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Article Excerpt
"People suffering from mental illness and other mental health problems are among the most stigmatized, discriminated against, marginalized, disadvantaged and vulnerable members of our society" (Johnstone, 2001, p. 201). Negative connotations and false assumptions connected with mental illness may be as harmful as the disease itself. Schizophrenia may evoke visions of violence and inability to care for oneself. Depression may conjure thoughts of laziness and substance abuse. Societal stigma significantly limits opportunities that are available for people with serious mental illnesses (Johnstone, 2001). In 1999, the Surgeon General's report pointed to stigma as a key variable in understanding the course of illness and outcomes for people who have been given a psychiatric diagnoses (Corrigan, Green, Lundin, Kubiak, & Penn, 2001). In this article, we first review the definitions of mental illness and stigma and then review the literature about the theories of stigma and the impact that stigma has on people with mental illnesses. Using current research as our basis, we suggest ways that counselors can work to mitigate the stigma of mental illness. We conclude with suggestions for dispelling the stigmatizing beliefs that counselors hold.
* Defining Mental Illness and Stigma
Concepts about mental illness can be subjective, and it can be difficult to define. One of the definitions listed for mental illness in the Merriam-Webster Dictionary (1990) is "mentally disordered, mad, or crazy" (p. 506). During the Middle Ages, people with mental illness were considered to be living examples of the weakness of humankind. The common belief was that mental illness was a result of being unable to remain morally strong. People with mental illnesses were jailed as criminals and, on some occasions, put to death (Corrigan, 2002). In 1974, Thomas Szasz wrote about the "myth" of mental illness. He stated that physicians used anatomical and pathological methods to help identify physical illness. There was proof that these illnesses existed because of how they altered the physical body. Szasz's belief was that medical illnesses were being discovered, whereas psychiatric illnesses were being invented. According to Szasz, psychiatrists were inventing diseases based on groups of common symptoms. Most of the symptoms that accompany mental illness are invisible, leading people who experience these symptoms to doubt their reality and to experience isolation within that reality (Glass, 1989).
A broader and more current definition of mental illness refers to the spectrum of cognitions, emotions, and behaviors that interfere with interpersonal relationships as well as functions required for work, at home, and in school (Johnstone, 2001). This definition takes into account a myriad of different functions and how they affect a person's ability to perform the tasks necessary for daily living. This definition is also present in the current psychiatric diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994). Most of the diagnostic categories take into consideration the degree to which the symptoms of a mental illness impede a person's daily functioning when identifying the severity of the diagnosis. With this definition as a criterion, Hardcastle and Hardcastle (2003) found that 30% of all general practitioner consultations involved a mental illness. They also reported that one in four people has a mental illness at some time in her or his life.
As is the case with major mental illness, stigma is also a difficult concept to define. Historically, stigma comes from the Greek word stigmata, which refers to "a mark of shame or discredit; a stain, or an identifying mark or characteristic" (Merriam-Webster Dictionary, 1990, p. 506). Stigma, when it is used in reference to mental illness, is a multifaceted construct that involves feelings, attitudes, and behaviors (Penn & Martin, 1998). There are several current theories about the construct of stigma and how it might be deconstructed and defined. These theories include social identity, self-stigma, and structural stigma.
* Theories of Stigma
Social identity theory considers how people use social constructs to judge or label someone who is different or disfavored. Societies, or large groups within societies, evaluate people to determine if they fit the social norms. Social identity is a concept first written about by Goffman (1963). He discussed how stigmatized people form a virtual social identity when they become disfavored or dishonored in the eyes of society, and then they become outcasts. This applies to people with mental illness because, historically, mental illness has been viewed as a character or moral flaw. The term spoiled collective identity was also coined by Goffman to describe people who were stigmatized and whose identity as a whole was brought into question. Individuals who are not stigmatized are also judged by society. People with mental illness are often judged by their behaviors, but this does not reflect their whole being. With spoiled collective identity, the stigmatized person is reduced in the minds of others from a whole and normal person to a tainted, discounted one. Crawford and Brown (2002) agreed that stigma arises when an actual social identity falls short of a societally defined ideal identity.
The second theory of stigma is self-stigma. Self-stigma is an internal evaluation process whereby people judge themselves. This judgment could be a result of messages received from societal norms, but ultimately it is the individual who is creating the judgment toward himself or herself. This judgment decreases self-esteem as a person tells him- or herself that he or she does not fit in or is not good enough to live up to the expectations that others impose on a person and his or her environment (Blankertz, 2001). Self-efficacy has an impact on the belief that one can perform, and, consequently, confidence in one's future is greatly reduced when self-efficacy is poor (Blankertz, 2001; Corrigan, 2004). Individuals may internalize an identity that dehumanizes them. When individuals do not live up to the social norms regarding their identity, they have feelings of inferiority, self-hate, and shame (Lenhardt, 2004). Corrigan (2002) described self-stigma as a private shame that diminishes self-esteem and causes self-doubt regarding whether one can live independently, hold a job, earn a livelihood, and find a life mate.
Structural stigma is similar to Goffman's (1963) spoiled collective identity because it is an external evaluation of a person that is based on societal norms. This theory looks more in depth at the process of stigma throughout a culture and how stigma works as a system. The theory of structural stigma depicts the tangible barriers created for people who have mental illness. According to Johnstone (2001), one third of all states restrict the rights of people with a mental health diagnosis to hold elective offices or sit on juries, and one half of all states restrict the child custody rights of someone with a mental health diagnosis. Structural stigma describes a process that works to deny people with a mental illness their entitlement to things that people who are considered "normal" take for granted. People with a mental illness may have difficulty finding their function or a sense of place in the intersubjective world (Johnstone, 2001). They might also be challenged in the effort to find empathetic and supportive relationships with others, happiness, participatory citizenship, and peace of...
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