Strategies for reducing stigma
toward persons with mental illness
PENN1 and SHANNON M COUTURE1
of Psychology, University of North Carolina-Chapel Hill, Davie
Hall, CB#3270, Chapel Hill, NC 27599-3270, USA
the impact of stigma on people with mental illness"
on page 16.
Corrigan and Watson have written an
excellent overview on the impact of stigma on the lives of
persons with severe mental illness (SMI). In this commentary, we
would like to expand on one aspect of that article, namely
strategies for reducing stigma toward persons with SMI.
Corrigan and Watson have identified three
approaches for reducing stigma: protest, education, and contact.
Although these approaches have promise, they are not without
weaknesses. A potential disadvantage of using protest (i.e.,
telling the public to stop believing negative views about mental
illness) is that it may actually increase, rather than decrease
stigma. In fact, research has shown that instructing individuals
to ignore or suppress negative thoughts and attitudes towards a
particular group can have paradoxical rebound effects; stigma
will be augmented rather than reduced (1).
To examine this issue with respect to psychiatric stigma, we
instructed participants to either suppress or not to suppress
their stereotypes of persons with SMI and evaluated the effects
on stigma-related attitudes and behaviors (2).
The results showed that suppression instructions did reduce
negative attitudes, but did not impact behavior toward
persons with SMI, and that the paradoxical rebound effects did
not occur. This suggests that stereotype suppression may have
modest, although limited effects, on psychiatric stigma.
There is evidence that individuals who
possess more information about mental illness are less
stigmatizing than individuals who are misinformed about mental
illness (3). This
suggests that providing individuals with factual information
about SMI, in particular regarding dangerousness and SMI, would
reduce stigmatization. We have generally found support for this
hypothesis. Information regarding the residential context of
persons with SMI (i.e., that they may live in supervised
and the relationship between dangerousness and SMI (5),
were both associated with reduced stigmatization to persons with
SMI in general and to a hypothetical individual with SMI.
However, the positive effects of factual information on
psychiatric stigma were attenuated when subjects had to rate
their reactions to actual persons with SMI (6).
Thus, factual information regarding SMI may be more effective in
reducing stigma toward persons with SMI in general, than toward
Finally, there is convincing evidence that
increased contact with persons with SMI is associated with lower
stigma (7). However,
there are a number of problems that plague work in this area.
First, many studies have examined the effects of previous
self-reported contact on stigma, rather than how contact changes
stigma prospectively (7).
In those studies in which direct contact was measured, the
manipulation often took place in the context of contrived
laboratory situations or as part of a course and/or training
program. Scant attention has been placed on how direct
interpersonal contact affects stigma during ongoing
naturalistic relationships. Second, the mechanism(s)
underlying stigma reduction, as a function of contact, are
unknown. In other words, how does contact reduce stigma? Two
theories have been proposed for this. According to the
recategorization theory (8),
contact with an outgroup member results in changes in outgroup
member classification, from 'them' to relationships. New York:
Freeman, 1984. 60. Chamberlin J. Citizenship rights and
psychiatric disability. Psychiatr Rehabil J 1998;21:405-8. 61.
Crocker J, Major B. Social stigma and self-esteem: the
self-protective properties of stigma. Psychol Rev 1989;96:608-
30. 62. Deegan PE. Spirit breaking: when the helping professions
hurt. Human Psychol 1990;18:301-13. 63. Corrigan PW. Empowerment
and serious mental illness: treatment partnerships and community
opportunities. Psychiatr Q, in press. 64. Corrigan PW, Watson
AC. The paradox of self-stigma and mental illness. Clin Psychol
Sci Pract, in press. 21 'us'. A related model of stigma change
is rooted in attribution theory. Attributions are explanations
that an individual makes about another individual's behavior.
Although attributions can be made along various dimensions
(e.g., internal-external), the controllability dimension is
especially relevant to perceptions of persons with SMI.
Mental/behavioral disorders are viewed as more controllable than
medical disorders and hence, more stigmatizing (9).
These attributions result in perceptions of the person with SMI
as being responsible for her/his condition, which culminates in
feelings of anger and distaste toward her/him (9).
Sustained interpersonal contact with a person with SMI may
debunk the myth that her/his condition is under her/his control
(i.e., that she/he may have caused the disorder). This shift in
attributions, from controllable to uncontrollable, should
correspond to a change in feelings, from anger to sympathy,
which should augment helping behavior. Unfortunately, these
theories have not been adequately tested in the area of
stigmatization toward persons with SMI.
The foregoing underscores some of the
problems with work in this area. Although we have made much
progress in reducing stigma, we are, in many ways, still in the
nascent stage of research, particularly with respect to theory
development. It is hoped that this Forum will serve as an
impetus to scientists, practitioners, and persons with SMI to
collaborate on efforts to tackle this persistent and pernicious
problem presented by psychiatric stigma.
Sherman JW. Devine PG. Suppression as a stereotype control
strategy. Pers Soc
Psychol Rev. 1998;2:63–82.
Corrigan PW. The effects of stereotype suppression on
Schizophr Res. in
Penn DL. Lessons from social psychology on discrediting
psychiatric stigma. Am
Penn DL. Guynan K. Daily T, et al.
Dispelling the stigma of
schizophrenia: what sort of information is best?
Penn DL. Kommana S. Mansfield M, et al.
Dispelling the stigma of
schizophrenia, II: The impact of information on dangerousness.
Link B. Dispelling the stigma of schizophrenia, III: The role of
gender, laboratory-manipulated contact, and factual information.
Skills. in press.
ME. Johnson BT. Interpersonal contact and acceptance of persons
with psychiatric disorders: a research synthesis.
J Consult Clin Psychol.
Mann J. Dovidio JF, et al. How does cooperation reduce
intergroup bias? J Pers
Soc Psychol. 1990;59:692–704.
Mental health stigma as social attribution: implications for
research methods and attitude change.
Clin Psychol Sci Pract.