There has been a substantial increase in research on the stigma related to mental illness over the past 10 years (Major & O'Brien, 2005; Weiss et al, 2006). This chapter clarifies current practice in one area: the survey measurement of stigma among those who have personal experience of mental illness. The definition and construct of stigma are first discussed, and then the method and results of a review of current measures of personal mental illness stigma are presented.
The classic starting point for defining the stigma of mental illness is Goffman's ‘an attribute that is deeply discrediting’. The recognition of this attribute leads the stigmatised person to be ‘reduced … from a whole and usual person to a tainted or discounted one’ (Goffman, 1963, p. 3). This presents stigma as the relationship between attribute and stereotype. In Goffman's terms, attributes can be categorised in three main groups: abominations of the body (e.g. physical disability or visible deformity); blemishes of individual character (e.g. mental illness, criminal conviction); and ‘tribal’ stigmas (e.g. race, gender, age).
The work of Jones et al (1984) built on these categorisations with a focus on the study of ‘marked relationships’. In this definition, stigma occurs when the mark links the identified person, via attributional processes, to undesirable characteristics, which discredit him or her. They propose six dimensions of stigma:
concealability – how obvious or detectable a characteristic is to others
course – whether the difference is lifelong or reversible over time
disruptiveness – the impact of the difference on interpersonal relationships
aesthetics – whether the difference elicits a reaction of disgust or is perceived as unattractive
origin – the causes of the difference, particularly whether the individual is perceived as responsible for this difference
peril – the degree to which the difference induces feelings of threat or danger in others.
Elliott et al (1982) emphasised the social interaction in stigma. In their definition, stigma is a form of deviance that leads others to judge an individual as illegitimate for participation in a social interaction. This occurs because of a perception that that person lacks the skills or abilities to carry out such an interaction, and is also influenced by judgements about the dangerousness and unpredictability of the person.