31st October 2023

Stigma and Prejudice 

Stigma is defined as ‘a mark of disgrace associated with a person, a personal quality, or a personal circumstance’. In social psychology, any person who is perceived as not fitting with societal norms may experience stigma. Stigma sets an individual apart from others, leading to alienation, poor self-esteem, and overall reduced wellbeing in the individual. On a larger scale, stigma contributes to social inequality.

In Stigma: Notes on the Management of Spoiled Identity, Erving Goffman looked at the way in which people who are considered ‘abnormal’ by society are treated. He refers to stigma as an ‘attribute that is deeply discrediting’ – this can be something visible, such as having a certain ethnicity or physical appearance, or it can be hidden – for example, a mental illness. Goffman thought that most people would experience stigma to some degree at some point in their lives. He identified three categories of stigma:

• Stigma associated with mental illness
• Stigma associated with physical disfiguration 
• Stigma attached to identification with a particular ethnicity, religion, ideology, etc.

In more recent research, several different subtypes of stigma have been identified in regard to mental health:

• Self-stigma (also referred to as internalised stigma) – Refers to the negative attitude held by an individual towards themselves. For example, Janet has a diagnosis of severe depression, and as a result, she has needed to take time off work for the past few months. She views herself as being worthless and pathetic for not being able to carry on.
• Enacted stigma – The experience of negative and unfair treatment from others. For example, Jamie has a diagnosis of paranoid schizophrenia. He has applied for a job in a café. However, the owner of the café rejects his application as they have been told that people with schizophrenia are dangerous and unpredictable.
• Felt stigma – The experience of feelings of shame or embarrassment in an individual when they anticipate others’ reaction to them. For example, Mark has been feeling depressed and has experienced suicidal thoughts. However, he refrains from sharing this with his wife, as he worries that she will perceive him as being weak.
• Public stigma – Negative attitudes held by the general public towards a certain characteristic, often based on prejudice.
• Professional stigma – Seen when healthcare professionals hold stigmatising beliefs about their patients, which can impact on patient care.
• Institutional stigma – An organisation’s beliefs or policies towards a stigmatised group.
• Courtesy stigma – The stigma felt by family and friends of a stigmatised person by way of association with them.

In Conceptualizing Stigma (2001), Phelan and Link identify four steps in the development of stigma:

1. Differentiation and labelling – Whereby a deviation from perceived societal norms is identified and labelled as such.
2. Stereotyping – Linking the label to prejudices; associating the label with negative attributes.
3. Separation – Development of an ‘us vs them’ ethic, resulting in isolation.
4. Status loss and discrimination – The societal disadvantage conferred to people in the ‘them’ category.

Prejudice is defined as a ‘preconceived opinion that is not based on reason or actual experience’. In social psychology, this refers to the attitude of one group towards members of another group.

Stereotyping refers to a similar concept. However, a stereotype is typically seen as a specific belief held about a group – for example, a blanket statement that all members of that group share a particular physical or behavioural characteristic. Stereotyping is defined as ‘a widely held but fixed and oversimplified image or idea of a particular type of person or thing’. Stereotyping reinforces the differences between groups and leads to discrimination.

Discrimination refers to ‘the unjust or prejudicial treatment of different categories of people, especially on the grounds of ethnicity, age, sex, or disability’. Discrimination can result in whole groups of people being placed at a disadvantage purely due to their membership in a particular group.

Pettigrew identified ultimate attribution error as a phenomenon whereby ingroup members view negative behaviours in the outgroup as being disproportionately due to internal factors rather than as a result of any external factor beyond their control. Conversely, any positive outgroup behaviour is seen as being by chance rather than as a result of internal factors. This means that outgroup members struggle to escape prejudice since any positive behaviours they demonstrate are shrugged off, whilst negative behaviours are just seen to confirm the ingroup’s negative perception of them.

Stigma and mental illness

In 1998, the Royal College of Psychiatrists launched a 5-year ‘Changing Minds’ campaign, aiming to target stigma and to address the prejudice against people with mental illness. However, a recent YouGov poll in 2013 revealed that the UK public still regards people with mental illness as being the most discriminated-against group.

Results showed that schizophrenia, alcoholism and drug addiction were associated with the highest proportion of negative opinions. 70% of people surveyed felt that individuals suffering from these issues were dangerous, whilst 80% saw them as being unpredictable. Furthermore, alcoholism and drug use were associated with the perception that people with these disorders were to blame for their illness (60-65%). Over 60% of respondents saw people with depression as being hard to talk to, 19% thought that they should pull themselves together, and 23% thought that they were dangerous to others.

Tackling stigma

Legal aspects

There are laws in place designed to protect individuals from experiencing discrimination. Key examples are the Universal Declaration of Human Rights 1948 and the Equality Act 2010.

The Universal Declaration of Human Rights 1948 details the basic rights that all humans should be entitled to. This includes the following:

• Article 1 – The right to be free and to be equal in dignity and rights.
• Article 2 – The right to freedom from discrimination.
• Article 23 – The right to work and to equal pay without discrimination.

The Equality Act 2010 lists 8 protected characteristics, conveying protection from discrimination on the basis of any of these:

• Age.
• Disability.
• Gender reassignment.
• Marriage and civil partnership.
• Pregnancy and maternity.
• Race.
• Religion or belief.
• Sex.
• Sexual orientation.

Public campaigns

Public campaigns can be beneficial in terms of raising awareness of mental health issues and tackling the stigma associated with them.

One example is the Royal College of Psychiatrists Changing Minds campaign (1998-2003), which involved public education on mental health issues. More recently, the RCPsych have run a further campaign, Fair Deal, advocating for parity of esteem between mental health and physical health services in the UK.

Governmental policy can also contribute to reducing mental health-related stigma, for example, the UK government’s No Health Without Mental Health strategy and, more recently, the Time to Change campaign – run by the charities Mind and Rethink Mental Illness and funded by the Department of Health.

References

• Andersen, M.M., Varga, S., Folker, A.P. [2022]. On the definition of stigma. J Eval Clin Pract. 28: 847- 853.
• Crisp, A., Gelder, M., Rix, S., Meltzer, H., & Rowlands, O. [2000]. The stigmatisation of people with mental illnesses. The British Journal of Psychiatry, 177(1), 4-7.
• LibreTexts [2021]. Deviance and Social Stigma. [Website: https://socialsci.libretexts.org/@go/page/8123]
• Pettigrew, T. F. [1979]. The Ultimate Attribution Error: Extending Allport’s Cognitive Analysis of Prejudice. Personality and Social Psychology Bulletin. 5(4), 461–476
• Subu, M.A., Wati, D.F., Netrida, N. et al. [2021]. Types of stigma experienced by patients with mental illness and mental health nurses in Indonesia: a qualitative content analysis. Int J Ment Health Syst 15, 77 (2021).