The impact of stigma on people with mental illness

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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 oppor-
tunities, 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)
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. Although research has gone far to
understand the impact of the disease, it has
only recently begun to explain stigma in
mental illness. Much work yet needs to be
done to fully understand the breadth and
scope of prejudice against people with men-
tal illness. Fortunately, social psychologists
and sociologists have been studying phe-
nomena related to stigma in other minority
groups for several decades. In this paper, we
integrate research specific to mental illness
stigma with the more general body of
research on stereotypes and prejudice to
provide a brief overview of issues in the
area.
The impact of stigma is twofold, as out-
lined in Table 1. Public stigma is the reac-
tion that the general population has to peo-
ple 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 effi-
cient because people can quickly generate
impressions and expectations of individuals
who belong to a stereotyped group (4).
The fact that most people have knowl-
edge of a set of stereotypes does not imply
that they agree with them (5). For example,
many persons can recall stereotypes about
different racial groups but do not agree that
the stereotypes are valid. People who are
prejudiced, on the other hand, endorse
these negative stereotypes (Thats 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 cog-
nitive and affective response, leads to dis-
crimination, the behavioral reaction (9).
Prejudice that yields anger can lead to hos-
tile behavior (e.g., physically harming a
minority group) (10). In terms of mental ill-
ness, angry prejudice may lead to withhold-
ing help or replacing health care with serv-
ices provided by the criminal justice system
(11). Fear leads to avoidance; e.g., employ-
ers do not want persons with mental illness
nearby so they do not hire them (12).
Alternatively, prejudice turned inward leads
to self-discrimination. Research suggests
self-stigma and fear of rejection by others
lead many persons to not pursuing life
opportunities for themselves (13,14). The
remainder of this paper further develops
examples of public and self-stigma. In the
process, we summarize research on ways of
changing the impact of public and self-stig-
ma.
PUBLIC STIGMA
Stigmas about mental illness seem to be
widely endorsed by the general public 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, stigma-
tizing views about mental illness are not lim-
ited to uninformed members of the general
public; even well-trained professionals from
most mental health disciplines subscribe to
stereotypes about mental illness (22-25).
Stigma seems to be less evident in Asian
and African countries (26), though it is
unclear whether this finding represents a
cultural sphere that does not promote stig-
ma or a dearth of research in these societies.
The available research indicates that, while
attitudes toward mental illness vary among
non-Western cultures (26,27), the stigma of
PATRICK W. CORRIGAN, AMY C. WATSON
University of Chicago Center for Psychiatric Rehabilitation and Chicago Consortium
for Stigma Research, 7230 Arbor Drive, Tinley Park, IL 60477, USA
Understanding the impact of stigma on people
with mental illness
FORUM - STIGMA AND MENTAL ILLNESS
17
mental illness may be less severe than in
Western cultures. Fabrega (26) suggests that
the lack of differentiation between psychi-
atric 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).
Cross-cultural examinations of the concepts,
experiences, and responses to mental illness
are clearly needed.
Several themes describe misconceptions
about mental illness and corresponding stig-
matizing 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 per-
ceptions of the world that should be mar-
veled; or they are responsible for their illness
because they have weak character (29-32).
Results of two independent factor analyses of
the survey responses of more than 2000
English and American citizens parallel these
findings (19,33):
a) fear and exclusion: persons with severe
mental illness should be feared and, there-
fore, be kept out of most communities;
b) authoritarianism: persons with severe
mental illness are irresponsible, so life deci-
sions should be made by others;
c) 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 disabili-
ties 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 disabili-
ties, persons with mental illness are per-
ceived by the public to be in control of their
disabilities and responsible for causing
them (34,36). Furthermore, research
respondents are less likely to pity persons
with mental illness, instead reacting to psy-
chiatric disability with anger and believing
that help is not deserved (35,36,39).
have been effective in getting stigmatizing
images of mental illness withdrawn. There is,
however, little empirical research on the psy-
chological impact of protest campaigns on
stigma and discrimination, suggesting an
important direction for future research.
Protest is a reactive strategy; it attempts to
diminish negative attitudes about mental ill-
ness, but fails to promote more positive atti-
tudes that are supported by facts. Education
provides information so that the public can
make more informed decisions about men-
tal illness. This approach to changing stigma
has been most thoroughly examined by
investigators. Research, for example, has
suggested that persons who evince a better
understanding of mental illness are less like-
ly to endorse stigma and discrimination
(17,19,52). Hence, the strategic provision of
information about mental illness seems to
lessen negative stereotypes. 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 effec-
tive for a wide variety of participants, includ-
ing college undergraduates, graduate stu-
dents, adolescents, community residents,
and persons with mental illness.
Stigma is further diminished when mem-
bers of the general public meet persons with
mental illness who are able to hold down jobs
or live as good neighbors in the community.
Research has shown an inverse relationship
between having contact with a person with
mental illness and endorsing psychiatric stig-
ma (54,57). Hence, opportunities for the
public to meet persons with severe mental ill-
ness may discount stigma. Interpersonal con-
tact is further enhanced when the general
public is able to regularly interact with people
with mental illness as peers.
SELF-STIGMA
One might think that people with psychi-
atric disability, living in a society that widely
endorses stigmatizing ideas, will internalize
these ideas and believe that they are less val-
ued because of their psychiatric disorder.
Self-esteem suffers, as does confidence in
ones future (7,58,59). Given this research,
The behavioral impact (or discrimina-
tion) that results from public stigma may
take four forms: withholding help, avoid-
ance, 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 pub-
lic strives to not interact with people with
mental illness altogether. The 1996 General
Social Survey (GSS), in which the Mac
Arthur Mental Health Module was adminis-
tered to a probability sample of 1444 adults
in the United States, found that more than a
half of respondents are unwilling to: spend
an evening socializing, work next to, or have
a family member marry a person with men-
tal illness (41). Social avoidance is not just
self-report; it is also a reality. Research has
shown that stigma has a deleterious impact
on obtaining good jobs (13,42-44) and leas-
ing safe housing (45-47).
Discrimination can also appear in public
opinion about how to treat people with men-
tal illness. For example, though recent stud-
ies have been unable to demonstrate the
effectiveness of mandatory treatment
(48,49), more than 40% of the 1996 GSS
sample agreed that people with schizophre-
nia 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 representa-
tions 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 men-
tal illness. To the public: STOP believing neg-
ative views about mental illness. Wahl (32)
believes citizens are encountering far fewer
sanctioned examples of stigma and stereo-
types because of protest efforts. Anecdotal
evidence suggests that protest campaigns
18
WWoorrlldd PPssyycchhiiaattrryy 11::11 --
February 2002
models of self-stigma need to account for
the deleterious effects of prejudice on an
individuals conception of him or herself.
However, research also suggests that, instead
of being diminished by the stigma, many
persons become righteously angry because
of the prejudice that they have experienced
(60-62). This kind of reaction empowers
people to change their roles in the mental
health system, becoming more active partic-
ipants in their treatment plan and often
pushing for improvements in the quality of
services (63).
Low self-esteem versus righteous anger
describes a fundamental paradox in self-stig-
ma (64). Models that explain the experience
of self-stigma need to account for some per-
sons whose sense of self is harmed by social
stigma versus others who are energized by,
and forcefully react to, the injustice. And
there is yet a third group that needs to be
considered in describing the impact of stig-
ma on the self. The sense of self for many
persons with mental illness is neither hurt,
nor energized, by social stigma, instead show-
ing a seeming indifference to it altogether.
We propose a situational model that
explains this paradox, arguing that an indi-
vidual with mental illness may experience
diminished self-esteem/self-efficacy, right-
eous anger, or relative indifference depend-
ing on the parameters of the situation (64).
Important factors that affect a situational
response to stigma include collective repre-
sentations that are primed in that situation,
the persons perception of the legitimacy of
stigma in the situation, and the persons iden-
tification with the larger group of individuals
with mental illness. This model has eventual
implications for ways in which persons with
mental illness might cope with self-stigma as
well as identification of policies that promote
environments in which stigma festers.
CONCLUSIONS
Researchers are beginning to apply what
social psychologists have learned about prej-
udice and stereotypes in general to the stig-
ma related to mental illness. We have made
progress in understanding the dimensions
of mental illness stigma, and the processes
by which public stereotypes are translated
into discriminatory behavior. At the same
time, we are beginning to develop models of
self-stigma, which is a more complex phe-
nomenon than originally assumed. The
models developed thus far need to be tested
on various sub-populations, including differ-
ent ethnic groups and power-holders (legis-
lators, judges, police officers, health care
providers, employers, landlords). We are
also learning about stigma change strategies.
Contact in particular seems to be effective
for changing individual attitudes.
Researchers need to examine whether
changes resulting from anti-stigma interven-
tions are maintained over time.
All of the research discussed in this paper
examines stigma at the individual psycho-
logical 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 serv-
ices, and the justice system are structured as
well as ways in which resources are allocated.
Research that focuses on the social struc-
tures that maintain stigma and strategies for
changing them is sorely needed.
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Strategies for reducing stigma
toward persons with mental illness
COMMENTARIES
DAVID L. PENN,
S
HANNON M. COUTURE
Department of Psychology, University of North
Carolina-Chapel Hill, Davie Hall, CB#3270, Chapel
Hill, NC 27599-3270, USA
Corrigan and Watson have written an
excellent overview on the impact of stigma
on the lives of persons with severe mental ill-
ness (SMI). In this commentary, we would
like to expand on one aspect of that article,
namely strategies for reducing stigma
toward persons with SMI.
Corrigan and Watson have identified
three approaches for reducing stigma:
protest, education, and contact. Although
these approaches have promise, they are not
without weaknesses. A potential disadvan-
tage of using protest (i.e., telling the public
to stop believing negative views about men-
tal illness) is that it may actually increase,
rather than decrease stigma. In fact,
research has shown that instructing individ-
uals to ignore or suppress negative thoughts
and attitudes towards a particular group can
have paradoxical rebound effects; stigma
will be augmented rather than reduced (1).
To examine this issue with respect to psychi-
atric stigma, we instructed participants to
either suppress or not to suppress their
stereotypes of persons with SMI and evaluat-
ed the effects on stigma-related attitudes
and behaviors (2). The results showed that
suppression instructions did reduce nega-
tive attitudes, but
did not impact behavior
toward persons with SMI, and that the para-
doxical rebound effects did not occur. This
suggests that stereotype suppression may
have modest, although limited effects, on
psychiatric stigma.
There is evidence that individuals who pos-
sess more information about mental illness
are less stigmatizing than individuals who are
misinformed about mental illness (3). This
suggests that providing individuals with factu-
al information about SMI, in particular
regarding dangerousness and SMI, would
reduce stigmatization. We have generally
found support for this hypothesis.
Information regarding the residential context
of persons with SMI (i.e., that they may live in
supervised housing) (4), and the relationship
between dangerousness and SMI (5), were
both associated with reduced stigmatization to
persons with SMI in general and to a hypo-
thetical individual with SMI. However, the
positive effects of factual information on psy-
chiatric stigma were attenuated when subjects
had to rate their reactions to actual persons
with SMI (6). Thus, factual information
regarding SMI may be more effective in
reducing stigma toward persons with SMI in
general, than toward specific individuals.
Finally, there is convincing evidence that
increased contact with persons with SMI is
associated with lower stigma (7). However,
there are a number of problems that plague
work in this area. First, many studies have
examined the effects of
previous self-report-
ed contact on stigma, rather than how con-
tact changes stigma
prospectively (7). In those
studies in which direct contact was meas-
ured, the manipulation often took place in
the context of contrived laboratory situa-
tions or as part of a course and/or training
program. Scant attention has been placed
on how direct interpersonal contact affects
stigma during
ongoing naturalistic relation-
ships. Second, the mechanism(s) underlying
stigma reduction, as a function of contact,
are unknown. In other words, how does con-
tact reduce stigma? Two theories have been
proposed for this. According to the recate-
gorization theory (8), contact with an out-
group member results in changes in out-
group member classification, from them to
relationships. New York: Freeman, 1984.
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    Background A shortage of specialists in psychiatry, both in terms of psychiatrists and psychiatric nurses is evident worldwide. While there are multiple factors leading to an individual’s decision to specialize in psychiatry, the individual’s perceptions and attitudes towards psychiatry tend to play an essential role. This study thus aimed to explore attitudes towards psychiatry amongst medical and nursing students in Singapore and examine factors associated with these attitudes. Methods The present cross-sectional study used an online web survey tool to assess attitudes towards psychiatry amongst 502 medical and 500 nursing students in Singapore using the Attitudes towards Psychiatry (ATP-18) scale. Descriptive statistics and multiple linear regressions were used to examine associated factors (sociodemographic and education). Results The majority of students in this population endorsed favourable attitudes towards the following aspects of psychiatry: challenges within psychiatry, importance of psychiatry and psychiatric skills, treatment efficacy and view towards psychiatrists, but had generally unfavourable attitudes towards psychiatric patients. Male participants (compared to female; β = − 1.190, p < 0.05), participants in the middle income group (compared to higher income group; β = − 0.945, p < 0.05), participants who rated average for psychiatry lecture course and psychiatry clinical placement course (compared to above average; β = − 1.654, p < 0.05; β = − 1.181, p < 0.05) had a less favourable attitude to psychiatry. Not surprisingly, participants who were more likely to specialize in psychiatry (β = 2.053, p < 0.001) had a more favourable attitude towards psychiatry compared to those who were less likely to specialize in psychiatry. Conclusions The majority of students in this study endorsed unfavourable attitudes towards patients in the psychiatric setting. The present psychiatry curriculum could be improved to nurture the development of empathetic attitudes towards people with mental illness. De-stigmatization strategies could also be integrated into other curricula besides psychiatry.
  • Article
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    Background: Stigma poses an additional burden for people suffering from mental illness, one that often impairs their social participation and can prevent them from seeking adequate help. It is therefore crucial to understand how stigma develops in order to counteract it by setting up effective evidence-based anti-stigma interventions. The present study examines the effect of causal beliefs on stigmatizing behavioral intentions, namely people's desire to distance themselves from persons with mental illness. In addition, we draw cross-cultural comparisons between native Germans and Turkish immigrants to investigate the influence of culture on stigma and causal beliefs and to broaden knowledge on the biggest immigrant group in Germany and on immigrants in Western countries in general. Methods:n = 302 native Germans and n = 173 Turkish immigrants were presented either a depression or a schizophrenia vignette. Then, causal beliefs, emotional reaction and desire for social distance were assessed with questionnaires. Path analyses were carried out to investigate the influence of causal beliefs on the desire for social distance and their mediation by emotional reactions for Germans and Turkish immigrants, respectively. Results: We found an influence of causal beliefs on the desire for social distance. Emotional reactions partly mediated this relationship. Causal attribution patterns as well as the relationship between causal attributions and stigma varied across both subsamples and mental illnesses. In the German subsample, the ascription of unfavorable personal traits resulted in more stigma. In the Turkish immigrant subsample, supernatural causal beliefs increased stigma while attribution to current stress reduced stigma. Conclusion: Our study has implications for future anti-stigma interventions that intend to reduce stigmatization of mentally ill people. Targeting the ascription of unfavorable personal traits and supernatural causal attributions as well as promoting current stress as the cause for mental illness appears to be of particular importance. Also, the mediating influence of emotional responses to causal beliefs needs to be addressed. Furthermore, differential interventions across cultural groups and specific mental illnesses may be appropriate.
  • Article
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    Background: Schizophrenia is a chronic mental illness affecting the social and occupational lives of the sufferers and posing a considerable burden on the patients and their families. Furthermore, negative societal reactions and the internalization of these attitudes exacerbate the difficulties encountered. This study examines the perspectives of Turkish people with schizophrenia on how they view the impact of the illness on their lives, the societal reactions and attitudes to schizophrenia and whether they agree with these reactions. Methods: Twenty-three adult participants, all members of two schizophrenia associations in Ankara, capital of Turkey, were recruited. Semistructured interviews were used to find out their perspectives on how the illness affected their lives, how the society reacts to them and their views on these reactions. Interviews were recorded, transcribed and thematic analysis was used to capture the general and the subthemes. Results: The findings suggest that causal attributions for the illness, the impact of illness on various life domains, challenges of living with the illness and finally stigmatization are general categories that capture the perspectives of the participants. Conclusion: People diagnosed with schizophrenia experience the impacts and burdens of their illness in various domains of their lives and negative societal reactions heighten these burdens. It seems important to consider the challenges faced by people with schizophrenia in living with their illness and the impacts of negative societal behaviors and attitudes in offering psychosocial interventions programs for supporting this group. Furthermore, combating negative societal attitudes also seems to be necessary.
  • Article
    While previous research has demonstrated the negative impact of stigma in individuals with mental health problems, little is known about cross-cultural differences in experiences and explanations of mental health, in particular in young people, despite the first episode of psychosis often occurring in adolescence. Aim of this study was to examine cultural differences in causal beliefs and stigma toward mental health, in particular psychosis. White British and South Asian young people (N = 128) from two schools and colleges in the United Kingdom, aged 16 to 20 years, completed a cross-sectional survey. Results revealed significant associations between ethnic group and our dependent measures. White British reported more previous contact with a mental health service as well as with people with mental health problems than South Asians. They also reported lower stigma in form of a greater intentions to engage in contact with people with mental health problems. Furthermore, South Asians reported higher beliefs in supernatural causes of psychosis than White British. Psychotic experiences moderated the effect of ethnic group on supernatural beliefs, with South Asians reporting higher supernatural beliefs than White British when their own psychotic experiences were low to moderate. We discuss the implications of the findings, arguing that a greater culture-sensitive understanding of mental health is important to reach ethnic minorities with psychosis, and to challenge stigma toward psychosis from an early age on.
  • Article
    Mental health stigma has serious ramifications on people with a severe mental illness (SMI). Stigma damages self‐esteem, recovery outcomes, family relationships, socialization abilities, access to housing, and career prospects. The cultural tendencies of Chinese people have been shown to be associated with particularly high levels of stigmatization. These cultural tenets can result in high levels of self‐stigma due to experiencing shame and a perceived need to keep mental illness a secret. Although there is a lack of existing evidence, it is possible that such experiences present unique challenges to Chinese mothers diagnosed with SMI when they parent their children. Therefore, this qualitative study explored the experiences of parenting and self‐stigmatization of Chinese mothers with SMI. Individual semi‐structured interviews were conducted with 15 mothers who were direct carers of their children aged under 18 and who were receiving community‐based care in Hong Kong. Manual inductive thematic analysis was used to analyse the interview data. Three main themes related to self‐stigmatization emerged from the interviews: (i) distancing and being distanced; (ii) doubting myself; and (iii) struggling for control. The experiences of self‐stigmatization appeared to damage these mothers’ self‐efficacy, which may negatively affect their parenting self‐esteem, tendency to seek professional help, and ability to manage their own mental health. Strategies to improve self‐efficacy, including psychoeducation, and additional childcare support/resources are required for mothers with SMI so they can better manage and balance the demands of motherhood and their mental healthcare needs.
  • Article
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    Background Illness-related stigma has been identified as an important public health concern. Past research suggests there is a disproportionate risk of mental-health stigma in the military, but this same finding has not yet been established for physical-health stigma. The current study aimed to assess the independent contribution of mental and physical health on both enacted stigma (discriminatory behaviour) and felt stigma (feelings of embarrassment) and to determine whether these associations were stronger for military personnel than civilians. Methods Data were obtained from the 2002 Canadian Community Health Survey - Mental Health and Well-being and its corresponding Canadian Forces Supplement. Logistic regressions were used to examine a potential interaction between population (military [N = 1900] versus civilian [N = 2960]), mental health, and physical health in predicting both enacted and felt stigma, with adjustments made for socio-demographic information, mental health characteristics, and disability. Results Mental health did not predict enacted or felt stigma as a main effect nor in an interaction. There was a strong link between physical health and enacted and felt stigma, where worse physical health was associated with an increased likelihood of experiencing both facets of stigma. The link between physical health and enacted stigma was significantly stronger for military personnel than for civilians. Conclusions Physical health stigma appears to be present for both civilians and military personnel, but more so for military personnel. Elements of military culture (e.g., the way care is sought, culture of toughness, strict fitness requirements) as well as the physical demands of the job could be potential predictors of group differences.
  • Article
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    Background Military families who have a family member with a mental illness see themselves confronted with many demands. Stigmatization is one of these challenges. Stigmatization affects not only the individual who suffers from a mental illness but also other family members via stigma by association and vicarious stigma. Stigma by association occurs when mental illness stigma spills over to individuals associated with an individual with a mental illness. Vicarious stigma describes the suffering of family members when they note the impact of stigma on their relative with mental illness. As a societal phenomenon, stigma plays out in social interactions and might therefore influence the social networks of families. It is also associated with healthcare utilization. Method Narrative interviews were conducted with 15 family members (partners, spouses, parents and children) of former soldiers of the German Armed Forces with a service-induced mental illness. The transcribed interview data were analyzed using a thematic analysis approach, in which codes were formed and emerging themes were systemized. Relationships between stigma, the families’ reactions to it, its effects on their social relationships and its interference with their healthcare utilization were analyzed. Results This study provides a detailed description of how relatives of former German soldiers with mental health problems experience stigma by association and vicarious stigma. Their perceptions are shown in a model that describes stigma-related attitudes, reactions to them and their effects on the social relationships of former soldiers’ families. These families felt stigmatized because of the former soldiers’ mental illness (mental illness stigma) and the military context in which it occurred (former soldier stigma). They reacted with nondisclosure, anger, acceptance and self-blame. Stigma was associated with smaller and weaker social networks that were characterized by social exclusion, self-segregation and conflicts with extended family, friends and colleagues. Stigma also affected the families’ healthcare utilization. Conclusions Urgently needed anti-stigma campaigns, particularly in the civilian context, should address the stigmatization of both mental illness and the military participation of the families affected. They should consider the needs of both former soldiers with a mental illness and their families.
  • Article
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    Background Survivors of the 2014–2016 West Africa Ebola epidemic have been reported to suffer high levels of stigmatization after return to their communities. We sought to characterize the stigma encountered by a cohort of Ebola survivors in Liberia over time. Methods Ebola-related stigma was assessed from June 2015 to August 2017 in 299 adolescent and adult Liberian Ebola Survivor Cohort participants at three month intervals using adapted HIV stigma scales scored from 0 to 10 according to the proportion of answers indicating stigmatization. Findings The median time from Ebola Virus Disease (EVD) to study entry was 393 days (IQR 336–492). Participants (43% female) had a median age of 31 (IQR 25–40) years. Mean self-reported stigma levels were greater at baseline (6.28 ± 0.15 [IQR: 4.38–8.75]) compared to the first post-baseline visit (0.60 ± 0.10 [IQR: 0–0]; p<0.0001). During follow-up, stigma levels were stable. Baseline stigma significantly increased during enrollment and following clusters of Ebola re-emergence in Liberia. Survivors encountered primarily enacted and perceived external stigma rather than internalized stigma. Conclusions Ebola-related stigma was prevalent among Liberian survivors more than a year after EVD recovery. Self-reported stigma was greater in the period before cohort enrollment; however, some degree of stigmatization persisted years after EVD. Transient rises in stigma were observed following episodic Ebola re-emergence of EVD in Liberia. During future EVD outbreaks, enhanced public health interventions designed to prevent and mitigate Ebola-related stigma that is enacted and external should be implemented to support survivor recovery and community re-integration.
  • Article
    It is widely documented that persons with mental illness (MI) experience much stigma, contributing to undesirable outcomes for persons with MI and posing barriers to their psychosocial rehabilitation. It is our argument that stigma and violence have a reciprocal relationship. In particular, stigma increases the risk of violence by this population by acting as a barrier to treatment participation and by increasing criminogenic risk factors among this population. Discrimination in social relationships, housing, and employment increases the likelihood that persons with MI will experience substance abuse, unemployment, stressed family relationships, antisocial characteristics, and less engagement in prosocial activities, all of which are known to increase the risk of criminal behavior. It is well documented that family members are the most common victims of violence by persons with MI. However, many family victims do not report acts of violence to authorities due to fear of exacerbating the stigma of MI. As such, not only does stigma increase the risk of violence by persons with MI, it also decreases the likelihood that family victims will report violence, preventing them from receiving victim services and other valuable supports. Reduction in stigma may be an essential element of a comprehensive approach to decreasing the risk of violence by persons with MI and increasing reporting and service use among family members who have been victims by persons with MI.
  • Article
    Three studies tested basic assumptions derived from a theoretical model based on the dissociation of automatic and controlled processes involved in prejudice. Study 1 supported the model's assumption that high- and low-prejudice persons are equally knowledgeable of the cultural stereotype. The model suggests that the stereotype is automatically activated in the presence of a member (or some symbolic equivalent) of the stereotyped group and that low-prejudice responses require controlled inhibition of the automatically activated stereotype. Study 2, which examined the effects of automatic stereotype activation on the evaluation of ambiguous stereotype-relevant behaviors performed by a race-unspecified person, suggested that when subjects' ability to consciously monitor stereotype activation is precluded, both high- and low-prejudice subjects produce stereotype-congruent evaluations of ambiguous behaviors. Study 3 examined high- and low-prejudice subjects' responses in a consciously directed thought-listing task. Consistent with the model, only low-prejudice subjects inhibited the automatically activated stereotype-congruent thoughts and replaced them with thoughts reflecting equality and negations of the stereotype. The relation between stereotypes and prejudice and implications for prejudice reduction are discussed.
  • Article
    This paper hypothesizes that official labeling gives personal relevance to an individual's beliefs about how others respond to mental patients. According to this view, people develop conceptions of what others think of mental patients long before they become patients. These conceptions include the belief that others devalue and discriminate against mental patients. When people enter psychiatric treatment and are labeled, these beliefs become personally applicable and lead to self-devaluation and/or the fear of rejection by others. Such reactions may have negative effects on both psychological and social functioning. This hypothesis was tested by comparing samples of community residents and psychiatric patients from the Washington Heights section of New York city. Five groups were formed (1) first-treatment contact patients, (2) repeat-treatment contact patients, (3) formerly treated community residents, (4) untreated community cases, and (5) community residents with no evidence of severe psychopathology. These groups were administered a scale that measured beliefs that mental patients would be devalued and discriminated against by most people. Scores on this scale were associated with demoralization, income loss, and unemployment in labeled groups but not in unlabeled groups. The results suggest that labeling may produce negative outcomes like those specified by the classic concept of secondary deviance.
  • Article
    Investigated the effect of several variables on helping behavior, using subway express trains as a field laboratory. 4 teams of undergraduates, each made up of a victim, model, and 2 Os, staged standard collapses in which type of victim (drunk or ill), race of victim (black or white), and presence or absence of a model were varied. It was found that: (a) an apparently ill person is more likely to receive aid than one who appears drunk; (b) race of victim has little effect on race of helper except when the victim is drunk; (c) the longer the emergency continues without help being offered, the more likely it is that someone will leave the area of the emergency; and (d) the expected "diffusion of responsibility effect" found by J. Darley and B. Latane (see 43:3) did not occur. Implications of this difference between laboratory and field results are discussed, and a brief model for the prediction of behavior in emergency situations is presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    Discussions of rights and rights protection for people labeled "mentally ill" are often termed "the rights of the mentally ill," as if being "mentally ill," or carrying that label, means that this group has special, or different rights than other people. The author argues that this is the wrong way to think about rights. She discusses why the supposedly medical diagnosis of "mental illness" carries with it such a profound effect on the rights of those so labeled and contrasts it with the rights accorded those with physical disorders. She argues that paternalism is the ethical system that drives the involuntary commitment, forced treatment, and psychiatric control over decision making of the "mentally ill." In conclusion, she notes the gains made by the patients' movement, but believes there is still a long way to go to reach the goals of full citizenship, equality, and human dignity. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
  • Article
    Forty-six medical students were administered the Opinion About Mental Illness (OMI) questionnaire and Derogatis' Symptom Checklist (SCL-90-R) before and after an eight-week academic and clinical course in psychiatry. Significant changes were found after the course on dimensions of Benevolence and Interpersonal Etiology, and mean scores on the community portion of the OMI scale revealed movement in a positive direction. Using multiple regression analysis the pre-test attitude scores accounted for most of the variance on post-test attitudes. Stereotyping, a very important dimension of the OMI scale, was not rejected on either the pre-course or post-course measures. The students' own psychological distress did not have an effect on attitude change.
  • Article
    Objective: This article reviews the attitudes towards mental illness and psychiatric stigma in Asian cultures. Method: Relevant literature published in English was reviewed. Results: Psychiatric stigmas in Asian cultures share some common features. However, response to mental illness has many variations across cultures. Psychiatric stigma is prevalent and severe in some but not all Asian cultures. Conclusions: The stigma of mental illness needs to be studied within its sociocultural context in order to understand its origins, meanings and consequences. It may be relevant to examine the indigenous concepts, experience and implications of psychological problems to address problems in mental health care relating to stigma.
  • Article
    Too often the human services dehumanize and depersonalize those who come to receive services, as well as those professionals who provide physical disabilities and people with psychiatric disabilities are frequently hurt by helping professionals, the phenomenon of “spirit breaking” is introduced. Suggestions for re‐humanizing the human services are made, including new models for clinical interaction that serve to empower rather than disempower service recipients, and the contributions that people with disabilities are making in their own state and national movements for social justice and the right to humane treatment and rehabilitation services.
  • Article
    In the 1950s, the public defined mental illness in much narrower and more extreme terms than did psychiatry, and fearful and rejecting attitudes toward people with mental illnesses were common. Several indicators suggest that definitions of mental illness may have broadened and that rejection and negative stereotypes may have decreased since that time. However, lack of comparable data over time prevents us from drawing firm conclusions on these questions. To address this problem, the Mental Health Module of the 1996 General Social Survey repeated a question regarding the meaning of mental illness that was first asked of a nationally representative sample in 1950. A comparison of 1950 and 1996 results shows that conceptions of mental illness have broadened somewhat over this time period to include a greater proportion of non-psychotic disorders, but that perceptions that mentally ill people are violent are frightening substantially increased, rather than decreased. This increase was limited to respondents who viewed mental illness in terms of psychosis. Among such respondents, the proportion who described a mentally ill person as being violent increased by nearly 2 1/2 times between 1950 and 1996 We discuss the possibility that there has been a real move toward acceptance of many forms of mental illness as something that can happen to one of "us," but that people with psychosis remain a "them" who are more feared than they were half a century ago.