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Vol. LXI, No. 6
March 20, 2009

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Stigma: Lessons, New Directions from Research

People with mental illnesses, and those who care for and about them, have long struggled with the prejudice and discrimination attached to these disorders. The phenomenon—stigma—stems from labeling someone in ways that devalue them or from stereotyping them in ways that diminish their status in the community and enables discrimination in all its forms (employment, housing, insurance, etc.). Stigma leads individuals with mental illness to feel shame, avoid discussing their condition and even refuse therapy.

In the early 1960s, Erving Goffman pioneered stigma research, recognizing that stigma, whether associated with skin color or health status, tends to diminish people, marking them as somehow less than human. He noted that stigma is only operational during social interaction, can take many forms and is dynamic. Thus, reducing stigma is a sociological as well as behavioral challenge. The scientific foundations necessary to craft interventions only started taking shape in the mid-1990s, when there was a resurgence in both research and policy efforts devoted to mental illness stigma.

Dr. Bernice A. Pescosolido, professor of sociology at Indiana University and director of the Indiana Consortium for Mental Health Services Research, focuses on how social networks connect individuals to their communities and to institutional structures, providing the “wires” through which people’s attitudes and actions are influenced, particularly with regard to health care services, stigma and suicide. She shared her results at a recent OBSSR lecture.

The concept of “public stigma” has been the focus of much of Pescosolido’s research, and that of other teams trying to understand how public attitudes about mental illness have been shaped and changed over the past 40 years. Public attitudes are a “hard measure” of the presence of stigma. The results of these studies provide mixed assessments of the current state of stigmatizing views. On the one hand, a national study of stigma revealed that the public has become more mental health literate in the past 40 years—meaning it has a broader understanding of mental health and is more likely to admit to personally suffering from depression. However, 46 percent of the public still harbors an unwillingness to interact with people with mental illness. And, some conditions—for example, schizophrenia—are more highly stigmatized than others, such as depression.

A study that compared attitudes across 15 countries found that Americans, more than any other group, erroneously associate mental illness with violence. In addition, a study of public stigma toward children with mental health problems found that people are more concerned about depression in children than they are about ADHD, even going so far as to state that ADHD is not a mental illness. These studies reveal consistent yet surprising findings about the public’s view of the underlying causes of mental illness, the social rejection associated with it and its treatment, widespread concern about violence and views about the acceptability of coercion with regard to treatment.

Studies of television programming, including commercials and public service announcements, reveal a high proportion of mental health content, with the most positive presentations involving fuller and lengthier portrayals of characters with mental illness. The less information a viewer has about mental illness, the more powerful the media message. One lesson learned from a recent anti-stigma PSA effort is that stigma can be reduced when people with mental illness are portrayed as “a person like any other” rather than as having “a disease like any other.” Together, these studies suggest a set of principles regarding reducing public stigma and offer direction on future efforts to improve the lives of people with mental illness. NIHRecord Icon

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