Academic journal article Social Work

How Clinical Diagnosis Might Exacerbate the Stigma of Mental Illness

Academic journal article Social Work

How Clinical Diagnosis Might Exacerbate the Stigma of Mental Illness

Article excerpt

Autistic children never play normally with other children. They often do not respond normally to their mothers' affections or to any tenderness. (Freedman, Kaplan, & Sadock, 1976, p. 449)

The sociopath persistently violates the rights of others, shows indifference to commitments, and encounters conflict with the law. (Rathus, 1984, p. 451)

These quotes are two examples of how the use of diagnostic terms can sometimes worsen the stigma of mental illness. Stigma can significantly undermine the quality of life of people with mental illness. The social opprobrium that results from stigma can rob people labeled mentally ill of a variety of work, housing, and other life opportunities commonly enjoyed by adults in the United States. It can also prevent some people who might otherwise benefit from clinical services from pursuing treatment in an effort to avoid the label. One important part of the system of care--clinical diagnosis--may strengthen the stereotypes that lead to stigma. Diagnosis may intensify both the "groupness" and the "differentness" aspects governing public perceptions of people with mental illness.

THE PROBLEM OF THE STIGMA OF MENTAL ILLNESS

Stigma harms people with mental illness in three ways: label avoidance, blocked life goals, and self-stigma.

Label Avoidance

Epidemiological research has consistently shown that the majority of people who might benefit from mental health care either opt not to pursue it or do not fully adhere to treatment regimens once begun. As an example, consider people with schizophrenia, the group that might be construed as being most in need of services. Results from the Epidemiologic Catchment Area Study showed that only 60 percent of people with schizophrenia participated in treatment (Regier, Narrow, Rae, & Manderscheid, 1993). Taking into account symptom severity, Narrow and colleagues (2000) found that people with serious mental illness were no more likely to participate in treatment than those with relatively minor disorders. The National Comorbidity Survey showed similar results (Kessler et al., 2001); fewer than 40 percent of respondents with a serious mental illness such as schizophrenia had received medical treatment in the past year.

Research has suggested that many people choose not to pursue mental health services because they do not want to be labeled a "mental patient" or suffer the prejudice and discrimination that the label entails. Results from the Yale arm of the Epidemiological Catchment Area data showed negative attitudes about mental health inhibit service use in those at risk of a psychiatric disorder (Leaf, Bruce, Tischler, & Holzer, 1987). Findings from the National Comorbidity Survey identified stigmatizing beliefs that might sway people from treatment (Kessler et al., 2001). These included concerns about what others might think and the desire to solve one's own problems. Sirey and colleagues (2001) found a direct relationship between stigmatizing attitudes and treatment adherence. Endorsing stigma was associated with whether 134 adults were compliant with their antidepressant medication regimen three months later. Hence, people may opt not to pursue treatment where labels are conferred to avoid the egregious effects of stigma.

Blocked Opportunities

A primary goal of mental health and rehabilitative services is to assist people in accomplishing their work, independent living, and relationship goals. In part, difficulties achieving goals occur because of the disabilities that result from serious mental illness (Corrigan, 2001). Some people with serious mental illness lack the social and coping skills to meet the demands of the competitive workforce and independent housing. Nevertheless, the problems of many people with psychiatric disability are further hampered by labels and stigma. People with mental illness are frequently unable to obtain good jobs or find suitable housing because of the prejudice of employers and landlords. …

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