STIGMA AND MISCONCEPTIONS

OF MENTAL ILLNESS
The Different Voices of Stigma and Discrimination
If I apply for the job The doctor left me waitin in
n tell them I hv the emergency room, fighting
schizo., I wont b my delusions for 6 hrs; they
hired. If I don’t tell said other people’s probs
them n they find out were more serious than mine.
later, or I suffer a
relapse,I’ll b fired. My parents support UNITED STATES
me but we cant tell
CANAD any of our neighbours. The only way I found
A It would hurt my out the doctors had
sistetr;s chances of diagnosed me with
being married. schizophrenia was
because I managed
Women with an illness INDIA to read it upside down
like this will be kept at on my medical notes!
home to do domestic No one had told me n
chores, while we men finding out that way
are sent out of the was very frightening ,
house. I felt very alone

JAPAN
UNITED
 What is Stigma?
• The word stigma is of Greek origin and means to
pierce, to make a hole.

• Stigma is defined as a sign of disgrace or discredit,

which sets a person apart from others. Stigma is a
term used to describe a process where a person is
denied full and equal social standing with another
person.

• The process often begins with the application of a

label, which distinguishes “normal” or “well" people
from "sick" or "abnormal" people. Stigma takes
many forms and occurs at many different levels.
 Stigma and Mental Illness

• The stigma attached to mental illness and all that

is related to it- patients who suffer from mental
disorders, their families, psychiatric institutions,
and psychotropic medications- is the main
obstacle to better mental health care and better
quality of life of people who have the illness, of
their families, of their communities and health
service staff that deals with psychiatric disorders.

• It is a basic component of the negative

discrimination that people with mental illness
experience everyday.
Components of Stigma
• Labeling someone with a condition.
• Stereotyping people who have that condition.
• Creating a division — a superior "us" group
and a devalued "them" group, resulting in loss
of status in the community.
• Emotional reactions: associated with
emotions of anger, irritation, anxiety, pity, and
fear.
• Discriminating against someone on the basis
of their label.
 Less
Marke
resista
r
nce

Greate
r Loadin
disabili g
ty

Less
Self-
Stigma
estee
m Discri
minati
on

Fig.: Cycle of stigmatization for the individual

(Sartorius,2000)
 earance Shame ,
of the guilt
stigmati and
sed worry
illness

Increase Reduce
d stress d
for all reserves

Less
support
Disadva
to
ntages
member
s

Fig.: Cycle of stigmatization for the family

(Sartorius,2000)
 Enhanc involunt
ed ary
stigma admissi
of the ons and
service ‘problem
pts.’
Poor
Poor
reputatio
staff
n of
output
services

Poor Reducti
quality on in
staff funding
Deterior
ating
services

Fig.: Cycle of stigmatization for mental health

services (Sartorius,2000)
Harmful effects of Stigma…..
For someone with a mental illness, the consequences of
stigma can be devastating — in some cases, worse than
the illness itself. Some of the harmful effects of stigma
include:
• Trying to pretend nothing is wrong
• Refusal to seek treatment
• Rejection by family and friends
• Work problems or discrimination
• Difficulty finding housing
• Being subjected to physical violence or harassment
• Inadequate health insurance coverage of mental illnesses
• Stigma is pervasive & spreads to family and remains
present across generations
Harmful Effects
Contd.
• Mental illness is considered untreatable or treatment is
inefficient and dangerous
• Stigma against mental hospitals and staff
• Prevents timely contact, treatment and effective
rehabilitation
• Life long discrimination
• Affects employment, marriage, emigration
• Negative impact on geographical placement of mental
health services and funding for services and research
• They may try to hide their symptoms and not stick to
treatment regimens.
• become socially isolated, locked out of their community
by the shame and embarrassment that stigma triggers
leads to social distancing
 Misconceptions…
• A misconception happens when a person
believes in a concept that is objectively false.

• Misconceptions about mental illness are

pervasive, and the lack of understanding can
have serious consequences for millions of
people who have a psychiatric illness (National
Alliance for Research on Schizophrenia and
Depression).

• Misconceptions about mental illness contribute

to the stigma, which leads many people to be
ashamed and prevents them from seeking help.
Some Common Misconceptions About Mental
Illness
• All Mental Illness is Caused by Sin.
• Young people and children don’t suffer from mental
health problems.
• People who need psychiatric care should be locked
away in institutions.
• A person who has had a mental illness can never be
normal.
• Mentally ill persons are dangerous.
• People with mental illnesses can work low-level jobs
but aren’t suited for really important or responsible
positions.
• Psychiatric disorders are not true medical illnesses like
heart disease and diabetes. People who have a
mental illness are just "crazy.“
Misconceptions
Contd.
• People with a severe mental illness, such as
schizophrenia, are usually dangerous and violent.
• Mental illness is the result of bad parenting.
• Depression results from a personality weakness or
character flaw, and people who are depressed could
just snap out of it if they tried hard enough.
• Schizophrenia means split personality, and there is
no way to control it.
• Depression and other illnesses, such as anxiety
disorders, do not affect children or adolescents. Any
problems they have are just a part of growing up.
 Misconceptions Contd.
• Depression is a normal part of the aging process.
• If you have a mental illness, you can will it away.
Being treated for a psychiatric disorder means an
individual has in some way "failed" or is weak.
• Addiction is a lifestyle choice and shows a lack of
willpower. People with a substance abuse
problem are morally weak or "bad".
• Electroconvulsive therapy (ECT), formerly known
as "shock treatment," is painful and barbaric.
Action Against Stigma…

Four main areas

1. Public relations – working with the media
 Articles in popular news papers/ magazines
 Festivals, events, workshops, seminars
 Public relations by psychiatric service institutions
 Internet, new media

2. Changes in mental health care

 More communication with patients & relatives
 More outpatient and preventive services
 More community based services, better networking
 Involve users & families in evaluating mental health services
 Action Against Stigma Contd.
3. Support for users and families
 Training programmes
 Stigma- coping, empowerment, social competencies
 More information about schizophrenia/ treatment options in
lay terms
 Creation of job opportunities

4. Education and Training

 Mental health as a topic in school (students & teachers)
 Improvement of psychiatric training
 Better education about schizophrenia for health
 Professionals, especially general practioners
 Training seminars for employers
 Training seminars for the police and legal professionals.
 Use of ‘Politically Correct’ language: e.g., ‘Psychophobic’.
 Studies on Stigma…
• Stigmatization and Self- Esteem of persons in Recovery From
Mental Illness: The Role of Peer Support. Mieke Verhaeghe et al
(2008). International Journal of Social Psychiatry,54.
• Self-stigma, empowerment, and perceived legitimacy of
discrimination among women with mental illness. Rusch, N.,
Lieb, K., Bohus, M., et al (2006) Psychiatric Services, 57
• Stigma: the feelings and experiences of 46 people with mental
illness. Qualitative study. Dinos, S., Stevens, S., Serfaty, M., et al
(2004) British Journal of Psychiatry.
• Perceptions of discrimination among persons with serious
mental illness. Corrigan, P., Thompson, V., Lambert, D., et al
(2003) Psychiatric Services,54.
• Stigma as a barrier to recovery: the consequences of stigma
for the self-esteem of people with mental illness. Link, B. G.,
Struening, E. L., Neese-Todd, S., et al (2001) Psychiatric Services,
52
• Community attitudes to mental illness. Wolff, G., Pathare, S.,
Craig, T., et al (1996) British Journal of Psychiatry
Some Important Terms…
• Self-Stigma
• Perceived Discrimination/ Stigma
• Legitimacy of Discrimination
• Coping with stigma (withdrawal)
• Self-Esteem
 Some Indian Studies…
• Beliefs about mental illness: a study of a rural south Indian
community .
R. Thara, Anwar Islam, R. Padmavati
International journal of mental health, vol.27, no3, fall 1998. 70-84

• How stigmatising is schizophrenia in India?

R. Thara, T.N. Srinivasan.
International journal of Social Psychiatry (2000) vol. 46 no. 2, 135-141.

• Women with schizophrenia and broken marriages–doubly

disadvantaged? Part I: Patient perspective.
Thara R, Shantha Kamath, Shuba Kumar.
The International Journal of Social Psychiatry: 2003 Vol.49 (3), 225-232.

• Women with schizophrenia and broken marriages – doubly

disadvantaged? Part II: Family perspective.
Thara R, Shantha Kamath, Shuba Kumar.
International Journal of Social Psychiatry: 2003 Vol.49 (3), 233-240
Scales Used for Studying Stigma…
• Internalised Stigma of Mental Illness scale
developed by Ritsher et al (2003)
• The Stigma Scale by Michael King, et al in
2007(28-item stigma scale has a 3-factor structure:
the 1st concerns discrimination, the 2nd disclosure
and the 3rd potential positive aspects of mental
illness.)
• Mental Illness Stigma Scale by Day,
EmerN.; Edgren, Kara; Eshleman, Amy, 2007(a
Likert-type scale was developed to measure 7
factors of attitudes toward people with mental
illness: interpersonal anxiety, relationship
disruption, poor hygiene, visibility, treatability,
 References….
• Sartorious Norman and Schulze Hugh, Reducing the Stigma of
Mental Illness, published in the United States of America by
Cambridge University Press, New York, 2005.
• Bruce Q. Link, Lawrence H. Yang, Jo C. Phelan, and Pamela Y.
Collins, Measuring Mental Illness Stigma, Schizophrenia Bulletin,
Vol. 30, No. 3, 2004
• Day, EmerN.; Edgren, Kara; Eshleman, Amy, Measuring Stigma
Toward Mental Illness: Development and Application of the
Mental Illness Stigma Scale, Journal of Applied Social Psychology,
Volume 37, Number 10, October 2007.
• Michael King, Sokratis Dinos, Jenifer Shaw, Robert Watson, Scott
Stevens, Filippo Passetti, Scott Weich, and Marc Serfaty
The Stigma Scale: development of a standardised measure of the
stigma of mental illness,The British Journal of Psychiatry, Mar 2007;
190: 248 - 254.
• www.mentalhealthworks.ca/facts/sheets/stigma.asp
• www.mayoclinic.com/health/mental-health/MH00076
• www.mhagstl.org
• www.mindframe-media.info
THANK YOU