Stigma associated to mental illness: Types, consequences and strategies to fight it

Journal title RIVISTA SPERIMENTALE DI FRENIATRIA
Author/s Luca Pingani, Giulia Reali, Paola Carozza
Publishing Year 2021 Issue 2021/3 Language Italian
Pages 26 P. 134-158 File size 251 KB
DOI 10.3280/RSF2021-003009
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

This paper aims to investigate the phenomenon of stigma in the context of mental health. After an introduction dedicated to the evolution over time of the term "stigma", its different types are analyzed using recent literature: public stigma, structural stigma, self-stigma, felt or perceived stigma, experienced stigma, label avoidance, courtesy stigma and spiritual stigma. Among the different declinations of the discriminating phenomenon, a broad description is provided of the iatrogenic one: the discrimination perpetrated by health professionals against people with mental illness. A narrative and non-systematic revision of the literature was conducted about this specific type of stigma to allow the reader an exhaustive overview for the classification of this form of stigma. The last part of the paper is dedicated to the main strategies, supported by scientific evidence, used for fighting stigma. In addition to the well-established methods such as education, protest and contact, the Italian translation of the "Coming Out Proud" manual by prof. Corrigan (Illinois Institute of Technology) is proposed as a useful tool for the fight against self-stigma. This manual is proposed to service users and mental health professionals to address the coming out process and the issue of identity. It is divided into three parts that address the key issues of disclosure: weighing the costs and benefits of coming out; consider the different strategic approaches (degrees) for disclosure; learn an effective method for formulating personal stories relating to the experience of mental illness.

Keywords: Stigma, mental health, social psychiatry, mental health services, mental health professionals, Coming Out Proud.

  1. Verhaeghe M, Bracke P. Stigma and Trust Among Mental Health Service Users. Archives of Psychiatric Nursing 2011; 25: 294-302.
  2. Kua EH. Focus on psychiatry in Singapore. British Journal of Psychiatry 2004; 185: 79-82.
  3. Zisook S, Balon R, Bjorksten KS, Everall I, Dunn L, Ganadjian K, et al. Psychiatry Residency Training Around the World. Academic Psychiatry 2007; 31: 309-25.
  4. Yuan Q, Picco L, Chang S, Abdin E, Chua BY, Ong S, et al. Attitudes to mental illness among mental health professionals in Singapore and comparisons with the general population. PLoS ONE 2017; 12: e0187593.
  5. Pianigiani O. Vocabolario etimologico della lingua italiana. Roma (I): Società Editrice Dante Alighieri; 1907.
  6. Patota G. Garzanti: i compatti Italiano. Milano (I): Garzanti; 2010.
  7. Goffman E. Stigma: notes on the management of spoiled identity. New York: Simon & Schuster; 1986.
  8. Goffman E, Basaglia F. Asylums: le istituzioni totali: i meccanismi dell’esclusione e della violenza. Segrate (I): Einaudi; 2010.
  9. 5. Choudhry FR, Mani V, Ming L, Khan TM. Beliefs and perception about mental health issues: a meta-synthesis. Neuropsychiatric Disease and Treatment 2016; 12: 2807-18.
  10. Gulliver A, Griffiths KM, Christensen H. Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review. BMC Psychiatry 2010; 10:113.
  11. Pingani L, Forghieri M, Ferrari S, Ben-Zeev D, Artoni P, Mazzi F, et al. Stigma and discrimination toward mental illness: translation and validation of the Italian version of the attribution questionnaire-27 (AQ-27-I). Social Psychiatry and Psychiatric Epidemiology 2012; 47: 993-9.
  12. Link BG, Phelan JC. Conceptualizing Stigma. Annual Review of Sociology 2001; 27: 363-85.
  13. Pingani L, Sampogna G, Evans-Lacko S, Gozzi B, Giallonardo V, Luciano M, et al. How to Measure Knowledge About Mental Disorders? Validation of the Italian Version of the MAKS. Community Ment Health Journal 2019; 55: 1354-61.
  14. Pingani L, Sampogna G, Borghi G, Nasi A, Coriani S, Luciano M, et al. How the use of the term «schizo*» has changed in an Italian newspaper from 2001 to 2015: Findings from a descriptive analysis. Psychiatry Research 2018; 270: 792-800.
  15. Pingani L, Evans-Lacko S, Luciano M, Del Vecchio V, Ferrari S, Sampogna G, et al. Psychometric validation of the Italian version of the Reported and Intended Behaviour Scale (RIBS). Epidemiology and Psychiatric Sciences 2016; 25: 485-92.
  16. Corrigan PW, Watson AC. Understanding the impact of stigma on people with mental illness. World Psychiatry. 2002; 1: 16-20.
  17. Watson AC, Corrigan P, Larson JE, Sells M. Self-Stigma in People With Mental Illness. Schizophrenia Bulletin 2006; 33: 1312-8.
  18. Van Brakel WH. Measuring health-related stigma-A literature review. Psychology, Health & Medicine 2006; 11: 307-34.
  19. Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, et al. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine 2015; 45: 11-27.
  20. Byrne P. Stigma of mental illness and ways of diminishing it. Advances in Psychiatric Treatment 2000; 6: 65-72.
  21. Wesselmann ED, Graziano WG. Sinful and/or Possessed? Religious Beliefs and Mental Illness Stigma. Journal of Social and Clinical Psychology 2010; 29: 402-37.
  22. Pingani L, Giberti S, Coriani S, Ferrari S, Fierro L, Mattei G, et al. Translation and Validation of an Italian Language Version of the Religious Beliefs and Mental Illness Stigma Scale (I-RBMIS). Journal of Religion and Health 2021; 60: 3530-44.
  23. Loch AA, Guarniero FB, Lawson FL, Hengartner MP, Rössler W, Gattaz WF, et al. Stigma toward schizophrenia: do all psychiatrists behave the same? Latent profile analysis of a national sample of psychiatrists in Brazil. BMC Psychiatry 2013; 13: 92.
  24. Pinna F, Del Vecchio V, Luciano M, Sampogna G, De Rosa C, Ferrari S, et al. Shall psychiatry change its target? Reflections on the evolving role of psychiatry. Rivista di Psichiatria 2015; 50: 3-7.
  25. World Health Organization. Mental health action plan 2013-2020. Plan d’action global pour la santé mentale 2013-2020. Geneva: World Health Organization; 2013.
  26. Corrigan PW. Principles and practice of psychiatric rehabilitation: an empirical approach. Second edition. New York: The Guilford Press; 2016.
  27. Walsh DAB, Foster JLH. A Call to Action. A Critical Review of Mental Health Related Anti-stigma Campaigns. Frontiers in Public Health 2021; 8: 569539.
  28. Mittal D, Sullivan G, Chekuri L, Allee E, Corrigan PW. Empirical Studies of Self-Stigma Reduction Strategies: A Critical Review of the Literature. Psychiatric Services 2012; 63: 974-81.
  29. Yanos PT, Lucksted A, Drapalski AL, Roe D, Lysaker P. Interventions targeting mental health self-stigma: A review and comparison. Psychiatric Rehabilitation Journal 2015; 38: 171-8.
  30. McCay E, Beanlands H, Leszcz M, Goering P, Seeman MV, Ryan K, et al. A Group Intervention to Promote Healthy Self-Concepts and Guide Recovery in First Episode Schizophrenia: A Pilot Study. Psychiatric Rehabilitation Journal 2006; 30: 105-11.
  31. Fung KMT, Tsang HWH, Cheung W. Randomized controlled trial of the selfstigma reduction program among individuals with schizophrenia. Psychiatry Research 2011; 189: 208-14.
  32. Lucksted A, Drapalski A, Calmes C, Forbes C, DeForge B, Boyd J. Ending self-stigma: Pilot evaluation of a new intervention to reduce internalized stigma among people with mental illnesses. Psychiatric Rehabilitation Journal 2011; 35: 51-4.
  33. Yanos PT, Roe D, Lysaker PH. Narrative Enhancement and Cognitive Therapy: A New Group-Based Treatment for Internalized Stigma Among Persons with Severe Mental Illness. International Journal of Group Psychotherapy 2011; 61: 576-95.
  34. Corrigan PW, Kosyluk KA, Rüsch N. Reducing Self-Stigma by Coming Out Proud. American Journal of Public Health 2013; 103: 794-800.
  35. Russinova Z, Rogers ES, Gagne C, Bloch P, Drake KM, Mueser KT.
  36. A Randomized Controlled Trial of a Peer-Run Antistigma Photovoice Intervention. Psychiatric Services 2014; 65: 242-6.
  37. Tsang HWH, Ching SC, Tang KH, Lam HT, Law PYY, Wan CN. Therapeutic intervention for internalized stigma of severe mental illness: A systematic review and meta-analysis. Schizophrenia Research 2016; 173: 45-53.
  38. Büchter RB, Messer M. Interventions for reducing self-stigma in people with mental illnesses: a systematic review of randomized controlled trials. GMS German Medical Science 2017; 15: Doc07.
  39. Carozza P, Reali G. COMING OUT PROUD per eliminare lo stigma della malattia mentale. -- https://www.riabilitazionepsicosociale.it/coming-out-proudper-eliminare-lo-stigma-della-malattia-mentale/.
  40. Buchholz B, Corrigan P. “Coming Out” Might Be Worth It. -- http://www.comingoutproudprogram.org/images/ComingOutMightBeWorthIt.pdf.
  41. Chambers M, Guise V, Välimäki M, Botelho MAR, Scott A, Staniuliené V, et al. Nurses’ attitudes to mental illness: A comparison of a sample of nurses from five European countries. International Journal of Nursing Studies 2010; 47: 350-62. Hengartner MP, Loch AA, Lawson FL, Guarniero FB, Wang Y-P, Rössler W, et al. Atitudes de profissionais de saúde mental em relação a indivíduos com esquizofrenia: uma comparação transcultural entre Suíça e Brasil. Revista de Psiquiatria Clínica 2012; 39: 115-21.
  42. Corrigan PW, Morris SB, Michaels PJ, Rafacz JD, Rüsch N. Challenging the Public Stigma of Mental Illness: A Meta-Analysis of Outcome Studies. Psychiatric Services 2012; 63: 963-73.
  43. Thornicroft G, Mehta N, Clement S, Evans-Lacko S, Doherty M, Rose D, et al. Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet 2016; 387: 1123-32.
  44. Delaney KR. Psychiatric Mental Health Nurses: Stigma Issues We Fail to See. Archives of Psychiatric Nursing 2012; 26: 333-5.
  45. Ebrahimi H, Namdar H, Vahidi M. Mental illness stigma among nurses in psychiatric wards of teaching hospitals in the north-west of Iran. Iranian Journal of Nursing and Midwifery Research 2012; 17: 534-8.
  46. Markham D, Trower P. The effects of the psychiatric label ‘borderline personality disorder’ on nursing staff’s perceptions and causal attributions for challenging behaviours. British Journal of Clinical Psychology 2003; 42: 243-56.
  47. Ellsworth RB. A behavioral study of staff attitudes toward mental illness. Journal of Abnormal Psychology 1965; 70: 194-200.
  48. Forchuk C, Westwell J, Martin M-L, Azzapardi WB, Kosterewa-Tolman D, Hux M. Factors Influencing Movement of Chronic Psychiatric Patients From the Orientation to the Working Phase of the Nurse-Client Relationship on an Inpatient Unit. Perspectives in Psychiatric Care 1998; 34: 36-44.
  49. Forsyth A. The effects of diagnosis and non-compliance attributions on therapeutic alliance processes in adult acute psychiatric settings. Journal of Psychiatric and Mental Health Nursing 2007; 14.
  50. Hansson L, Jormfeldt H, Svedberg P, Svensson B. Mental health professionals’ attitudes towards people with mental illness: Do they differ from attitudes held by people with mental illness? International Journal of Social Psychiatry 2013; 59: 48-54.
  51. Lauber C, Anthony M, Ajdacic-Gross V, Rössler W. What about psychiatrists’attitude to mentally ill people? European psychiatry 2004; 19: 423-7.
  52. Mårtensson G, Jacobsson JW, Engström M. Mental health nursing staff’s attitudes towards mental illness: an analysis of related factors. Journal of Psychiatric and Mental Health Nursing 2014; 21: 782-8.
  53. Nordt C, Rossler W, Lauber C. Attitudes of Mental Health Professionals Toward People With Schizophrenia and Major Depression. Schizophrenia Bulletin 2005; 32: 709-14.
  54. Tay S-EC, Pariyasami S, Ravindran K, Ali MIA, Rowsudeen MT. Nurses’ attitudes toward people with mental illnesses in a psychiatric hospital in Singapore. Journal of Psychosocial Nursing and Mental Health Services 2004; 42: 40-7.

  • Targeted placement for people with disabilities in Italy: a perspective from Lombardian companies Matteo Moscatelli, Nicoletta Pavesi, Chiara Ferrari, in Equality, Diversity and Inclusion: An International Journal /2024 pp.1
    DOI: 10.1108/EDI-07-2023-0228

Luca Pingani, Giulia Reali, Paola Carozza, Lo stigma associato alla malattia mentale: tipologie, conseguenze e strategie per contrastarlo in "RIVISTA SPERIMENTALE DI FRENIATRIA" 3/2021, pp 134-158, DOI: 10.3280/RSF2021-003009