1 Psychology and human development1.10 Social psychology
1.10.4.8 Stigma and prejudice
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Written by Resident Doctor Committee · Published
Prejudice
Prejudice is an attitude with three components.
Component | Content | Example |
|---|---|---|
Cognitive | Stereotype | Believing people with schizophrenia are unpredictable |
Affective | Hostility | Fear or contempt on hearing the diagnosis |
Behavioural | Discrimination | Withdrawing a job offer or refusing a tenancy |
Allport's scale grades discriminatory behaviour from antilocution to extermination.
Routine practices can discriminate without any hostility.
Goffman's concept of stigma
Goffman brought stigma into sociology in Stigma (1963): an attribute that deeply discredits its bearer, so that others see a spoiled, lesser person instead of an ordinary whole one.
The labelling theorists (Becker, Lemert, Scheff) wrote about social reaction but did not introduce the concept.
Type | Attribute | Task for the person |
|---|---|---|
Discredited | Visible at once or already known | Managing reactions |
Discreditable | Concealable, discrediting only once disclosed or discovered: human immunodeficiency virus (HIV) infection, most psychiatric history | Managing information by passing (being taken as normal), covering or withdrawal |
Labelling theory
Primary deviance is the original, unlabelled behaviour, and it leaves the self-image intact.
Secondary deviance (Lemert) is behaviour and identity that develop after, and because of, the societal reaction to a label.
Link and Phelan's model
Stigma exists when these components occur together under a power imbalance:
People distinguish and label a socially selected human difference.
They attach negative stereotypes to the labelled person.
They separate "us" from "them".
The labelled person loses status.
The labelled person meets discrimination.
Why some conditions are more stigmatised
Jones and colleagues (1984) named six dimensions that set how strongly a condition is stigmatised.
Dimension | Effect on stigma |
|---|---|
Concealability | Whether the condition can be hidden |
Course | Higher when believed progressive and irreversible |
Disruptiveness | Higher when the condition disrupts social interaction |
Aesthetic qualities | Higher with disfigurement, self-neglect or odd behaviour |
Origin | A self-inflicted origin attracts blame rather than sympathy |
Peril | Perceived danger is the single strongest driver |
Hayward and Bright described four recurring themes in stigmatising beliefs about mental illness: dangerousness, attribution of responsibility, poor prognosis and disruption of social interaction.
British population attitude surveys found that people with mental illness are widely seen as hard to talk to, across disorders and not only in psychosis.
Types of stigma
Type | What it is | Example |
|---|---|---|
Public | Population-level stereotypes and discrimination | Media portrayal, objections to supported housing |
Enacted (Scambler) | Discrimination or unfair treatment that actually occurs | Job loss after disclosure, refused insurance |
Felt (Scambler and Hopkins) | Internalised shame and fear of discrimination, which may occur with no discriminatory act at all | First described in people with epilepsy |
Anticipated | Expectation of future judgement or discrimination | Not applying for a job, not telling the general practitioner |
Self-stigma | Applying the stereotypes to oneself | The "why try" effect of abandoning goals |
Courtesy (associative) | Discredit that passes to a person through association with a stigmatised person or group, imposed by others | Relatives blamed, psychiatry's low standing within medicine |
Structural | Disadvantage written into the laws, policies, rules and funding of public or private bodies | Occurs whether or not anyone intends harm |
Felt stigma is often more disruptive than enacted stigma.
Courtesy stigma arises from association, not from any attribute of the person's own; relatives, carers and mental health staff can all meet it.
Intersection with other prejudice
Racism and psychiatric stigma interact rather than simply add, and inequality shows in policing, detention, restraint and access to treatment.
Lesbian and gay adoptive parents meet stigma about their sexual orientation on top of the stigma all adoptive families meet, and this layered stigma can harm their mental health.
Reducing stigma
Approach | Evidence |
|---|---|
Contact | Best-supported way to reduce public stigma; works through equal status, sustained interaction, shared activity and credible lived experience |
Education | Mixed; improves knowledge more reliably than lasting behaviour |
Protest | Can backfire |
Structural action | Ranked above public education by people with mental illness |
Mental health professionals are not free of stigmatising attitudes.
Reduced contact worsens fear, and concealment removes the contact that might correct it.
Better survey attitudes need not bring less discrimination, partly because of social desirability, so outcomes in housing, work, care and coercion are measured instead.
Campaign | Details |
|---|---|
Changing Minds | Royal College of Psychiatrists, 1998 to 2003; a time-limited educational campaign encouraging patient advocacy and public understanding, including that mental disorders are treatable |
Time to Change | England's national programme, one of the world's longest running, led by Mind and Rethink Mental Illness |