The Power of Stigma

Published in the Fall 2007 issue of SSA Magazine

The shame of mental illness can derail clients already receiving treatment

By Cindy Barrymore

As part of her research on the quality of services for people with serious and longterm mental illness, SSA associate professor Beth Angell studies the social integration of clients. She says that the lingering stigma of mental illness plays notable, and in some ways surprising, roles in how patients interact with others— which in turn can affect how well they are served by treatment programs.

Researchers have been able to document the impact of stereotypes and negative attitudes, from preference for social distance to outright discrimination, about those who have a mental illness. For example, a cross-cultural study Angell conducted on employer attitudes toward people with psychotic disorders shows that public misperceptions can hinder these clients' employment prospects. A new study she is conducting with Amy Watson, Ph.D., '01, an assistant professor at the Jane Addams College of Social Work, is finding that people with mental illness who've had contact with the criminal justice system face stigma from both statuses, limiting housing and employment opportunities.

Research also shows, though, that people with mental illness hold the same stereotypes about the condition as the general public. Once they've been formally diagnosed, people with mental illness are often less likely to interact socially. "It's threatening to their self-esteem, and they fear that other people can detect [mental illness] in them," Angell says. "Because many withdraw from mainstream social interactions, their social networks can become dominated by either service providers or fellow clients in the program."

While some people with mental illness relish the comfort of the common bond with other patients, others don't want to be reminded of this "powerful signal of their own illness" or to organize their lives exclusively around a disabled identity, Angell says. And for clients, a more complete social network is an important step to learning to live with the illness, and its social capital can provide opportunities from child care options to job referrals to emotional support.

Some service providers incorporate specialized interventions to bring clients delicately into the flow of "mainstream" relationships. For example, a program pilot tested in New Haven paired volunteer peers with people with mental illness and gave them funds to support recreational activities. Other programs, including a flagship project at the VA medical center in Los Angeles, aim to increase social functioning by teaching social skills to clients. "In my view the most important thing that professionals can do, though, is advocate for their clients to live and work in the mainstream community and to access community resources. This means avoiding clustering people with mental illness together in large congregated facilities," Angell says.

Unfortunately, innovating programming is becoming less common. "Mental health programs in an area of restricted funding focus on the most pressing needs first, such as psychiatric stabilization, locating affordable housing, and securing financial benefits," Angell says. "When programs are forced to operate solely in a crisis mode, goals of helping people integrate into the community go by the wayside. I see this happening more now than when I began studying this issue in the mid-1990s."