Stigma and mental illness By Iheanyichukwu Akpara Co-author: Ogbonnaya Akpara Brooklyn College
Stigma and mental illness
By Iheanyichukwu Akpara
Co-author: Ogbonnaya Akpara
Brooklyn College
The purpose of this research paper is to talk about stigma and mental illness. This
research paper will further discuss the development of stigma of mentally ill people, the
definition of mental illness and stigma, theories of stigma, the stigma process, effects of stigma,
improving clinician training to minimize stigma. The final part of my research paper will discuss
how people as a whole can modify or change the public stigma through protest, education,
contact and research specifically in regards to community based participatory research (CPBR).
Stigma is one of the hardest and toughest characteristics of modern society. Stigma is
defined as the shame that most people have which they have no control over. It stops them from
seeking support which leads to isolation. Mental illness affects the way you think, your behavior
and what your mood will be for that given day. Mentally ill individuals are treated unfairly by
people who are not mentally ill, and they suffer from being stigmatized. Scientists have
researched on the many forms of stigma including perceived stigma, institutional stigma, and
structural stigma.
According to the article “The Stigma of Mental Illness,” by Overton, S.L., & Medina,
S.L., the authors state that “stigma when used in terms of mental illness is a multifaceted
construct that involves feelings, attitudes and behavior” (Overton, Medina, 2008, p. 143). This
means that stigma is a mental illness that is all-around and it consists of perception, demeanor
and conduct. The authors also makes a point that “the theories of stigma include social identity
theory, self-stigma, and structural stigma” (Overton, Medina, 2008, p.144). This means that
social identity theory determines the type of individual he or she is, depending on the type of
individual he or she affiliates themselves with.
The authors mention that:
“The social identity theory considers how people use social constructs to judge or label
someone who is different or disfavored. Goffman makes mentionable note that societies,
or large groups within societies, evaluate people to determine if they fit the social norms.
This applies to people with a mental illness because throughout history they have been
viewed as a character or moral flaw. The term spoiled collective identity was defined by
E. Goffman to describe people who were stigmatized and whose identity as a whole was
brought into question. Individuals who are not stigmatized are also judged by society.
People with mental illness are often judged by their behaviors, but this does not reflect
their whole being. With spoiled collective identity, the stigmatized person is reduced in
the minds of others from a whole and normal person to a tainted and discounted one”
(Overton, Medina, 2008, p. 144).
In other words, social identity theory deals with how individuals use societal beliefs to
criticize an individual who is distinct and not very enthusiastic. An institution within the
organization classifies an individual to see if they fit the guideline or principle of societal
standards. Self-stigma is when you have negative feelings about yourself which will lead to
anger and hopelessness which will prevent an individual from seeking care and employment for
their condition. Structural stigma consists of policies, rules, regulations and practices that
prevents those with mental illness opportunities.
Stigma process includes cues that affects a person who has a mental illness, stereotypes
and the prejudice or discrimination against an individual suffering from mental illness. The
authors clarify that “a cue can present itself in several forms. It can be as simple as recognizing
that something is different about a person, or something observable such as a shortfall in social
skills” (Overton, Medina, 2008, p. 144). In other words, a cue can identify an individual's
characteristics just by noticing any signs that is out of the ordinary. Another broad cue that can
be used is a label or a psychiatric diagnoses, which can serve as a stronger cue than others. The
authors are unclear if this is because “mood disorders are more prevalent and acceptable in our
culture or because psychotic symptoms are often feared and are further from the norm of
acceptable behavior” (Overton, Medina, 2008, p. 144).
After an individual is cued, in one of the forms previously discussed, stereotypes are then
activated within that individual’s mind—and the stigmatization process is put into effect. The
authors also makes a point that “Even though someone may hold stereotypes about a group of
people, they may not believe them or endorse these ideals.” (Overton, Medina, 2008, p.144).
This means that individuals who are prejudiced are hurtful and unfavorable to those they
stigmatize because of the barriers they create. By acting out on prejudice, they are reinforcing the
stigma and creating a cycle where the mentally ill are constantly under attack for reasons they
have no control over. This cycle of repeat prejudice moves towards becoming a cycle of
discrimination.
In the article “Discrimination Against People With Mental Illness: What can Psychiatrists
do?” by Thornicroft, G., Rose, D., & Mehta, N., the authors talk about the effects of
discrimination on an individual. The authors make a point that “such strong and rejecting
prejudicial attitudes can translate into discriminatory behaviour” (Thornicroft, Brohan, 2010 p.
55). This means that this behavior is also expressed by healthcare professionals towards patients,
where often times depending on their mental illness are less welcome. This connection between
stigma and prejudice, which leads to discrimination, becomes such a strong behavioral response
that often times when normal people interact with the mentally ill there response is often
reflexive in a negative way. Discrimination involves different aspects for the majority group, in
that the majority group consist of positive actions whereas the stigmatized group involve
negative aspects.
A joint action that a mainstream group can take when dealing with stigmatized groups is
avoidance. Avoidance is used to remove something believed unwanted. In the article “The
Stigma of Mental Illness” by Overton, S.L., & Medina, S.L., the authors state that “There are
three functions associated with avoidance. They are social exchange, maintenance, and
contagion.” (Overton, Medina, 2008, p.145). Social exchange is based on the signal that an
individual gets out of societal collaborations. Moreover, without normal communication, social
identity is difficult to establish and therefore makes launching a societal control structure near
unbearable. Maintenance is an alternative goal that avoidance may be used with someone with a
mental illness. Preserving a distinctiveness is very essential to strengthen societal standards and
principles. Contagion has to do with mental illness being transmittable and there is no
investigation to back up that claim. When intermingling with an individual that is mentally ill,
you are more likely to suffer from mental illness also.
Avoidance is the ability to escape situations that are not beneficial towards you. It is also
the ability to avoid something that causes pain or anxiety. According to the article “The Stigma
of Mental Illness” by Overton, S.L., & Medina, S.L., the authors state that “avoidance is useful
in dealing with the social consequence that being associated or socializing with a stigmatized
person may influence one’s social standing. People who are motivated to control initial
prejudicial behaviors display more approach behavior toward the people they have stigmatized
after they have had time to process. However, there are times when, even after reflection, people
still choose avoidance” (Overton, Medina, 2008, p.145). This means that when mingling with a
stigmatized individual, it may effect one’s societal standing. Individuals who are brilliant to
control detrimental behaviors exhibits more tactic behavior toward the individuals they have
stigmatized after they have had time to process.
Many people suffering from mental illness go through challenges that will affect them in
the long run. They are not treated fairly and this may affect their health and their way of living.
They won't be able to find a place to live, no job and will face bias by healthcare professionals
who are treating these individuals. According to the article “The Stigma of Mental Illness” by
Overton, S.L and Medina, S.L., the authors state that the effects of stigma includes “limitations
on finding adequate shelter, lack of employment opportunities, barriers to obtaining treatment
services and negative attitudes of mental health professionals and the role of the media in
perpetuating the negative image of people with a mental illness. Researchers have found that
once people have been labeled mentally ill, they are more likely to be underemployed and to earn
less than people with the same psychiatric differences but who have not been identified as having
them” (Overton, Medina, 2008, p.145-146). This means that an individual who is categorized as
mentally ill experiences institutional racism which is the distinction to have access to the goods,
services, and opportunities of society by “race”. For example, housing, education, employment
and income. According to the article “Stigma and Discrimination of Mental Health Problems:
Workplace Implications” by Brohan, E., & Thornicroft, G., the authors state that
“There is evidence that people with mental health problems report being turned down for
a job because of their mental health problem or stopping themselves from looking for
work because they anticipate discrimination. Disclosure of a mental health problem in the
workplace can also lead to discriminatory behaviors from managers and colleagues such
as micro-management, lack of opportunities for advancement, over-inferring of mistakes
to illness, gossip and social exclusion. Krupa highlighted four assumptions underlying
workplace stigma. People with mental health problems lack the competence to meet the
demands of work. People with mental health problems are dangerous or unpredictable in
the workplace. Working is not healthy for people with a mental health problem and
providing employment for people with mental illness is an act of charity” (Brohan,
Thornicroft, 2010, p.414).
In other words, racism continues to diminish in the United States. The definition of
racism is a system of structuring opportunity and assigning value based on the social
interpretation of how an individual looks. Racism unfairly disadvantages individuals and
communities. Racism leads to discrimination, and major disparities in physical and
mental health. Disparities arise from lack of quality of care, access to care and life
opportunities, exposures and stresses.
The article “The Stigma of Mental Illness” by Overton, S. L., & Medina, S. L., the
authors mentioned that “financial barriers can make access to services difficult. If an individual
has a mental illness, he or she might have a difficult time getting a job because of the stigma
imposed on them by employers. They might also have challenges related to their symptoms that
make it difficult to hold a job. Lack of resources and continued budget cuts can make it almost
impossible for a person to receive comprehensive services. Such financial constraints also mean
that mental health centers are often understaffed and underpaid so that frustrations trickle down
and can sometimes be reflected in the attitudes of those providing the services that are being
offered to community members” (Overton, Medina, 2008, p.146). This means that people who
have mental illness have economic obstacles that prevent them from attaining a cure. Individuals
who are mentally ill experience health disparities that arise from the absence of quality of
maintenance, access to care and life opportunities, exposures and stresses. Without any financial
resources and job employment, the individuals who are mentally ill, will not find resources they
need to survive in a world surrounding negative impacts on the mentally ill individuals and the
dangerous conditions that remain to be a difficult or hard challenge to tackle.
Mental health professionals plays a crucial role in the everyday lives of mentally ill
people. They are responsible for treating mentally ill people but due to the stigmatization of
mentally ill people, mental health professionals perceive the same attitudes as people in the
public which will affect how they treat people with mental illness. Historically, this has not
changed much in the mental health field. Patients are often thought to be unskilled.
Mental health professionals tried to change their attitudes regarding mentally ill people
through professional contact but it didn't help in terms of prognosis and treatment. Every time
family members come to visit their relative with mental illness, they already know what the
outcome will be based on the way mental health professionals feel about mentally ill people.
The authors also makes a point that “Attitudes held by mental health professionals were
influenced by the professional’s personal work experiences with clients and by prevailing
attitudes of the profession and the professionals with whom they worked. Professional contact
may improve general attitudes about mental illness, but such contact was not helpful in changing
negative attitudes about predicting prognosis and long term outcomes. Fear is the most prevalent
emotion reported by mental health professionals regarding this population. Some other secondary
emotions include dislike, neglect and anger. Fear is such a strong emotion that it may perpetuate
stigma by creating more labels that influence client’s behaviors and symptoms” (Overton,
Medina, 2008, p.146).
Clinician training plays a role in the relationship that counselors will have on those
individuals suffering from a mental illness. Clinician training includes education on stigma and
developing relationships with people with mental illness. In the article “The Stigma of Mental
Illness” by Overton, S. L., & Medina, S. L., the authors states that “an individual must improve
clinician training to minimize stigma.” (Overton, Medina, 2008, p.146). The authors suggests
that “counselors receive education about stigma and its impact on individuals with mental illness,
that educators in counselor training programs work to increase their students capacity for
cognitive complexity and that counselors find opportunities for developing egalitarian
relationships with individuals having a mental illness. Counselor educators should help students
to think more complexly and process information more quickly. They even suggested that the
curriculum in counselor training programs should be more demanding to increase student level
of cognitive complexity or that only students with high levels of cognitive complexity be
admitted to counselor training programs. Education should help students to achieve a higher
level of cognitive complexity because they are exposed to diverse patterns of behavior and social
situations through higher education” (Overton, Medina, 2008, p.148-149).
There are so many ways educators can reach out to those individuals going through
mental illness. These ways can help overcome stereotypes and prejudices that people with mental
illness face on a daily basis. The article “Measuring the Impact of Programs that Challenge the
Public Stigma of Mental Illness” by Corrigan, P.W., & Shapiro, J.W., the authors suggest that
“educational approaches to stigma challenge inaccurate stereotypes about mental illnesses
replacing them with factual information. Educators bestow the knowledge that challenges the
prejudices and stereotypes of this disability.” (Corrigan, Shapiro, 2010, p.7-8).
Changing the public stigma of mental illness includes going in contact with people who
are suffering from mental illness. This will likely decrease the chances of being prejudiced and
discriminated on. In the article “The Stigma of Mental Illness” by Overton, S.L., & Medina, S.L.,
the authors state that “the more personal contact a person has with a stigmatized group, the fewer
stigmatizing attitudes he or she will have. A combination of personal contact, education and
cooperative contact, such as working with someone toward a common goal, could reduce stigma.
Specifically, contact with the stigmatized group minimizes the perception of group differences.
When people have contact with someone with a mental illness and this person is perceived to
have equal status, either professionally or personally, then such contact mitigates stigma. One-
on-one contact or more intimate intrapersonal contact also enables contact to work more
effectively. Cooperative contacts are also important because as people work together toward
common goals, stereotypes are more easily displaced” (Overton, Medina, 2010, p.148).
Protesting is another way we can change the public stigma of individuals suffering from
mental illness. Protesting is when you make a complaint against something you disapprove. It
can be challenged, declared, questioned, argue against, oppose, and object. When you protest,
according to the article “ The Stigma of Mental Illness” by Overton, S. L., & Medina, S.L., the
author states that “you are helping the individual not to think about the negative aspects of
stereotypes.”(Overton, Medina, 2008, p. 147). Another way of changing the public stigma of
mental illness is through Community based Participatory Research. Community Based
Participatory Research consists of individuals contributing to research and being able to
acknowledge what the individual brings to the table. CBPR starts off with a research topic that
everyone in the community wants to participate in. The next thing is to gather knowledge and
achieve social change so the knowledge gathered can be used to improve health and eliminate
disparities associated with health.
According to the article “Community-Based Participatory Research: Partnering with
Communities for Effective and Sustainable Behavioral Health Interventions” by Bogart, L.M., &
Uyeda, K., the authors states that “similar to administration councils of any human service
program, the CBPR team is responsible for all activities related to: research on stigma change
programs that are then used to broaden campaigns meant to control prejudice and discrimination.
This approach signals a paradigm shift for many researchers. Basic to their work under CBPR,
social scientists need to engage with other stakeholders in all aspects of effective evaluation.
Indeed, “engage the stakeholder” is not sufficient as a descriptor. Partnership is more
appropriate; scientists and consumer share all decisions about a study. This means the researcher
needs to educate stakeholders about key aspects of the research approach” (Bogart, Uyeda, 2009,
p. 7).
According to the article “Measuring the Impact of Programs that Challenge the Public
Stigma of Mental Illness” by Corrigan, P.W., & Shapiro, J.R., the authors state that the
“Approach to the mental health system, and therefore to mental health stigma, varies by role,
with survivors, for example, likely to be more critical and skeptical of the system than those who
understand themselves as current consumers of care. Other stakeholders may need to be included
in a CBPR effort. Family members of people with serious mental illness often have different
priorities than their relatives with the disability. Family takes many forms; often parents, but also
siblings, children and spouses. Service providers may be valuable members of a CBPR team and
are likely to vary by discipline and authority (e.g., physicians usually have legal authority on
multidisciplinary teams). If a central strategy for stigma change is targeting persons in powerful
roles, then representatives from these groups might also be useful partners in CBPR. For
example, it would be important to include employers in an anti-stigma research project on hiring
people with mental illnesses. Who better knows the prejudice and discrimination that employers
may hold against individuals with mental illnesses than employers themselves?” (Corrigan,
Shapiro, 2010 p.7-8).
To measure stigma change, one should choose a measure that is beneficial towards the
stakeholder in order to accomplish that goal. The people that should handle this measure are
people that are part of the Community Based Participatory Research team. We should include
diversity in stigma change. Diversity includes sexual orientation, SES, education, ethnicity and
gender. Diversity is an important peacemaker in how individuals perceive mental illness.
Diversity are identifiers when it comes to people with mental illness. Stakeholders consider
behavior as the most important in measuring behavior change. Don't choose behaviors that are of
social desirability. Yet choose a behavior that has social validity. To understand anti-stigma
approach and behavior, look for attitudes, emotions, physiological processes, information and
knowledge and discuss why each of them affects anti-stigma and behavior. Develop stigma
theory models for attitudes and emotions and discuss if awareness made a change in anti-stigma.
The authors also states that “Research needs to represent an agenda of priorities, with this
agenda reflecting the interests and exigencies of the community of relevant stakeholders. This
begins with development of a CBPR team, the group with ultimate control of program
evaluation. The CBPR team includes local stakeholders with the most prominent group there
being people with psychiatric disabilities. Diversity is important when developing CBPR teams.
Relevant categories include ethnicity, gender, SES, age, and education. CBPR activities are
successful when the research design includes measures with social validity. Social validity
represents the “so what” effect. So what if instrument X changed: what implications does it
actually have for controlling stigma and bettering the lives of people with psychiatric disorders?
Behaviors are often cited by stakeholder groups as the most important for stigma change; the
most resounding response to “so what!” But not all behavior is on target, Anti-stigma programs
are not effective if an employer indiscriminately increases his or her interviews of just anyone. Is
an anti-stigma program on mental illness stigma successful if it improves employer behavior of
Black men? Probably not. So what about programs for people in wheelchairs, with substance
abuse disorders, or with transient depression? The goal is to determine the impact of
interviewing people with disabilities AND whether the action leads to an increase in people with
mental illnesses obtaining more and better jobs” (Corrigan, Shapiro, 2010 p.20).
To conclude, the research paper discussed the definition of mental illness and stigma, the
theories of stigma, the stigma process, effects of stigma, improving clinician training to minimize
stigma and changing the public stigma of mental illness through protest, education, contact and
research specifically community based participatory research.
References
Bogart LM., Uyeda K. (2009). Community- based participatory research: partnering with
communities for effective and sustainable behavioral health interventions. Health Psychology
28 Volume (4): 391-393 [PubMed: 19594261]. Retrieved from
https://www.ncbi.nlm.gov/pubmed/19594261
Brohan, E., Slade, M., Clement, S., Thornicroft, G. (2010). Experiences of
mental illness stigma, prejudice and discrimination: a review of measures. Retrieved from
http://www.biomedcentral.com/1472-6963/10/80. Volume 10, Journal of BMC Health
Services 1-11
Brohan, E., Thornicroft, G. (2010). Stigma and discrimination of mental health
problems: workplace implications. Retrieved from
occmed.oxfordjournals.org/content/60/6/414.full.pdf+html. Volume 60. Journal of the
society of Occupational medicine ; 414-420
Christopher S., Watts V., McCormick A., Young S. Building and maintain trust in a
community-based participatory research partnership. American Journal of Public Health
(2008); 98 volume (8) :1398-1406, [PubMed: 18556605]. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/18556505
Corrigan, PW., Shapiro, JR, (June 2010). Measuring the impact of programs that
challenge the public stigma of mental illness. Retrieved from
https://www.researchgate.net/publication/45439012_Measuring_The_impact_of_program
s_that_challenge_the_public_stigma_of_mental_illness. Volume 10. Journal: Clinical
psychology review: 1-33
Corrigan, PW., Wassel, A. (2008 January 1). Understanding and Influencing the
Stigma of Mental illness. Retrieved from www.healio.com/psychiatry/journals/jpn/2008-
1-46-1/{832b9ec6-8afb-49cc-90dc-e26bc7e37a1f}/understanding-and-influencing-the-
stigma-of-mental-illness. Journal of Psychosocial Nursing
and Mental Health Services. Volume 16. Issue 1: 42-48
Finklestein J., Lapshin O., Wassermann, E. Randomized study of different anti-stigma media.
Patient Education & Counseling. 71. Volume 2; 204-214. [PubMed: 18289823].
Retrieved from http://dx.doi.org/10/1016/j.pec.2008.01.002 p.
Krupa, T. (January 2009). Understanding the stigma of mental illness in employment Work.
Retrieved from researchgate.net/publication/38099397-
Understanding_the_stigma_of_mental_illness_in_employment. Work 33 Volume (4):
413-425 Journal: PubMed
Norman, R, M, G., Sorrentino, RM., Windell, D.et al. (Nov 2008. The role of perceived norms in
the stigmatization of mental illness. Soc Psychiat Epidemiol. 43:
851.doi:10.1007/s00127-008-0375-4
Overton, SL., Medina, SL (Spring 2008). The stigma of mental illness. Retrieved
from pzacad.pitzer.edu/~hfairchi/pdf/psychology/social & Diversity/Overton (2008)
Stigma Mental illness .pdf. Volume 86. Journal of counseling and development 143-151
Parle, S. (Oct 2012). How does stigma affect people with mental illness. Retrieved from
https://www.nursingtimes.net/Journals/2012/07/06/q/p/l/120710-How-does-stigma-
affect-people-with-mental-illness.pdf. Journal: Nursing times 10.07.12/vol 108 No 28
Thornicroft G., Brohan, E., Kassam, A, Lewis-Holmes, E. Reducing stigma and discrimination:
Candidate interventions. International Journal of Mental Health Systems:2: Volume 3
[PubMed: 18405393] Retrieved from
https://ijmns.biomedcentral.com/articles/10.1186/1752-4458-2-3 1-7
Thornicroft, G., Rose, D., Mehta, N. (Jan 2010). Discrimination against people with
mental illness: what can psychiatrists do. Retrieved from
apy.repsych.org/content/16/1/53. Journal: Advances in psychiatric treatment. Volume 16.
By Iheanyichukwu Akpara
Co-author: Ogbonnaya Akpara
Brooklyn College
The purpose of this research paper is to talk about stigma and mental illness. This
research paper will further discuss the development of stigma of mentally ill people, the
definition of mental illness and stigma, theories of stigma, the stigma process, effects of stigma,
improving clinician training to minimize stigma. The final part of my research paper will discuss
how people as a whole can modify or change the public stigma through protest, education,
contact and research specifically in regards to community based participatory research (CPBR).
Stigma is one of the hardest and toughest characteristics of modern society. Stigma is
defined as the shame that most people have which they have no control over. It stops them from
seeking support which leads to isolation. Mental illness affects the way you think, your behavior
and what your mood will be for that given day. Mentally ill individuals are treated unfairly by
people who are not mentally ill, and they suffer from being stigmatized. Scientists have
researched on the many forms of stigma including perceived stigma, institutional stigma, and
structural stigma.
According to the article “The Stigma of Mental Illness,” by Overton, S.L., & Medina,
S.L., the authors state that “stigma when used in terms of mental illness is a multifaceted
construct that involves feelings, attitudes and behavior” (Overton, Medina, 2008, p. 143). This
means that stigma is a mental illness that is all-around and it consists of perception, demeanor
and conduct. The authors also makes a point that “the theories of stigma include social identity
theory, self-stigma, and structural stigma” (Overton, Medina, 2008, p.144). This means that
social identity theory determines the type of individual he or she is, depending on the type of
individual he or she affiliates themselves with.
The authors mention that:
“The social identity theory considers how people use social constructs to judge or label
someone who is different or disfavored. Goffman makes mentionable note that societies,
or large groups within societies, evaluate people to determine if they fit the social norms.
This applies to people with a mental illness because throughout history they have been
viewed as a character or moral flaw. The term spoiled collective identity was defined by
E. Goffman to describe people who were stigmatized and whose identity as a whole was
brought into question. Individuals who are not stigmatized are also judged by society.
People with mental illness are often judged by their behaviors, but this does not reflect
their whole being. With spoiled collective identity, the stigmatized person is reduced in
the minds of others from a whole and normal person to a tainted and discounted one”
(Overton, Medina, 2008, p. 144).
In other words, social identity theory deals with how individuals use societal beliefs to
criticize an individual who is distinct and not very enthusiastic. An institution within the
organization classifies an individual to see if they fit the guideline or principle of societal
standards. Self-stigma is when you have negative feelings about yourself which will lead to
anger and hopelessness which will prevent an individual from seeking care and employment for
their condition. Structural stigma consists of policies, rules, regulations and practices that
prevents those with mental illness opportunities.
Stigma process includes cues that affects a person who has a mental illness, stereotypes
and the prejudice or discrimination against an individual suffering from mental illness. The
authors clarify that “a cue can present itself in several forms. It can be as simple as recognizing
that something is different about a person, or something observable such as a shortfall in social
skills” (Overton, Medina, 2008, p. 144). In other words, a cue can identify an individual's
characteristics just by noticing any signs that is out of the ordinary. Another broad cue that can
be used is a label or a psychiatric diagnoses, which can serve as a stronger cue than others. The
authors are unclear if this is because “mood disorders are more prevalent and acceptable in our
culture or because psychotic symptoms are often feared and are further from the norm of
acceptable behavior” (Overton, Medina, 2008, p. 144).
After an individual is cued, in one of the forms previously discussed, stereotypes are then
activated within that individual’s mind—and the stigmatization process is put into effect. The
authors also makes a point that “Even though someone may hold stereotypes about a group of
people, they may not believe them or endorse these ideals.” (Overton, Medina, 2008, p.144).
This means that individuals who are prejudiced are hurtful and unfavorable to those they
stigmatize because of the barriers they create. By acting out on prejudice, they are reinforcing the
stigma and creating a cycle where the mentally ill are constantly under attack for reasons they
have no control over. This cycle of repeat prejudice moves towards becoming a cycle of
discrimination.
In the article “Discrimination Against People With Mental Illness: What can Psychiatrists
do?” by Thornicroft, G., Rose, D., & Mehta, N., the authors talk about the effects of
discrimination on an individual. The authors make a point that “such strong and rejecting
prejudicial attitudes can translate into discriminatory behaviour” (Thornicroft, Brohan, 2010 p.
55). This means that this behavior is also expressed by healthcare professionals towards patients,
where often times depending on their mental illness are less welcome. This connection between
stigma and prejudice, which leads to discrimination, becomes such a strong behavioral response
that often times when normal people interact with the mentally ill there response is often
reflexive in a negative way. Discrimination involves different aspects for the majority group, in
that the majority group consist of positive actions whereas the stigmatized group involve
negative aspects.
A joint action that a mainstream group can take when dealing with stigmatized groups is
avoidance. Avoidance is used to remove something believed unwanted. In the article “The
Stigma of Mental Illness” by Overton, S.L., & Medina, S.L., the authors state that “There are
three functions associated with avoidance. They are social exchange, maintenance, and
contagion.” (Overton, Medina, 2008, p.145). Social exchange is based on the signal that an
individual gets out of societal collaborations. Moreover, without normal communication, social
identity is difficult to establish and therefore makes launching a societal control structure near
unbearable. Maintenance is an alternative goal that avoidance may be used with someone with a
mental illness. Preserving a distinctiveness is very essential to strengthen societal standards and
principles. Contagion has to do with mental illness being transmittable and there is no
investigation to back up that claim. When intermingling with an individual that is mentally ill,
you are more likely to suffer from mental illness also.
Avoidance is the ability to escape situations that are not beneficial towards you. It is also
the ability to avoid something that causes pain or anxiety. According to the article “The Stigma
of Mental Illness” by Overton, S.L., & Medina, S.L., the authors state that “avoidance is useful
in dealing with the social consequence that being associated or socializing with a stigmatized
person may influence one’s social standing. People who are motivated to control initial
prejudicial behaviors display more approach behavior toward the people they have stigmatized
after they have had time to process. However, there are times when, even after reflection, people
still choose avoidance” (Overton, Medina, 2008, p.145). This means that when mingling with a
stigmatized individual, it may effect one’s societal standing. Individuals who are brilliant to
control detrimental behaviors exhibits more tactic behavior toward the individuals they have
stigmatized after they have had time to process.
Many people suffering from mental illness go through challenges that will affect them in
the long run. They are not treated fairly and this may affect their health and their way of living.
They won't be able to find a place to live, no job and will face bias by healthcare professionals
who are treating these individuals. According to the article “The Stigma of Mental Illness” by
Overton, S.L and Medina, S.L., the authors state that the effects of stigma includes “limitations
on finding adequate shelter, lack of employment opportunities, barriers to obtaining treatment
services and negative attitudes of mental health professionals and the role of the media in
perpetuating the negative image of people with a mental illness. Researchers have found that
once people have been labeled mentally ill, they are more likely to be underemployed and to earn
less than people with the same psychiatric differences but who have not been identified as having
them” (Overton, Medina, 2008, p.145-146). This means that an individual who is categorized as
mentally ill experiences institutional racism which is the distinction to have access to the goods,
services, and opportunities of society by “race”. For example, housing, education, employment
and income. According to the article “Stigma and Discrimination of Mental Health Problems:
Workplace Implications” by Brohan, E., & Thornicroft, G., the authors state that
“There is evidence that people with mental health problems report being turned down for
a job because of their mental health problem or stopping themselves from looking for
work because they anticipate discrimination. Disclosure of a mental health problem in the
workplace can also lead to discriminatory behaviors from managers and colleagues such
as micro-management, lack of opportunities for advancement, over-inferring of mistakes
to illness, gossip and social exclusion. Krupa highlighted four assumptions underlying
workplace stigma. People with mental health problems lack the competence to meet the
demands of work. People with mental health problems are dangerous or unpredictable in
the workplace. Working is not healthy for people with a mental health problem and
providing employment for people with mental illness is an act of charity” (Brohan,
Thornicroft, 2010, p.414).
In other words, racism continues to diminish in the United States. The definition of
racism is a system of structuring opportunity and assigning value based on the social
interpretation of how an individual looks. Racism unfairly disadvantages individuals and
communities. Racism leads to discrimination, and major disparities in physical and
mental health. Disparities arise from lack of quality of care, access to care and life
opportunities, exposures and stresses.
The article “The Stigma of Mental Illness” by Overton, S. L., & Medina, S. L., the
authors mentioned that “financial barriers can make access to services difficult. If an individual
has a mental illness, he or she might have a difficult time getting a job because of the stigma
imposed on them by employers. They might also have challenges related to their symptoms that
make it difficult to hold a job. Lack of resources and continued budget cuts can make it almost
impossible for a person to receive comprehensive services. Such financial constraints also mean
that mental health centers are often understaffed and underpaid so that frustrations trickle down
and can sometimes be reflected in the attitudes of those providing the services that are being
offered to community members” (Overton, Medina, 2008, p.146). This means that people who
have mental illness have economic obstacles that prevent them from attaining a cure. Individuals
who are mentally ill experience health disparities that arise from the absence of quality of
maintenance, access to care and life opportunities, exposures and stresses. Without any financial
resources and job employment, the individuals who are mentally ill, will not find resources they
need to survive in a world surrounding negative impacts on the mentally ill individuals and the
dangerous conditions that remain to be a difficult or hard challenge to tackle.
Mental health professionals plays a crucial role in the everyday lives of mentally ill
people. They are responsible for treating mentally ill people but due to the stigmatization of
mentally ill people, mental health professionals perceive the same attitudes as people in the
public which will affect how they treat people with mental illness. Historically, this has not
changed much in the mental health field. Patients are often thought to be unskilled.
Mental health professionals tried to change their attitudes regarding mentally ill people
through professional contact but it didn't help in terms of prognosis and treatment. Every time
family members come to visit their relative with mental illness, they already know what the
outcome will be based on the way mental health professionals feel about mentally ill people.
The authors also makes a point that “Attitudes held by mental health professionals were
influenced by the professional’s personal work experiences with clients and by prevailing
attitudes of the profession and the professionals with whom they worked. Professional contact
may improve general attitudes about mental illness, but such contact was not helpful in changing
negative attitudes about predicting prognosis and long term outcomes. Fear is the most prevalent
emotion reported by mental health professionals regarding this population. Some other secondary
emotions include dislike, neglect and anger. Fear is such a strong emotion that it may perpetuate
stigma by creating more labels that influence client’s behaviors and symptoms” (Overton,
Medina, 2008, p.146).
Clinician training plays a role in the relationship that counselors will have on those
individuals suffering from a mental illness. Clinician training includes education on stigma and
developing relationships with people with mental illness. In the article “The Stigma of Mental
Illness” by Overton, S. L., & Medina, S. L., the authors states that “an individual must improve
clinician training to minimize stigma.” (Overton, Medina, 2008, p.146). The authors suggests
that “counselors receive education about stigma and its impact on individuals with mental illness,
that educators in counselor training programs work to increase their students capacity for
cognitive complexity and that counselors find opportunities for developing egalitarian
relationships with individuals having a mental illness. Counselor educators should help students
to think more complexly and process information more quickly. They even suggested that the
curriculum in counselor training programs should be more demanding to increase student level
of cognitive complexity or that only students with high levels of cognitive complexity be
admitted to counselor training programs. Education should help students to achieve a higher
level of cognitive complexity because they are exposed to diverse patterns of behavior and social
situations through higher education” (Overton, Medina, 2008, p.148-149).
There are so many ways educators can reach out to those individuals going through
mental illness. These ways can help overcome stereotypes and prejudices that people with mental
illness face on a daily basis. The article “Measuring the Impact of Programs that Challenge the
Public Stigma of Mental Illness” by Corrigan, P.W., & Shapiro, J.W., the authors suggest that
“educational approaches to stigma challenge inaccurate stereotypes about mental illnesses
replacing them with factual information. Educators bestow the knowledge that challenges the
prejudices and stereotypes of this disability.” (Corrigan, Shapiro, 2010, p.7-8).
Changing the public stigma of mental illness includes going in contact with people who
are suffering from mental illness. This will likely decrease the chances of being prejudiced and
discriminated on. In the article “The Stigma of Mental Illness” by Overton, S.L., & Medina, S.L.,
the authors state that “the more personal contact a person has with a stigmatized group, the fewer
stigmatizing attitudes he or she will have. A combination of personal contact, education and
cooperative contact, such as working with someone toward a common goal, could reduce stigma.
Specifically, contact with the stigmatized group minimizes the perception of group differences.
When people have contact with someone with a mental illness and this person is perceived to
have equal status, either professionally or personally, then such contact mitigates stigma. One-
on-one contact or more intimate intrapersonal contact also enables contact to work more
effectively. Cooperative contacts are also important because as people work together toward
common goals, stereotypes are more easily displaced” (Overton, Medina, 2010, p.148).
Protesting is another way we can change the public stigma of individuals suffering from
mental illness. Protesting is when you make a complaint against something you disapprove. It
can be challenged, declared, questioned, argue against, oppose, and object. When you protest,
according to the article “ The Stigma of Mental Illness” by Overton, S. L., & Medina, S.L., the
author states that “you are helping the individual not to think about the negative aspects of
stereotypes.”(Overton, Medina, 2008, p. 147). Another way of changing the public stigma of
mental illness is through Community based Participatory Research. Community Based
Participatory Research consists of individuals contributing to research and being able to
acknowledge what the individual brings to the table. CBPR starts off with a research topic that
everyone in the community wants to participate in. The next thing is to gather knowledge and
achieve social change so the knowledge gathered can be used to improve health and eliminate
disparities associated with health.
According to the article “Community-Based Participatory Research: Partnering with
Communities for Effective and Sustainable Behavioral Health Interventions” by Bogart, L.M., &
Uyeda, K., the authors states that “similar to administration councils of any human service
program, the CBPR team is responsible for all activities related to: research on stigma change
programs that are then used to broaden campaigns meant to control prejudice and discrimination.
This approach signals a paradigm shift for many researchers. Basic to their work under CBPR,
social scientists need to engage with other stakeholders in all aspects of effective evaluation.
Indeed, “engage the stakeholder” is not sufficient as a descriptor. Partnership is more
appropriate; scientists and consumer share all decisions about a study. This means the researcher
needs to educate stakeholders about key aspects of the research approach” (Bogart, Uyeda, 2009,
p. 7).
According to the article “Measuring the Impact of Programs that Challenge the Public
Stigma of Mental Illness” by Corrigan, P.W., & Shapiro, J.R., the authors state that the
“Approach to the mental health system, and therefore to mental health stigma, varies by role,
with survivors, for example, likely to be more critical and skeptical of the system than those who
understand themselves as current consumers of care. Other stakeholders may need to be included
in a CBPR effort. Family members of people with serious mental illness often have different
priorities than their relatives with the disability. Family takes many forms; often parents, but also
siblings, children and spouses. Service providers may be valuable members of a CBPR team and
are likely to vary by discipline and authority (e.g., physicians usually have legal authority on
multidisciplinary teams). If a central strategy for stigma change is targeting persons in powerful
roles, then representatives from these groups might also be useful partners in CBPR. For
example, it would be important to include employers in an anti-stigma research project on hiring
people with mental illnesses. Who better knows the prejudice and discrimination that employers
may hold against individuals with mental illnesses than employers themselves?” (Corrigan,
Shapiro, 2010 p.7-8).
To measure stigma change, one should choose a measure that is beneficial towards the
stakeholder in order to accomplish that goal. The people that should handle this measure are
people that are part of the Community Based Participatory Research team. We should include
diversity in stigma change. Diversity includes sexual orientation, SES, education, ethnicity and
gender. Diversity is an important peacemaker in how individuals perceive mental illness.
Diversity are identifiers when it comes to people with mental illness. Stakeholders consider
behavior as the most important in measuring behavior change. Don't choose behaviors that are of
social desirability. Yet choose a behavior that has social validity. To understand anti-stigma
approach and behavior, look for attitudes, emotions, physiological processes, information and
knowledge and discuss why each of them affects anti-stigma and behavior. Develop stigma
theory models for attitudes and emotions and discuss if awareness made a change in anti-stigma.
The authors also states that “Research needs to represent an agenda of priorities, with this
agenda reflecting the interests and exigencies of the community of relevant stakeholders. This
begins with development of a CBPR team, the group with ultimate control of program
evaluation. The CBPR team includes local stakeholders with the most prominent group there
being people with psychiatric disabilities. Diversity is important when developing CBPR teams.
Relevant categories include ethnicity, gender, SES, age, and education. CBPR activities are
successful when the research design includes measures with social validity. Social validity
represents the “so what” effect. So what if instrument X changed: what implications does it
actually have for controlling stigma and bettering the lives of people with psychiatric disorders?
Behaviors are often cited by stakeholder groups as the most important for stigma change; the
most resounding response to “so what!” But not all behavior is on target, Anti-stigma programs
are not effective if an employer indiscriminately increases his or her interviews of just anyone. Is
an anti-stigma program on mental illness stigma successful if it improves employer behavior of
Black men? Probably not. So what about programs for people in wheelchairs, with substance
abuse disorders, or with transient depression? The goal is to determine the impact of
interviewing people with disabilities AND whether the action leads to an increase in people with
mental illnesses obtaining more and better jobs” (Corrigan, Shapiro, 2010 p.20).
To conclude, the research paper discussed the definition of mental illness and stigma, the
theories of stigma, the stigma process, effects of stigma, improving clinician training to minimize
stigma and changing the public stigma of mental illness through protest, education, contact and
research specifically community based participatory research.
References
Bogart LM., Uyeda K. (2009). Community- based participatory research: partnering with
communities for effective and sustainable behavioral health interventions. Health Psychology
28 Volume (4): 391-393 [PubMed: 19594261]. Retrieved from
https://www.ncbi.nlm.gov/pubmed/19594261
Brohan, E., Slade, M., Clement, S., Thornicroft, G. (2010). Experiences of
mental illness stigma, prejudice and discrimination: a review of measures. Retrieved from
http://www.biomedcentral.com/1472-6963/10/80. Volume 10, Journal of BMC Health
Services 1-11
Brohan, E., Thornicroft, G. (2010). Stigma and discrimination of mental health
problems: workplace implications. Retrieved from
occmed.oxfordjournals.org/content/60/6/414.full.pdf+html. Volume 60. Journal of the
society of Occupational medicine ; 414-420
Christopher S., Watts V., McCormick A., Young S. Building and maintain trust in a
community-based participatory research partnership. American Journal of Public Health
(2008); 98 volume (8) :1398-1406, [PubMed: 18556605]. Retrieved from
https://www.ncbi.nlm.nih.gov/pubmed/18556505
Corrigan, PW., Shapiro, JR, (June 2010). Measuring the impact of programs that
challenge the public stigma of mental illness. Retrieved from
https://www.researchgate.net/publication/45439012_Measuring_The_impact_of_program
s_that_challenge_the_public_stigma_of_mental_illness. Volume 10. Journal: Clinical
psychology review: 1-33
Corrigan, PW., Wassel, A. (2008 January 1). Understanding and Influencing the
Stigma of Mental illness. Retrieved from www.healio.com/psychiatry/journals/jpn/2008-
1-46-1/{832b9ec6-8afb-49cc-90dc-e26bc7e37a1f}/understanding-and-influencing-the-
stigma-of-mental-illness. Journal of Psychosocial Nursing
and Mental Health Services. Volume 16. Issue 1: 42-48
Finklestein J., Lapshin O., Wassermann, E. Randomized study of different anti-stigma media.
Patient Education & Counseling. 71. Volume 2; 204-214. [PubMed: 18289823].
Retrieved from http://dx.doi.org/10/1016/j.pec.2008.01.002 p.
Krupa, T. (January 2009). Understanding the stigma of mental illness in employment Work.
Retrieved from researchgate.net/publication/38099397-
Understanding_the_stigma_of_mental_illness_in_employment. Work 33 Volume (4):
413-425 Journal: PubMed
Norman, R, M, G., Sorrentino, RM., Windell, D.et al. (Nov 2008. The role of perceived norms in
the stigmatization of mental illness. Soc Psychiat Epidemiol. 43:
851.doi:10.1007/s00127-008-0375-4
Overton, SL., Medina, SL (Spring 2008). The stigma of mental illness. Retrieved
from pzacad.pitzer.edu/~hfairchi/pdf/psychology/social & Diversity/Overton (2008)
Stigma Mental illness .pdf. Volume 86. Journal of counseling and development 143-151
Parle, S. (Oct 2012). How does stigma affect people with mental illness. Retrieved from
https://www.nursingtimes.net/Journals/2012/07/06/q/p/l/120710-How-does-stigma-
affect-people-with-mental-illness.pdf. Journal: Nursing times 10.07.12/vol 108 No 28
Thornicroft G., Brohan, E., Kassam, A, Lewis-Holmes, E. Reducing stigma and discrimination:
Candidate interventions. International Journal of Mental Health Systems:2: Volume 3
[PubMed: 18405393] Retrieved from
https://ijmns.biomedcentral.com/articles/10.1186/1752-4458-2-3 1-7
Thornicroft, G., Rose, D., Mehta, N. (Jan 2010). Discrimination against people with
mental illness: what can psychiatrists do. Retrieved from
apy.repsych.org/content/16/1/53. Journal: Advances in psychiatric treatment. Volume 16.
Comments
Post a Comment