Evaluate the relationship between contemporary diagnostic frameworks and mental health stigma, invoking relevant empirical evidence.
How does the diagnostic frameworks cause mental health stigma?
Mental health stigma
biopsychosocial approach
outdated term
madness
Conceptualisation of of mental disorder
outdated since Freud
Mental Health Act 1983
The Crown Procecution Service
continuum model
symptoms instead of diagnostic labels
"This ‘problem definition, formulation’ approach rather than a ‘diagnosis, treatment’ approach would yield all the benefits of the current approach without its many inadequacies and dangers."
DSM-5 contributes to stigma
ICD sensible clinical diagnosis
Public stigma
Perceived stigma
Experienced stigma
Self-stigma
Label avoidance
"Diagnosis is a social force" (Ben-Zeev et al)
"Something bad about the moral character of the bearer"
Low self-esteem
Low self-efficacy
to avoid stigmatizing label
Harms of stigma
stereotype
incompetent
not improving
prejudice
discrimination
diminished confidence in their future
loss of opportunities
"confidence in the ability to exert control over one's own motivation, behavior, and social environment."
struggle to maintain positive self-concept
"why try" effect
does not receive care
blame
mental ilnesses are thought to be homogeneous "they are all the same"
illnesses have definable boundaries
Groupness increase stereotypes. Stereotypes increase groupness.
Mental illnesses are thought to be stable, permanent or unchanging.
Groupness endure when they are associated with attributes describe them.
Research findings
"Public were likely to stigmatize a person with a label even in the absence of any aberrant behaviour" Link 1987
"Labels that have negative societal reactions exacerbate the course of the person's disorder" Link 1987, 1999
overgeneralization error
pessimism
affects treatment effacacy
dimensions over categories
"tainted and discounted one" goffman 2009
Internalization of public schema
decreased access to social capital
not reaching their potential
stages to internalize the public stigma
- be aware of the stigma
- endorse and apply the beliefs to themselves
- self-esteem decrement
Personal recovery (Bellack, 2006)
not turning it into self-stigma
stay indifferent
consider public stigma as illegitimate
ANGER to perceived stigma and discrimination (Corrigan & Watson 2002)
how to buffer?
ccollectivist culture has higher levels of self-stigma
domains of outcomes
well-being
personal recovery
clinical recovery
functional recovery
experienced stigma cause more self-stigma than perceived stigma
"more likely to internalize stigma if they experienced discrimination"
many reasons to conceal their diagnosis
need to tackle both public and self stigma at the same time
even if you don't internalize, you're still negatively affected by it.
On Being Sane in Insane Places. Science, 179(4070), 250-258.
double challenge
symptoms & disabilities
stereotypes & prejudice
change strategies
protest
education
contact
violent
Even normal behaviour is interpreted through the disorder lens after the diagnosis
Lewis and Appleby 1988
anti-stigma campaigns
public awareness campaigns
education
social interaction (contact)
media reporting
mental health industry perpetuate stigma (vanessa pinfold)
Drs need to listen to patients
affiliate stigma
attribution theory
affiliate stigma
Public stigma stages
Stage 1: Behavioural cues
DSM label can be a cue.
Stage 2: Stereotyping
Mental frameworks about the affected group is invoked.
Stage 3: Prejudice
DSM has influence on people's knowledge about disorders
Emotional response
People who are self-aware can tell themselves that stereotype is not true even though the stereotype is invoked.
DSM's influence at this stage is how much knowledge a person has.
Stage 4: Discrimination
Unfair treatment
at this point, DSM can positive influence. Person with label can ask for accomodation. Special programs for person with disability.
Protest
Education
Contact
Attitude
Stability of a cause
Controllability
Uncontrollable
Controllable
For example, Hostility and hypercriticism of depressed person
can lead person to relapse.
Drunk -> More stigma
Fainted -> Less stigma
Pity and helping behaviour
Stable cause
Genetics
Cannot be changed. Permanent.
More stigma
Unstable cause
Mood
Can be changed and improved
Less stigma
Did they catch the illness?
Responsible for their illness
Blame
More powerful factor than stability of a cause
Trying to overcome the illness
Biological model
DSM (medical model)
DSM
More punishing behaviour
Mental illness is likely to benefit from treatment
injury
Lack of trying
Lack of opportunity
if they are perceived to be dangerous
danger elicits fear
Locus of control
Internal cause
External cause
weakness
"the level ofcontrollability predicts the
direction of affect" (Aydogmus, 2020)
the level of stability predicts the magnitude of
the affect (e.g., high vs. low anger) (Aydogmus, 2020)
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Previous versions Attribution Questionnaire (Johnson-Kwochka et al., 2021)
Personal responsibility
pity
anger
fear
helping
coercion/segregation
blame
dangerousness,
avoidance
Final Model: Attribution Questionnaire (Johnson-Kwochka et al., 2021)
Personal Responsibility
Pity
Help & Interact
Fear & Danger
Anger
Coercive Treatment