MENTAL ILLNESS STIGMA
General overview of theories and consequences of social mental illness stigma
Mental illnesses account for approximately 7% of overall disease burden; with 15.5% of the
global population, that is over 1.1 billion people, estimated to have at least one psychiatric
disorder (Rehm & Shield 2019). Yet individuals affected by mental illnesses remain one of the
most marginalized and stigmatized groups across the globe (Rice, Richardson & Kraemer
2014). Goffman (1963, p.3) defined stigma as ‘’…an attribute that makes a person …of a less
desirable kind-…dangerous, or weak… reduced in our minds from a whole and usual person
to a tainted, discounted one’’. On the basic level, stigma researchers and theorists distinguish
between the social stigma of mental illness, which refers to the attitudes and reactions of
members of the general population to individuals with psychiatric illnesses, and self-stigma,
which occurs when persons with mental disorders internalize the negative beliefs widely
endorsed by the public (Corrigan and Watson 2002).
The social-cognitive model conceptualizes the social stigma of mental illness as a process
involving four key elements: cues, stereotypes, prejudice and discrimination (Abdullah &
Brown 2011). Unusual, poor physical appearance, psychiatric symptoms and impaired social
skills represent cues that are often used by members of the public to infer that an individual
has a mental disorder (Corrigan 2004). These indicators then can activate stereotypes;
collectively held social knowledge structures, about people with psychiatric illnesses (Corrigan
2004). Stigmatizing beliefs towards members of this target population such as that they are
violent and incompetent are widely endorsed by members of the general public (Parcesepe
& Cabassa, 2013; Rossler, 2016). Numerous studies (Lauber et al., 2006; Marques, Figueiras
& Queiros, 2012; Nordt, Rossler & Lauder, 2006; Schulze 2007) also reported that even well-
informed mental health professionals may subscribe to such negative stereotypic views about
people with mental disorders. If endorsed, these stereotypes lead to prejudice; an attitude
characterized by negative evaluation as well as negative affect such as anger, fear and disgust
(Corrigan et al. 2003). The behavioural manifestation of prejudice is discrimination, which in
relation to persons with mental illnesses can present itself in individual as well as institutional
forms. Physical harm and social avoidance represent instances of individual discrimination,
while coercion, insufficient allocation of financial resources to mental health care and
psychiatric research are examples of structural discrimination (Link and Phelan 2001). In
1
,addition to these core elements, Link and Phelan (2001) argued that social, political and
economic power is also required for the production of public stigma, as stigmatization can
only occur in the context of power differences.
Despite the high global prevalence of mental illnesses, people with such disorders have
been severely stigmatized in all known societies worldwide (Rossler 2016). Considering its
cross-cultural and historical consistency, evolutionary psychologists theorized that
biologically driven mechanisms likely underlie stigmatization. Kurzban and Leavy (2001)
postulated that the process of natural selection likely led to the development of a set of
evolutionary adaptive social exclusion cognitions in humans to solve reoccurring problems of
sociality, thus aiding the survival and effective functioning of their groups. These internal
cognitive programs caused people to avoid fellow humans who appeared to be potential
carriers of communicable pathogens and/or poor social exchange partners. People with
mental illnesses, considering the nature of behaviours often accompanying these conditions,
likely signalled both threat of contamination as well as low social capital. As a consequence,
these individuals were stigmatized. This evolutionary perspective provides a plausible
explanation for the long-standing and seemingly universal nature of mental illness stigma,
however, as Hinshaw and Stier (2008) pointed out, the theory has proven to be rather difficult
to test empirically.
Although such negative stigmatizing attitudes are not limited to psychiatric disorders by
any means, members of the general population seem to express much less willingness to be
associated with persons with psychiatric illnesses than people with physical illnesses and
deformities (Hinshaw, 2007; Kasow & Weisskirch, 2010; Rossler, 2016). This greater
disapproval of people with mental illnesses is often reflected in language use as well, which
has been shown to be both a powerful source (Granello & Gibbs 2016) as well as sign of
stigmatization (Link & Phelan 2001). As Rusch, Angermeyer and Corrigan (2005) pointed out,
when describing persons with physical illnesses, people tend to employ primarily
postmodified language saying that ‘a person has cancer’. On the other hand, when speaking
of individuals with mental illnesses, they often use pre-modified terms such as ‘alcoholics’
and ‘schizophrenics’, instead of saying ‘people with alcohol dependence or schizophrenia’. As
a consequence, a person afflicted with a physical illness, although happens to have an
attribute, remains essentially ‘one of the people’. However, an individual with a mental
2
, disorder, instead of being viewed as a person, who is simply being beset by an illness, quite
often becomes the label that is attached to him or her, making them appear to be
fundamentally different from the people, who do not share their labels.
Mass media portrayals of individuals with mental illnesses have also been demonstrated
to contribute to the development and perpetuation of the public’s pejorative attitudes
toward members of this population (Granello & Pauley, 2000; Klin & Lemish, 2008; McGinty,
2017; Sieff, 2003). As Wahl (1995) argued, the majority of people, especially those lacking
direct experience with mental illnesses, tend to rely primarily on facets of mass media for
their perceptions of those with psychiatric conditions. Meanwhile, media representations of
psychiatric illnesses have been overwhelmingly negative; emphasizing propensities toward
violence, unpredictability and incompetence (Hinshaw & Stier, 2008; Ma, 2017; McGinty et
al., 2016; Rossler, 2016). In his review, Hyler (2003) pointed out that the longest running
stereotype of individuals with psychiatric conditions in film has been that of the ‘’homicidal
maniac’’.
The social learning theory postulates that humans do not only learn through direct
personal experience but also via observation (Bandura 1963). According to Bandura (2001),
media plays a particularly important role in observational learning. When applied to social
mental illness stigma, this theory would suggest that media contributes to stigma as it leads
people to learn that individuals with mental disorders are dangerous and frightful, and are
therefore best to be avoided and feared (McGinty, 2017; Overton & Medina, 2008; Stout,
Villegas & Jennings, 2004). This notion has been supported by studies (Diefenbach & West,
2007; Granello & Pauley, 2000), which reported that individuals who watched a lot of
television harboured more negative views of people with psychiatric illnesses than did those
who watched considerably less television. Although there is an increased overall risk for
violence among people with some psychiatric illnesses such as antisocial personality and
substance-related disorders, the actual percentage of those with mental illnesses who act
violently is quite low (Beeber, 2018; Hinshaw & Stier, 2008; Kondo, 2008; Swanson, McGinty,
Fazel & Mays, 2014). Yet the media continues to overemphasize interpersonal violence and
unpredictability in their depictions of mental illnesses, which may not only increase the
public’s endorsement of stigmatization of people with psychiatric illnesses, but might also
3
General overview of theories and consequences of social mental illness stigma
Mental illnesses account for approximately 7% of overall disease burden; with 15.5% of the
global population, that is over 1.1 billion people, estimated to have at least one psychiatric
disorder (Rehm & Shield 2019). Yet individuals affected by mental illnesses remain one of the
most marginalized and stigmatized groups across the globe (Rice, Richardson & Kraemer
2014). Goffman (1963, p.3) defined stigma as ‘’…an attribute that makes a person …of a less
desirable kind-…dangerous, or weak… reduced in our minds from a whole and usual person
to a tainted, discounted one’’. On the basic level, stigma researchers and theorists distinguish
between the social stigma of mental illness, which refers to the attitudes and reactions of
members of the general population to individuals with psychiatric illnesses, and self-stigma,
which occurs when persons with mental disorders internalize the negative beliefs widely
endorsed by the public (Corrigan and Watson 2002).
The social-cognitive model conceptualizes the social stigma of mental illness as a process
involving four key elements: cues, stereotypes, prejudice and discrimination (Abdullah &
Brown 2011). Unusual, poor physical appearance, psychiatric symptoms and impaired social
skills represent cues that are often used by members of the public to infer that an individual
has a mental disorder (Corrigan 2004). These indicators then can activate stereotypes;
collectively held social knowledge structures, about people with psychiatric illnesses (Corrigan
2004). Stigmatizing beliefs towards members of this target population such as that they are
violent and incompetent are widely endorsed by members of the general public (Parcesepe
& Cabassa, 2013; Rossler, 2016). Numerous studies (Lauber et al., 2006; Marques, Figueiras
& Queiros, 2012; Nordt, Rossler & Lauder, 2006; Schulze 2007) also reported that even well-
informed mental health professionals may subscribe to such negative stereotypic views about
people with mental disorders. If endorsed, these stereotypes lead to prejudice; an attitude
characterized by negative evaluation as well as negative affect such as anger, fear and disgust
(Corrigan et al. 2003). The behavioural manifestation of prejudice is discrimination, which in
relation to persons with mental illnesses can present itself in individual as well as institutional
forms. Physical harm and social avoidance represent instances of individual discrimination,
while coercion, insufficient allocation of financial resources to mental health care and
psychiatric research are examples of structural discrimination (Link and Phelan 2001). In
1
,addition to these core elements, Link and Phelan (2001) argued that social, political and
economic power is also required for the production of public stigma, as stigmatization can
only occur in the context of power differences.
Despite the high global prevalence of mental illnesses, people with such disorders have
been severely stigmatized in all known societies worldwide (Rossler 2016). Considering its
cross-cultural and historical consistency, evolutionary psychologists theorized that
biologically driven mechanisms likely underlie stigmatization. Kurzban and Leavy (2001)
postulated that the process of natural selection likely led to the development of a set of
evolutionary adaptive social exclusion cognitions in humans to solve reoccurring problems of
sociality, thus aiding the survival and effective functioning of their groups. These internal
cognitive programs caused people to avoid fellow humans who appeared to be potential
carriers of communicable pathogens and/or poor social exchange partners. People with
mental illnesses, considering the nature of behaviours often accompanying these conditions,
likely signalled both threat of contamination as well as low social capital. As a consequence,
these individuals were stigmatized. This evolutionary perspective provides a plausible
explanation for the long-standing and seemingly universal nature of mental illness stigma,
however, as Hinshaw and Stier (2008) pointed out, the theory has proven to be rather difficult
to test empirically.
Although such negative stigmatizing attitudes are not limited to psychiatric disorders by
any means, members of the general population seem to express much less willingness to be
associated with persons with psychiatric illnesses than people with physical illnesses and
deformities (Hinshaw, 2007; Kasow & Weisskirch, 2010; Rossler, 2016). This greater
disapproval of people with mental illnesses is often reflected in language use as well, which
has been shown to be both a powerful source (Granello & Gibbs 2016) as well as sign of
stigmatization (Link & Phelan 2001). As Rusch, Angermeyer and Corrigan (2005) pointed out,
when describing persons with physical illnesses, people tend to employ primarily
postmodified language saying that ‘a person has cancer’. On the other hand, when speaking
of individuals with mental illnesses, they often use pre-modified terms such as ‘alcoholics’
and ‘schizophrenics’, instead of saying ‘people with alcohol dependence or schizophrenia’. As
a consequence, a person afflicted with a physical illness, although happens to have an
attribute, remains essentially ‘one of the people’. However, an individual with a mental
2
, disorder, instead of being viewed as a person, who is simply being beset by an illness, quite
often becomes the label that is attached to him or her, making them appear to be
fundamentally different from the people, who do not share their labels.
Mass media portrayals of individuals with mental illnesses have also been demonstrated
to contribute to the development and perpetuation of the public’s pejorative attitudes
toward members of this population (Granello & Pauley, 2000; Klin & Lemish, 2008; McGinty,
2017; Sieff, 2003). As Wahl (1995) argued, the majority of people, especially those lacking
direct experience with mental illnesses, tend to rely primarily on facets of mass media for
their perceptions of those with psychiatric conditions. Meanwhile, media representations of
psychiatric illnesses have been overwhelmingly negative; emphasizing propensities toward
violence, unpredictability and incompetence (Hinshaw & Stier, 2008; Ma, 2017; McGinty et
al., 2016; Rossler, 2016). In his review, Hyler (2003) pointed out that the longest running
stereotype of individuals with psychiatric conditions in film has been that of the ‘’homicidal
maniac’’.
The social learning theory postulates that humans do not only learn through direct
personal experience but also via observation (Bandura 1963). According to Bandura (2001),
media plays a particularly important role in observational learning. When applied to social
mental illness stigma, this theory would suggest that media contributes to stigma as it leads
people to learn that individuals with mental disorders are dangerous and frightful, and are
therefore best to be avoided and feared (McGinty, 2017; Overton & Medina, 2008; Stout,
Villegas & Jennings, 2004). This notion has been supported by studies (Diefenbach & West,
2007; Granello & Pauley, 2000), which reported that individuals who watched a lot of
television harboured more negative views of people with psychiatric illnesses than did those
who watched considerably less television. Although there is an increased overall risk for
violence among people with some psychiatric illnesses such as antisocial personality and
substance-related disorders, the actual percentage of those with mental illnesses who act
violently is quite low (Beeber, 2018; Hinshaw & Stier, 2008; Kondo, 2008; Swanson, McGinty,
Fazel & Mays, 2014). Yet the media continues to overemphasize interpersonal violence and
unpredictability in their depictions of mental illnesses, which may not only increase the
public’s endorsement of stigmatization of people with psychiatric illnesses, but might also
3
