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Stigma and mental disorder: Conceptions of illness, public attitudes, personal disclosure, and social policy
Abstract
The end of the last millennium witnessed an unprecedented degree of public awareness regarding mental disorder as well as motivation for policy change. Like Sartorius, we contend that the continued stigmatization of mental illness may well be the central issue facing the field, as nearly all attendant issues (e.g., standards of care, funding for basic and applied research efforts) emanate from professional, societal, and personal attitudes towards persons with aberrant behavior. We discuss empirical and narrative evidence for stigmatization as well as historical trends regarding conceptualizations of mental illness, including the field's increasing focus on genetic and neurobiological causes and determinants of mental disorder. We next define stigma explicitly, noting both the multiple levels (community, societal, familial, individual) through which stigma operates to dehumanize and delegitimize individuals with mental disorders and the impact of stigma across development. Key developmental psychopathology principles are salient in this regard. We express concern over the recent oversimplification of mental illness as “brain disorder,” supporting instead transactional models which account for the dynamic interplay of genes, neurobiology, environment, and self across development and which are consistent with both compassion and societal responsibility. Finally, we consider educational and policy-related initiatives regarding the destigmatization of mental disorder. We conclude that attitudes and policy regarding mental disorder reflect, in microcosmic form, two crucial issues for the next century and millennium: (a) tolerance for diversity (vs. pressure for conformity) and (b) intentional direction of our species' evolution, given fast-breaking genetic advances.
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“Major problems in suicide prevention are the paucity of specialized mental health services and the reluctance of many at-risk people, especially men, to avail themselves of treatment due to stigma [91] and social norms [92].”
From A systematic review of social factors and suicidal behavior in older adulthood (2012) · cites this paper as [91]
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“Stigma is claimed to dehumanize people experiencing mental disorders (Hinshaw & Cicchetti, 2000), and pro-choice advocates are claimed to dehumanize the fetus (Brennan, 1995).”
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“For example, individuals with mental health problems are often perceived as incompetent and dangerous, and the general public often exhibit an unwillingness to socialize with them (Hinshaw & Cicchetti, 2000).”
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“Background Stigma has been identified by policy makers, professional and non-government organisations, researchers and consumers as a key issue in mental illness ([1-7]).”
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“Because the problem of stigma is pervasive within children’s mental health and has been well documented (Hinshaw and Cicchetti 2000; US Department of Health and Human Services (DHHS) 1999, 2001), one can speculate whether persistent stigma is contributing to the rise in the popularity of family…”
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“These events might cause internalizing problems in the short and long term (see the review by Hinshaw & Cicchetti, 2000, on the developmental effects of stigma in relation to mental illness).”
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“However, as articulated by Hinshaw and Cicchetti (2000) and others, the “brain disorders” movement has had the effect of further stigmatizing patients with mental illnesses.”
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“In addition, the general public seems to disapprove persons with mental illness more than persons with physical disabilities (Corrigan et al., 2000, 2003; Hinshaw and Cicchetti, 2000; Rusch et al., 2005; Socall and Holtgraves, 1992).”
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“[ 28-30 ]. For example, in Scotland most children do not know what to do if they have a mental health problem, or what to recommend to a friend with mental health difficulties.”
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Causadias, J. M. (2013) · Development and Psychopathology · doi:10.1017/s0954579413000679 · Cited by 187
“It is important that researchers in the field have consistently underlined the role of culture as the context that defines what is normal and what is not (Cicchetti, 1993; Cohler, Stott, & Musick, 1995; Hinshaw & Cicchetti, 2000; Santostefano, 1978; Sroufe & Rutter, 1984).”
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“However, it is suggested that stigma deters individuals from seeking and obtaining help (Dubin and Fink, 1992; Hinshaw and Cicchetti, 2000).”
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“Stigmatized groups are systematically excluded and have poorer life chances (Herek, 1999; Hinshaw & Cicchetti, 2000; Puhl & Heuer, 2009; Smeets, van Lierop, Vanhoutvin, Aldenkamp, & Nijhuis, 2007).”
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“A recent review of research on stigma documented discrimination against persons with mental illnesses in housing, jobs, and social interactions (1).”
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Suggested avenues to reduce the stigma of mental illness in the Middle East
Sewilam, A. M., Watson, A. M. M., Kassem, A. M., Clifton, S., McDonald, M. C., Lipski, R., Deshpande, S. N., Mansour, H., & Nimgaonkar, V. L. (2014) · International Journal of Social Psychiatry · doi:10.1177/0020764014537234 · Cited by 173
“The external effects of public stigma refer mainly to discrimination against PWMI in relation to housing, work and social interactions (Hinshaw & Cicchetti, 2000).”
BackgroundEffects of school-based interventions on mental health stigmatization: a systematic review
Schachter, H., Girardi, A., Ly, M., Lacroix, D., Lumb, A. B., van Berkom, J., & Gill, R. M. (2008) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/1753-2000-2-18 · Cited by 158
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“Another way to understand how those with mental illnesses are viewed is to examine the ways they are presented and described (Hinshaw & Cicchetti, 2000; Wahl, 1995).”
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Depictions of mental illnesses in children's media
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“As Hinshaw & Cicchetti (2000) argue, then, it is reasonable – if not necessary – to look carefully at what the media present about mental illnesses to discover what attitudes toward those illnesses are being fostered.”
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“Indeed, research has shown that prejudicial attitudes about mental illness lead to discrimination in jobs and housing, and limit the amount of resources allotted to mental health services [12, 19], imposing multiple barriers to recovery.”
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“…al., 2005; Hirschfeld, Cass, Holt, & Carlson, 2005!. Stigma continues to be a potent force in psychiatric illness and diagnosis, often yielding huge delays to treatment onset even in the face of quite severe symptomatology ~Barney, Griffiths, Jorm, & Christiensen, 2005; Hinshaw & Cicchetti, 2000!.”
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“Scholars (eg, Hinshaw & Cicchetti, 2000 ) argue that one must look at the content of such media presentations to anticipate what its viewers will learn.”
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“Indeed, shame has been found to associate with avoiding treatment for emotional and mental health problems (Corrigan, 2004; Hinshaw & Cicchetti, 2000) and lack of disclosure of emotional distress to friends, family and professionals (Hook & Andrews, 2005; Macdonald & Morley, 2001).”
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“Recent developments understanding the role of culture in service selection, stigma, and attitudes to treatment also provides more rich inputs into the decision-making process (Hinshaw & Cicchetti, 2000; Yeh et al., 2005).”
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“…and are frequently candidates for psychiatric treatment, in part because of the stigma toward mental illness in the larger social system ~Hinshaw & Cicchetti, 2000; Perlick et al., 2005, 2006!. Fortunately, advances in the treatment of EOBD indicate that early intervention may lead to…”
BackgroundPublic Stigma of Disordered Gambling: Social Distance, Dangerousness, and Familiarity
Horch, J. D., & Hodgins, D. C. (2008) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2008.27.5.505 · Cited by 105
“While consensus has been reached that attitudes do “significantly and substantially predict future behavior” (Kraus, 1995, p. 58), further research with ecologically valid behavioral measures that supplement attitudinal measures is needed ( Hinshaw & Cicchetti, 2000 ).”
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ADHD and the Rise in Stimulant Use Among Children
Mayes, R., Bagwell, C. L., & Erkulwater, J. L. (2008) · Harvard Review of Psychiatry · doi:10.1080/10673220802167782 · Cited by 106
Reducing stigma by meeting and learning from people with mental illness.
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“The external effects of stigma refer primarily to discrimination against people with mental illnesses with regard to housing, work, and social interactions ( Hinshaw & Cicchetti, 2000 ).”
Supported employment for persons with serious mental illness: Current status and future directions
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“…of stigma among these youth may also contribute to improved treatment seeking and to the prevention and reduction of the long-term effects of stigma that are so profound and deleterious in adulthood (Hinshaw & Cicchetti, 2000; Link, Struening, Rahav, Phelan, & Nuttbrock, 1997; Link & Phelan, 2001).”
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“Given literature suggesting that ethnic minority families might be less engaged in treatment (Garland et al., 2005) or experience more stigma related to disclosing symptoms (Hinshaw & Cicchetti, 2000), one might expect agreement to be lower for ethnic minority youths.”
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“Sources of stigma associated with mental disorders are likely to be broad and include cultural, societal, inter-individual and intra-individual factors (Hinshaw & Cicchetti, 2000).”
BackgroundInfluentialSmall business employers' views on hiring individuals with mental illness.
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da Silva, A. G., Baldaçara, L., Cavalcante, D. A., Fasanella, N. A., & Palha, A. J. P. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00573 · Cited by 99
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“Reducing the stigma of mental illness has been identified as one of the major challenges of the mental health field [38, 64, 74].”
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Self-citationIntergroup Contact and Prejudice Against People With Schizophrenia
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“…of prejudice is more widely accepted than other prejudices (West & Hewstone, 2012a) and has persisted, or even increased, as tolerance for other previously stigmatized groups has grown (Angermeyer & Matschinger, 1997; Hinshaw & Cicchetti, 2000; Stier & Hinshaw, 2007; Trute, Tefft, & Segall, 1989).”
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“Some previous research has suggested that the biological view of mental health problems may not be as beneficial as it has hoped for in modifying public attitudes (Read & Law, 1999; Phelan 2002; Hinshaw & Cicchetti, 2000).”
BackgroundSocial distance towards a person with Alzheimer's disease
Werner, P. (2005) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.1268 · Cited by 72
“Social distance has been defined as the degree of closeness or distancing desired from another individual (Hinshaw and Cicchetti, 2000).”
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Mental illness disclosure in Chinese immigrant communities.
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“However, a major concern and possible consequence of disclosure is mental illness stigma, which may exert its impact at community, societal, familial, and individual levels (Hinshaw & Cicchetti, 2000).”
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Is temporary employment a cause or consequence of poor mental health? A panel data analysis
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Resilience as a response to the stigma of depression: A mixed methods analysis
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“Many researchers have studied the effects of mental health stigma for ways to reduce its impact and prevalence (e.g. Hinshaw & Cicchetti, 2000; Stier & Hinshaw, 2007).”
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Lebowitz, M. S., & Ahn, W. (2012) · Psychiatric Services · doi:10.1176/appi.ps.201100265 · Cited by 56
“S of people with mental disorders has been called the central issue of mental health (1).”
Stigma related to help-seeking from a mental health professional
Aphroditi, Z. (2010) · ICUS and Nursing Web Journal · Cited by 55
Lipsky, S., Caetano, R., & Roy‐Byrne, P. (2010) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-010-0258-3 · Cited by 57
People with a borderline personality disorder diagnosis describe discriminatory experiences
Veysey, S. A. (2014) · Kōtuitui New Zealand Journal of Social Sciences Online · doi:10.1080/1177083x.2013.871303 · Cited by 42
“It is widely recognised that stigma/discrimina‐ tion related to mental disorder can have adverse effects on self-esteem and help-seeking behaviour, which can in turn have long-ranging effects on an individual’s quality of life and health outcomes (Hinshaw & Cicchetti 2000; Corrigan 2004; Kane 2006).”
BackgroundPilkington, P. D., Reavley, N. J., & Jorm, A. F. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.04.019 · Cited by 47
Cook, J. Α., Razzano, L. A., Burke-Miller, J. K., Blyler, C. R., Leff, H. S., Mueser, K. T., Gold, P. B., Goldberg, R. W., Shafer, M. S., Onken, S. J., et al. (2007) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2006.07.0079 · Cited by 49
“Disclosure may elicit both positive and negative reactions from employers and coworkers [28–31].”
BackgroundTillaart, S. V. D., Kurtz, D., & Cash, P. (2009) · International Journal of Mental Health Nursing · doi:10.1111/j.1447-0349.2009.00599.x · Cited by 53
Elkington, K. S., Hackler, D., Walsh, T. A., Latack, J. A., McKinnon, K., Borges, C., Wright, E. R., & Wainberg, M. L. (2013) · Journal of Adolescent Research · doi:10.1177/0743558412467686 · Cited by 45
“…stigma reduction programs as well as HIV/ STI intervention preventions tailored to the specific needs of youth with psychiatric illness, offsetting or eliminating the long-term effects of stigma that are so profound and deleterious in adulthood (Hinshaw & Cicchetti, 2000; Link & Phelan, 2001).”
BackgroundSelf-Stigma and Age-Related Hearing Loss: A Qualitative Study of Stigma Formation and Dimensions
David, D., Zoizner, G., & Werner, P. (2018) · American Journal of Audiology · doi:10.1044/2017_aja-17-0050 · Cited by 50
O’Grady, C., & Skinner, W. J. W. (2012) · Qualitative Health Research · doi:10.1177/1049732312443736 · Cited by 41
Young, R., Goldberg, J. O., Struthers, C., Mccann, D., & Phills, C. E. (2019) · Journal of Social Issues · doi:10.1111/josi.12343 · Cited by 28
The depiction of mental illnesses in children's television programs
Wahl, O. F., Hanrahan, E., Karl, K., Lasher, E., & Swaye, J. (2006) · Journal of Community Psychology · doi:10.1002/jcop.20138 · Cited by 40
A Public Health Approach to Safeguarding in the 21st Century
Barlow, J., & Calam, R. M. (2011) · Child Abuse Review · doi:10.1002/car.1194 · Cited by 40
“Stigma has long been recognised as a barrier to access to mental health services (Hinshaw and Cicchetti, 2000).”
BackgroundStigma and Mental Illness: Developmental Issues and Future Prospects
Hinshaw, S. P. (2015) · Wiley eBooks · doi:10.1002/9780470939406.ch22 · Cited by 40
Self-citationSuicide Prevention in Older Adults.
Heisel, M. J., & Duberstein, P. R. (2005) · Clinical Psychology: Science and Practice · doi:10.1093/clipsy.bpi030 · Cited by 85
Managing Stigma: Disclosure-Response Communication Patterns in Pro-Anorexic Websites
Chang, P. F., & Bazarova, N. N. (2015) · Health Communication · doi:10.1080/10410236.2014.946218 · Cited by 47
“The social distance created by stigma between those who are perceived as stigmatized and those who are not (Hinshaw & Cicchetti, 2000) influences stigmatized individuals to find comfort with similar others who share common social values with them.”
BackgroundReavley, N. J., & Jorm, A. F. (2014) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867414528054 · Cited by 39
“However, some experts have criticised the emphasis on biological factors as being overly simplistic and argue that public health messages should acknowledge the complex interaction between biogenetic and psychosocial factors (Hinshaw and Cicchetti, 2000).”
Folk Psychiatry: Lay Thinking about Mental Disorder
Haslam, N. (2003) · Social research · doi:10.1353/sor.2003.0030 · Cited by 39
Hinshaw, S. P. (2004) · Journal of Clinical Child & Adolescent Psychology · doi:10.1207/s15374424jccp3302_22 · Cited by 37
“Also, professionals and scientists may themselves fall into the stigmatizing “us” versus “them” perceptions that tend to dehumanize those whom they assess, treat, and investigate (Hinshaw & Cicchetti, 2000).”
BackgroundSelf-citation‘Not a good person’: family stigma of mental illness from the perspectives of young siblings
Liegghio, M. (2016) · Child & Family Social Work · doi:10.1111/cfs.12340 · Cited by 35
Brown, R. L., Moloney, M., & Brown, J. (2017) · Journal of Community Psychology · doi:10.1002/jcop.21933 · Cited by 34
Public perceptions of adult ADHD: Indications of stigma?
Godfrey, E., Fuermaier, A. B. M., Tucha, L., Butzbach, M., Weisbrod, M., Aschenbrenner, S., & Tucha, O. M. (2020) · Journal of Neural Transmission · doi:10.1007/s00702-020-02279-8 · Cited by 45
Relatively Socially Acceptable Prejudice Within and Between Societies
West, K., & Hewstone, M. (2011) · Journal of Community & Applied Social Psychology · doi:10.1002/casp.1112 · Cited by 34
Greenberg, S. A., Shuman, D. W., & Meyer, R. G. (2004) · International Journal of Law and Psychiatry · doi:10.1016/j.ijlp.2004.01.001 · Cited by 34
Metadata
- Authors
- HINSHAW, S. P., & CICCHETTI, D.
- Affiliations
- University of California, Berkeley (US)
- University of Rochester (US)
- Venue
- Development and Psychopathology
- Publisher
- Cambridge University Press (CUP)
- Published
- 2000-12
- Volume
- 12
- Issue
- 4
- Pages
- 555-598
- ISSN
- 0954-5794 (ISSN-L)
- 1469-2198
- OpenAlex
- W2136434200
- Cited by
- 311
- References
- 8
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 12 · 2023: 6 · 2022: 5 · 2021: 6 · 2020: 9 · 2019: 10 · 2018: 9 · 2017: 12 · 2016: 19 · 2015: 10 · 2014: 21 · 2013: 22 · 2012: 32
- FWCI
- 5.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Development and Psychopathology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH 45064, MH45027, MH50461, U01MH050461)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
- Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
- Keywords
- mental health stigma, self-disclosure, mental health policy, conceptualization of mental illness, transactional model, developmental psychopathology, stigma reduction, dehumanization, social responsibility, genetic advance
- MeSH terms
- Attitude to Health, Mental Disorders, Deinstitutionalization, Humans, Mental Health Services, Prejudice, Public Policy, Self Disclosure, Stereotyping
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