{"id":1277,"date":"2020-08-25T19:34:39","date_gmt":"2020-08-25T19:34:39","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/abnormalpsych\/?post_type=chapter&#038;p=1277"},"modified":"2022-07-26T20:06:52","modified_gmt":"2022-07-26T20:06:52","slug":"mental-disorders-and-stigma","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/chapter\/mental-disorders-and-stigma\/","title":{"raw":"Mental Disorders and Stigma","rendered":"Mental Disorders and Stigma"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li>Describe types of stigma associated with mental disorders and ways to challenge these stereotypes<\/li>\r\n<\/ul>\r\n<\/div>\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"416\"]<img src=\"https:\/\/cdn.pixabay.com\/photo\/2015\/11\/07\/09\/11\/board-1030589_960_720.jpg\" alt=\"Image result for stigma against psychological disorders \" width=\"416\" height=\"277\" \/> <strong>Figure 1<\/strong>. Though awareness of mental health issues continues to increase, there is still a stigma associated with many mental disorders that should be addressed, both at an individual and societal level.[\/caption]\r\n\r\nPublic-opinion studies have confirmed the widespread existence of negative stereotypes about individuals with mental health problems: they are considered dangerous, unpredictable, and difficult to talk to. These negative stereotypes can have detrimental consequences on the users of mental health services through processes of <strong>public stigma<\/strong>, <strong>self-stigma<\/strong>, and <strong>stigma expectations<\/strong> with regard to such outcomes as self-efficacy, depressive symptoms, self-esteem, life satisfaction, client satisfaction, work, income, and social relationships, in addition to treatment continuation and medication adherence. A <strong>stereotype,<\/strong> in general, refers to\u00a0an expectation that people might have about every person of a particular group. A stereotype is distinct from stigma.\u00a0<b>Public stigma<\/b>\u00a0refers to a set of negative attitudes and beliefs that motivate individuals to fear, reject, avoid, and discriminate against people with mental illness (Corrigan and Penn 1999).[footnote]Parcesepe, A. M., &amp; Cabassa, L. J. (2013). Public stigma of mental illness in the United States: a systematic literature review. Administration and policy in mental health, 40(5), 384\u2013399. https:\/\/doi.org\/10.1007\/s10488-012-0430-z[\/footnote] <strong>Self-stigma<\/strong> is thought to be particularly damaging, and is said to occur when individuals internalize stigmatizing social attitudes and come to believe the negative societal conceptions and stereotypes associated with their condition (Corrigan and Watson, 2002;\u00a0Watson et al., 2007;\u00a0Corrigan and Rao, 2012). Whether stigma is only anticipated or directly experienced, self-stigmatizing beliefs can lead to withdrawal from social support, rejection of help, avoidance of treatment, treatment withdrawal, and limited prospects for recovery (Link and Cullen, 1990;\u00a0Link, 2001;\u00a0Corrigan, 2004;\u00a0Vogel et al., 2007).[footnote]Bracke P, Delaruelle K and Verhaeghe M (2019) Dominant Cultural and Personal Stigma Beliefs and the Utilization of Mental Health Services: A Cross-National Comparison. Front. Sociol. 4:40. doi: 10.3389\/fsoc.2019.00040[\/footnote]\r\n\r\nWith regard to culture and mental health stigma, <strong>stigma expectations<\/strong>\u2014\u201cthe extent to which individuals believe that \u2018most people' (the community at large) will devalue and discriminate against a mental patient\u201d\u2014do not differ between individuals with and without mental health problems or history of treatment. They interpret this as an indication that such expectations constitute a component of culture. In addition, stigma expectations lead individuals with mental health problems to use adaptive strategies (e.g., secrecy or withdrawal). They thus do not necessarily believe in these negative stereotypes; they only know (and fear) that the stereotypes will be applied to them once they have been \u201clabeled.\u201d\r\n\r\nApplying this logic, cultural stereotypes might hinder the utilization of mental health services due to fear of discrimination and devaluation. In this vein, a\u00a0fear of disclosure can be viewed as the core reason why users of mental health services keep their psychiatric status secret. The preference for nondisclosure; the anticipation of social judgement, rejection, and discrimination; and the anticipation of disrespect from professionals are but a few of the many reasons why individuals refrain from seeking help, even if they do not personally adhere to such stigma beliefs.\u00a0<span style=\"font-size: 1rem; text-align: initial;\">Stigma thus constitutes a major barrier to the utilization of mental health services<\/span><span style=\"font-size: 1rem; text-align: initial;\">.\u00a0[footnote]Bracke P, Delaruelle K and Verhaeghe M (2019) Dominant Cultural and Personal Stigma Beliefs and the Utilization of Mental Health Services: A Cross-National Comparison.\u00a0<i>Front. Sociol<\/i>. 4:40. doi: 10.3389\/fsoc.2019.00040.[\/footnote]<\/span>\r\n<h2>Stigma of Mental Illness<\/h2>\r\nThe word <strong>stigma<\/strong> referred originally to a mark or brand on Greek slaves, clearly separating them from free men. It\u00a0<span style=\"font-size: 1em;\">is a label that causes us to regard certain people as different, defective, and set apart from mainstream members of society.<\/span>\r\n\r\nIn his 1963 book,[footnote]Goffman E. Stigma: Notes on the Management of Spoiled Identity. Harmondsworth: Penguin, 1963[\/footnote], Goffman defines stigma as \"a trait which is deeply discrediting.\" He clearly says that stigmatization is an interactive social process, but some interpret his work as indicating that the blame lies with the person carrying the stigma. More recent authors have used the term stigma in a wider sense\u2014for example, to refer to the reaction of other people, or even to include the attitude and behavior of both the victim and the perpetrator.\r\n\r\nIt is important for researchers to define which concept of stigma they are working with. For some, stigma takes on the two forms as described below:\r\n<ul>\r\n \t<li><strong><span style=\"font-size: 1em;\">Enacted stigma<\/span><\/strong><span style=\"font-size: 1em;\">\u2014<\/span><span style=\"font-size: 1em;\">(external stigma, discrimination) refers to the experience of unfair treatment by others.<\/span><\/li>\r\n \t<li><strong><span style=\"font-size: 1em;\">Felt stigma<\/span><\/strong><span style=\"font-size: 1em; text-align: initial;\">\u00a0\u2014<\/span><span style=\"font-size: 1em; text-align: initial;\">(internal stigma or self-stigmatization) refers to the shame and expectation of discrimination that prevents people from talking about their experiences and stops them from seeking help.<\/span><\/li>\r\n<\/ul>\r\nFelt stigma can be as damaging as enacted stigma since it leads to withdrawal and restriction of social support.\u00a0Many psychiatric disorders can be hidden once the person has recovered. This allows people to pass as normal so long as no one finds out. In his classic treatise,\u00a0Goffman (1963)[footnote]Chaudoir, S. R., Earnshaw, V. A., &amp; Andel, S. (2013). \"Discredited\" Versus \"Discreditable\": Understanding How Shared and Unique Stigma Mechanisms Affect Psychological and Physical Health Disparities. Basic and applied social psychology, 35(1), 75\u201387. https:\/\/doi.org\/10.1080\/01973533.2012.746612[\/footnote]\u00a0delineates between people who are\u00a0<em>discredited<\/em>\u2014whose stigma is clearly known or visible\u2014and people who are\u00a0<em>discreditable<\/em>\u2014whose stigma is unknown and can be concealable. Goffman\u00a0describes people with a <strong>discreditable condition<\/strong>\u2014e.g., bipolar disorder in remission\u2014as having to decide how much to tell and to whom. By careful information management, they can minimize social rejection and enacted stigma. Individuals who live with a <strong>discrediting condition<\/strong>\u2014such as schizophrenia with tardive dyskinesia\u2014will have difficulties with information management and are at higher risk of experiencing enacted stigma.\u00a0[footnote]Scambler G. Stigma and disease: changing paradigms. Lancet 1998;352: 1054-5 [PubMed][\/footnote][footnote]Gray A. J. (2002). Stigma in psychiatry. Journal of the Royal Society of Medicine, 95(2), 72\u201376. https:\/\/doi.org\/10.1258\/jrsm.95.2.72[\/footnote]\r\n<div class=\"textbox shaded\">\r\n<p id=\"P2\"><em>Does the stigmatized individual assume his differentness is known about already or is evident on the spot, or does he assume it is neither known about by those present nor immediately perceivable by them? In the first case one deals with the plight of the\u00a0discredited, in the second with that of the\u00a0discreditable. This is an important difference.<\/em><\/p>\r\n\r\n<div class=\"half_rhythm align_right attrib\" style=\"text-align: right;\">\u2014\u00a0<a class=\" bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3666955\/#R31\" target=\"_blank\" rel=\"noopener\">Goffman (1963<\/a>, p. 4)[footnote]Chaudoir, S. R., Earnshaw, V. A., &amp; Andel, S. (2013). \"Discredited\" Versus \"Discreditable\": Understanding How Shared and Unique Stigma Mechanisms Affect Psychological and Physical Health Disparities. Basic and applied social psychology, 35(1), 75\u201387. https:\/\/doi.org\/10.1080\/01973533.2012.746612[\/footnote]<\/div>\r\n<\/div>\r\n<div class=\"textbox examples\">\r\n<h3>Watch It<\/h3>\r\nThis short clip highlights the importance of removing the stigma surrounding mental health conditions.\r\n\r\n<iframe src=\"\/\/plugin.3playmedia.com\/show?mf=1793545&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=Gzk7sSOHGSQ&amp;video_target=tpm-plugin-haphf8e7-Gzk7sSOHGSQ\" width=\"800px\" height=\"450px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe>\r\n\r\nYou can <a href=\"https:\/\/oerfiles.s3-us-west-2.amazonaws.com\/Psychology\/Transcriptions\/StigmaFreeMayimBialik.txt\" target=\"_blank\" rel=\"noopener\">view the transcript for \"#StigmaFree: Mayim Bialik\" here (opens in new window)<\/a>.\r\n\r\n<\/div>\r\n<h2>#Stigma Free<\/h2>\r\nWords can hurt. Many derogatory words and phrases are used in relation to mental illness. However, these words maintain the stereotyped image and not the reality about mental illness.\u00a0<span style=\"font-size: 1em;\">\u201cMentally ill people are nuts, crazy, wacko.\u201d<\/span><span style=\"font-size: 1em;\">\u00a0<\/span><span style=\"font-size: 1em;\">\u00a0<\/span><span style=\"font-size: 1em;\">How often have we heard comments like these or seen these types of portrayals in movies, television shows, or books? We may even be guilty of making comments like them ourselves. Is there any truth behind these portrayals, or is that negative view based on our ignorance and fear?\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\">Try not to use these words, and encourage others not to use them. It is more appropriate to refer to \u201ca person who has a mental illness\u201d when speaking about someone.\u00a0Each of those preconceptions about people who have a mental illness is based on false information. Very few people who have a mental illness are dangerous to society. Most can hold jobs, attend school, and live independently. A person who has a mental illness cannot simply decide to get over it any more than someone who has a different\u00a0chronic\u00a0disease such as diabetes, asthma, or heart disease can. A mental illness, like those other diseases, is caused by a physical problem in the body.<\/span>\r\n\r\nIn fact, not all brain diseases are categorized as mental illnesses. Disorders such as epilepsy, Parkinson's disease, and multiple sclerosis are brain disorders, but they are considered neurological diseases rather than mental illnesses. Interestingly, the lines between mental illnesses and these other brain or neurological disorders is somewhat blurring. As scientists continue to investigate the brains of people who have mental illnesses, they are learning that mental illness is associated with changes in the brain's structure, chemistry, and function, and that mental illness does indeed have a biological basis.[footnote]National Institutes of Health (US); Biological Sciences Curriculum Study. NIH Curriculum Supplement Series [Internet]. Bethesda (MD): National Institutes of Health (US); 2007. Information about Mental Illness and the Brain. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK20369\/[\/footnote]\r\n<h2>Stigma and Illness<\/h2>\r\nStigma has been defined as an attribute that is deeply discrediting. This stigmatized trait sets the bearer apart from the rest of society, bringing with it feelings of shame and isolation. Often, when a person with a stigmatized trait is unable to perform an action because of the condition, other people view the person as the problem rather than viewing the condition as the problem. More recent definitions of stigma focus on the results of stigma\u2014the prejudice, avoidance, rejection, and discrimination directed at people believed to have an illness, disorder, or other trait perceived to be undesirable. Stigma causes needless suffering, potentially causing a person to deny symptoms, delay treatment and refrain from daily activities. As mentioned earlier, Stigma can exclude people from access to housing, employment, insurance, and appropriate medical care. Thus, stigma can interfere with prevention efforts, and examining and combating stigma is a public health priority.\r\n\r\nThe Substance Abuse and Mental Health Services Administration (SAMHSA) and the CDC have examined public attitudes toward mental illness in two surveys. In the 2006 HealthStyles survey, only one-quarter of young adults between the ages of 18 and 24 believed that a person with mental illness can eventually recover (HealthStyles survey). In 2007, adults in 37 states and territories were surveyed about their attitudes toward mental illness, using the 2007 Behavioral Risk Factor Surveillance System Mental Illness and Stigma module. This study found that\r\n<ul>\r\n \t<li>78% of adults with mental health symptoms and 89% of adults without such symptoms agreed that treatment can help persons with mental illness lead normal lives.<\/li>\r\n \t<li>57% of adults without mental health symptoms believed that people are caring and sympathetic to persons with mental illness.<\/li>\r\n \t<li>Only 25% of adults with mental health symptoms believed that people are caring and sympathetic to persons with mental illness.<\/li>\r\n<\/ul>\r\nThese findings highlight both the need to educate the public about how to support persons with mental illness and the need to reduce barriers for those seeking or receiving treatment for mental illness.\r\n<h2>Challenging Stereotypes about Mental Illness<\/h2>\r\n<p style=\"text-align: justify;\">Recovery from mental illness is a complex process. As with all serious illness, the well-being of recovering individuals is affected by the attitudes that surround them. Despite increasing sensitivity about most disabilities, mental illness all too often remains a target for ridicule and misrepresentation in advertising, entertainment, and the mainstream media.<\/p>\r\n<p style=\"text-align: justify;\">Most of what we know as individuals comes not from personal experience, but from the stories that surround us from birth. In the past, it was families, religious institutions, schools, and respected members of the community who instilled cultural attitudes. But \u201cToday, this is done by the mass media,\u201d says George Gerbner, founder of the Cultural Environment Movement, and a researcher whose career includes 30 years of monitoring the cultural impact of television on society. Television is, in Gerbner\u2019s words, \u201cthe wholesale distributor of the stigma of mental illness.\u201d Gerbner's research has shown that characters portrayed on television as having mental illnesses have four times the violence rate and six times the victimization rate of other characters. Gerbner notes that \u201cViolence and retribution are shown as inherent in the illness itself and thus inescapable. No other group in the dramatic world of television suffers and is shown to deserve such a dire fate.\u201d<\/p>\r\nThe portrayal of mental illness in the movies is similarly distorted. In the late 1980s, Steven E. Hyler of Columbia University and his colleagues identified six categories of psychiatric characters in films: homicidal maniac, narcissistic parasite, seductress, enlightened member of society, rebellious free spirit, and zoo specimen. Hyler concluded that these predominantly negative stereotypes had a damaging effect on the viewing public and on the patients themselves, their family members, and policy makers. More recently, Otto F. Wahl of George Mason University, an authority on public images of mental illness, found that in the decade from 1985 to 1995, Hollywood released more than 150 films with characters who have mental illnesses, the majority of them killers and villains. There can be no doubt that Hollywood stereotypes are a large part of what people know, or think they know, about people with psychiatric vulnerabilities. Newspaper reports about mental illness are often more accurate than the characters one sees in TV entertainment and movies. Still, people with psychiatric histories generally are reported negatively. In 1991, researchers Russell E. Shain and Julie Phillips found that 86% of all print stories dealing with former mental patients focused on violent crime. Media stereotypes of persons with mental illness as villains, failures, buffoons\u2014together with the misuse of terms like \u201cschizophrenia\u201d and \u201cpsychotic\u201d in negative contexts\u2014have far-reaching consequences. On the most deeply personal level, biased stereotypes damage the sense of self-worth of millions of persons diagnosed with serious psychiatric illnesses. On the social and economic levels, negative stereotyping may result in large-scale discrimination against an entire class of people in the areas of housing, employment, health insurance, and medical treatment.\r\n\r\nIncreasingly, the media are doing better work; at times, their efforts are excellent. Diana Ross\u2019s moving and realistic portrayal of schizophrenia in <em>Out of Darkness<\/em>, an ABC television drama, was praised by mental health activists. \u201cGood\u201d characters with mental illness are appearing from time to time in prime-time television entertainment. Feature stories about the achievements of individuals diagnosed with mental illness\u2014such as\u00a0 a New York Times business section feature about John Forbes Nash, Jr., the winner of a Nobel Prize for economics\u2014also help shatter stereotypes. In 1959, Nash began showing clear signs of mental illness, and spent several years at psychiatric hospitals being treated for\u00a0paranoid schizophrenia. After 1970, his condition slowly improved, allowing him to return to academic work by the mid-1980s.\u00a0His struggles with his illness and his recovery became the basis for\u00a0Sylvia Nasar's biography,\u00a0<em>A Beautiful Mind<\/em>, as well as a\u00a0film of the same name\u00a0starring\u00a0Russell Crowe\u00a0as Nash.\u00a0 And increasingly, people with first-hand experience of mental illness are writing books, appearing on television news and talk shows, producing documentaries and radio programs, and contributing articles to the print media. The disparity between mental illness as it is perceived by much of the public and mental illness as it is lived and experienced is a gulf to be bridged.\r\n<div class=\"textbox exercises\">\r\n<h3>Link to learning<\/h3>\r\nThere are countless examples of mental disorders in movies and TV shows, but only sometimes do they get it right.<a href=\"https:\/\/www.youtube.com\/watch?time_continue=1&amp;v=s5Hjk0Nda5s&amp;feature=emb_logo\" target=\"_blank\" rel=\"noopener\"> This video clip from Mojo highlights some of the more accurate portrayals of mental disorders in media<\/a>.\r\n\r\n<\/div>\r\n<div class=\"textbox key-takeaways\">\r\n<h3>LEARNING ACTIVITY:\u00a0REDUCE STIGMA ABOUT MENTAL ILLNESS<\/h3>\r\nYou can promote fair, accurate, and balanced portrayals of mental illness in the media. Your voice does make a difference. Whether you handwrite it, type it, or email it, it\u2019s your passion and knowledge that persuade, that get your letters read (and published), and that change hearts and minds.\r\n\r\nUse the\u00a0<a href=\"https:\/\/ia803103.us.archive.org\/35\/items\/challengingstereotypes\/challenging%20stereotypes.pdf\" target=\"_blank\" rel=\"nofollow noopener\">Challenging Stereotypes: An Action Guide<\/a>\u00a0to help decrease the barriers of prejudice toward people who have mental illnesses by calling attention to media portrayals of mental illness that are stigmatizing, stereotyping, and\/or inaccurate.\r\n\r\n<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try IT<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/d4cc5a69-c51d-43be-90df-a37e48b2af48\r\n\r\n<\/div>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Glossary<\/h3>\r\n<strong>discreditable condition:<\/strong>\u00a0a condition that is unknown and can be concealable\r\n\r\n<strong>discrediting condition: <\/strong>a condition\u00a0that is clearly known or visible\r\n<p style=\"text-align: justify;\"><strong style=\"font-size: 1rem; text-align: initial;\">enacted stigma:\u00a0<\/strong><span style=\"font-size: 1em;\">refers to the experience of unfair treatment by others<\/span><\/p>\r\n<p style=\"text-align: justify;\"><strong>felt stigma:\u00a0<\/strong><span style=\"font-size: 1em;\">refers to the shame and expectation of discrimination that prevents people from talking about their experiences and stops them seeking help<\/span><\/p>\r\n<b>public stigma:\u00a0<\/b>refers to a set of negative attitudes and beliefs that motivate individuals to fear, reject, avoid, and discriminate against people with mental illness\r\n\r\n<strong>self-stigma:<\/strong>\u00a0occurs when individuals internalize stigmatizing social attitudes and come to believe the negative societal conceptions and stereotypes associated with their condition\r\n<p id=\"firstHeading\" class=\"firstHeading\" lang=\"en\" style=\"text-align: justify;\"><strong>stereotype:\u00a0<\/strong>an expectation that people might have about every person of a particular group<\/p>\r\n<p lang=\"en\" style=\"text-align: justify;\"><b>stigma:\u00a0<\/b><span style=\"font-size: 1em;\">a label that causes us to regard certain people as different, defective, and set apart from mainstream members of society<\/span><\/p>\r\n<p lang=\"en\"><strong>stigma expectations:\u00a0<\/strong>the extent to which individuals believe that \"most people\" (the community at large) will devalue and discriminate against someone with a mental disorder<\/p>\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li>Describe types of stigma associated with mental disorders and ways to challenge these stereotypes<\/li>\n<\/ul>\n<\/div>\n<div style=\"width: 426px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/cdn.pixabay.com\/photo\/2015\/11\/07\/09\/11\/board-1030589_960_720.jpg\" alt=\"Image result for stigma against psychological disorders\" width=\"416\" height=\"277\" \/><\/p>\n<p class=\"wp-caption-text\"><strong>Figure 1<\/strong>. Though awareness of mental health issues continues to increase, there is still a stigma associated with many mental disorders that should be addressed, both at an individual and societal level.<\/p>\n<\/div>\n<p>Public-opinion studies have confirmed the widespread existence of negative stereotypes about individuals with mental health problems: they are considered dangerous, unpredictable, and difficult to talk to. These negative stereotypes can have detrimental consequences on the users of mental health services through processes of <strong>public stigma<\/strong>, <strong>self-stigma<\/strong>, and <strong>stigma expectations<\/strong> with regard to such outcomes as self-efficacy, depressive symptoms, self-esteem, life satisfaction, client satisfaction, work, income, and social relationships, in addition to treatment continuation and medication adherence. A <strong>stereotype,<\/strong> in general, refers to\u00a0an expectation that people might have about every person of a particular group. A stereotype is distinct from stigma.\u00a0<b>Public stigma<\/b>\u00a0refers to a set of negative attitudes and beliefs that motivate individuals to fear, reject, avoid, and discriminate against people with mental illness (Corrigan and Penn 1999).<a class=\"footnote\" title=\"Parcesepe, A. M., &amp; Cabassa, L. J. (2013). Public stigma of mental illness in the United States: a systematic literature review. Administration and policy in mental health, 40(5), 384\u2013399. https:\/\/doi.org\/10.1007\/s10488-012-0430-z\" id=\"return-footnote-1277-1\" href=\"#footnote-1277-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a> <strong>Self-stigma<\/strong> is thought to be particularly damaging, and is said to occur when individuals internalize stigmatizing social attitudes and come to believe the negative societal conceptions and stereotypes associated with their condition (Corrigan and Watson, 2002;\u00a0Watson et al., 2007;\u00a0Corrigan and Rao, 2012). Whether stigma is only anticipated or directly experienced, self-stigmatizing beliefs can lead to withdrawal from social support, rejection of help, avoidance of treatment, treatment withdrawal, and limited prospects for recovery (Link and Cullen, 1990;\u00a0Link, 2001;\u00a0Corrigan, 2004;\u00a0Vogel et al., 2007).<a class=\"footnote\" title=\"Bracke P, Delaruelle K and Verhaeghe M (2019) Dominant Cultural and Personal Stigma Beliefs and the Utilization of Mental Health Services: A Cross-National Comparison. Front. Sociol. 4:40. doi: 10.3389\/fsoc.2019.00040\" id=\"return-footnote-1277-2\" href=\"#footnote-1277-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><\/p>\n<p>With regard to culture and mental health stigma, <strong>stigma expectations<\/strong>\u2014\u201cthe extent to which individuals believe that \u2018most people&#8217; (the community at large) will devalue and discriminate against a mental patient\u201d\u2014do not differ between individuals with and without mental health problems or history of treatment. They interpret this as an indication that such expectations constitute a component of culture. In addition, stigma expectations lead individuals with mental health problems to use adaptive strategies (e.g., secrecy or withdrawal). They thus do not necessarily believe in these negative stereotypes; they only know (and fear) that the stereotypes will be applied to them once they have been \u201clabeled.\u201d<\/p>\n<p>Applying this logic, cultural stereotypes might hinder the utilization of mental health services due to fear of discrimination and devaluation. In this vein, a\u00a0fear of disclosure can be viewed as the core reason why users of mental health services keep their psychiatric status secret. The preference for nondisclosure; the anticipation of social judgement, rejection, and discrimination; and the anticipation of disrespect from professionals are but a few of the many reasons why individuals refrain from seeking help, even if they do not personally adhere to such stigma beliefs.\u00a0<span style=\"font-size: 1rem; text-align: initial;\">Stigma thus constitutes a major barrier to the utilization of mental health services<\/span><span style=\"font-size: 1rem; text-align: initial;\">.\u00a0<a class=\"footnote\" title=\"Bracke P, Delaruelle K and Verhaeghe M (2019) Dominant Cultural and Personal Stigma Beliefs and the Utilization of Mental Health Services: A Cross-National Comparison.\u00a0Front. Sociol. 4:40. doi: 10.3389\/fsoc.2019.00040.\" id=\"return-footnote-1277-3\" href=\"#footnote-1277-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><\/span><\/p>\n<h2>Stigma of Mental Illness<\/h2>\n<p>The word <strong>stigma<\/strong> referred originally to a mark or brand on Greek slaves, clearly separating them from free men. It\u00a0<span style=\"font-size: 1em;\">is a label that causes us to regard certain people as different, defective, and set apart from mainstream members of society.<\/span><\/p>\n<p>In his 1963 book,<a class=\"footnote\" title=\"Goffman E. Stigma: Notes on the Management of Spoiled Identity. Harmondsworth: Penguin, 1963\" id=\"return-footnote-1277-4\" href=\"#footnote-1277-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a>, Goffman defines stigma as &#8220;a trait which is deeply discrediting.&#8221; He clearly says that stigmatization is an interactive social process, but some interpret his work as indicating that the blame lies with the person carrying the stigma. More recent authors have used the term stigma in a wider sense\u2014for example, to refer to the reaction of other people, or even to include the attitude and behavior of both the victim and the perpetrator.<\/p>\n<p>It is important for researchers to define which concept of stigma they are working with. For some, stigma takes on the two forms as described below:<\/p>\n<ul>\n<li><strong><span style=\"font-size: 1em;\">Enacted stigma<\/span><\/strong><span style=\"font-size: 1em;\">\u2014<\/span><span style=\"font-size: 1em;\">(external stigma, discrimination) refers to the experience of unfair treatment by others.<\/span><\/li>\n<li><strong><span style=\"font-size: 1em;\">Felt stigma<\/span><\/strong><span style=\"font-size: 1em; text-align: initial;\">\u00a0\u2014<\/span><span style=\"font-size: 1em; text-align: initial;\">(internal stigma or self-stigmatization) refers to the shame and expectation of discrimination that prevents people from talking about their experiences and stops them from seeking help.<\/span><\/li>\n<\/ul>\n<p>Felt stigma can be as damaging as enacted stigma since it leads to withdrawal and restriction of social support.\u00a0Many psychiatric disorders can be hidden once the person has recovered. This allows people to pass as normal so long as no one finds out. In his classic treatise,\u00a0Goffman (1963)<a class=\"footnote\" title=\"Chaudoir, S. R., Earnshaw, V. A., &amp; Andel, S. (2013). &quot;Discredited&quot; Versus &quot;Discreditable&quot;: Understanding How Shared and Unique Stigma Mechanisms Affect Psychological and Physical Health Disparities. Basic and applied social psychology, 35(1), 75\u201387. https:\/\/doi.org\/10.1080\/01973533.2012.746612\" id=\"return-footnote-1277-5\" href=\"#footnote-1277-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a>\u00a0delineates between people who are\u00a0<em>discredited<\/em>\u2014whose stigma is clearly known or visible\u2014and people who are\u00a0<em>discreditable<\/em>\u2014whose stigma is unknown and can be concealable. Goffman\u00a0describes people with a <strong>discreditable condition<\/strong>\u2014e.g., bipolar disorder in remission\u2014as having to decide how much to tell and to whom. By careful information management, they can minimize social rejection and enacted stigma. Individuals who live with a <strong>discrediting condition<\/strong>\u2014such as schizophrenia with tardive dyskinesia\u2014will have difficulties with information management and are at higher risk of experiencing enacted stigma.\u00a0<a class=\"footnote\" title=\"Scambler G. Stigma and disease: changing paradigms. Lancet 1998;352: 1054-5 [PubMed]\" id=\"return-footnote-1277-6\" href=\"#footnote-1277-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a><a class=\"footnote\" title=\"Gray A. J. (2002). Stigma in psychiatry. Journal of the Royal Society of Medicine, 95(2), 72\u201376. https:\/\/doi.org\/10.1258\/jrsm.95.2.72\" id=\"return-footnote-1277-7\" href=\"#footnote-1277-7\" aria-label=\"Footnote 7\"><sup class=\"footnote\">[7]<\/sup><\/a><\/p>\n<div class=\"textbox shaded\">\n<p id=\"P2\"><em>Does the stigmatized individual assume his differentness is known about already or is evident on the spot, or does he assume it is neither known about by those present nor immediately perceivable by them? In the first case one deals with the plight of the\u00a0discredited, in the second with that of the\u00a0discreditable. This is an important difference.<\/em><\/p>\n<div class=\"half_rhythm align_right attrib\" style=\"text-align: right;\">\u2014\u00a0<a class=\"bibr popnode\" role=\"button\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3666955\/#R31\" target=\"_blank\" rel=\"noopener\">Goffman (1963<\/a>, p. 4)<a class=\"footnote\" title=\"Chaudoir, S. R., Earnshaw, V. A., &amp; Andel, S. (2013). &quot;Discredited&quot; Versus &quot;Discreditable&quot;: Understanding How Shared and Unique Stigma Mechanisms Affect Psychological and Physical Health Disparities. Basic and applied social psychology, 35(1), 75\u201387. https:\/\/doi.org\/10.1080\/01973533.2012.746612\" id=\"return-footnote-1277-8\" href=\"#footnote-1277-8\" aria-label=\"Footnote 8\"><sup class=\"footnote\">[8]<\/sup><\/a><\/div>\n<\/div>\n<div class=\"textbox examples\">\n<h3>Watch It<\/h3>\n<p>This short clip highlights the importance of removing the stigma surrounding mental health conditions.<\/p>\n<p><iframe loading=\"lazy\" src=\"\/\/plugin.3playmedia.com\/show?mf=1793545&amp;p3sdk_version=1.10.1&amp;p=20361&amp;pt=375&amp;video_id=Gzk7sSOHGSQ&amp;video_target=tpm-plugin-haphf8e7-Gzk7sSOHGSQ\" width=\"800px\" height=\"450px\" frameborder=\"0\" marginwidth=\"0px\" marginheight=\"0px\"><\/iframe><\/p>\n<p>You can <a href=\"https:\/\/oerfiles.s3-us-west-2.amazonaws.com\/Psychology\/Transcriptions\/StigmaFreeMayimBialik.txt\" target=\"_blank\" rel=\"noopener\">view the transcript for &#8220;#StigmaFree: Mayim Bialik&#8221; here (opens in new window)<\/a>.<\/p>\n<\/div>\n<h2>#Stigma Free<\/h2>\n<p>Words can hurt. Many derogatory words and phrases are used in relation to mental illness. However, these words maintain the stereotyped image and not the reality about mental illness.\u00a0<span style=\"font-size: 1em;\">\u201cMentally ill people are nuts, crazy, wacko.\u201d<\/span><span style=\"font-size: 1em;\">\u00a0<\/span><span style=\"font-size: 1em;\">\u00a0<\/span><span style=\"font-size: 1em;\">How often have we heard comments like these or seen these types of portrayals in movies, television shows, or books? We may even be guilty of making comments like them ourselves. Is there any truth behind these portrayals, or is that negative view based on our ignorance and fear?\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\">Try not to use these words, and encourage others not to use them. It is more appropriate to refer to \u201ca person who has a mental illness\u201d when speaking about someone.\u00a0Each of those preconceptions about people who have a mental illness is based on false information. Very few people who have a mental illness are dangerous to society. Most can hold jobs, attend school, and live independently. A person who has a mental illness cannot simply decide to get over it any more than someone who has a different\u00a0chronic\u00a0disease such as diabetes, asthma, or heart disease can. A mental illness, like those other diseases, is caused by a physical problem in the body.<\/span><\/p>\n<p>In fact, not all brain diseases are categorized as mental illnesses. Disorders such as epilepsy, Parkinson&#8217;s disease, and multiple sclerosis are brain disorders, but they are considered neurological diseases rather than mental illnesses. Interestingly, the lines between mental illnesses and these other brain or neurological disorders is somewhat blurring. As scientists continue to investigate the brains of people who have mental illnesses, they are learning that mental illness is associated with changes in the brain&#8217;s structure, chemistry, and function, and that mental illness does indeed have a biological basis.<a class=\"footnote\" title=\"National Institutes of Health (US); Biological Sciences Curriculum Study. NIH Curriculum Supplement Series [Internet]. Bethesda (MD): National Institutes of Health (US); 2007. Information about Mental Illness and the Brain. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK20369\/\" id=\"return-footnote-1277-9\" href=\"#footnote-1277-9\" aria-label=\"Footnote 9\"><sup class=\"footnote\">[9]<\/sup><\/a><\/p>\n<h2>Stigma and Illness<\/h2>\n<p>Stigma has been defined as an attribute that is deeply discrediting. This stigmatized trait sets the bearer apart from the rest of society, bringing with it feelings of shame and isolation. Often, when a person with a stigmatized trait is unable to perform an action because of the condition, other people view the person as the problem rather than viewing the condition as the problem. More recent definitions of stigma focus on the results of stigma\u2014the prejudice, avoidance, rejection, and discrimination directed at people believed to have an illness, disorder, or other trait perceived to be undesirable. Stigma causes needless suffering, potentially causing a person to deny symptoms, delay treatment and refrain from daily activities. As mentioned earlier, Stigma can exclude people from access to housing, employment, insurance, and appropriate medical care. Thus, stigma can interfere with prevention efforts, and examining and combating stigma is a public health priority.<\/p>\n<p>The Substance Abuse and Mental Health Services Administration (SAMHSA) and the CDC have examined public attitudes toward mental illness in two surveys. In the 2006 HealthStyles survey, only one-quarter of young adults between the ages of 18 and 24 believed that a person with mental illness can eventually recover (HealthStyles survey). In 2007, adults in 37 states and territories were surveyed about their attitudes toward mental illness, using the 2007 Behavioral Risk Factor Surveillance System Mental Illness and Stigma module. This study found that<\/p>\n<ul>\n<li>78% of adults with mental health symptoms and 89% of adults without such symptoms agreed that treatment can help persons with mental illness lead normal lives.<\/li>\n<li>57% of adults without mental health symptoms believed that people are caring and sympathetic to persons with mental illness.<\/li>\n<li>Only 25% of adults with mental health symptoms believed that people are caring and sympathetic to persons with mental illness.<\/li>\n<\/ul>\n<p>These findings highlight both the need to educate the public about how to support persons with mental illness and the need to reduce barriers for those seeking or receiving treatment for mental illness.<\/p>\n<h2>Challenging Stereotypes about Mental Illness<\/h2>\n<p style=\"text-align: justify;\">Recovery from mental illness is a complex process. As with all serious illness, the well-being of recovering individuals is affected by the attitudes that surround them. Despite increasing sensitivity about most disabilities, mental illness all too often remains a target for ridicule and misrepresentation in advertising, entertainment, and the mainstream media.<\/p>\n<p style=\"text-align: justify;\">Most of what we know as individuals comes not from personal experience, but from the stories that surround us from birth. In the past, it was families, religious institutions, schools, and respected members of the community who instilled cultural attitudes. But \u201cToday, this is done by the mass media,\u201d says George Gerbner, founder of the Cultural Environment Movement, and a researcher whose career includes 30 years of monitoring the cultural impact of television on society. Television is, in Gerbner\u2019s words, \u201cthe wholesale distributor of the stigma of mental illness.\u201d Gerbner&#8217;s research has shown that characters portrayed on television as having mental illnesses have four times the violence rate and six times the victimization rate of other characters. Gerbner notes that \u201cViolence and retribution are shown as inherent in the illness itself and thus inescapable. No other group in the dramatic world of television suffers and is shown to deserve such a dire fate.\u201d<\/p>\n<p>The portrayal of mental illness in the movies is similarly distorted. In the late 1980s, Steven E. Hyler of Columbia University and his colleagues identified six categories of psychiatric characters in films: homicidal maniac, narcissistic parasite, seductress, enlightened member of society, rebellious free spirit, and zoo specimen. Hyler concluded that these predominantly negative stereotypes had a damaging effect on the viewing public and on the patients themselves, their family members, and policy makers. More recently, Otto F. Wahl of George Mason University, an authority on public images of mental illness, found that in the decade from 1985 to 1995, Hollywood released more than 150 films with characters who have mental illnesses, the majority of them killers and villains. There can be no doubt that Hollywood stereotypes are a large part of what people know, or think they know, about people with psychiatric vulnerabilities. Newspaper reports about mental illness are often more accurate than the characters one sees in TV entertainment and movies. Still, people with psychiatric histories generally are reported negatively. In 1991, researchers Russell E. Shain and Julie Phillips found that 86% of all print stories dealing with former mental patients focused on violent crime. Media stereotypes of persons with mental illness as villains, failures, buffoons\u2014together with the misuse of terms like \u201cschizophrenia\u201d and \u201cpsychotic\u201d in negative contexts\u2014have far-reaching consequences. On the most deeply personal level, biased stereotypes damage the sense of self-worth of millions of persons diagnosed with serious psychiatric illnesses. On the social and economic levels, negative stereotyping may result in large-scale discrimination against an entire class of people in the areas of housing, employment, health insurance, and medical treatment.<\/p>\n<p>Increasingly, the media are doing better work; at times, their efforts are excellent. Diana Ross\u2019s moving and realistic portrayal of schizophrenia in <em>Out of Darkness<\/em>, an ABC television drama, was praised by mental health activists. \u201cGood\u201d characters with mental illness are appearing from time to time in prime-time television entertainment. Feature stories about the achievements of individuals diagnosed with mental illness\u2014such as\u00a0 a New York Times business section feature about John Forbes Nash, Jr., the winner of a Nobel Prize for economics\u2014also help shatter stereotypes. In 1959, Nash began showing clear signs of mental illness, and spent several years at psychiatric hospitals being treated for\u00a0paranoid schizophrenia. After 1970, his condition slowly improved, allowing him to return to academic work by the mid-1980s.\u00a0His struggles with his illness and his recovery became the basis for\u00a0Sylvia Nasar&#8217;s biography,\u00a0<em>A Beautiful Mind<\/em>, as well as a\u00a0film of the same name\u00a0starring\u00a0Russell Crowe\u00a0as Nash.\u00a0 And increasingly, people with first-hand experience of mental illness are writing books, appearing on television news and talk shows, producing documentaries and radio programs, and contributing articles to the print media. The disparity between mental illness as it is perceived by much of the public and mental illness as it is lived and experienced is a gulf to be bridged.<\/p>\n<div class=\"textbox exercises\">\n<h3>Link to learning<\/h3>\n<p>There are countless examples of mental disorders in movies and TV shows, but only sometimes do they get it right.<a href=\"https:\/\/www.youtube.com\/watch?time_continue=1&amp;v=s5Hjk0Nda5s&amp;feature=emb_logo\" target=\"_blank\" rel=\"noopener\"> This video clip from Mojo highlights some of the more accurate portrayals of mental disorders in media<\/a>.<\/p>\n<\/div>\n<div class=\"textbox key-takeaways\">\n<h3>LEARNING ACTIVITY:\u00a0REDUCE STIGMA ABOUT MENTAL ILLNESS<\/h3>\n<p>You can promote fair, accurate, and balanced portrayals of mental illness in the media. Your voice does make a difference. Whether you handwrite it, type it, or email it, it\u2019s your passion and knowledge that persuade, that get your letters read (and published), and that change hearts and minds.<\/p>\n<p>Use the\u00a0<a href=\"https:\/\/ia803103.us.archive.org\/35\/items\/challengingstereotypes\/challenging%20stereotypes.pdf\" target=\"_blank\" rel=\"nofollow noopener\">Challenging Stereotypes: An Action Guide<\/a>\u00a0to help decrease the barriers of prejudice toward people who have mental illnesses by calling attention to media portrayals of mental illness that are stigmatizing, stereotyping, and\/or inaccurate.<\/p>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Try IT<\/h3>\n<p>\t<iframe id=\"assessment_practice_d4cc5a69-c51d-43be-90df-a37e48b2af48\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/d4cc5a69-c51d-43be-90df-a37e48b2af48?iframe_resize_id=assessment_practice_id_d4cc5a69-c51d-43be-90df-a37e48b2af48\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<div class=\"textbox learning-objectives\">\n<h3>Glossary<\/h3>\n<p><strong>discreditable condition:<\/strong>\u00a0a condition that is unknown and can be concealable<\/p>\n<p><strong>discrediting condition: <\/strong>a condition\u00a0that is clearly known or visible<\/p>\n<p style=\"text-align: justify;\"><strong style=\"font-size: 1rem; text-align: initial;\">enacted stigma:\u00a0<\/strong><span style=\"font-size: 1em;\">refers to the experience of unfair treatment by others<\/span><\/p>\n<p style=\"text-align: justify;\"><strong>felt stigma:\u00a0<\/strong><span style=\"font-size: 1em;\">refers to the shame and expectation of discrimination that prevents people from talking about their experiences and stops them seeking help<\/span><\/p>\n<p><b>public stigma:\u00a0<\/b>refers to a set of negative attitudes and beliefs that motivate individuals to fear, reject, avoid, and discriminate against people with mental illness<\/p>\n<p><strong>self-stigma:<\/strong>\u00a0occurs when individuals internalize stigmatizing social attitudes and come to believe the negative societal conceptions and stereotypes associated with their condition<\/p>\n<p id=\"firstHeading\" class=\"firstHeading\" lang=\"en\" style=\"text-align: justify;\"><strong>stereotype:\u00a0<\/strong>an expectation that people might have about every person of a particular group<\/p>\n<p lang=\"en\" style=\"text-align: justify;\"><b>stigma:\u00a0<\/b><span style=\"font-size: 1em;\">a label that causes us to regard certain people as different, defective, and set apart from mainstream members of society<\/span><\/p>\n<p lang=\"en\"><strong>stigma expectations:\u00a0<\/strong>the extent to which individuals believe that &#8220;most people&#8221; (the community at large) will devalue and discriminate against someone with a mental disorder<\/p>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-1277\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Modification, adaptation, and original content. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Contemporary Health Issues. <strong>Authored by<\/strong>: Judy Baker, Ph.D., Dean of Foothill Global Access at Foothill College. <strong>Provided by<\/strong>: Foothill College. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/courses.lumenlearning.com\/diseaseprevention\/chapter\/stigma-of-mental-illness\/\">https:\/\/courses.lumenlearning.com\/diseaseprevention\/chapter\/stigma-of-mental-illness\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>The Social Impact of Psychological Disorders. <strong>Authored by<\/strong>: Sonja Ann Miller. <strong>Provided by<\/strong>: Hudson Valley Community College. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/courses.lumenlearning.com\/hvcc-abnormalpsychology\/chapter\/1-2-the-social-impact-of-psychological-disorders\/\">https:\/\/courses.lumenlearning.com\/hvcc-abnormalpsychology\/chapter\/1-2-the-social-impact-of-psychological-disorders\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Stop the Stigma Image. <strong>Provided by<\/strong>: Pixabay. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/pixabay.com\/illustrations\/board-chalk-psychology-1030589\/\">https:\/\/pixabay.com\/illustrations\/board-chalk-psychology-1030589\/<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Dominant Cultural and Personal Stigma Beliefs and the Utilization of Mental Health Services: A Cross-National Comparison. <strong>Authored by<\/strong>: Bracke P, Delaruelle K and Verhaeghe M. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsoc.2019.00040\/full\">https:\/\/www.frontiersin.org\/articles\/10.3389\/fsoc.2019.00040\/full<\/a>. <strong>Project<\/strong>: Frontiers in Psychology. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Social Stigma. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Social_stigma\">https:\/\/en.wikipedia.org\/wiki\/Social_stigma<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">All rights reserved content<\/div><ul class=\"citation-list\"><li>#StigmaFree: Mayim Bialik. <strong>Authored by<\/strong>: NAMI. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.youtube.com\/watch?v=Gzk7sSOHGSQ\">https:\/\/www.youtube.com\/watch?v=Gzk7sSOHGSQ<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Standard YouTube License<\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">Public domain content<\/div><ul class=\"citation-list\"><li>Information about Mental Illness and the Brain. <strong>Provided by<\/strong>: National Institutes of Health (US). <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK20369\/\">https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK20369\/<\/a>. <strong>Project<\/strong>: Biological Sciences Curriculum Study. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/pdm\">Public Domain: No Known Copyright<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-1277-1\">Parcesepe, A. M., &amp; Cabassa, L. J. (2013). Public stigma of mental illness in the United States: a systematic literature review. Administration and policy in mental health, 40(5), 384\u2013399. https:\/\/doi.org\/10.1007\/s10488-012-0430-z <a href=\"#return-footnote-1277-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-1277-2\">Bracke P, Delaruelle K and Verhaeghe M (2019) Dominant Cultural and Personal Stigma Beliefs and the Utilization of Mental Health Services: A Cross-National Comparison. Front. Sociol. 4:40. doi: 10.3389\/fsoc.2019.00040 <a href=\"#return-footnote-1277-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-1277-3\">Bracke P, Delaruelle K and Verhaeghe M (2019) Dominant Cultural and Personal Stigma Beliefs and the Utilization of Mental Health Services: A Cross-National Comparison.\u00a0<i>Front. Sociol<\/i>. 4:40. doi: 10.3389\/fsoc.2019.00040. <a href=\"#return-footnote-1277-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-1277-4\">Goffman E. Stigma: Notes on the Management of Spoiled Identity. Harmondsworth: Penguin, 1963 <a href=\"#return-footnote-1277-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-1277-5\">Chaudoir, S. R., Earnshaw, V. A., &amp; Andel, S. (2013). \"Discredited\" Versus \"Discreditable\": Understanding How Shared and Unique Stigma Mechanisms Affect Psychological and Physical Health Disparities. Basic and applied social psychology, 35(1), 75\u201387. https:\/\/doi.org\/10.1080\/01973533.2012.746612 <a href=\"#return-footnote-1277-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-1277-6\">Scambler G. Stigma and disease: changing paradigms. Lancet 1998;352: 1054-5 [PubMed] <a href=\"#return-footnote-1277-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><li id=\"footnote-1277-7\">Gray A. J. (2002). Stigma in psychiatry. Journal of the Royal Society of Medicine, 95(2), 72\u201376. https:\/\/doi.org\/10.1258\/jrsm.95.2.72 <a href=\"#return-footnote-1277-7\" class=\"return-footnote\" aria-label=\"Return to footnote 7\">&crarr;<\/a><\/li><li id=\"footnote-1277-8\">Chaudoir, S. R., Earnshaw, V. A., &amp; Andel, S. (2013). \"Discredited\" Versus \"Discreditable\": Understanding How Shared and Unique Stigma Mechanisms Affect Psychological and Physical Health Disparities. Basic and applied social psychology, 35(1), 75\u201387. https:\/\/doi.org\/10.1080\/01973533.2012.746612 <a href=\"#return-footnote-1277-8\" class=\"return-footnote\" aria-label=\"Return to footnote 8\">&crarr;<\/a><\/li><li id=\"footnote-1277-9\">National Institutes of Health (US); Biological Sciences Curriculum Study. NIH Curriculum Supplement Series [Internet]. Bethesda (MD): National Institutes of Health (US); 2007. Information about Mental Illness and the Brain. 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