How to understand mental health and remove the stigmas (behavioral issues Book 9)

Classic work on mental illness stigma and labeling theory reinforced beliefs, and behavioral dispositions that targeted public stigma and in our understanding of and response to the stigma of mental illness. of stigma—for both adults and children with mental health problems; ;54(9)–
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They reported either no difference or a greater willingness for treatment, sometimes expressing greater optimism about health care outcomes Schnittker, Pescosolido, and Croghan On gender, women vignette characters were seen as less dangerous, but female respondents did not differ on expressions of social distance or danger Schnittker Overall, differences in public responses centered on cultural attitudes, valuations of the situation, and occasionally on social location Olafsdottir and Pescosolido ; Phelan And in some cases in which the direct effects of sociodemographics were documented, the effects disappeared when attributions were taken into account.

These findings are relevant not only to the sociology of mental health and to sociology as a whole but to research and practical efforts to reduce stigma. GSS findings suggest that targeting sociodemographic groups as the blueprint for future campaigns might be too loosely couple research to programming e. The resurgence simultaneously represented progress and laid bare research limitations, raising concerns about measuring the culture of stigma. Some analyses offered tentative insights and signaled new directions for the next phase of stigma research.

Looking to GSS findings on treatment endorsement, a naive conclusion suggests that cultural barriers to help-seeking for mental health problems have been dismantled. Public treatment recommendations revealed very high levels of accepting formal and informal sources of care. However, even as preeminent psychiatric epidemiological studies documented a reduction from one in five to one in four individuals in need receiving care for mental health Wang et al.

Standard explanations can be offered: In fact, hints of the latter possibility appeared in GSS findings on psychiatric medications. The overwhelming majority 60 percent to 75 percent reported positive opinions on the efficacy of psychiatric medications, including relatively few reporting concerns with side effects.

Yet the proportion willing to use them, even when faced with quite severe symptoms e. In response, we repurposed GSS data on treatment endorsement, asking not whether respondents supported the use of treatment providers but whether analyses by attributions, assessments, and sociodemographics revealed cleavages among endorsements. In fact, beliefs about causes and consequences demarcated important lines.

For example, although perceived severity led respondents to endorse any source of care, in line with past utilization research Pescosolido et al. Assessments of potential danger were associated with greater support for specialists psychiatrists, hospitalization over others. Although respondents endorsed multiple treatment options, they clearly discriminated among them, suggesting that a more nuanced cultural schema lay hidden under the typically high and unrealistic treatment endorsements Olafsdottir and Pescosolido We drew on these findings to modify measurement in later GSS modules.

Overall, spontaneous mentions were more in line with actual service use rates and sociodemographic proxies thought to measure cultural differences Pescosolido and Olafsdottir Our efforts focused on measurement, not method. Surveys are capable of capturing cultural issues. Design changes, even within large-scale surveys, offered a promising start for integrating new conceptualizations of culture into research on how individuals respond to mental illness. Individuals in every society have a reservoir of embedded knowledge and attitudes used to address problems in their lives and those of family and friends.

The resurgence included cross-national research on societal profiles of stigma; however, differences or similarities could only be inferred with great caution. Only recently have data become available to address two critical questions: Do larger cultural contexts of stigma differ significantly? Does this matter for individuals? Even in regions expected to have greater cultural similarities Europe , levels of recognition and prejudice show significant variation in public response to mental illness Olafsdottir and Pescosolido ; Pescosolido, Olafsdottir, et al. Basic descriptive results Figure 3 reveal significant differences not easily explained by geography under a diffusion perspective or even GDP under a world systems perspective.

The population proportion indicating an unwillingness to have the schizophrenia-vignette person as a neighbor ranges from under a quarter Brazil to over three quarters Bangladesh. Ongoing analyses suggest that this variation is often in evidence across measures, while within-country consistency is high. Speaking to the second issue, researchers used the Eurobarometer A follow-up, focusing on 14 Eurobarometer countries where larger cultural context could be linked to individuals with histories of mental health problems from the Global Alliance of Mental Illness Advocacy Networks Study; Evans-Lacko et al.

Furthermore, where public levels of comfort with talking to people with mental health problems were higher, consumers reported lower levels of discrimination and a greater sense of empowerment. Research at these levels is rare and recent. Although they begin to suggest critical macro-micro connections, they support the call for both more research in this vein and further rethinking of stigma research, practice, and policy.

Nearly two decades of research and community building efforts have produced a growing, connected network of stigma researchers.

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As an important source of intellectual ferment, discussions often come back to issues that will play an essential role in future research, program, and policy efforts. They often reflect the spirit of the third CDC question: Directly connected to fundamental sociological issues and to changing stigma, they require dedicated research efforts aligned with planning initiatives for policy change.

And although they neither dismiss nor downplay the salience of issues of neuroscience or clinical interventions, they call for a resource shift to greater fiscal, intellectual, and social capital dedicated to social problems surrounding mental illness. Perhaps one of the greatest contributions of the resurgence lay in countering assumptions and unsystematic observations of larger trends in prejudice and discrimination. To push our understanding of the cultural landscape of stigma further and to guide programmatic efforts, there must be a dedicated effort to mark trends.


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The gap of 45 years between the Star survey and the GSS represents a lesson not to be repeated. The discussion of monitoring evokes the standard mantra of measuring change over time: The robust findings of the resurgence are remarkable given the myriad measures used to tap prejudice and discrimination. Yet these differences leave us asking, What is it about mental illness that is stigmatizing?

Typically, the economics of original data collection result in the inclusion of one or two batteries, limiting research that unpacks the first question. While focusing on specific hypotheses e. Both sets of findings suggest stepping back to consider where we are and what directions may be most productive.

What are the mutable roots and potential limits in eliminating prejudice and discrimination? Allport himself was concerned that stereotyping is a special case of ordinary cognitive functioning and therefore not totally alterable Katz The GSS studies, and the larger body of innovative and rigorous studies that constitute my claim of a resurgence of stigma research, have reconfigured the landscape of science and program development, at least to some extent.

Yet fundamental questions, only some of which are elaborated above, are critical in order to continue to shine a harsh light on the social fault lines of a society that produces prejudice and discrimination that translates mental illness stigma into a to year reduction in life expectancy Piatt, Munetz, and Ritter As Goffman reminded us early on, stigma is fundamentally a social phenomenon rooted in social relationships and shaped by the culture and structure of society.

If stigma emanates from social relationships, the solution to understanding and changing must similarly be embedded in changing social relationships and the structures that shape them. I would like to thank members of the Award Committee and the many researchers who have been part of this collaborative research agenda on public stigma. I would also like the thank the core of the research team that has been involved for most of the duration, including Jo Phelan, Jack K.

Special thanks to Tait Medina for assistance on the to graphics presented here. I would like to thank Tom W. Smith, both as one of the principal investigators of the GSS and as former secretariat of the International Social Survey Program, for his invaluable assistance at several key points; Emeline Otey at the NIMH for her continual support of stigma research; Thom Bornemann and Rebecca Palpant at the Carter Center for convening several Stigma Leaders Workshops to push the agenda for change; and Glenn Close and Bring Change 2 Mind for reminding me why we do this research.

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Any errors contained within are solely my responsibility. She has focused her research and teaching on social issues in health, illness, and healing. This agenda encompasses three basic areas: The first mention of mental illness stigma in a sociology journal came in Social Forces: Conclusions from the raw and adjusted analyses Pescosolido et al.

Although Gove suggested that this remains a way that individuals destigmatize emotional problems rather than the more harsh term mental illness , psychiatry did not. Without using nervous breakdown , comparisons over time would be compromised. Sociodemographic analyses suggested no systematic groups here.

This article is a revision of the Leonard I. National Center for Biotechnology Information , U. J Health Soc Behav. Author manuscript; available in PMC May Bernice Pescosolido, Indiana University, E. The publisher's final edited version of this article is available at J Health Soc Behav. See other articles in PMC that cite the published article. Abstract By the s, sociology faced a frustrating paradox. Open in a separate window. General Social Survey Note: Confronting assumptions of change Much of the motivation for the U. General Social Survey Source: Debates Resolved, Assumptions Questioned, Predictions Fulfilled In stigma research, some issues became flash-points because they pitted hypotheses against each other or because they were implicit or explicit foundations for stigma reduction efforts.

The limited role of sociodemographics Findings on stigma revealed little that could be systematically explained by social characteristics. The Essential Role of Monitoring Stigma at the Global and Individual Levels Perhaps one of the greatest contributions of the resurgence lay in countering assumptions and unsystematic observations of larger trends in prejudice and discrimination. Acknowledgments I would like to thank members of the Award Committee and the many researchers who have been part of this collaborative research agenda on public stigma.

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Americans View Their Mental Health. The Mark of Shame: Stigma of Mental Illness and an Agenda for Change. Oxford University Press; Receiving Houses for Incipient Mental Disorder. Medical Journal of Australia.

Attitudes about Mental Illness and its Treatment: Community Mental Health Journal. Situational Patterning in Intergroup Relations. Journal of Consulting and Clinical Psychology. Revisiting the Contact Hypothesis: The Case of Public Exposure to Homelessness. A Handbook for the Study of Mental Health.

Cambridge University Press; Annual Review of Sociology. On Stigma and Its Consequences: The Construction of Fear: Of Fear and Loathing: Stigma and Global Health: Psychiatric Diagnosis as Reified Measurement. Social Psychiatry and Psychiatric Epidemiology. The Negro Problem and Modern Democracy. Popular Conceptions of Mental Health. Medicalization and Mental Health: Olafsdottir Sigrun, Pescosolido Bernice A. Society and Mental Health. Children, Culture, and Mental Illness: Public Knowledge and Stigma toward Childhood Problems. Culture, Children, and Mental Health Treatment: Response to Torrey Letter.

American Journal of Psychiatry. Handbook of the Sociology of Mental Health. Findings from the National Stigma Study—Children. Stigma and the Sociological Enterprise. Mental Health, Social Mirror. Rethinking Theoretical Approaches to Stigma: Through the Looking Glass: The Fortunes of the Sociology of Mental Health. American Journal of Public Health. The Cultural Turn in Sociology: Arboleda-Florez J, Sartorius N, editors. Understanding the Stigma of Mental Illness: Does Intergroup Contact Reduce Prejudice?

Reducing Prejudice and Discrimination: Geneticization of Deviant Behavior and Consequences for Stigma: Mental illness, as somebody who comes from Africa, we think it's a curse. We think you're possessed by the devil, but it's a mental health problem. We don't know that. So it's a kind of a stigma that we Black people are taught; people with mental illness who are not the same [as us], who are not completely normal as we are AM03, African. A view expressed particularly among faith leaders was that mental illness was indicative of a moral failing on the part of the individual.

Profound belief in moral fortitude in the face of adversity meant that mental illness was regarded as a phenomenon experienced by those who failed to conform to societal norms. According to participants, such beliefs were likely to generate stigma towards individuals with mental illness. Mental illness [in our communities] is seen as weakness and we don't handle weakness very well. You don't have enough faith. You don't have enough belief in God. There's not enough of God in you because if there was enough of God in you, you wouldn't be here at this particular spot now FL06, African Caribbean.

Mental illness is not given the appropriate attention as, say, maybe a broken arm or high blood pressure. It's not given that same level of attention because it's seen as weakness and we don't handle weakness very well FL06, African Caribbean. There was some disagreement among participants as to whether attitudes towards mental illness differed among people born in the UK vs.

Africa or the Caribbean. For some respondents, acculturation seemed to change the ways in which people perceived mental illness, whereas others were puzzled at the lack of change over time. The stigma [attached to mental illness] comes in two perspectives…. Instead of them addressing it, they would rather look at it from a different point of view FL05, African. I think these three things have bedeviled the Black community. You are rejected by your own community, by your own environment. They will say that you're not useful any more.

Stigma affects [people] individually in terms of denying things. I mean as a victim, there's feelings of being kind of being hurt, being ostracised, being isolated and there's also the case of not seeking appropriate help, not engaging with the services available to actually deal with something properly. The biggest damage is the person's attitude to themselves, in terms of what they're going through and also how that influences what they do to try and deal with their situation AM04, African.

Loss of aspirations was regarded as being the direct result of the negative effects of internalized stigma related to mental illness. For some of the people I have spoken to, it [mental illness] sort of cuts short any types of aspirations and a hope that they may have had …it cuts short any type of opportunities, any type of beliefs anybody would have in them. You receive a label of mental ill health, anything that you do, whether you are feeling well or unwell, you will be pathologised RA04, African.

Participants described the response and the sense of shame internalized stigma experienced as a result of having someone in the family diagnosed with a mental illness. If somebody within their family has gone mentally ill, it's a shame, and they rather push that person out of the way and don't talk. So, you have that thing that you bring that kind of stigma with you. If somebody goes mentally ill in your family you don't talk about it really. If it goes wrong in a family, something is wrong with that [whole] family, so, you shut that person away.

It's this big, denial, and it has been from the whole cultural thing AM06, African Caribbean. Denial and refusal to accept someone in the family with mental illness was thought to be underpinned by a lack of understanding about mental illness. In their accounts, participants indicated that families they knew would go to the extent of avoiding contact with someone in the family with a mental illness, resulting in family withdrawal and increased social isolation especially when persons were hospitalized. In some ways, [if you are] mentally ill you are isolated in the hospital and that's it.

Even sometimes families wouldn't go and visit because they don't want to know.

In a way, we kind of try and bury it, it's not happened to us. It's a sense of denial that this has not happened, so, we deny it. We're not open with it and we don't want to talk about it. It's the shame that somebody within their family has gone mentally ill RA07, African. In this respect, a participant commented:. There's a lot of ideological stigma in mental illness as well as a lot of shame in terms of how this makes you look in front of other people. It is shame because of what it means in the eyes of the family, in the eyes of the community, because as a people, our family and our community kind of mean a lot to us AM04, African.

Even within the family, when they have it [mental illness], they won't let people know that a member of their family is having that, and as a result it escalates and results in them rather than being treated, it wasn't a situation they want to face [they deny it]. That's the key thing, if they don't come out. People keep it to themselves and the way they see mental illness it's something very, very terrible and it's: This is illustrated in this account of how a family's distancing from and denial of their son's mental illness enacted stigma, provoking a feeling of shame and a sense of emotional separation and isolation from his own family:.

I remember when I went to see someone and his family was around him and I was speaking with him and the family was saying: He needs to pull himself together. He needs to sort himself out. So, I think we protect ourselves by avoiding having to talk about or say any of those things AM02, African.

So powerful is the stigma of mental illness in these communities that it was regarded by some respondents as a form of demonization, which was perceived as detrimental both to the individual experiencing mental illness and the communities as a whole. I think with mental health issues there has been a longstanding demonisation of anything of people that don't fit.

There hasn't been an extended hand to help them.

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And people might withdraw from that individual instead of seeking to help them. It's divisive, it divides the community. It leaves people who are suffering from mental health issues isolated, being treated by… unfamiliar group of people [mental health professionals] that don't understand their culture, their values or their norms RA03, African. It breaks down communities in terms of communication. It develops — people are isolated. The more it goes on the less we talk, the less we talk the more it goes on FL06, African Caribbean. Participants revealed that the church was often the first port of call when someone experienced psychological distress in their communities and that church leaders often adopted primarily spiritual approaches to providing help and support rather than advising them to seek help from mental health professionals.

If somebody comes into the church with a mental health issue, they [pastors] are most likely to pray for this person and annoy the person with asking them to try things, rather than asking the person to seek for professional help […] Pastors think a person taken over by an evil spirit has mental illness, so, the evil spirit must be exorcised out of them. And once you exorcise people they do not progress to become better, they progressively become worse AM03, African.

Not all behaviour is necessarily a spiritual manifestation, and I don't think we always make that distinction. And in many cases we're not equipped to distinguish what is spiritual need and what is mental health need. Frequently, this is the only source of care sought. In our study, beliefs about the relationship between evil spirits, devil possession and mental illness carried with them implicit assumptions about moral failings on the part of individuals experiencing psychological distress. Although originally developed in relation to physical illnesses, evidence from this study and elsewhere suggests the framework which describes how individuals suffer in silence because of shame, stigma and related absence of discourse within these communities is applicable to mental illness.

As reported by respondents, normative cultural beliefs in the existence of evil spirits and demonic possession might influence perceptions of what may or may not be evidence of psychiatric illness. In consequence, they are at risk of increased social isolation which is both antithetical to recovery from mental illness and increases the likelihood of relapse and hospitalization, 60 which further reinforces stigma.

Public sector resources have often failed to meet the needs of persons with mental illness, especially BAME groups, 61 who are less likely than White people to seek treatment from mainstream sources.

The Public Stigma of Mental Illness: What Do We Think; What Do We Know; What Can We Prove?

The provision of appropriate and responsive services that meet the needs of people experiencing mental illness should take account of intersectional complexity and attempt to develop culturally sensitive services and therapies in partnership with those who will become the recipients.

FBOs are trusted entities within many communities with histories of providing spiritual refuge and renewal. They have the potential to become bridges between the cultures of health care and different minority communities and thus bring about change by improving communication and information sharing. We acknowledge that these are important additional perspectives if we are fully to understand the impact of stigma on individuals experiencing mental illness. The authors would like to acknowledge the organizers of the community project who facilitated the access and recruitment of participants, and had an input in the informed consent procedure.

We would also like to acknowledge the research assistant Stephen Joseph for his role in data collection, and the study participants for their willingness to share their views and opinions. Thanks also to the reviewers for their helpful comments. National Center for Biotechnology Information , U. Journal List Health Expect v. Published online Apr Accepted Mar This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC. Abstract Background Stigma related to mental illness affects all ethnic groups, contributing to the production and maintenance of mental illness and restricting access to care and support. Introduction People with mental illness experience more stigma than those with other health problems. Stigma Stigma is principally a psychological and social phenomenon.

Sampling and recruitment We applied a purposive convenience sampling strategy to recruitment. Ethics The data collection for this aspect of the study fell under the remit of the aforementioned study. Results A total of 26 interviews were completed with 14 African Caribbean and 12 African participants. In this respect, a participant commented: This is illustrated in this account of how a family's distancing from and denial of their son's mental illness enacted stigma, provoking a feeling of shame and a sense of emotional separation and isolation from his own family: Supporting information Appendix S1.

Click here for additional data file. University of Leicester, Mental Health Foundation, Canadian Journal of Psychiatry , ; Fighting Stigma and the Lessons Learned.

Mental Health & Stigma | Psychology Today

Oxford University Press, Understanding and addressing the stigma of mental illness with ethnic minority communities. Health Sociology Review , ; National Institute for Clinical Excellence. Psychosis and schizophrenia in adults: