Challenging the Stigma of Mental Illness (book)

Challenging the Stigma of Mental Illness (edited by Patrick Corrigan)/2011

The debate around the stigmatisation of mentally ill people revolves around this question: is it the label of being mentally ill that leads people to be shunned by others in workplaces and housing or is it the behavior caused by the mental illness which leads people to turn away from them? This question is dealt with extensively in this unique set of essays edited by Patrick Corrigan. This review will cover a few of the ideas outlined in that book and then present Corrigan's conclusions.

It is no secret that mental-health labels are often accompanied by negative stereotypes, and that the labels are at least partly the driving factor in producing stigmatisation. The label might come from a psychiatrist, from the person themselves, or be obtained through association, such as being seen coming out of a psychologist’s office. These stereotypes might not bind to the labels by necessity, but cultural history has so deeply entrenched them into the meaning of psychiatric diagnosis that for all practical purposes they are bound together.

According to labelling theory, when a psychiatric label is applied to an individual, the individual suffers social rejection in various subtle ways, and that this leads to further deviance from the norm as the individual begins to play the role of a mentally ill person as established by social convention. Being ‘mentally ill’, according to this theory, is a role that persons may be cast in.

Multiple studies have shown that the general public were more likely to stigmatise a person labelled mentally ill even in the absence of any negative behaviour (Link, Cullen, Frank and Wozniak). The study by Bruce Link found that psychiatric labelling affected patients’ income and employment twice as much as other status (marital status, education, age, and occupation).

Moreover, being labelled, or experiencing rejection leads mentally ill individuals to self-stigmatise. This self-stigmatisation contains a cognitive element, as the individual begins to view himself as inferior to “normals”, and a behavioural element, in the form of acting less confidently, more defensively, and at times avoiding potentially threatening contact completely.

It is not difficult to imagine the impact such a process would have on the life of a mentally ill individual. In searching for employment, the mentally ill person may face a combination of periods out of the workforce due to hospitalisation, expectations of rejection, low ratings of self-efficacy, and lack of social contacts. Moreover, an inability to gain stable and reasonable employment impacts the ability of individuals to gain satisfactory living conditions, start families, and improve feeling of low self-worth.

Patrick Corrigan notes the difficulty for mentally ill individuals in achieving the two most important life goals: obtaining competitive employment and living independently in a safe and comfortable home. He notes that American surveys consistently show that less than 15% of people with serious and persistent mental illness are employed, even though the majority desire regular work. Moreover, he points out that studies have also shown that the majority of Americans considered ‘long-term mentally ill’ live in inadequate housing, lack needed supports, or are homeless. In a powerful conclusion he states:

‘In part, these problems occur because of the disabilities that result from serious mental illness. Many people with serious mental illness lack the social and coping skills to meet the demands of the competitive work force and independent housing. Nevertheless, the problems of many people with psychiatric disability are exacerbated by labels and stigma. People with mental illness are frequently unable to obtain good jobs or find suitable housing because of the prejudice of key members in their communities: employers and landlords.’

The final part of this quote is fundamental: if stigmatisation of mental illness is going to reduce on a practical level, it needs to reduce in the minds and actions of employers and land owners. It is social and political power that allows stigmatisation to occur. For example, patients in a hospital might have stereotypes about their carers; however, these do not lead to stigmatisation, as the patients do not have the power to deprive those in control. It is only when those holding significant power implicitly or explicitly exclude a groups for having a certain trait that stigmatisation can truly occur.