Book contents
- Frontmatter
- Contents
- Contributors
- Acknowledgements
- 1 Introduction
- 2 Climate change in psychiatry: periodic fluctuations or terminal trend?
- Part I Theoretical and conceptual foundations
- Part II Social factors and the onset of psychosis
- Part III Social factors and the outcome of psychosis
- 11 Social factors as a basis for treatment
- 12 Public attitudes, stigma and discrimination against people with mental illness
- 13 Outcomes elsewhere: course of psychosis in ‘other cultures’
- Part IV Models and conclusions
- Index
- References
12 - Public attitudes, stigma and discrimination against people with mental illness
from Part III - Social factors and the outcome of psychosis
Published online by Cambridge University Press: 07 December 2009
Book contents
- Frontmatter
- Contents
- Contributors
- Acknowledgements
- 1 Introduction
- 2 Climate change in psychiatry: periodic fluctuations or terminal trend?
- Part I Theoretical and conceptual foundations
- Part II Social factors and the onset of psychosis
- Part III Social factors and the outcome of psychosis
- 11 Social factors as a basis for treatment
- 12 Public attitudes, stigma and discrimination against people with mental illness
- 13 Outcomes elsewhere: course of psychosis in ‘other cultures’
- Part IV Models and conclusions
- Index
- References
Summary
Introduction
Many people with mental illness are subjected to systematic disadvantages in most areas of their lives. Why should this be so? What can we learn from other conditions whose image may have changed over time? Should we fatalistically accept that these processes of exclusion are somehow tribal, deeply rooted and resistant to change? Or is it realistic to see stigma and discrimination as cultural constructions, which we can collectively change if we understand them clearly and commit ourselves to tackle them? These issues are at the core of this chapter.
The starting point: stigma
The unavoidable starting point for this discussion is the idea of stigma. This term (plural, stigmata) was originally used to refer to an indelible dot left on the skin after stinging with a sharp instrument, sometimes used to identify vagabonds or slaves (Cannan, 1895; Hobbes of Malmesbury, 1657). The resulting mark led to the metaphorical use of ‘stigma’ to refer to stained or soiled individuals who were in some way morally diminished (Gilman, 1985). In modern times stigma has come to mean ‘any attribute, trait or disorder that marks an individual as being unacceptably different from the ‘normal’ people with whom he or she routinely interacts, and that elicits some form of community sanction’ (Goffman, 1963; Scambler, 1998).
Stigma and physical conditions
While this chapter is concerned specifically with people who have diagnoses of mental illnesses, the stigma concept has also been used extensively for some particular physical conditions (Mason, 2001).
- Type
- Chapter
- Information
- Society and Psychosis , pp. 179 - 197Publisher: Cambridge University PressPrint publication year: 2008
References
(2002). Barcelona 2002: law, ethics, and human rights. HIV/AIDS-related stigma and discrimination: a conceptual framework. Canadian HIV/AIDS Policy and Law Review, 7 (2–3), 115–16.Google Scholar
(1954). The Nature of Prejudice. New York: Doubleday Anchor Books.
Amnesty International (2000). Ethical Codes and Declarations Relevant to the Health Professions. London: Amnesty International.
and (1997). Social distance towards the mentally ill: results of representative surveys in the Federal Republic of Germany. Psychological Medicine, 27 (1), 131–41.Google Scholar
and (2004). Public attitudes to people with depression: have there been any changes over the last decade? Journal of Affective Disorders, 83 (2–3), 177–82.Google Scholar
and (2005a). The stigma of mental illness in Germany: a trend analysis. International Journal of Social Psychiatry, 51 (3), 276–84.Google Scholar
and (2005b). Have there been any changes in the public's attitudes towards psychiatric treatment? Results from representative population surveys in Germany in the years 1990 and 2001. Acta Psychiatrica Scandinavica, 111 (1), 68–73.Google Scholar
, and (2003). Determinants of the public's preference for social distance from people with schizophrenia. Canadian Journal of Psychiatry, 48 (10), 663–8.Google Scholar
(1998). Discrimination in psychiatric disability coverage and the Americans with Disabilities Act. Psychiatric Services, 49 (7), 875–6.Google Scholar
and (2003). A Working Life for People with Severe Mental Illness. Oxford: Oxford University Press.
, and (2003). The Human Rights Act and mental health legislation. British Journal of Psychiatry, 182, 91–4.Google Scholar
and (1976). Two studies of comparative stigma: employer attitudes and practices toward rehabilitated convicts, mental and tuberculosis patients. Community Mental Health Journal, 12 (2), 168–75.Google Scholar
(2004). The theoretical basis of stigma as applied to genital herpes. Herpes, 11 (1), 4–7.Google Scholar
(2005). User/consumer involvement in mental health service delivery. Epidemiologia e Psichiatria Sociale, 14, 10–14.Google Scholar
(2004). Target-specific stigma change: a strategy for impacting mental illness stigma. Psychiatric Rehabilitation Journal, 28 (2), 113–21.Google Scholar
(2005). On the Stigma of Mental Illness. Washington, DC: American Psychological Association.
, , et al. (2001). Prejudice, social distance, and familiarity with mental illness. Schizophrenia Bulletin, 27 (2), 219–25.Google Scholar
, and (2004a). Structural levels of mental illness stigma and discrimination. Schizophrenia Bulletin, 30 (3), 481–91.Google Scholar
, , et al. (2004b). Stigmatizing attitudes about mental illness and allocation of resources to mental health services. Community Mental Health Journal, 40 (4), 297–307.Google Scholar
and (2003). A justification-suppression model of the expression and experience of prejudice. Psychology Bulletin. 129 (3), 414–46.Google Scholar
and (1995). Physical illness, stigma and social rejection. British Journal of Social Psychology, 34 (1), 67–83.Google Scholar
, and (2002). Social norms and the expression and suppression of prejudice: the struggle for internalization. Journal of Personality and Social Psychology, 82 (3), 359–78.Google Scholar
, and (2004). The College's anti-stigma campaign 1998–2003. Psychiatric Bulletin, 28, 133–6.Google Scholar
, , et al. (2005). Stigmatization of people with mental illnesses: a follow-up study within the Changing Minds campaign of the Royal College of Psychiatrists. World Psychiatry, 4, 106–13.Google Scholar
Crocker, J., Major, B. and Steele, C. (1998). Social stigma. In The Handbook of Social Psychology, 4th edn, ed. , and , Boston, MA: McGraw-Hill, pp. 504–33.
, , et al. (2003). American attitudes toward and willingness to use psychiatric medications. Journal of Nervous and Mental Disease, 191 (3), 166–74.Google Scholar
and (2001). ‘Patient’ voices, social movements and the habitus; how psychiatric survivors ‘speak out’. Social Science and Medicine, 52 (10), 1477–89.Google Scholar
and (1965). On the stigma of mental illness. Community Mental Health Journal, 1, 135–43.Google Scholar
and (1992). Landscapes of Despair. Princeton: Princeton University Press.
Department of Health (2000). Attitudes to Mental Illness Summary Report 2000. London: Department of Health.
Department of Health (2003). Attitudes to Mental Illness 2003 Report. London: Department of Health.
, , et al. (2002a). Mental disorders and quality of diabetes care in the veterans health administration. American Journal of Psychiatry, 159 (9), 1584–90.Google Scholar
, , et al. (2002b). Mental disorders and quality of care among post-acute myocardial infarction outpatients. Journal of Nervous and Mental Disease, 190 (1), 51–3.Google Scholar
, , et al. (2004). The relationship between public causal beliefs and social distance toward mentally ill people. Australian and New Zealand Journal of Psychiatry, 38 (5), 348–54.Google Scholar
, , et al. (2004). Stigma: the feelings and experiences of 46 people with mental illness. Qualitative study. British Journal of Psychiatry, 184, 176–81.Google Scholar
Dovidio, J., Brigham, J. C., Johnson, B. T. et al. (1996). Stereotyping, prejudice and discrimination: another look. In Stereotypes and Stereotyping, ed. , and . New York: Guilford Press, pp. 276–319.
Dovidio, J., Major, B. and Crocker, J. (2000). Stigma: introduction and overview. In The Social Psychology of Stigma, ed. , , and . New York: Guilford Press, pp. 1–28.
, , et al. (2000). Mental disorders and use of cardiovascular procedures after myocardial infarction. Journal of the American Medical Association, 283 (4), 506–11.Google Scholar
, , et al. (2001). Quality of medical care and excess mortality in older patients with mental disorders. Archives of General Psychiatry, 58 (6), 565–72.Google Scholar
and (1988). Disability beyond stigma: social interaction, discrimination, and activism. Journal of Social Issues, 44 (1), 3–23.Google Scholar
(1993). Social cognition and social perception. Annual Review of Psychology, 44, 155–94.Google Scholar
Fiske S. T. (1998). Stereotyping, prejudice and discrimination. In The Handbook of Social Psychology, 4th edn, ed. , . and , Boston, MA: McGraw-Hill, pp. 357–411.
, , M. et al. (2002). Public attitudes towards people with mental illness in six German cities: results of a public survey under special consideration of schizophrenia. European Archives of Psychiatry and Clinical Neuroscience, 252 (6), 278–87.Google Scholar
(1985). Difference and Pathology: Stereotypes of Sexuality, Race and Madness. Ithaca: Cornell University Press.
(2004). The Disability Discrimination Act 1995 and psychiatry: lessons from the first seven years. Psychiatric Bulletin, 28, 126–9.Google Scholar
(1963). Stigma: Notes on the Management of Spoiled Identity. Harmondsworth, Middlesex: Penguin Books.
(1994). Stigmatization and AIDS: critical issues in public health. Social Science and Medicine, 39 (9), 1359–66.Google Scholar
, and (2005). Psychophysiological evaluation of stigma towards schizophrenia. Schizophrenia Research, 76 (2–3), 317–27.Google Scholar
(1988). The politics of physical differences: disability and discrimination. Journal of Social Issues, 44, 39–47.Google Scholar
, , et al. (2003). The Social Psychology of Stigma. New York: Guilford Press.
(2000). Dispelling the myths and stigma of mental illness: the Surgeon General's report on mental health. Issue Brief National Health Policy Forum, 754, 1–7.Google Scholar
, and (2002). HIV-related stigma and knowledge in the United States: prevalence and trends, 1991–1999. American Journal of Public Health, 92 (3), 371–7.Google Scholar
, and (2003). Stigma, social risk, and health policy: public attitudes toward HIV surveillance policies and the social construction of illness. Health Psychology, 22 (5), 533–40.Google Scholar
(2004). Can we reduce the burden of depression? The Australian experience with beyondblue: the national depression initiative. Australasian Psychiatry, 12 (suppl.), s38–s46.Google Scholar
Hobbes of Malmesbury, T. (1657). ΣΤΙΓΜΑΙ Aγ∊ομ∊τρίας, Αγροικίας, Αντιπολι∊ίας, Αμαθ∊ίας; or Markes of the Absurd Geometry, Rural Language, Scottish Church Politicks, and Barbarismes of John Wallis Professor of Geometry and Doctor of Divinity. London: Andrew Crooke.
, , et al. (2004). Public knowledge, private grief: a study of public attitudes to epilepsy in the United Kingdom and implications for stigma. Epilepsia, 45 (11), 1405–15.Google Scholar
, , et al. (1984). Social Stigma: The Psychology of Marked Relationships. New York: W. H. Freeman and Co.
(2000). Mental health literacy. Public knowledge and beliefs about mental disorders. British Journal of Psychiatry, 177, 396–401.Google Scholar
, , et al. (1997). ‘Mental health literacy’: a survey of the public's ability to recognise mental disorders and their beliefs about the effectiveness of treatment. Medical Journal of Australia, 166 (4), 182–6.Google Scholar
, , et al. (1999). Attitudes towards people with a mental disorder: a survey of the Australian public and health professionals. Australian and New Zealand Journal of Psychiatry, 33 (1), 77–83.Google Scholar
, , et al. (2003). Providing information about the effectiveness of treatment options to depressed people in the community: a randomized controlled trial of effects on mental health literacy, help-seeking and symptoms. Psychological Medicine, 33 (6), 1071–9.Google Scholar
, and (2005). The impact of beyondblue: the national depression initiative on the Australian public's recognition of depression and beliefs about treatments. Australian and New Zealand Journal of Psychiatry, 39 (4), 248–54.Google Scholar
, , et al. (1987). Stigmatization of AIDS patients by physicians. American Journal of Public Health, 77 (7), 789–91.Google Scholar
, , et al. (2005). Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine, 352 (24), 2515–23.Google Scholar
, and (2004). Protecting the human rights of people with mental disorder: new recommendations emerging from the Council of Europe. British Journal of Psychiatry, 185, 277–9.Google Scholar
and (2003). Mortal Secrets: Truth and Lies in the Age of AIDS. Baltimore: The Johns Hopkins University Press.
, , et al. (2000). Public acceptance of restrictions on mentally ill people. Acta Psychiatrica Scandinavica, 102 (407) (suppl.), 26–32.Google Scholar
, , et al. (1989). A modified labeling theory approach in the area of mental disorders: an empirical assessment. American Sociological Review, 54, 100–23.Google Scholar
, , et al. (1994). Lifetime and five-year prevalence of homelessness in the United States. American Journal of Public Health, 84 (12), 1907–12.Google Scholar
, , et al. (2004). Measuring mental illness stigma. Schizophrenia Bulletin, 30 (3), 511–41.Google Scholar
and (1984). Stigma in patients with rectal cancer: a community study. Journal of Epidemiology and Community Health, 38 (4), 284–90.Google Scholar
, , et al. (1999). Changes in public attitudes towards mental illness in the Athens area (1979/1980–1994). Acta Psychiatrica Scandinavica, 99 (1), 73–8.Google Scholar
(2001). Stigma and Social Exclusion in Healthcare. London: Routledge.
(1997). Enemies of the people: the moral dimension to public health. Journal of Health Politics, Policy and Law, 22 (4), 993–1020.Google Scholar
and (1996). The Global Burden of Disease. Vol. 1 of A Comprehensive Assessment of Mortality and Disability from Diseases, Injuries and Risk Factors in 1990, and Projected to 2020. Cambridge, MA: Harvard University Press.
(1961). Popular Conceptions of Mental Health. New York: Holt, Rinehart and Winston.
and (2002). Improving Australians' depression literacy. Medical Journal of Australia, 177 (suppl.), s117–s121.Google Scholar
and (2003). Stigma, discrimination and mental illness. Journal of Mental Health, 12, 203–8.Google Scholar
, , et al. (2000). Public conceptions of mental illness in 1950 and 1996: what is mental illness and is it to be feared? Journal of Health and Social Behavior, 41, 188–207.Google Scholar
and (2002). The WPA Global Programme to Reduce Stigma and Discrimination Because of Schizophrenia. Geneva: World Psychiatric Association.
, , et al. (2005). Active ingredients in anti-stigma programmes in mental health. International Review of Psychiatry, 17 (2), 123–31.Google Scholar
and (2001). Dictionary of Psychology, 3rd edn. London: Penguin.
and (2003). Social Inclusion and Recovery. Edinburgh: Billière Tindall.
and (2005). Reducing the Stigma of Mental Illness. A Report from the Global Programme Against Stigma of the World Psychiatric Association. Cambridge: Cambridge University Press.
(2000). From Psychiatric Patient to Citizen. Overcoming Discrimination and Social Exclusion. Basingstoke: Palgrave.
(2003). Beyond good intentions. Making anti-discrimination strategies work. Disability and Society, 18, 625–42.Google Scholar
See Me Scotland (2004). The Second National Public Attitudes Survey, ‘Well? What do you think?’Edinburgh: Scottish Executive.
, , et al. (1999). Predictors of antidepressant prescription and early use among depressed outpatients. American Journal of Psychiatry, 156 (5), 690–6.Google Scholar
, , et al. (2001). Perceived stigma as a predictor of treatment discontinuation in young and older outpatients with depression. American Journal of Psychiatry, 158 (3), 479–81.Google Scholar
Social Exclusion Unit (2004). Mental Health and Social Exclusion. London: Office of the Deputy Prime Minister.
and (2001). Community attitudes toward people with schizophrenia. Canadian Journal of Psychiatry, 46, 245–52.Google Scholar
, , et al. (2004). The personal impact of schizophrenia in Europe. Schizophrenia Research, 69 (2–3), 125–32.Google Scholar
, , et al. (1995). Revision of the ICIDH: mental health aspects. WHO/MNH Disability Working Group. Disability and Rehabilitation, 17 (3–4), 202–9.Google Scholar
, , et al. (2005). [A survey on the prejudice and the stereotypes of mental illness in two communities with or without psychiatric residential facilities]. Epidemiologia e Psichiatria Sociale, 14 (3), 170–6. (In Italian, with English abstract.)Google Scholar
, , et al. (2001). Attitude towards psychiatric patients: a pilot study in a northern Italian town. European Psychiatry, 16 (8), 451–8.Google Scholar
(1999). Telling is a Risky Business: Mental Health Consumers Confront Stigma. New Jersey: Rutgers University Press.
(2003). Life with an indwelling urinary catheter: the dialectic of stigma and acceptance. Qualitative Health Research, 13, 1189–204.Google Scholar
- 8
- Cited by