Introduction
“The Ancient Greeks referred to stigma as a ‘bodily sign to expose something unusual and bad about the moral status of a person’. These marks were generally burnt or cut into the body to advertise the bearer was a slave, criminal or traitor, ‘a blemished person ritually polluted, to be avoided especially in public places’ (Goffman, 1963). Mental health in the United States has boiled down to the discovery of new diseases and medical issues. The social ramifications vary from drawing wrong conclusions about the state of mind, to the exclusion of social and health benefits. The development of stigmas in American society has created rampant generalizations about mental illness. The most prevalent of these is the association of mental illness and crime or imprisonment. Professionals believe there are solutions to the uneducated views of the public towards those people being diagnosed with a mental health issues. As a foundation, the general public must be more informed about the myths of mental health issues. The most efficient way for this to happen is through the media. The overall goal is for the general public to realize that psychology is part of daily lives, not the remedy for juvenile delinquency.
Main Issues
Mental illness affects many aspects of suffers’ life, the most important is that the diagnosis of mental illness comes with the additional burden of a negative label. The term stigma refers to any persistent trait of an individual or group which evokes negative or punitive responses. Goffman (1963) has made the salient point that it is not the functional limitations of impairment which constitute the greatest problems, but rather the perceptions of negative difference and their evocation of adverse social responses. He argues that a person is not a deviant until his acts or attributes are perceived as negatively different. Arboleda-Florez (2003) explains:
Stigma develops within a social matrix of relationships and interactions and has to be understood within a 3-dimensinal axis. The first of three dimensions is perspective; that is, the way stigma is perceived by the person who does the stigmatizing (perceiver) or by the person who is being stigmatized (target). The second dimension is identity, defined along a continuum from the entirely personal at one end to group-based identifications and group belongingness at the other. The third dimension is reactions; that is, the way the stigmatizer and the stigmatized react to the stigma and its consequences.
This stigma has become the standard, not the exception, with mental health cases in America. The psychological underpinning to this appears to be that so called normal people exaggerate the difference between those that are mentally ill and themselves, because disability symbolically represents fear of what could be. Corrigan (2004) adds, “Mental illness strikes with a two-edged sword. On one side is the psychological distress and psychiatric disabilities that prevent people from accomplishing and enjoying life goals. On the other hand, is the public’s reaction to mental illness; a plethora of prejudicial beliefs, emotions, and behaviors that cause the public to discriminate against those labeled mentally ill.”
Although the ability to refuse the internalization of negative societal attitudes exists, those with a mental illness often accept the premises and values which underlie their social identities. Vogel, Wade and Hackler (2007) contend that:
Despite the awareness of the relationship between perceived public stigma and the decision to seek treatment, the complex role that stigma plays in this decision-making process is not fully known…public stigma, is the perception held by others (i.e. by society) that an individual is socially unacceptable. The second, self stigma, is the perception held by the individual that he or she is socially unacceptable, which can lead to a reduction in self-esteem or self-worth if the person seeks psychological help.
Self stigma is also perpetuated through the views of individuals by mental health professionals. This is commonly referred to as disidentification. Servais and Saunders (2007) explain, “disidentification also occurs when one feature of an individual is used to define the totality of the individual’s existence, such as when mental health professionals refer to clients as their psychological disorder (e.g., “borderlines” and “schizophrenics”).”
In addition to the psychological perspective, researchers have also focused on the symbolic associations of medical labels and media images. Media portrayals are of great interest to researchers because they reflect and perpetuate stereotypical ways of thinking about mental health. Diefenbach and West (2007) explain, “Although media portrayals of mental illness have been predominantly negative, with factors such as ‘violence,’ ‘unpredictability,’ and ‘dangerousness’ cited as common characteristics of mentally disordered characters in the media, the question remains as to whether these portrayals are, indeed, inaccurate. The criminology literature supports the contention that media portrayals are sensationalized and exaggerated.” Television has always visualized violent and negative images of mental health issues. (Diefenbach and West, 2007).
The media has much to do with research into the social encounters between those with a mental illness and those without show there is a sense of being uncomfortable and uncertain when interacting with persons who are mentally ill. Corrigan, Larson and Kuwabara (2007) state the major form of discrimination against people with psychiatric disorders is represented in the belief that people with psychiatric disorders are dangerous or threats to society. In testing the hypothesis of disseminating more knowledge about mental illness, mental health professionals found it often leads to the increase in social distance. (Lauber, Nordt, Falcato & Rossler, 2004). As a result, many people choose to distance themselves from people with mental illness. Angermeyer and Matschinger (2005) stress, “regardless of whether people are familiar with mental illness or not, the beneficial effect of labeling on the stereotype, namely that there is less blaming for the occurrence of the illness, does not translate into a decrease for social distance.”
Social distance takes on a whole new meaning in America, in large part, due to the fact that so many people are still uninformed or, more likely, ill-informed about the course of mental illnesses. Arboleda-Florez (2003) simply tells us, “Prejudice often stems from ignorance or unwillingness to find the truth.” He continues:
For example, a study conducted by the Ontario Division of the Canadian Mental Health Association in 1993-1994 found that the most prevalent misconceptions about mental illness include the belief that mental patients are dangerous and violent (88%); that they have a low IQ or are developmentally handicapped (40%); that they cannot function, hold a job, or have anything to contribute (32%); that they lack willpower or are weak and lazy (24%); that they are unpredictable (20%); and finally, that they are to be blamed for their own condition and should just “shape up” (20%).
These myths and have not been substantiated through research. The misconceptions have constructed not only the common practice of social distance, but also the impression that people of all ages with mental illness have a stronger tendency for criminal activity.
After taking a closer look at the problem of stigma in mental illness, it becomes clearer that there are many layers to the association of mental illness and juvenile delinquency. Brett (2003) argues, “Arrest records have been used to examine patterns of offending in those with mental illness. Mentally disordered people have been found to be more likely to be arrested than those seemingly free of mental illness, even when the offending behaviors are the same.” To date, there is not a concise procedure for managing people with mental illness in regards to the justice system. Without the proper management of mental health cases, the justice system continues adding to the misconceptions.
Links between mental health and criminal activity have been closely associated, as well as increased attention to juvenile delinquency. Therefore, American children can be considered the difference in this equation. The connection between mental retardation and other disorders, especially autism, has become a growing debate. However, Edelson (2006) argues:
Research has shown that low scores on developmental scales do not predict subsequent development in children with autism as well as they predict the development in typical children and that adaptive scales can underestimate the intelligence of children with autism. Developmental and adaptive scales may be particularly problematic for higher functioning children with autism, who may have a discrepancy between their intelligence and what adaptive or developmental measures would predict.
The relationship between autism and juvenile delinquency has not been closely researched; however social behavior is very scrutinized. Edelson (n.d.) claims, “One of the most characteristic symptoms of autism is a dysfunction in social behavior.” Social avoidance, indifference and awkwardness are three classifications of social problems. Social avoidance is considered the complete evasion of any form of contact. Indifference takes place when the individual does not actively seek or avoid contact. Awkwardness occurs when individuals with autism might try extremely hard to create friendships, but continually struggle due to the fact that they often do not reciprocate the social interactions (Edelson, n.d.)
Even though these three classifications do not apply to all forms of mental illness, it is one of many examples the media uses to define mental illness to children. The media does this through animated films. Lawson & Fouts (2004) explain:
Understanding the presentation of mental illness in children’s movies is important for three reasons. First, numerous studies have shown that children’s exposure to TV and movies influence attitudes towards a wide range of social groups, that is, the elderly, persons with a mental disability and persons with obesity. Therefore, repeated exposure to depictions of mental illness in movies likely influences children’s attitudes towards persons with a mental illness.
Therefore, the media must be used to reverse this trend of misinformation and misconception.
Since this is a multidimensional problem, a multifaceted solution is required. Corrigan (2004) says, “Understanding stigma is only half of the battle; of equal importance is testing strategies that are… used in anti-stigma programs: protest, education and contact.” Arboleda-Florez (2003) adds:
Successful treatment and community management of mental illness relies heavily on the involvement of many levels of government, social institutions, clinicians, caregivers, the public at large, consumers and their families. Successful community reintegration of mental health patients and the acceptance of mental illness as an inescapable element of our social fabric can only be achieved by engaging the public in a true dialogue about the nature of mental illness, their devastating effects on individuals and communities, and the promise of better treatment and rehabilitation alternatives.
Furthermore, an important component of efforts to reduce stigma would be the dissemination of basic knowledge about mental illness to the general population. This would lead to the dissolution of fears and outrageous generalizations about mental illness and its parallel to violence and criminal activity; more importantly, juvenile delinquency. Since the media shapes the largest and most diverse audience, it stands to reason that the efficient method of dissemination is through the media. Defeinbach & West (2007) conclude, “Broadcast television is a unique medium because it uses the public airwaves. We have a vested interest in the content of broadcast television and the social effects of that content. Broadcasters must serve the public interest.” Newspapers could perhaps feature excerpts from memoirs of those who have written about their personal experiences of mental illness. Accounts of mental illness recovery would give positive and accurate portrayals of mental illness.
In addition to broadcast television, a very conducive alternative would be a program designed for the purpose of addressing mental health and stigmas. Goldberg (2006) explains her proposal for a talk show:
Therefore, to provide antidotes to tabloid talk shows, my program features licensed psychologists and descriptions of their professional credentials. The program’s interview format captures psychologists’ expertise and passion for their work. Programmers show respect for patient confidentiality by not exposing identities and problems.
These talk shows would need to find those mental health professionals that do not compound the stigmas of mental illness. This proposal could also branch off into an educational series designed for children, in order to correlate juvenile delinquency aspects of mental illness.
Moreover, mental health studies could expand on the areas of stigmatization effects, the relationship between the severity of illness and the perception of stigma. Mental health professionals could provide this information to develop a better understanding of the effects of stigmas on mental illness and approaches to weaken the stigma’s impact. (Corrigan, 2004). It would also be useful to get the public to articulate their beliefs and fears of mental illness, so that specific information could be provided to reduce negative beliefs about mental illness. These studies could be made available in either print or video publications to allow for wider audience dissemination. Also, mental health organizations can raise awareness by increasing the amount and scope of seminars and workshops, as well as open many of them to public audiences.
In addition to dissemination methods, judicial services could be provided to assist courts with cases involving mental health issues. Brett (2003) asserts, “In summary, mentally impaired defendants are an extremely stigmatized and marginalized group and good court liaison services can decrease the stigma and improve the management of these people. There are a large numbers of patients with mental illness in the justice system. As psychiatrists, we can help this group at many points, including ensuring that community services are comprehensive and community needs are addressed.” As part of the community, judiciary services can provide much needed assistance in reducing the affects of mental health stigmas in these cases and community issues at large.
Conclusion
Throughout mental health, the issues of stigma have plagued American society for a notable time. The idea that individuals must balance both a mental health issue and the social problem associated with it is quite overwhelming. Given that these cases also involve children, the affects are even more significant. The link between mental health issues such as autism and juvenile delinquency, as well as other violence, are a product of these common misconceptions by the general public. Through the use of a wide range of media, dissemination of material can not only inform and educate, but put to rest the stigma of mental illness. This will allow for the more important task of creating treatment and other services for those individuals diagnosed with a mental illness.
References
Angermeyer, M. C. & Matschinger, H. (2005) Labeling–stereotype–discrimination: An investigation of the stigma process. Social Psychiatry and Psychiatric Epidemiology, 40(5), 391-395.
Arboleda-Flórez, J. (2003). Considerations on the stigma of mental illness. The Canadian Journal of Psychiatry 48(10), 645-650.
Brett, A. (2003). Psychiatry, Stigma and Courts. Psychiatry, Psychology and Law, 10(2), 283-288.
Corrigan, P. W. (2004). Don’t call me nuts: An international perspective on the stigma of mental illness. Acta Psychiatrica Scandinavica, 109(6), 403-404.
Corrigan, P. W., Larson, J. E., & Kuwabara, S. A. (2007) Rehabilitation Mental illness stigma and the fundamental components of supported employment. Psychology, 52(4), 451-457.
Diefenbach, D. L., & West, M. D. (2007). Television and attitudes toward mental health issues: Cultivation analysis and the third-person effect. Journal of Community Psychology, 35(2), 181-195.
Edelson, M. G. (2006). Are the majority of children with autism mentally retarded? A systematic evaluation of the data. Focus on Autism and Other Developmental Disabilities, 21(2), 66-89. Web.
Edelson, M. S. (n.d.). Social Behavior in Autism. Web.
Feldman, D. B., & Crandall, C. S. (2007). Dimensions Of Mental Illness Stigma: What About Mental Illness Causes Social Rejection? Journal of Social and Clinical Psychology, 26(2), 137-155.
Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs: Penguin.
Goldberg, C. (2006). How to Make Psychology a Household Word Through Television: A Psychologist’s Experience as Host and Producer of a Weekly Program. Professional Psychology: Research and Practice, 37(2), 109-113.
Lauber, C., Nordt, C., Falcato, L., & Rossler, W. (2004). Factors Influencing Social Distance Toward People with Mental Illness. Community Mental Health Journal, 40(3), 265-274.
Lawson, A., & Fouts, G. (2004). Mental Illness in Disney Animated Films. The Canadian Journal of Psychiatry, 49(5), 310-314.
Servais, L. M., & Saunders, S. M. (2007). Clinical Psychologists’ Perceptions of Persons With Mental Illness. Professional Psychology: Research and Practice, 38(2), 214-219.
Vogel, D. L., Wade, N. G., & Hackler, A. H. (2007). Perceived Public Stigma and the Willingness to Seek Counseling: The Mediating Roles of Self-Stigma and Attitudes Toward Counseling. Journal of Counseling Psychology, 54(1), 40-50.