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2 - Theoretical Models to Understand Stigma of Mental Illness

from Part I - Understanding Stigma and Mental Health

Published online by Cambridge University Press:  28 July 2022

By
Lindsay Sheehan ,
Carlo Vittorio Palermo  and
Patrick Corrigan
Edited by
David L. Vogel  and
Nathaniel G. Wade
David L. Vogel
Affiliation:
Iowa State University
Nathaniel G. Wade
Affiliation:
Iowa State University
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Summary

Stigma is a socially constructed phenomenon that occurs on multiple levels and has broad implications for both individuals with mental illness and society as a whole. Theoretical orientations provide a framework for organizing and advancing research on the stigma of mental illness. This chapter describes theoretical perspectives on types of mental illness stigma, including public stigma, self-stigma, associative stigma, and structural stigma. In terms of public stigma (stereotypes, prejudice, and discrimination directed at people with mental illness), we discuss five theories: (1) modified labeling theory, (2) social-cognitive model, (3) stereotype content model, (4) implicit stigma, and (5) attribution theory. In terms of self-stigma (the internalization of public stigma), we describe the progressive model of self-stigma, stigma resistance, and two theoretical approaches to understand disclosure of mental illness: the disclosure process model and the disclosure decision-making model. While theoretical models to guide research on associative and structural stigma are limited, we review these concepts and suggest areas for future scholarship. Finally, we describe and critique several multi-level models of stigma including the Mental Illness Stigma Framework and the Health and Stigma Discrimination Framework.

Keywords

mental illnessmental disordersstigmatheoreticalprejudicediscrimination
Type
Chapter
Information
The Cambridge Handbook of Stigma and Mental Health , pp. 11 - 30
Publisher: Cambridge University Press
Print publication year: 2022

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References

Barry, C. L., Huskamp, H. A., & Goldman, H. H. (2010). A political history of federal mental health and addiction insurance parity. The Milbank Quarterly, 88(3), 404–433. https://doi.org/10.1111/j.1468-0009.2010.00605.xGoogle Scholar
Boysen, G. A. (2017). Exploring the relation between masculinity and mental illness stigma using the stereotype content model and BIAS map. The Journal of Social Psychology, 157(1), 98–113. https://doi.org/10.1080/00224545.2016.1181600Google Scholar
Brener, L., Rose, G., Von Hippel, C., & Wilson, H. (2013). Implicit attitudes, emotions, and helping intentions of mental health workers toward their clients. The Journal of Nervous and Mental Disease, 201(6), 460–463. https://doi.org/10.1097/NMD.0b013e318294744aGoogle Scholar
Brohan, E., Gauci, D., Sartorius, N., Thornicroft, G., & GAMIAN–Europe Study Group. (2011). Self-stigma, empowerment and perceived discrimination among people with bipolar disorder or depression in 13 European countries: The GAMIAN–Europe study. Journal of Affective Disorders, 129(1–3), 56–63. https://doi.org/10.1016/j.jad.2010.09.001CrossRefGoogle ScholarPubMed
Chaudoir, S. R., & Fisher, J. D. (2010). The disclosure processes model: Understanding disclosure decision making and post disclosure outcomes among people living with a concealable stigmatized identity. Psychological Bulletin, 136(2), 236. https://doi.org/10.1037/a0018193Google Scholar
Corrigan, P. W., Druss, B. G., & Perlick, D. A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest, 15(2), 37–70. https://doi.org/10.1177/1529100614531398Google Scholar
Chaudoir, S. R., Fisher, J. D., & Simoni, J. M. (2011). Understanding HIV disclosure: A review and application of the Disclosure Processes Model. Social Science & Medicine, 72(10), 161–1629. https://doi.org/10.1016/j.socscimed.2011.03.028CrossRefGoogle ScholarPubMed
Corrigan, P. W., Larson, J. E., & Rüsch, N. (2009). Self-stigma and the “why try” effect: Impact on life goals and evidence-based practices. World Psychiatry, 8(2), 75–81. https://doi.org/10.1002/j.2051-5545.2009.tb00218.xGoogle Scholar
Corrigan, P. W., Markowitz, F. E., & Watson, A. C. (2004). Structural levels of mental illness stigma and discrimination. Schizophrenia Bulletin, 30(3), 481-491. https://doi.org/10.1093/oxfordjournals.schbul.a007096Google Scholar
Corrigan, P. W., & Miller, F. E. (2004). Shame, blame, and contamination: A review of the impact of mental illness stigma on family members. Journal of Mental Health, 13(6), 537–548. https://doi.org/10.1080/09638230400017004Google Scholar
Corrigan, P. W., Rafacz, J., & Rüsch, N. (2011). Examining a progressive model of self-stigma and its impact on people with serious mental illness. Psychiatry Research, 189(3), 339–343. https://doi.org/10.1016/j.psychres.2011.05.024Google Scholar
Corrigan, P. W., & Wassel, A. (2008). Understanding and influencing the stigma of mental illness. Journal of Psychosocial Nursing and Mental Health Services, 46(1), 42–48. https://doi.org/10.3928/02793695-20080101-04CrossRefGoogle ScholarPubMed
Corrigan, P. W., & Watson, A. C. (2002). The paradox of self‐stigma and mental illness. Clinical Psychology: Science and Practice, 9(1), 35–53. https://doi.org/10.1093/clipsy.9.1.35Google Scholar
Corrigan, P. W., Watson, A. C., & Barr, L. (2006a). The self–stigma of mental illness: Implications for self–esteem and self–efficacy. Journal of Social and Clinical Psychology, 25(8), 875–884. https://doi.org/10.1521/jscp.2006.25.8.875Google Scholar
Corrigan, P. W., Watson, A. C., & Miller, F. E. (2006b). Blame, shame, and contamination: The impact of mental illness and drug dependence stigma on family members. Journal of Family Psychology, 20(2), 239. https://doi.org/10.1037/0893-3200.20.2.239Google Scholar
Cremin, K. M. (2012). Challenges to institutionalization: The definition of “institution” and the future of Olmstead litigation. Texas Journal on Civil Liberties & Civil Rights, 17(2), 143–180. https://doi.org/10.1177/136345930200600204Google Scholar
Fiske, S. T. (2018). Stereotype content: Warmth and competence endure. Current Directions in Psychological Science, 27(2), 67–73. https://doi.org/10.1177/0963721417738825CrossRefGoogle ScholarPubMed
Fiske, S. T., Cuddy, A. J., Glick, P., & Xu, J. (2002). A model of (often mixed) stereotype content: Competence and warmth respectively follow from perceived status and competition. Journal of Personality and Social Psychology, 82, 878–902. https://doi.org/10.1037//0022-3514.82.6.878Google Scholar
Firmin, R. L., Luther, L., Lysaker, P. H., et al. (2017). Stigma resistance at the personal, peer, and public levels: A new conceptual model. Stigma and Health, 2(3), 182. https://doi.org/10.1037/sah0000054Google Scholar
Fox, A. B., Earnshaw, V. A., Taverna, E. C., & Vogt, D. (2018). Conceptualizing and measuring mental illness stigma: The mental illness stigma framework and critical review of measures. Stigma and Health, 3(4), 348. https://doi.org/10.1037/sah0000104CrossRefGoogle ScholarPubMed
Goffman, E. (1963). Stigma: Notes on the Management of Spoiled Identity. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
Göpfert, N. C., Conrad von Heydendorff, S., Dreßing, H., & Bailer, J. (2019). Applying Corrigan’s progressive model of self-stigma to people with depression. PLoS ONE, 14(10), e0224418. https://doi.org/10.1371/journal.pone.0224418Google Scholar
Greene, K., Magsamen-Conrad, K., Venetis, M. K., et al. (2012). Assessing health diagnosis disclosure decisions in relationships: Testing the disclosure decision-making model. Health Communication, 27(4), 35–368. https://doi.org/10.1080/10410236.2011.586988CrossRefGoogle ScholarPubMed
Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. (1998). Measuring individual differences in implicit cognition: The implicit association test. Journal of Personality and Social Psychology, 74(6), 1464. https://doi.org/10.1037/0022-3514.74.6.1464Google Scholar
Halter, M. J. (2008). Perceived characteristics of psychiatric nurses: Stigma by association. Archives of Psychiatric Nursing, 22, 20–26. https://doi.org/10.1016/j.apnu.2007.03.003Google Scholar
Hatzenbuehler, M. L. (2016). Structural stigma: Research evidence and implications for psychological science. American Psychologist, 71(8), 742. https://doi.org/10.1037/amp0000068Google Scholar
Hofer, A., Post, F., Pardeller, S., Frajo-Apor, B., et al. (2019). Self-stigma versus stigma resistance in schizophrenia: Associations with resilience, premorbid adjustment, and clinical symptoms. Psychiatry Research, 271, 396–401. https://doi.org/10.1016/j.psychres.2018.12.029CrossRefGoogle ScholarPubMed
Kvaale, E. P., Gottdiener, W. H., & Haslam, N. (2013). Biogenetic explanations and stigma: A meta-analytic review of associations among laypeople. Social Science & Medicine, 96, 95–103. https://doi.org/10.1016/j.socscimed.2013.07.017Google Scholar
Link, B. G., Cullen, F. T., Struening, E., Shrout, P. E., & Dohrenwend, B. P. (1989). A modified labeling theory approach to mental disorders: An empirical assessment. American Sociological Review, 54(3), 400–423. https://doi.org/10.2307/2095613Google Scholar
Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27(1), 363–385. https://doi.org/10.1146/annurev.soc.27.1.363Google Scholar
Livingston, J. D., & Boyd, J. E. (2010). Correlates and consequences of internalized stigma for people living with mental illness: A systematic review and meta-analysis. Social Science & Medicine, 71(12), 2150–2161. https://doi.org/10.1016/j.socscimed.2010.09.030Google Scholar
Malterud, K., & Ulriksen, K. (2011). Obesity, stigma, and responsibility in health care: A synthesis of qualitative studies. International Journal of Qualitative Studies on Health and Well-being, 6(4), 8404. https://doi.org/10.3402/qhw.v6i4.8404Google Scholar
Mannarini, S., & Boffo, M. (2014). An implicit measure of associations with mental illness versus physical illness: Response latency decomposition and stimuli differential functioning in relation to IAT order of associative conditions and accuracy. PLoS ONE, 9(7), e101911. https://doi.org/10.1371/journal.pone.0101911CrossRefGoogle ScholarPubMed
Minkler, M., & Wallerstein, N. (2011). Community-Based Participatory Research for Health: From Process to Outcomes. John Wiley & Sons.Google Scholar
Mortensen, C. R., & Cialdini, R. B. (2010). Full‐cycle social psychology for theory and application. Social and Personality Psychology Compass, 4(1), 53–63. https://doi.org/111/j.1751-9004.2009.00239.xCrossRefGoogle Scholar
Moses, T. (2013). Stigma & family. In Corrigan, P. W. (Ed.), Stigma of Disease and Disability: Understanding Causes and Overcoming Prejudices (pp. 247–268). Washington, DC: American Psychological Association. https://doi.org/10.1037/14297-013Google Scholar
Olmstead v. L.C., 527 U.S. 581 (1999).Google Scholar
Pahwa, R., Fulginiti, A., Brekke, J. S., & Rice, E. (2017). Mental illness disclosure decision making. American Journal of Orthopsychiatry, 87(5), 575. https://doi.org/10.1037/ort0000250Google Scholar
Pearl, R. L., Forgeard, M. J., Rifkin, L., Beard, C., & Björgvinsson, T. (2017). Internalized stigma of mental illness: Changes and associations with treatment outcomes. Stigma and Health, 2(1), 2–15. https://doi.org/10.1037/sah0000036CrossRefGoogle Scholar
Peris, T. S., Teachman, B. A., & Nosek, B. A. (2008). Implicit and explicit stigma of mental illness: Links to clinical care. The Journal of Nervous and Mental Disease, 196(10), 752–760. https://doi.org/10.1097/NMD.0b013e3181879dfdGoogle Scholar
Picco, L., Pang, S., Lau, Y. W., et al. (2016). Internalized stigma among psychiatric outpatients: Associations with quality of life, functioning, hope and self-esteem. Psychiatry Research, 246, 500–506. https://doi.org/10.1016/j.psychres.2016.10.041CrossRefGoogle ScholarPubMed
Prewitt, K., Schwandt, T. A., & Straf, M. L. (Eds.) (2012). Using Science as Evidence in Public Policy. Washington, DC: The National Academies Press.Google Scholar
Reeder, G. D., & Pryor, J. B. (2008). Dual psychological processes underlying public stigma and the implications for reducing stigma. Mens Sana Monographs, 6(1), 175. https://doi.org/10.4103/0973-1229.36546CrossRefGoogle ScholarPubMed
Rüsch, N., Corrigan, P. W., Todd, A. R., & Bodenhausen, G. V. (2010). Implicit self-stigma in people with mental illness. The Journal of Nervous and Mental Disease, 198(2), 150–153. https://doi.org/10.1097/NMD.0b013e3181cc43b5Google Scholar
Sandhu, H. S., Arora, A., Brasch, J., & Streiner, D. L. (2019). Mental health stigma: Explicit and implicit attitudes of Canadian undergraduate students, medical school students, and psychiatrists. The Canadian Journal of Psychiatry, 64(3), 209–217. https://doi.org/1177/0706743718792193Google Scholar
Schomerus, G., Matschinger, H., & Angermeyer, M. C. (2014). Causal beliefs of the public and social acceptance of persons with mental illness: A comparative analysis of schizophrenia, depression and alcohol dependence. Psychological Medicine, 44(2), 303. https://doi.org/10.1017/S003329171300072XGoogle Scholar
Sheehan, L., Nieweglowski, K., & Corrigan, P. W. (2017). Structures and types of stigma. In Gaebel, W., Rössler, W., Sartorius, & N. (Eds.), The Stigma of Mental Illness – End of the Story? (pp. 43–66). Cham: Springer.Google Scholar
Stangl, A. L., Earnshaw, V. A., Logie, C. H., et al. (2019). The Health Stigma and Discrimination Framework: A global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Medicine, 17(1), 31. https://doi.org/10.1186/s12916-019-1271-3CrossRefGoogle ScholarPubMed
Stull, L. G., McGrew, J. H., Salyers, M. P., & Ashburn-Nardo, L. (2013). Implicit and explicit stigma of mental illness: Attitudes in an evidence-based practice. The Journal of Nervous and Mental Disease, 201(12), 1072. https://doi.org/10.1097/NMD.0000000000000056Google Scholar
Teachman, B. A., Wilson, J. G., & Komarovskaya, I. (2006). Implicit and explicit stigma of mental illness in diagnosed and healthy samples. Journal of Social and Clinical Psychology, 25(1), 75–95. https://doi.org/10.1521/jscp.2006.25.1.75Google Scholar
van der Sanden, R. L., Bos, A. E., Stutterheim, S. E., Pryor, J. B., & Kok, G. (2013). Experiences of stigma by association among family members of people with mental illness. Rehabilitation Psychology, 58(1), 73. https://doi.org/10.1037/a0031752Google Scholar
Weiner, B. (1995). Judgments of Responsibility: A Foundation for a Theory of Social Conduct. New York, NY: Guilford Press.Google Scholar
Zubritsky, C., Mullahy, M., Allen, M., & Alfano, E. (2006). The state of the Olmstead decision and the impact of consumer participation in planning. American Journal of Psychiatric Rehabilitation, 9(2), 131–143. https:/doi.org/10.1080/15487760600876345Google Scholar

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