Academic journal article Journal of Mental Health Counseling

The Relationships of Public and Self-Stigma to Seeking Mental Health Services

Academic journal article Journal of Mental Health Counseling

The Relationships of Public and Self-Stigma to Seeking Mental Health Services

Article excerpt

The label of mental illness has long been recognized as one of the most powerful of all stigmas. Public stigma, the common societal reactions to people who seek help for psychological distress, can be distinguished from self-stigma, the internalized impact of public stigma. This study examined how awareness and endorsement of public stigma may influence self-stigma. It also examined how both types of stigma are connected to attitudes and intentions to seeking counseling. Awareness and endorsement of public stigma were found to predict self-stigma. Endorsement of sympathy for a person with mental illness was especially predictive of self-stigma, while endorsement of public stigma and self-stigma were independently related to attitudes to seeking counseling. Finally, attitudes were most proximally related to intentions to seek counseling. These results suggest that different aspects of stigma play different roles in influencing attitudes to seeking mental health counseling.


Despite increased awareness of mental health services, each year at most only about one-third of persons with mental illness seek treatment from a mental health professional (Andrews, Issakidis, & Carter, 2001; Kessler et al., 2001; Stefl & Prosperi, 1985). Stigma is believed to be one of the major barriers to seeking treatment (Corrigan, 2004; Komiya, Good, & Sherrod, 2000; Vogel, Wade, & Haake, 2006). Both possession of a psychological diagnosis and the act of seeking treatment appear to be stigmatizing (Ben-Porath, 2002).

Stigma is related to treatment avoidance in at least two ways: First, people wish to avoid possibly being publically identified and labeled as "mentally ill" by seeking mental health counseling. Label avoidance is evidenced in efforts to conceal utilization of mental health services, such as paying out of pocket instead of using insurance (Sibicky & Dovidio, 1986). Second, by seeking treatment people implicitly accept the label of "someone who needs psychological help," which can threaten self-esteem (Corrigan).

The general public seems to infer mental illness from four cues: psychiatric symptoms, social-skill deficits, physical appearance (e.g., being unkempt), and labels (Corrigan, 2000; Penn & Martin, 1998). Research by Link and colleagues (Link, Struening, Cullen, Shrout, & Dohrenwend, 1989) put forth a modified labeling theory proposing that these stereotypes can be applied to a person through labeling, which stigmatizes them. This perspective suggests that even if labeling does not produce mental disorders, it creates many negative outcomes, such as devaluation, discrimination, and a corresponding loss of self-esteem (Link, Struening, Neese-Todd, Asmussen, & Phelan, 2001).


Public Stigma vs. Self-Stigma

The distinction between public stigma and self-stigma (Corrigan, 2004) has proved useful. Public stigma may be defined as the typical societal response that people have to stigmatizing attributes, and self-stigma represents the internalized psychological impact of public stigma.

The public stigma of mental illness can be viewed as essentially a form of prejudice, comprised of cognitive, affective, and behavioral reactions (Corrigan, Watson, et al., 2005). Cognitive reactions to persons with mental illness include such stereotypical beliefs as that people with mental illness are inherently dangerous (Corrigan & Watson, 2005), unkempt or disheveled (Schumacher, Corrigan, & Dejong, 2003), or somehow responsible for the onset of their illness (Corrigan, Watson, et al.). Common affective reactions to persons with mental illness are thought to include fear, a sense of irritation, and a lack of sympathy or pity (Corrigan, 2004; Martin, Pescosolido, Olafsdottir, & McLeod, 2007). People with mental illnesses often experience discrimination in employment, housing, health care, and social interaction (Dickerson, Sommerville, & Origoni, 2002; Wahl, 1999). …

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