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outdated term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outdated since Freud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

  1. be aware of the stigma
  1. endorse and apply the beliefs to themselves
  1. 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