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Reducing stigma and discrimination 

Reducing stigma and discrimination
Chapter:
Reducing stigma and discrimination
Author(s):

Graham Thornicroft

and Nisha Mehta

DOI:
10.1093/med/9780199565498.003.0139
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date: 20 August 2019

The term stigma (plural stigmata) was originally used to refer to an indelible dot left on the skin after stinging with a sharp instrument, sometimes used to identify vagabonds or slaves. The resulting mark led to the metaphorical use of ‘stigma’ to refer to stained or soiled individuals who were in some way morally diminished. In modern times stigma has come to mean ‘any attribute, trait or disorder that marks an individual as being unacceptably different from the “normal” people with whom he or she routinely interacts, and that elicits some form of community sanction’ (Goffman, 1963 ).

There is now a voluminous literature on stigma (Corrigan, 2005; Link et al., 1999 ; Mason, 2001 ; Sartorius and Schulze, 2005 ). The stigma of mental illness is the subject of many hundreds of scientific papers (Pickenhagen and Sartorius, 2002). The most complete model of the component processes of stigmatization has four key components (Link and Phelan, 2001 ): 1) labelling, in which personal characteristics are signalled or noticed as conveying an important difference; 2) stereotyping, which is the linkage of these differences to undesirable characteristics; 3) separating, the categorical distinction between the mainstream/normal group and the labelled group as in some respects fundamentally different; 4) status loss and discrimination: devaluing, rejecting, and excluding the labelled group. Interestingly, more recently the authors of this model have added a revision to include the emotional reactions which may accompany each of these stages (Link et al., 2004 ).

We shall consider later what needs to be done to allow people with mental illnesses a full opportunity for social participation. First of all we need to have a clear map to know where we are and where we want to go.

Stigma theories have not been enough to understand the feelings and experiences of people with mental illness, nor to know what practical steps are needed to reverse social exclusion (Social Exclusion Unit, 2004). Rather stigma can be seen as an overarching term that contains three important elements:

◆ Problems of knowledge (ignorance)

◆ Problems of attitudes (prejudice), and

◆ Problems of behaviour (discrimination).

In terms of social psychology, these are referred to as the cognitive, affective, and behavioural domains (Dovidio et al., 2000), and each will now be discussed.

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