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.
60. Chamberlin J. Citizenship rights and
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ous mental illness: treatment partner-
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Psychiatr Q, in press.
64. Corrigan PW, Watson AC. The paradox
of self-stigma and mental illness. Clin
Psychol Sci Pract, in press.
  • ... Allport's [31] seminal work argues that contact between social groups reduces prejudice. Supporting this theory, researchers have found that direct contact with people with a mental illness decreases the acceptance of stereotypes surrounding mental health [32,33]. Similarly, contact with people living with either hepatitis C (HCV) or HIV has been shown to decrease negative perceptions about those infections [9,[34][35][36]. ...
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    Stigma has significant detrimental health outcomes for those affected. This study examined socio-demographic characteristics that were associated with stigmatising attitudes among the general population towards people who inject drugs, and people living with blood borne viruses or sexually transmissible infections. Questions were included in the Australian Survey of Social Attitudes (total sample = 1,001). Attitudes towards each of the target populations were measured by 5-item stigma scales. Bivariate analyses and multiple regression analyses were conducted to identify socio-demographic characteristics associated with stigmatising attitudes. Knowing a person affected by a stigmatised attribute was associated with reduced stigmatising attitudes, while voting for a conservative political party was associated with increased stigmatising attitudes. Age, gender, education, income, and marital status were each related to some stigmatising attitudes. Results also highlight differences between attitudes towards a stigmatised behaviour (i.e., injecting drug use) and stigmatised conditions (i.e., blood borne viruses and sexually transmissible infections). Identifying socio-demographic characteristics that are associated with stigmatising attitudes may have global implications for informing stigma reduction interventions, in order to promote positive health outcomes for affected communities.
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    Background Over the past three decades, a range of international stakeholders have highlighted the possibility that genomic research may impact stigma associated with psychiatric disorders. Limited research has been conducted in Africa to investigate this relation.Method In the present study, using focus group discussions, we explored the relation between genetic attribution and stigma among 36 Xhosa people with schizophrenia. We addressed three main questions: (1) What causal beliefs do Xhosa people with schizophrenia use to explain their illness and to what extent do genetic explanations play a role in these beliefs? (2) What are the internalised stigma experiences of Xhosa people with schizophrenia? (3) How do genetic explanations relate to stigma experiences, if at all?ResultsMost participants were able to define genetics and some linked genetics to disease causation. Despite adequate knowledge of genetics and an emphasis on genetic explanations of schizophrenia in the study, most participants held a multitude of causal explanations including: psychosocial, environmental, and cultural. Moreover, participants rarely mentioned disease cause when describing their stigma experiences.DiscussionFor this population group, there was no straight-forward relation between a genetic attribution and stigma. Therefore, we did not find evidence that genetic attribution may significantly increase stigma. Although North American and European literature provides conflicting evidence regarding this relation, there is increased consensus that biomedical explanations for psychiatric disorders may reduce blame. This study found evidence supporting that consensus. This study provides an empirical foundation to inform ongoing work on the psychosocial implications of psychiatric genomics research in non-Western contexts.
  • Chapter
    Mental health practitioners have an ethical and moral responsibility to practice social justice principles in their work with their socially marginalized patients/clients. Using a social justice lens, this chapter will bring awareness of social injustice in the form of microaggressions, stereotypes, and social stigmatization experienced by socially marginalized patients/clients in interactions with their healthcare practitioners. The lack of practitioner cultural competence is discussed as a possible contributor to the unjust treatment that patients/clients experience. A philosophical and moral framework will be used to problematize the biases of practitioners who enact these behaviors in interactions with their clients. Social justice education will be suggested as a curriculum-based or professional development-based means to expose and modify unjust behaviors and attitudes.
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    This investigation reviews the effectiveness of anti-stigma interventions employed at educational institutes; to improve knowledge, attitude and beliefs regarding mental health disorders among students. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist guidelines were followed and protocol was registered in PROSPERO (CRD42018114535). Forty four randomized controlled trials were considered eligible after screening of 104 full-text articles against inclusion and exclusion criteria. Several interventions have been employed to tackle stigma toward psychiatric illnesses, including education through lectures and case scenarios, contact-based interventions, and role-plays as strategies to address stigma towards mental illnesses. A high proportion of trials noted that there was a significant improvement for stigma (19/25, 76%), attitude (8/11, 72%), helping-seeking (8/11, 72%), knowledge of mental health including recognition of depression (11/14, 78%), and social distance (4/7, 57%). These interventions also helped in reducing both public and self-stigma. Majority of the studies showed that the anti-stigma interventions were successful in improving mental health literacy, attitude and beliefs towards mental health illnesses.
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    Aim To explore levels of stigma in students of all fields of nursing and midwifery at different years and examine the impact of exposure to people with mental illness. Design A cross‐sectional survey was used. Methods The Community Attitudes to Mental Illness questionnaire was administered to all branches of student nurses (adult health, mental health, child health and learning disability) and midwives in all three years in one Higher Education Institution (HEI) in Scotland. Results Mental health nursing students scored significantly better on all stigma subscales. Stigma worsened with a little professional exposure to people with mental illness but then improved with increasing exposure. Both personal exposure and professional exposure to people with mental illness change perceptions. The professional results follow a J‐curve. Current plans for cross‐field experience involving short or virtual placements during student nurse training are likely to worsen stigma rather than improve it.
  • Article
    Objective Behavioral activation constitutes a promising behavioral treatment for depression. Due to its contextual and idiographic approach, the intervention might be well suited for treating depression in culturally diverse populations. Method The authors conducted a systematic literature review on culturally adapted behavioral activation treatments. Results Seventeen studies were identified through database searching involving different target populations and a variety of adapted interventions. Circumstances were frequently shaped by cultural values and a wide range of environmental stressors. Adaptations were found in different dimensions including language, content, methods, and context. Across studies, results indicated the effectiveness of behavioral activation and its cultural adaptations for treating depression in their respective target groups. Discussion The results of this review may serve as an input both for practitioners employing behavioral activation in their daily work with culturally diverse clients and for researchers interested in culturally adapting treatment to specific populations.
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    Background: While it is well-recognized that the stigma associated with alcohol use problems can prevent or delay help-seeking, there is limited research examining stigmatising attitudes towards alcohol misuse, or their consequences, during adolescence. The current study examined the results of a school-based intervention on adolescents' stigmatising attitudes towards alcohol misuse among their peers, and how changes in attitudes influenced intentions to encourage help-seeking, as well as participants' personal use and misuse of alcohol. Methods: Participants (n = 463) were a subset of a larger sample participating in a randomized controlled trial of the MAKINGtheLINK intervention. Of the included participants, 287 (62%) were allocated to the intervention group and 176 (38%) to the control group. Assessments were conducted at baseline and 6-weeks, 6-months, and 12-months post-baseline. At each assessment, participants were presented with a vignette describing a peer experiencing alcohol misuse and completed the General Help Seeking Questionnaire as well as a 10-item scale measuring stigmatising attitudes. Alcohol use was also assessed. Results: The intervention was associated with a greater reduction in 'weak-not-sick' attitudes over time, which in turn predicted stronger intentions to encourage help-seeking from family members and formal help sources at the 12-month follow-up. Perceptions of dangerousness did not change significantly as a result of the intervention, however overall perceptions of dangerousness demonstrated a trend towards encouraging help-seeking from formal sources. Changes in stigma were not associated with past-year alcohol use or problems. Conclusions: School-based interventions such as MAKINGtheLINK can decrease some stigmatising attitudes towards alcohol misuse during adolescence, and increase adolescents' intentions to encourage help-seeking from both formal and informal help sources. However, results varied depending on both the dimension of stigma examined and the type of help source, highlighting a complex relationship between stigma, intentions, and sources of help that requires further investigation. Importantly, reducing stigma did not appear to result in negative effects due to greater acceptance of drinking (e.g., heavier alcohol use), supporting continued efforts to reduce alcohol-related stigma during adolescence.Trial registration: Registered with the Australia and New Zealand Clinical Trials Register (ANZCTR) on the 27th of February 2013 (ACTRN12613000235707).
  • Article
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    Purpose: Negative cultural beliefs about psychotherapy patients represent one of the barriers in the psychological help-seeking and treatment adherence. In Chile today, there is little research about specific beliefs towards this group, and therefore measuring them represents a challenge. The aim of the present study was to develop and validate an instrument to measure cultural beliefs about psychotherapy patients. Methods: A mixed method design conducted in four stages was implemented. First, 32 semi-structured interviews were carried out to identify beliefs about psychotherapy patients in southern Chile. Then, a scale of beliefs about psychotherapy patients (SBPP) was developed and piloted in an adult sample (n = 109). Subsequently, the factorial structure of the new scale was explored in patients of primary health centres in La Araucanía Region of Chile (n = 201). Finally, the validity of the construct was assessed in adults who were not undergoing psychotherapy (n = 361). Results: The results showed the existence of negative cultural beliefs about psychotherapy patients which were included in the construction of the SBPP. The scale had a bifactorial structure (αtransitory situations = 0.81 and αstable characteristics = 0.79), consisting of 15 items with a Likert-type response format, and showed good indicators of validity and reliability on the samples in which were applied. Conclusions: The present study shows the importance of using mixed methods for the examination of socially shared beliefs by the cultural group under study, in order to construct instruments that are psychometrically robust and culturally pertinent.
  • Article
    Aim: Stigma is commonly experienced among individuals with schizophrenia spectrum disorders and has been shown to be a barrier to help-seeking and behavioural service utilization. Given the established relationships between stigma, barriers to treatment, and poorer psychiatric outcomes including depression and psychotic symptoms, we examined the relationships between symptoms of depression, positive and negative symptoms, and the emergence of stigma longitudinally among a sample of first-episode of psychosis (FEP) participants in the United States. Methods: Data were obtained from the Recovery After an Initial Schizophrenia Episode project of National Institute of Mental Health's Early Treatment Program. Participants (n = 404) included adults between ages 15 and 40 with schizophrenia or other psychotic disorders based on the DSM-IV. Data were analysed using structural equation modelling (SEM). Results: Findings indicated that increased positive and negative symptoms independently related to greater symptoms of depression at baseline. Furthermore, increased positive symptoms and symptoms of depression at baseline independently related to the emergence of greater stigma being experienced over time. Conclusions: Considering the role that symptoms of depression played as a factor explaining the relationships between positive and negative symptoms and emergence of stigma over time among individuals in FEP, and symptoms of depression is important predictor of stigma and may furthermore present as a viable and less stigmatizing initial treatment target in the early course of a psychotic disorder.
  • Article
    This study used population‐representative data to examine associations of risk and protective factor patterns among Alaska Native/American Indian (AN/AI; N = 592) and non‐Native (N = 1,018) children with maternal and child outcomes at age 3 years. Among AN/AI children, a high risk/moderate protection class was associated with child developmental risk and mothers being less likely to feel comfortable asking for help or knowing where to go for parenting information compared to a low socioeconomic status/high protection class. Among non‐Native children, a moderate risk/high protection class was associated with child developmental risk and mothers being less likely to feel comfortable asking for help compared to a low risk/high protection class. Results provide insight on the intersection of risk and protective factors among Alaska families.
  • 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.