Stigma

Question 1

Topics

Answer 1

1

Question 2

Names and years

Answer 2

2

Question 3

Definitions of stigma

Answer 3

• A sign of disgrace that extricates an individual from other people. It entails negative attitudes or discrimination against a person based on their differentiating characteristics, such as mental illnesses, health conditions, or debility (Corrigan & Watson, 2002).

Question 4

Public stigma

Answer 4

• When individuals are labelled based on their illnesses, they are no more viewed as people but as part of a stereotyped group. Negative outlooks and beliefs toward these groups develop prejudice, which results in negative actions and discrimination. Stigma is a significant challenge for individuals who experience mental disorders and has been recognised as one of the most challenging aspects of living with mental health problems for individuals and families (Henderson et al., 2013).
• STIGMA EXPERIENCED ASMULTIDIMENSIONAL
(Schulze &Angermeyer, 2003):
a) Interpersonal: reduction in quantity and quality of social contacts, sense of judgement, devalidation of one’s perspective
b) Structural: quality of mental health services, inequitable access to support, demands of labour market and welfare systems
c) Social roles: restricted access to employment, family roles
d) Public images: stereotypes in media, hostile social climate, mental illnesses not as real/important as somatic

Question 5

Self and internalised Stigma

Answer 5

• Further, stigma hinders the recovery process as individuals fail to seek care because they fear getting labelled as mentally challenged. Additionally, stigma can also be self-aspect. In this regard, self-stigma is described as the prejudice in which mentally ill individuals turn against themselves (Corrigan & Watson, 2002).
• Delineates ‘outsiders’ from ‘insiders’

• Self-stigma: poor self-image because negative
social stereotypes have been internalised
• Self-stigma has many negative effects (Livingston
& Boyd, 2010)
• Psychological: hope, empowerment, self-esteem
• Psychiatric: symptom severity, duration, treatment
adherence
• Becomes self-fulfilling prophecy
• Internalisation of perception of self as weak, dependent,
useless

Question 6

Tripartite aspects of stigma

Answer 6

• Both self and public stigmas are perceived from three perspectives, including stereotypes, prejudice, and discrimination
• STIGMAPROCESS (LINK&PHELAN,2001):
a) Difference from norm recognised & labelled
b) Individual linked with stereotypes attached to that label
c) Individual and structural discrimination

Question 7

Societal mutual agreement of group concepts

Answer 7

• Psychologists perceive stereotypes as specifically societal knowledge constructs that are acquired by most members of a social group. Stereotypes are termed social because they signify mutual agreed-upon concepts of groups of individuals (Stolzenburg et al., 2017).

Question 8

Mental illness and violence

Answer 8

• Research shows that mentally ill people are stereotyped as dangerous and impulsive (Stolzenburg et al., 2017).
• This is a common stereotype that is massively embroidered by the media.

• This widespread belief is a key factor in stigmatisation
• Label “previous hospitalisation” stimulated exclusion only
from those who believed mentally ill people were dangerous
(Link et al., 1987)
• Some disorders are associated with a higher risk but
others with a lower risk of crime/violence (Krakowski et al.,
1986)
• Better to look at specific symptoms not global
diagnosis
• Paranoid delusions
• Hallucinations

Question 9

Alcohol and violence

Answer 9

• Although some mental illnesses such as anti-social personality illness and acute state of some psychotic problems depict aggression and violence as potential symptoms, recent studies reveal that alcohol and drug consumption is more likely to cause violent behaviour than mental illnesses. In this regard, when a mentally challenged person abuses drugs and alcohol, they are likely to be violent (Stolzenburg et al., 2017).
• To some extent, a symptom of violence in mentally ill people is a stereotype committed by non-mentally ill individuals.

Question 10

Mental illness and incompetency

Answer 10

• People with mental disorders are stereotyped as incompetent (Knaak et al., 2017). This is a pervasive stereotype under which people with mental problems are perceived as wildly irrational and childlike.

Question 11

Mental Illness and Blame

Answer 11

• People with mental disorders are thought as they deserve the blame for their conditions. However, research disapproves of this stereotype, revealing that life experiences, trauma, and biology are associated with various mental illnesses, and thus they are to be blamed for mental disorders and not the people with the diagnosis (Knaak et al., 2017).

Question 12

Biological Views of mental illness

Answer 12

12

Question 13

Cons of Biological views of mental illness

Answer 13

• This is because, studies on stigma have shown that over the two last decades, the use of biogenetic breakthroughs to inform campaigns for reducing stigma and increase acceptance of mental illness and those who are affected by them, may have caused more harm than benefit. Speerforck and colleagues’ (2014) studies reveal that if somebody views mental disorder as predominantly caused by biological factors, they may absolve the patients of the responsibility of their symptoms, but they also tend to be less accepting of them, while also feeling less optimistic on their ability to recover and function well in society.

• Externalises problem – ‘not my fault’ (Easter, 2012)
• Reduces parental blame (Singh, 2004)
• Sense of social identity, ‘I’m not alone’
• Medical diagnosis a gateway into community of similar others
• Can promote fatalism about recovery prospects (Deacon & Baird, 2009)

DO BIOLOGICAL EXPLANATIONS EVER HELP? Biological explanations have better effects on
attitudes if combined with treatability information
(Lebowitz & Ahn, 2012)
• But many disorders don’t have optimal treatment
outcomes biologically

Question 14

General effects of stigma

Answer 14

• Stigma can greatly impact many facets of an individual’s life. Even a short mental disorder episode can affect a person’s health and disrupt their job, families, interactions, and social contacts.

Question 15

Societal (+work) effects of stigmatisation

Answer 15

• Social stigmatisation greatly affects people with mental illnesses. Mentally ill individuals cannot access social services because of their conditions (Mannarini & Rossi, 2019). They are discriminated against in the community, encountering instances of being physically and verbally abused by the public.
• 1996 survey of 800 service-users (Read &
Baker, 1996)
• 47% reported being harassed in public
• Harassment had forced 26% to move home

Question 16

Emotional effects of stigmatisation

Answer 16

• In the long run, mentally challenged people are affected by emotions resulting from their encounters with discrimination and prejudice (Murney et al., 2020).
• These individuals can suffer from dejection, anxiety, dread, isolation, humiliation, and hurt.
• Stigma has causal role in depression and other mental health problems (Cox et al., 2012)
• Attempting to conceal problem increases intrusive thoughts (Smart & Wegner, 1999)

Question 17

Effects of Stigmatisation on seeking healthcare help

Answer 17

• Furthermore, people with mental health problems face stigma and biases while seeking healthcare services. These people face stigma when accessing healthcare care, including general care. In most cases, the caregivers appear dismissive and ignore their physical presentations claiming that their problems are all in mind (da Silva et al., 2020). This may lead to reluctance in the hospital for further care, which may injure physical health (Ford, 2012).

• Corrigan (2004) Stigma impedes recovery by preventing people
from:
• Seeking professional help
• Disclosing their illness to others
• Engaging with treatment
• Stigma effects on help-seeking especially
pronounced for certain groups
• Young people and senior citizens
• Men
• Certain ethnic groups

• Some evidence doctors give poorer quality care to patients with comorbid psychiatric diagnosis (Druss et al., 2000)

Question 18

Physical effects of stigmatisation

Answer 18

• Research supports this assertion by revealing that individuals with mental health issues are at a greater risk of suffering physical health difficulties like cardiovascular diseases, diabetes, obesity, and respiratory illnesses and experiencing premature deaths (Corrigan & Watson, 2002). In this case, stigma hinders people from seeking early care and treatment options. Many individuals will not ask for medical care until their signs and symptoms become severe. Moreover, other people detach themselves from care services, therapeutic involvements, or even cease to take their prescribed medications, resulting in relapse or hamper recovery.

Question 19

Relational effects of stigmatisation

Answer 19

• People with mental health disorders may break down in their relationships with partners, friends, and families (da Silva et al., 2020). In some instances, partners, friends, and families may stigmatise their partners or family members because of their conditions. Further, children get harassed and bullied due to the mental health conditions that their parents are experiencing.

Question 20

Education

Answer 20

• Education is an anti-stigma involvement that disseminates factual information regarding stigmatisation, intending to rectify misrepresentation or control views and negative perceptions and beliefs ( National Academies of Sciences, Engineering, and Medicine, 2016). Education literacy campaigns can help reduce stigma across the nation and worldwide by countering inaccurate stereotypes and misconceptions and replacing them with factual information.
• More awareness of mental health issues in
recent years, but little evidence stigma has
receded (Angermeyer & Dietrich, 2006)
• For instance, education operates to combat the view that individuals with mental health disorders are vicious murderers by showing statistics depicting homicide incidents of both mentally ill people and the general public.

Question 21

Interpersonal Contact interventions

Answer 21

• Contact interventions can also be applied to help reduce stigma. Across the continuum of stigmatising conditions, non-mentally ill people have little or no meaningful contact with those who have these disorders (Corbière et al., 2012). The absence of meaningful contacts nurtures discomfort, despair, and dread. Contact intervention targets to overcome the relational gap and foster affirmative relations and a link between people. In this case, contact-based social health anti-stigma interventions can be incorporated to reduce stigma.
• For instance, individuals who have stayed with mental disorders can interact with society and present their challenges and success attributes. This strategy is targeted to decrease stigma on an individual-to-individual basis. However, the method can also develop a sense of empowerment and boost the self-esteem of a person.

• Contact with mentally ill helps reduce stigma
(Couture & Penn, 2003)
• Interventions targeted at normalising mental
illness and encouraging disclosure

Question 22

Cons of interventions

Answer 22

Sometimes a backlash effect
• If person perceived as erratic or threatening, could reinforce stigma

• Mehta et al. (2015): meta analysis of interventions (mostly contact/education-based)
• Moderately successful at improving knowledge but small (although positive) effect on attitudes
• Changes intended not actual behaviour (Evans-Lacko et al., 2013)

Question 23

Peer support services

Answer 23

• Stigma can also be reduced through the use of peer support services. This can neutralise the discrimination, dismissal, and segregation faced by mentally ill people while seeking mental substance abuse care services and medication (Corbière et al., 2012).
• The impacts of supportive peer services can assist bear longer-term and more systematic consumption of treatment services. Simultaneously, incorporating “peer helpers” can benefit both the client and the care professionals on the path to recovery.
• Peer support services reduce stigma and improve the rights of the affected individuals by enhancing the treatment-seeking process, developing greater employment decisions, and ultimately improving the quality of life.

Question 24

Remonstrations (protestation)

Answer 24

• Lastly, remonstrations (protestation) and advocacy effectively reduce stigma and advance the mentally challenged people’s rights. Protestations can be used to denounce the inappropriateness of negative attitudes and depictions of mental disorders incorporated by the public and the media (National Academies of Sciences, Engineering, and Medicine, 2016). Several means such as letter writing, product boycotting, and public demonstrations can advocate for people with mental illnesses. A demand for action can motivate unengaged stakeholders by increasing awareness regarding the harmful impacts of stigma ( National Academies of Sciences, Engineering, and Medicine, 2016). The target audience for remonstrations and advocacy campaigns include opinion leaders like politicians, reporters, and community officers. The aim is essential to suppress negative perceptions and eliminate negative demonstrations and content regarding mentally ill people ( National Academies of Sciences, Engineering, and Medicine, 2016). Moreover, protests can focus on legislative reforms to demand improvement, enaction to protect rights, enhance access to social amenities, and decrease disparities facing people with mental health disorders.

Question 25

CAN WE RUN AWAY FROM STIGMA?

Can we run away from stigma?

Answer 25

• In 2002 Japan changed name of schizophrenia
from ‘mind-split-disease’ to ‘integration
disorder’ (Sartorius et al., 2014)
• Increase in % who were informed about their diagnosis
(36.7% in 2002; 69.7% in 2004)
• 86% psychiatrists felt new term made communication
easier
• People who are aware of new term show more positive
attitudes about outcomes, disclosure and social
integration

Question 26

Characteristics of mental Illness Stigma

Answer 26

• Different mental illnesses differ in quantity and
quality of stigma (Angermeyer & Dietrich, 2006)
• High: schizophrenia, eating disorders, substance abuse
• Low(er): depression, anxiety disorders

Question 27

Schizophrenia and Crime

Answer 27

• People with schizophrenia more prone to violence
• Responsible for 3-4% of all violence in society (Taylor,
2004)
BUT
• Much of the risk due to comorbid substance abuse
• More likely to be arrested for same offence if erratic
behaviour/speech (Teplin, 1985)
• More likely to be victims than perpetrators of crime

Question 28

World Survey of Mental Illness Stigma

Answer 28

WORLD SURVEY OF MENTAL ILLNESSSTIGMA (Seeman et al., 2016))
• ½ million respondents from 229 countries
•
‘Mentally ill are more violent’: 7% developed
countries vs. 15% developing countries
•
‘Mental illness is like physical illness’: 45-51%
developed countries vs. 12-15% developing countries
•
‘Mental illness can be overcome’: 5-7% developed
countries vs. 12-16% developing countries

Question 29

Labelling

Answer 29

Label → identity and behaviour adapt to label
• Expectancy effects
• Particular concern with childhood diagnosis
• Children less friendly when interacting with a partner they believed had ADHD (Harris et al., 1992)
• ‘Rosenthal effect’ (Rosenthal & Jacobson, 1968) - Self-fulfilling prophecy

Question 30

Cons of Educaiton

Answer 30

• Public ‘mental health literacy’ generally low
• But stigma is fundamentally about attitudes and emotions, not knowledge
Knowledge alone won’t fix stigma
• Stigmatising attitudes common among mental health professionals (McNicholas et al., 2016)