I was inspired to write this post after reading the book The Stigma Effect by psychologist Patrick Corrigan. The book looks at what research has to say about what works and what doesn’t to fight stigma. Corrigan is a prolific stigma researcher, and I first encountered his work when I was doing my master’s thesis.
The stigma effect that the book is based on refers to unintended negative consequences of anti-stigma efforts. While public campaigns to fight stigma are well-intentioned, they sometimes end up having the opposite of the intended effect. That’s why I think it’s really important that we pay attention to what Corrigan has to say; we need to make sure that we’re being as effective as possible in the fight against stigma.
What is stigma?
Corrigan starts the book with a primer on what stigma is. Stigma is not actually inherent in mental illness itself. Instead, things like psychiatric symptoms, social skills deficits, poor hygiene, and illness labels act as cues for people to apply stereotyped beliefs, which are used to justify discriminatory behaviours. Stereotyped beliefs are framed as facts, but in reality, they’re based on inaccurate assumptions.
We’ve all been exposed to the stigmatized belief that people with mental illness are dangerous and unpredictable. Corrigan explains that in a 2006 study, around 40% of Americans thought people with mental illness were dangerous. This was about the same as the figure in 1996, and double that from 1956. Yet there’s more education now about the reality of mental illness and public exposure to anti-stigma campaigns, so something isn’t adding up.
How do we fight it?
The book outlines three broad types of anti-stigma approaches: protest, education, and contact. These may be informed by different agendas depending on who’s leading the campaign. Professional groups tend to promote the idea that decreasing stigma will lead to more people accessing mental health services. Families and other supporters may have a similar agenda, whereas people with mental illness may be more focused on promoting dignity and self-worth.
Corrigan uses the term “slacktivism” in which people are able to easily endorse or support something, e.g. on social media. This takes little effort and generally doesn’t translate into any sort of meaningful action.
There are multiple large campaigns that allow for slacktivist engagement, including Bell Let’s Talk Day. There’s a ton of promotion, and these efforts capitalize on the easy buy-ins across a broad swath of the population. However, from what Corrigan has to say, these may not be very effective.
I also wonder how much having awareness days up the wazoo helps. With an awareness day for almost everything under the sun, I wonder how much the mental health-related ones stand out from the crowd.
Chances are many of us have seen (or been) people arguing about language change, such as using “completed suicide” rather than “committed suicide”, or person-first language like “person with schizophrenia” rather than “schizophrenic”. Except you know what? It can actually have a negative effect, according to Corrigan. There are a couple of elements to this. If you tell someone not to think about a white bear, what are they certain to think about? A white bear.
Also, we haven’t necessarily come that far from our inner 6-year-old; telling people what not to do naturally triggers reactance. This is a form of psychological resistance that makes us push back against the change being argued for. Corrigan also points out that language is the result of stigma, not the cause of it, so targeting language tries to address the issue backwards.
I found it interesting that Corrigan uses the term patient to refer to a role that people may play. I choose the same term in the same context, although I recognize some may see it as archaic. Apparently, surveys of people with lived experience show no particular label that’s preferred; however, “consumer” has been found to be the least preferred. That rather surprised me. Personally, I can’t stand the term consumer; I thought I was somewhat 