs about being able to change one's sexual interest in children are reflected in the actual sexual interest in children. According to literature on the labeling theory (e.g., Link, Struening, Cullen, Shrout, & Dohrenwend, 1989) or on the effects of a self-stigma in people with mental illness (e.g., Corrigan, Watson, & Barr, 2006;Pasman, 2011), and taking into account previous research on SSIC (Tozdan & Briken, 2015a;Tozdan & Briken, 2015b;Tozdan et al., 2015), we suggest the avoidance of generalized and absolute statements about the immutability of a sexual interest in children. Such statements might have serious consequences for some individuals' self-beliefs about their ability to change the sexual interest in children (Tozdan et al., 2016) and might become a self-fulfilling prophecy according to the present results. ...
Among 26 pedophilic/hebephilic men, we investigated (1) the relationship between ‘specific self-efficacy for modifying a sexual interest in children’ (SSIC) and actual sexual interest in children and (2) whether changes of SSIC are associated with changes of sexual interest in children. Results showed that the more clients believe they are able to influence their sexual interest in children, the less strong they perceive their sexual interest in children. Furthermore, an increase of SSIC is associated with a decrease of the sexual interest in children. We suggest avoiding generalized statements about the immutability of a sexual interest in children.
... This might thus decrease their motivation to change their sexual interest in children and might thus also hinder possible actual changes in behaviors and interests. According to the literature on labeling theory (Link, Struening, Cullen, Shrout, & Dohrenwend, 1989), on the effects of a self-labeling process (Walters, 2002) and on self-stigmatization (Pasman, 2011), the assumption of the immutability of one's sexual interest in children might become a self-fulfilling prophecy. In contrast, presenting the information that pedophilia is considered by experts to be more or less flexible and changeable may increase an affected person's SSIC. ...
In this study, the impact of suggesting that pedophilia is immutable on a man's specific self-efficacy for modifying his sexual interest in children was examined in 94 men with a sexual interest in children. The participants were selected from differing contexts and included non-forensic patients, forensic patients, and participants from the Internet. Randomly distributed to two conditions, the mutable condition group received the information that experts consider pedophilia to be modifiable, whereas the immutable condition group received the information that experts consider pedophilia to be stable. Afterward, the participants' levels of specific self-efficacy for modifying their sexual interest in children were assessed. Non-forensic participants in the mutable condition reported higher levels of specific self-efficacy than those in the immutable condition. No differences in specific self-efficacy were revealed for the forensic and Internet participants when comparing the mutable and immutable conditions. It would appear appropriate to avoid generalized and absolute statements about the (im)mutability of sexual interest in children, as scientific research on this topic remains insufficient. Furthermore, given the present results, such statements might have serious consequences for an individual's belief in being able to change his sexual interest in children.
... The classification-problem results from the inevitable subjectivity of basic diagnostic categories. Besides, the subjectivity of diagnosis, the stigmatization of mental illness and the associated shame and social exclusion distinguishes mental health problems from most somatic health problems (e.g., McDaid 2003;Pasman 2011;Sartorius 2006). ...
A more nuanced perspective on cognition, behavior, personality, and pathology. Mind/brain. It is explained that mental activity is not possible without concepts/memory structures that exist in the brain and result from perceptual learning. Core mental activities including thinking, reasoning, and judgment are described as components of self-regulation and in terms of interacting neural systems. This framework also leads to a more specific and less stigmatizing system for classifying and diagnosing mental illnesses. This concise volume: Introduces the S-O-R (stimulus-organism-response) model of mental activity. • Recasts mental processes as neuro-mental processes. • Provides empirical evidence for the neural basis for judgments. • Addresses ongoing mind/brain questions such as whether thinking is unconscious. Key Insights into Basic of Mental Activity will interest scientists doing research in psychology, psychiatry, psychotherapy, human biology/anthropology, linguistics, and neuroscience. Professors, lecturers, and instructors will find it important as a class text in these fields. And the book’s clinical implications make it useful to practitioners of psychology, psychiatry, and psychotherapy.
... The societal expectations (from the mentally ill) become a lens through which a patient's behaviour is evaluated. People are being labelled; they are seen as being mentally ill instead of having a mental illness (Pasman 2011). Therefore, according to labelling theory, the label of being mentally ill actually causes one to be mentally ill as a result of effects described as the Thomas theorem. ...
This chapter explains some interpretive substantive theories in medical sociology including social construction of illness, trajectory of chronic illness, labelling theory, theory of social stigma, the total institution theory, and a note on postmodernism. All of the substantive theories are based on microanalysis, subjectivity, and the idiographic approach. The social construction of illness focuses on how social forces or context shape human understanding of illness. It focuses on the social origin of disease and how individuals also construct responses within a sociocultural context. The social construction of illness indicates that illness does not mean the same across cultures and that it depends on the perception of the individuals. The key references here include Kleinmann’s explanatory model of health and illness, focusing on perceived aetiology, symptoms, pathophysiology, course of illness, and treatment. The peculiarities of chronic illness are explored with a model developed by Corbin and Strauss. Then, two social reaction theories, namely labelling theory and the theory of social stigma, are presented. Reference is made to the works of Howard S. Becker and other classical proponents of labelling theory. After the discussion of the features of labelling theory with the aid of a framework, reference is made to the works Thomas Scheff and Walter Gove, who are leading proponents in the application of labelling theory to mental illness. The later part of the discussion relates to the application of the labelling theory to mental illness. Two important theoretical stances from Erving Goffman (1922–1982) are presented—the theories of stigma and total institution. Some emerging trends of the classical ideas of Goffman are examined.
... The prevalence of feelings of non-acceptance and lower self-esteem (Corrigan et al., 2009;Davis et al., 2012;Verhaeghe et al., 2008;Yanos et al., 2008) leads individuals to avoid social interactions, which, in turn, may lead to compromised outcomes such as isolation and worse quality of life (QOL). Social stigma may provoke the strategy of social withdrawal (Pasman, 2011;Perlick et al., 2001) to protect self-esteem (Crocker & Major, 1989). ...
Background:
People with mental illness who internalize stigma often experience reduced self-esteem and impaired quality of life (QOL).
Aims:
To propose a theoretical model in which self-esteem mediates the effects of internalized stigma on the multidimensional domains comprising QOL.
Method:
In 403 inpatients and outpatients (DSM-IV, American Psychiatric Association, 1994), from hospital-based and community mental health facilities, self-report measures of internalized stigma (ISMI), self-esteem (RSES) and QOL (WHOQOL-Bref) were administrated.
Results:
Structural equation modeling results supported the proposed model. Self-esteem fully mediated the relation between internalized stigma and the physical and the social relationships domains, and partially mediated the relationship between internalized stigma and psychological, environment and level of independence QOL domains. Such results provided empirical support and shed light upon previous research. Specifically the results emphasize the mediating role that self-esteem plays in the degree to which internalized stigma exerts a negative effect on specific QOL domains.
Conclusions:
Self-esteem appears to be a core element in reducing the negative effects of internalized stigma on aspects of QOL among people with mental illness. These findings suggest there is a crucial impact regarding clinical mental health interventions along with important theoretical implications.
... A Dynamic Cycle of Familial Mental Illness commences at the time of parental diagnosis of mental illness. While it is acknowledged that a person may experience mental health changes prior to the time of diagnosis, the diagnostic period is highlighted within the literature as a particular time of concern, given increased experiences of stigmas, labelling of illness and a noticeable reduction in individual and familial recovery efficiency beliefs (Angermeyer & Matschinger, 2003;Link, Cullen, Struening, Shrout, & Dohrenwend, 1989;Moses, 2008;Pasman, 2011). The child's experiences of stigma in relation to parental mental illness are offered. ...
In this paper, we present A Dynamic Cycle of Familial Mental Illness; an innovative framework, which considers family members' experiences and responses to mental illness. There is an acknowledged discourse noting parental experiences of mental illness alongside a growing body of knowledge acknowledging children's needs while living with parental mental illness. However, there is a paucity of literature that makes reference to the concept of familial mental illness and the cyclic interface of parental and child distress and symptoms. The model is supported by published research studies from several differing disciplines to demonstrate the relationship between parent and child experiences and to synthesise the published short- and longer-term possible impact of familial mental illness. An extensive search of the literature using recognised search engines, keywords and phrases has been undertaken, to generate an appropriate literature base for this work. This literature demonstrates how a child's possible emotional distancing as a response to parental mental illness could increase parental distress. A Dynamic Cycle of Familial Mental Illness adopts the underpinning philosophy of a Stress Vulnerability Model of Mental Illness, which assumes that predisposing factors and increased stress for a parent may have possible links to exacerbation of parental mental distress and symptomology. We advocate for further research of familial mental illness, and argue for a family approach to mental health assessment and treatment in mainstream health and social care sectors.
The self-concept is conceived as the idea that a person has built of himself, product of the self-observation of his own capacities and limitations. The aim of this paper is to describe the self-concept in a sample of patients with bipolar disorder. Cross-sectional study, with descriptive characteristics. Intentional sampling, 36 people were evaluated through the AF5 questionnaire. When performing a comparison of means between groups, no statistically significant differences were found for any of the dimensions. Women scored below the scale in the emotional and family dimensions and men scored below in the social and family dimension. It is important that future studies establish relationships with other variables that can mediate the emotional response in the presence of a diagnosis of mental illness, such as resilience, in the same way other clinical samples and from different age ranges should be included, the importance of knowing The functioning of the variable studied in different population groups and clinical conditions lies in the possibility of generating intervention strategies that can affect the prognosis of the disease itself. The results are discussed in light of the scientific literature on the subject.
Concern over substance use, including alcohol, marijuana, and amphetamines, among college students remains high. Substance use on campus is associated with a seemingly endless list of negative outcomes including decreased academic performance, inhibited cognitive functions, physical and sexual violence, and even death. Cast against a backdrop of increasing substance use rates over the past few decades, we argue that criminologists must turn towards examining novel—and perhaps unexpected—correlates of substance use to better address this issue. In light of this, the current study draws from labeling theory to explore the linkage between paranormal beliefs, stigma, and substance use among college students. Specifically, we examine how both internalized negative messages about paranormal beliefs and perceived external stigma about paranormal beliefs relate to substance use among college students. Analysis of an original dataset from a midsized university revealed that respondents who internalized a negative label about their paranormal beliefs reported elevated levels of substance use relative to those who did not internalize negative paranormal labels. Second, individuals who reported believing society assigns a negative stigma to paranormal beliefs reported lower levels of substance use. Finally, considering the importance of both internal and external stigma, examination of an interaction between these two constructs indicated that greater levels of external social stigma conditioned a negative relationship between label internalization and substance use. We examine the implications of these findings for substance use among college students.
The self-fulfilling prophecy can be best described as an assumption that, only because of the fact of being believed, provokes certain expectations and patterns of behavior that eventually make the initial assumption come true. This phenomenon has been long studied in a variety of applied settings, including the one of mental health care: in this regard, the concepts of stigma and self-stigma have been proven to be, in part, self-fulfilling. Service design has been working in the field of mental health care to address these issues by promoting service co-production and a recovery-oriented approach. However, shared beliefs and norms within organizations, rooted in unquestioned and taken-for-granted ways of operating, may hinder this transformational process. In fact, these shared beliefs and norms may result in unconscious self-fulfilling prophecies, that are, positive and negative feedback loops of thinking and acting in the form of virtuous and vicious circles. Recent studies in service design identify institutional theory at the macro-level and mental models’ theory at the micro-level as promising practices to prompt individual and collective reflexivity to overcome these barriers. This chapter aims to further develop this research stream to address both virtuous and vicious circles at the micro-level, in order to reveal, question, and transform them if necessary to foster change at the macro-level, too. Through an experimental work within a Northern-Italy department of mental health care, this chapter reflects on which kinds of service design reflexivity tools can help to enable transformational processes across service systems.
Aim
To understand how employees with schizophrenia in disability employment interpret their work experience.
Method
Nine people with schizophrenia were interviewed. Data were analysed with the interpretative phenomenological analysis.
Results
All participants regarded themselves as ‘persons with mental illness’. Some participants developed their mental illness identity by realising that working without accommodations is difficult. Although participants found working in the current company comfortable because the supervisors provided appropriate accommodations, they were dissatisfied with low salary. A proportion of the participants felt dissatisfaction with the menial work, which led to low levels of self-esteem as they viewed non-disability employment of higher value. In addition, the present study noted a difference between self-labelling and labelling by others; although participants regarded themselves as ‘persons with mental illness’, they felt reluctant to be viewed as such by others. Most of the participants wanted to work in non-disability employment in future for financial and personal reasons, such as to increase self-esteem.
Conclusion
It is imperative that benefits and other issues in disability employment for people with psychosocial disability relating to mental illness are explored more broadly in future research. Further, employers must create healthy workplaces, for all employees regardless of disability can benefit from it.
Sanism is the systematic oppression of people who have experiences often labeled as mental illness. The author, a psychiatrically disabled, queer art therapist, describes her direct experiences of stigma and sanism as a past art therapy student and current art therapy educator. The framework of disability justice, a creative and intersectional response to ableism and sanism, resists pathologizing, medical model approaches to disability and engages art as a means of change-making. Art therapy educators can use a disability justice framework to challenge sanism in the classroom and embrace anti-oppressive pedagogy as a means of dismantling oppressive cultural norms in art therapy.
Self-stigmatisation is recognized as a significant barrier for people who suffer from a psychiatric disorder. However, its treatment has largely been neglected since self-stigmatisation is difficult to detect via the usual models of psychotherapy. Creative art therapies (CAT) seem to be a factor of positive change towards patients’ lives. Nonetheless, the role that art can play on patients’ self-stigmatisation emotions has not been fully investigated yet. The present study covers this gap, focusing on creative art therapists’ understanding of how they can help psychiatric patients who suffer from self-stigmatisation. Seven creative art therapists were individually interviewed via semi-structured interviews. Interviews were audio recorded, transcribed verbatim and analysed via Interpretative Phenomenological Analysis (IPA).The findings bring to light therapists’ consensus for the potential of CAT to contribute to patients’ relief from self-stigma emotions. Additionally, the concept of mental illness self-stigmatisation offered therapists an opportunity to explore, understand and describe their attitudes when working with people considered self-stigmatised.
Stigma associated with alcoholism is common in Japan, and individuals who suffer from alcoholism often feel that it is a taboo to discuss their problems with alcohol in the general public. This paper describes the way in which the self-help group called Danshukai offers a model for recovery for people suffering from alcoholism in Japan. Since 2006, the authors have been involved in various meetings and conducted conversational and semi-structured interviews with leaders and rank-and-file members of Danshukai. In Danshukai, recovery is viewed as a spiritual process offering the potential for a new life compared to models offered by medical treatment that place little emphasis on the role of spirituality in recovery. While medical models seek to reduce alcohol-related stigma by viewing it as a treatable ‘disease’, rather than a personality weakness, Danshukai encourages members to embrace their identity as a Danshukai member and to engage with a ‘way of abstinence’ that includes a lifelong commitment to Danshukai activities and helping others with similar problems.
Aim:
To report on the analysis of the concept of the stigma of mental illness within the Haitian American community.
Background:
Mental illness is a highly stigmatized condition within certain communities making it challenging for individuals to seek effective treatment. The consequences of such stigma can have lifelong corollaries for the individuals, the families and the communities.
Introduction:
The concept of stigma is not fully developed in nursing; clarity of the concept of stigma of mental illness is still needed in the nursing literature. In order to assist patients in accessing mental health services, the concept of stigma must first be clarified.
Methods:
The method used for this concept analysis was that of Walker and Avant.
Findings:
Five attributes were identified, creating the following definition: labelling, stereotype, negative attitude, emotional response, and discrimination. The antecedents for stigma of mental illness are lack of knowledge about mental illness, emotional state and cultural beliefs and values.
Implications for nursing and health policy:
The origins of stigmatization of mental illness among Haitian Americans need to be understood. Mental health illnesses are stigmatized within the Haitian culture, which presents as a barrier to accessing help for many Haitian American women suffering from mental illness. The defining attributes can be used to develop tools to help clinicians identify patients being stigmatized. Once stigma is recognized, nurses can develop strategies and policies that can mitigate the effects of stigmatization of mental illness among this patient population.
Conclusion:
Further research is essential to examine the ways in which this concept impacts the Haitian American community, as well as effective strategies to help minimize its effects.
Title: Interpersonal contact and the stigma of mental illness: A review of the literature Background. Stigmatization of mental illness is widespread in Western societies (Crisp et al., 2001) and other cultures (Chung et al., 2001). Furthermore, researchers have found that stigma is detrimental to the well being of persons with a mental illness (Wahl, 1999), potentially resulting in decreased life satisfaction and discrimination in obtaining housing and employment (Link & Phelan, 2001). It is for these reasons researchers have sought methods for reducing stigma. Aims: One strategy purported to reduce stigma is interpersonal contact with people with a mental illness. This article reviews the literature of contact and stigma reduction and provides considerations and recommendations for future research. Method: A thorough review of article databases was conducted to identify all relevant studies. Studies were then grouped into retrospective and prospective reports of contact. Conclusions: Research shows that both retrospective and prospective contact tends to reduce stigmatizing views of persons with a mental illness. However, this literature has been plagued with various methodological problems, and other factors (such as the nature of the contact) have rarely been considered. Declaration of interest: None
Examined (a) the assumptions of a multifaceted, hierarchical construct, self-concept, with increasing stability toward the apex that can be differentiated from academic achievement; (b) the causal predominance of self-concept and achievement; and (c) how the analysis of covariance structures can simultaneously examine measurement, structural, and theoretical concerns. With 99 junior high school Ss and multiple indicators of subject-specific area and general self-concept (Way I Feel About Myself Scale, Tennessee Self-Concept Scale, and Michigan Self-Concept of Ability Scale), support was found for a multifaceted, hierarchical interpretation. Facets of the construct could be distinguished from achievement; self-concept appeared to be causally predominant over achievement. Data did not support the assumptions that facets of self-concept become increasingly stable toward the apex of the hierarchy or that changes in self-concept operate from the base to the apex. (1 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Throughout the 1980s, psychiatry has promoted diagnosis--with its language of categories--as the preeminent measure of psychological problems. In clinical psychiatry, the decade opened with the publication of the Diagnostic and Statistical Manual of Mental Disorders-III (DSM-III). In psychiatric epidemiology, the decade saw the development of the Diagnostic Interview Schedule (DIS) and its use in the large-scale Epidemiologic Catchment Area (ECA) surveys. Proponents of the diagnostic approach herald the DIS as a breakthrough. We argue, on the contrary, that diagnosis as a form of measurement hinders understanding. If the ECA studies provide new insight into the patterns and causes of psychological problems, they will do so despite the use of diagnostic measurement. We present here a critical analysis of the inherent weaknesses of diagnosis as a form of measurement, particularly as a means of representing psychological problems. First, we describe the weaknesses: diagnosis treats attributes as entities; it reduces the signal but not the noise; and it collapses the structural relationships. Second, we offer an interpretation of why psychiatry promotes a form of measurement poorly suited to its subject: the linguistic legacy of nineteenth-century biology and epidemiology; the social construction of the need for mental health services; and the enclosure of a scientific and professional domain. Third, we conclude that diagnostic measurement impedes understanding. We recommend eliminating diagnosis from research on the nature, causes, and consequences of mental, emotional, and behavioral problems.
Building on modified labeling theory, I examine the relationships between stigma, psychological well-being, and life satisfaction among persons with mental illness. The study uses longitudinal data from 610 individuals in self-help groups and outpatient treatment. Results from cross-sectional and lagged regression models show adverse effects of stigma on the outcomes considered. However, much of the effects of anticipated rejection are due to discriminatory experiences. The results also indicate that stigma is related to depressive-anxiety types of symptoms but not psychotic symptoms. Although the findings show that the negative effect of stigma on life satisfaction is partly mediated by self-concept, reciprocal effects models indicate that the relationship between self-concept and life satisfaction is bi-directional. The study suggests ways in which stigma processes need to be explored in greater detail.
Objective: To evaluate the psychological impact of receiving a diagnosis of ADHD in adulthood and treatment with medication and to examine how diagnosis and treatment with medication changes an individual's self-perception and view of the future. Method: Participants were eight individuals diagnosed with ADHD at a tertiary service. Semistructured interviews were conducted and the data were analyzed according to the principles of Interpretative Phenomenological Analysis. Results: Three master themes emerge from the analysis: Participants engage in a (a) review of the past, particularly how they feel different from others, (b) the emotional impact of the diagnosis, and (c) consideration of the future. These themes suggest a six-stage model of psychological acceptance of a diagnosis of ADHD: (a) relief and elation, (b) confusion and emotional turmoil, (c) anger, (d) sadness and grief, (e) anxiety, and (f) accommodation and acceptance. Conclusion: The model indicates an important role for psychological treatment, which should begin at the point of diagnosis. Cognitive behavioral techniques will help clients diagnosed with ADHD in adulthood cope with the adjustment process. Adults should be taught skills to anticipate future hurdles and challenges and apply appropriate coping strategies. (J. of Att. Dis. 2008; 11(4) 493-503)
The purpose of this paper is to examine negative societal and professional attitudes and discriminatory insurance practices against individuals with mental illness. Violations of the Americans with Disabilities Act will be discussed. The ethical principle of beneficence and the Fair Opportunity Rule will be examined as it applies to the humane treatment for individuals with mental illness. Suggestions will be made regarding the ethical obligation of rehabilitation counselors to advocate for better services for individuals with mental illness.
Critics of labeling theory vigorously dispute Scheff's (1966) provocative etiological hypothesis and downplay the importance of factors such as stigma and stereotyping. We propose a modified labeling perspective which claims that even if labeling does not directly produce mental disorder, it can lead to negative outcomes. Our approach asserts that socialization leads individuals to develop a set of beliefs about how most people treat mental patients. When individuals enter treatment, these beliefs take on new meaning. The more patients believe that they will be devalued and discriminated against, the more they feel threatened by interacting with others. They may keep their treatment a secret, try to educate others about their situation, or withdraw from social contacts that they perceive as potentially rejecting. Such strategies can lead to negative consequences for social support networks, jobs, and self-esteem. We test this modified labeling perspective using samples of patients and untreated community residents, and find that both believe that "most people" will reject mental patients. Additionally, patients endorse strategies of secrecy, withdrawal, and education to cope with the threat they perceive. Finally, patients' social support networks are affected by the extent to which they fear rejection and by the coping responses they adopt to deal with their stigmatized status.
Labeling theory proponents and the theory's critics have different views of stigma and thus differ on the consequences of labeling for people with mental illness. The labeling perspective posits that because of stigma, official labeling through treatment contact has negative consequences for mental patients. In contrast, critics of labeling theory claim that stigma is relatively inconsequential. Instead, they argue that because labeling results in receiving needed services, it provides significant benefits for mental patients. Thus far, no study has tested the relative positive and negative effects of labeling. I examine these views by comparing the importance of perceived stigma versus the receipt of services for the quality of life of persons with chronic mental illness. Results show that both stigma and services received are significantly associated with quality of life, but in opposite ways. These findings have important implications for interventions for mental illness.
We introduce “stigma sentiments” as a way to operationalize the cultural conceptions of the mentally ill. Stigma sentiments are the evaluation, potency, and activity (EPA) associated with the cultural category “a mentally ill person.” We find consistent support for the validity of the evaluation and potency components as measures of these conceptions. We also demonstrate the validity of EPA ratings of self-identities (“myself as I really am”) and reflected appraisals (“myself as others see me”) as measures of self-meaning among psychiatric patients. Then we assess hypotheses derived from the modified labeling theory of mental illness: we expect each stigma sentiment to be related positively to the corresponding dimension of self-identities and reflected appraisals among psychiatric patients but unrelated to the corresponding dimension among non-patients. We find support for 13 of the 18 components to these hypotheses. We also find three cross-dimensional results that were not anticipated. The results suggest that the cultural conceptions of the mentally ill do affect the self-meanings of individuals diagnosed with a mental disorder, although the connection is sometimes more complex than a one-to-one relationship between a stigma sentiment and its corresponding dimension of self-meaning.
The 1st and 2nd editions of this book (1966, 1984) presented a sociological theory of mental disorder (MD). Seeing MD from the point of view of a single discipline, the theory was 1-dimensional. Since then, there have been substantial advances in the biology, psychology, and even in the sociology of MD. What is now most needed is an interdisciplinary approach, one that would integrate the disparate viewpoints and findings of the relevant disciplines.
Given the need for consilience (i.e., the interlocking of frameworks from the relevant disciplines), is there any point in resurrecting labeling theory, yet another 1-dimensional approach to the complex problem of MD? The author's decision that labeling theory still has value was based on the following ideas. First, while waiting for consilient approaches to be developed, headways can still be made with 1- or 2-dimensional approaches. A 2nd idea is that biopsychiatry, the dominant force in the field, like all disciplines, accentuates the positive. Labeling theory can be considered to be a countertheory, critical of the weakest points in the dominant theory, and focusing on issues that it neglects.
This edition attempts to provide a clear statement of a sociological approach to MD and integrate it with other approaches. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The first part of this paper is a response to several recent critiques of labelling theory. The second part assesses the state of the evidence on the labelling theory of mental illness. The majority of the studies reviewed support the theory.
The objective of this study was to determine whether stigma affects the self-esteem of persons who have serious mental illnesses or whether stigma has few, if any, effects on self-esteem.
Self-esteem and two aspects of stigma, namely, perceptions of devaluation-discrimination and social withdrawal because of perceived rejection, were assessed among 70 members of a clubhouse program for people with mental illness at baseline and at follow-up six and 24 months later.
The two measures of perceptions of stigma strongly predicted self-esteem at follow-up when baseline self-esteem, depressive symptoms, demographic characteristics, and diagnosis were controlled for. Participants whose scores on the measures of stigma were at the 90th percentile were seven to nine times as likely as those with scores at the 10th percentile to have low self-esteem at follow-up.
The stigma associated with mental illness harms the self-esteem of many people who have serious mental illnesses. An important consequence of reducing stigma would be to improve the self-esteem of people who have mental illnesses.
Little is known about how women with borderline personality disorder (BPD) and women with social phobia react to mental illness stigma. The goal of this study was to assess empirically self-stigma and its correlates in these groups. Self-stigma and related constructs were measured by self-report questionnaires among 60 women with BPD and 30 women with social phobia. Self-stigma was inversely related to self-esteem, self-efficacy, and quality of life and predicted low self-esteem after controlling for depression and shame-proneness. Stereotype awareness was not significantly correlated with self-esteem or quality of life. While there was no difference in stereotype awareness between women with BPD and women with social phobia, women with BPD showed higher self-stigma than women with social phobia. Self-stigma is associated with low self-esteem and other indices of poor psychological well-being. In comparison to women with social phobia, women with BPD suffer from more self-stigma. This may reflect intense labeling processes as being mentally ill due to repeated hospitalizations, frequent interpersonal difficulties, and visible scars.
Stigma can greatly exacerbate the experience of mental illness. Diagnostic classification frequently used by clinical social
workers may intensify this stigma by enhancing the public's sense of “groupness” and “differentness” when perceiving people
with mental illness. The homogeneity assumed by stereotypes may lead mental health professionals and the public to view individuals
in terms of their diagnostic labels. The stability of stereotypes may exacerbate notions that people with mental illness do
not recover. Several strategies may diminish the unintended effects of diagnosis. Dimensional approaches to diagnosis may
not augment stigma in the same manner as classification. Moreover, regular interaction with people with mental illness and
focusing on recovery may diminish the stigmatizing effects of diagnosis.
The relationship between self-stigma and self-esteem in patients with schizophrenia is receiving increased attention. However, studies to date have been limited to samples of persons under the age of 65.Aim: To examine the relationship between self-stigma and self-esteem in people with schizophrenia in both younger and older age groups.
Face-to-face interviews were completed with 86 inpatients with schizophrenia in a psychiatric hospital (mean age = 54, 55% female). Self-esteem was assessed using Rosenberg's Self Esteem Scale. Self-stigma was assessed using an adapted version of the Internalized Stigma of Mental Health (ISMI) scale. Information regarding socio-demographic characteristics and psychiatric history and symptomatology was collected.
Self-stigma was moderate with only 20-33% of the participants reporting high levels of stigmatization. Older participants reported lower levels of self-stigma than younger participants. A relatively strong association between self-stigma and self-esteem was found.
The findings point to the complexity of the association between self-stigma, self-esteem and age in people with schizophrenia. This study stresses the importance of clinicians taking the issue of self-stigma into consideration when treating young and old patients with schizophrenia.
A pressing need for interrater reliability in the diagnosis of mental disorders emerged during the mid-twentieth century, prompted in part by the development of diverse new treatments. The Diagnostic and Statistical Manual of Mental Disorders (DSM), third edition answered this need by introducing operationalized diagnostic criteria that were field-tested for interrater reliability. Unfortunately, the focus on reliability came at a time when the scientific understanding of mental disorders was embryonic and could not yield valid disease definitions. Based on accreting problems with the current DSM-fourth edition (DSM-IV) classification, it is apparent that validity will not be achieved simply by refining criteria for existing disorders or by the addition of new disorders. Yet DSM-IV diagnostic criteria dominate thinking about mental disorders in clinical practice, research, treatment development, and law. As a result, the modern DSM system, intended to create a shared language, also creates epistemic blinders that impede progress toward valid diagnoses. Insights that are beginning to emerge from psychology, neuroscience, and genetics suggest possible strategies for moving forward.
Psychological Science
- M Gazzaniga
- T Heatherton
- D Halpern
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