Define what is meant by stigma.
- a mark of disgrace associated with a particular circumstance, quality, or person.
- Goffman (1963) describes stigma as attributes which are “deeply discrediting” to the individual.
-Can also be defined as negative attitudes or discrimination towards an individual based on distinguishing characteristics.
E.g., related to culture, race, age, gender, or health.
Describe the process of stigma (Link and Phelan, 2001).
- Labelling difference or categorising.
- Stereotyping.
- Separation of ‘them’ and ‘us’.
- Status loss and discrimination.
- These stages occur in situations in which power is exercised.
Describe the components of stigma according to Corrigan and Watson, 2002.
Stereotypes: ‘stereotypes as especially efficient, social knowledge structures that are learned by most members of a social group’.
Efficient: : quickly generate impressions/expectations of stereotyped individuals.
Social: collectively agreed upon ideas of groups or communities.
These can lead to inaccurate knowledge about a particular group/community.
Describe the components of stigma according to Thornicroft, Rose, Kassam, & Sartorius, 2007.
Prejudice/attitudes:
-Not just negative thoughts. Also emotions - anxiety, anger, resentment, hostility, distaste, disgust.
- May predict discrimination more than stereotypes.
-Much stigma research just focuses on prejudice.
Describe what is meant by discrimination
‘Discrimination is the unfair treatment of people and groups based on characteristics such as race, gender, age or sexual orientation’ (APA)
Describe Thornicroft et al’s (2007) research in relation to discrimination.
- Research often focuses on ‘imaginary scenarios’ e.g. Social distance measures: what would you do if a friend said they had a mental illness?
- Emphasise what non-mentally ill people think they would do without exploring lived experiences of mentally ill individuals
- Assumes responses are congruent with actual behaviour
- Ignores emotions and the social context
Explain the impacts of stigma.
- stigma may impact across several levels of society, such as the individual, their family and friends and organisations.
- Individuals diagnosed with a mental illness say stigma impacts negatively in almost all areas of their lives.
- Stigma can impact employment, accommodation, relationships, self-esteem, insurance, help-seeking, illness and mortality.
- self-fulfilling prophecy.
- attributional ambiguity.
What is the Impact of stigma on help-seeking?
- stigma that related to mental disorders/mental health services may be the primary cause for poor help-seeking.
- Study: Authors aimed to investigate the impact of different stigma types on active help-seeking in the general population.
- metaanalysis of 27 studies.
- associated with less active help-seeking
- Participants stigmatising attitudes towards people with a mental illness.
- Participants’ own negative attitudes towards mental health help-seeking.
What is the impact on self-esteem on the risk of suicide?
- Stigma related to self-esteem including feelings of lovability, how capable an individual feels, and how influential or important an individual feels (Lysaker et al. 2008)
- Internalised stigma: when stigmatised individuals begin to believe the stigmatising views which are common in society.
- Internalised stigma is significantly associated with quality of life (Mashiach-Eizenberg et al. 2013).
- 179 people with severe mental illnesses
- Stigma associated with quality of life
- Relationship mediated by self esteem
There is a relationship between internalised stigma and suicide risk (Sharaf et al. 2012).
- 200 individuals with schizophrenia
- 38% classified as having a severe suicide risk
- Internalized stigma and depression independently predicted suicide risk
What is the impact on physical health and mortality?
- Hong Kong: individuals with schizophrenia die 8-9 years earlier than those in the general population (Yung et al., 2020)
- America: individuals with severe mental illnesses die between 14 to 32 yrs earlier than the general population (Colton and Mandersheid, 2006)
Describe how we can address stigma?
Protest: seeks to suppress stigmatising attitudes about mental illness.
Education: replaces myths about mental illness with accurate concepts.
Contact: challenges attitudes about mental illness through direct interactions with people who have experienced living with a mental illness.
(Corrigan et al. 2001)
Describe research related to protesting (Corrigan et al, 2001)
Aim: to compare contact, education, protest, and no intervention in improving stigma.
Participants: 152 community college students.
Results: Contact intervention = most successful, education = some success, protest = no improvement in attitudes.
This may be due to:
Psychological reactance: people are less likely to comply with a request if they perceive it as limiting their freedom or choices.
Rebound effect: Where people ordered to supress negative stereotypes become more sensitised to them.
Describe the theory of intergroup contact (Allport, 1954)
- Interaction between different groups reduces conflict, prejudice, and discrimination between these groups.
- From ‘them’ and ‘us’ to ‘we’.
- The optimal conditions for contact interventions (Pettigrew, 1998)
- Equal
Common goals
Co-operation rather than competition
Approval of authority
Describe research concerning mental illness stigma and treatment within the African American Community.
- Introduction: stigma may be worse in African American communities.
- Aim: to examine the effects of 2 types of contact intervention in reducing stigma.
- in-person contact: an African American man discussing his experiences with mental illness and psychotherapy.
- video contact: the same session as above but pre-recorded.
- Method: 158 participants assigned to the conditions. Stigma measured immediately before, after, and 2 weeks following the stigma intervention
- Results: stigma and help-seeking attitudes improved in both conditions equally
State an example of contact outside of mental illness stigma.
- # MeToo: a movement for individuals (particularly woman) that have been sexually harassed/ assaulted to speak up against harassment and to form a community where they can confide in others.
Describe research relating to Education and Contact.
- Ahuja et al (2017)
Aim: To improve attitudes towards people with mental illness among college students.
Participants: 50 young people attending collage
Method: A 2 hour intervention consisting of education and contact combined, as both strategies have been shown to be successful at improving attitudes. Measures of stigma collected before and immediately after the intervention, as well as one week later.
Results: Attitudes improved significantly after the intervention, and remained improved at one week follow up.
