To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure firstname.lastname@example.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Reducing stigma is a perennial target of mental health advocates, but effectively addressing stigma relies on the ability to correctly understand and accurately measure culture-specific and location-specific components of stigma and discrimination.
We developed two culture-sensitive measures that assess the core components of stigma. The 40-item Interpersonal Distance Scale (IDS) asks respondents about their willingness to establish four different types of relationships with individuals with 10 target conditions, including five mental health-related conditions and five comparison conditions. The 40-item Occupational Restrictiveness Scale (ORS) asks respondents how suitable it is for individuals with the 10 conditions to assume four different types of occupations. The scales – which take 15 min to complete – were administered as part of a 2013 survey in Ningxia Province, China to a representative sample of 2425 adult community members.
IDS and ORS differentiated the level of stigma between the 10 conditions. Of the total, 81% of respondents were unwilling to have interpersonal relationships with individuals with mental health-related conditions and 91% considered them unsuitable for various occupations. Substantial differences in attitudes about the five mental health-related conditions suggest that there is no community consensus about what constitutes a ‘mental illness’.
Selection of comparison conditions, types of social relationships, and types of occupations considered by the IDS and ORS make it possible to develop culture-sensitive and cohort-specific measures of interpersonal distance and occupational restrictiveness that can be used to compare the level and type of stigma associated with different conditions and to monitor changes in stigma over time.
Mental Health Systems and Policy: Introduction to Part III
Bruce G. Link, Distinquished Professor of Sociology and Public Policy, University of California at Riverside,
Jo C. Phelan, Professor, Sociomedical Sciences, Mailman School of Public Health, Columbia University
This chapter provides a frame for examining extant issues and evidence concerning labeling and stigma as it pertains to mental illnesses. The issues addressed are: (1) the conceptualization of labeling and stigma, (2) evidence about trends in stigma-relevant public attitudes and beliefs, and (3) how labeling and stigma affect individuals who develop mental illnesses. Both modified labeling theory and the conceptualization of stigma developed by Link and Phelan point to the importance of attitudes and beliefs, leading to questions about how such attitudes and beliefs are faring in trends over time. The research reviewed in this chapter shows that the public recognizes mental illnesses as illnesses with genetic and biological bases; however, the core stereotypes of dangerousness and incompetence have either changed little or actually become stronger. No change in social distancing responses has accompanied the increasingly medical conception of mental illnesses. Discrimination against people with mental illnesses occurs through multiple mechanisms, including direct person-to-person discrimination, discrimination operating through the stigmatized person, discrimination that emerges silently but perniciously through social interaction, and structural stigma. What are the policy implications of this chapter?
When we ask who is labeled mentally ill and what the consequences of such labeling are, we ask questions that are central to the sociological understanding of mental disorder. Such questions are relevant to those who are concerned that so many people with serious mental illnesses go unlabeled and untreated (Regier et al., 1993; Wang et al., 2005). Such questions are also relevant to people attempting to recover from mental illnesses who often feel that they suffer as much from being labeled mentally ill as they do from mental illness itself (Deegan, 1993).
As a society, we have created specific professions (including psychiatry, clinical psychology, psychiatric social work, and psychiatric nursing) upon whose members we confer the authority to define, label, and treat mental illnesses. Social processes determine who encounters these professionals and many of the important consequences that might follow from such an encounter. The treatment they receive may ameliorate their symptoms, improve their well-being, and enhance their social and occupational functioning. At the same time, along with treatment comes the possibility of pejorative labeling and stigma. Social science research on labeling and stigma can help us understand the processes involved, and, by bringing those processes to light, open the possibility of addressing some of their negative consequences.
The Time to Change campaign in England has attempted to change attitudes to mental illness at population level. The concept of cultural context is introduced to look at how mental illness functions in society and whether any change in the current context is feasible.
This chapter aims to further our understanding of how genetic research and genetic explanations of alcoholism and other addictions may affect the stigma that is attached to addictions. Because we found practically no empirical research directly addressing the connections among genetic causal attributions, stigma, and addictions, we approach the chapter in the following way. First, we review key conceptual models of stigma, which address three basic questions: (1) What is stigma? How can stigma be defined? (2) What are the dimensions of stigma? How does stigma vary depending on the characteristic that is stigmatized and the circumstances in which it is encountered? (3) Why do we stigmatize? How does stigmatization benefit the dominant nonstigmatized group? Second, we review existing conceptual and empirical work concerning the stigmatization of addictions, focusing primarily on alcohol and substance dependence, and we discuss addictions in relation to each of the general conceptual models of stigma.
Next, we focus on the implications of genetic explanations and understandings of addictions (or the “geneticization” of addictions) for stigma. Here we focus first on theories that have implications for the connection between genetic causal attributions and stigma, and then on empirical research that has addressed the connection between genetic attributions and stigma for characteristics such as mental illness, obesity, sexual orientation, anorexia, stuttering, and cancer. Finally, we use the theoretical models and empirical findings to construct predictions concerning the likely impact of genetic attributions for stigma related to addictions.
The mental health consumer/survivor movement is the human rights movement devoted to securing the rights and just treatment of persons identified as mentally ill. This chapter reviews trends in the struggles of activists to achieve the rights. After describing early conditions and moments in the movement, it examines the modern mental health consumer/survivor movement, focusing on the expatients and other advocates who fueled the modern movement, the reformist turn from antipsychiatry to consumerism, forces that bolstered or challenged the movement, subsequent challenges and more recent developments. In a political climate in which National Alliance on Mental Illness (NAMI) had acquired considerable influence, Community Support Program (CSP) was losing power and had become less favorably positioned to promote the consumer/ survivor cause. National and state organizations advance their consumer/ survivor agendas, and every state has a mandated consumer office through which consumers and survivors directly engage with policy makers.
This study investigates the associations between perceived stigma, depressive symptoms and coping among caregivers of people with bipolar disorder. Caregivers of 500 people with DSM–IV bipolar disorder responded to measures of these constructs at study entry Patients' clinical and functional status were evaluated within 30 days of the caregiver assessment. Perceived stigma was positively associated with caregiver depressive symptoms, controlling for patient status and socio-demographic factors. Social support and avoidance coping accounted for 63% of the relationship between caregiver stigma and depression. Results suggest that caregivers' perceptions of stigma may negatively affect their mental health by reducing their coping effectiveness.
An appropriate choice of controls in case/control studies of specific psychiatric disorders is crucial for valid risk-factor assessment. One suggested approach to control-group selection, the use of a well control group, is the focus of this paper. While using well controls has intuitive appeal, this paper shows that such a procedure can lead to ambiguous and biased results.
Email your librarian or administrator to recommend adding this to your organisation's collection.