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Description
The stigma of severe mental illness (SMI) is pervasive throughout the world. It is well-documented that the public views individuals with SMI as incompetent, violent, and even homicidal. Being labeled with SMI has been shown to significantly limit the opportunities for jobs and housing afforded to those who are diagnosed. Not surprisingly, many individuals with SMI choose to conceal their illness in an attempt to circumvent negative consequences the lay public's perceptions can have on their lives. Given perceived concerns regarding political correctness, however, contemporary stigma may not emerge directly from an SMI label but from other, less obvious, indicators of illness. Behavioral symptoms (e.g., unusual mannerisms) may 'leak' the diagnosis and serve as cues that trigger stigma independently of, or in conjunction with, clinical SMI labels. If this is the case, attempts by those with SMI to conceal their diagnosis may be seriously undermined. The current study investigated the effect of symptoms versus labels on stigma. Schizophrenia (SZ) and major depression (DP) were examined in a 3 (Symptoms: SZ, DP, Control) x 2 (Label: Absent, Present) x 2 (Order: Symptoms first, Label first) between-participants factorial design. Participants (N = 200) read a fictitious job application. Applicant qualifications (e.g., education, experience, etc.) were held constant across conditions. Symptoms were manipulated using notes from a telephone interview in which the applicant's former employer provides a description of the applicant's behavior pretested to be stereotypic of SZ, DP, or Controls. SMI label was manipulated using a background check containing a criminal, medical and psychiatric history. Stigma was assessed via likelihood of hiring the applicant, starting salary assigned, and expected job performance, among others It was hypothesized that, on average, applicants exhibiting SMI symptoms would be stigmatized more than applicants not exhibiting symptoms. Results revealed that this was indeed the case. If political correctness (PC) is not an issue for SMI stigma, applicants with an SMI label were expected to be stigmatized more than those with no SMI label. Results revealed that this was not the case. If PC is an issue, it was hypothesized that applicants presented with an SMI label should be stigmatized less, especially when the label information preceded symptoms information. Results revealed that this was the case, but that the effect varied by disorder type. When the SMI label was present, participants stigmatized the SZ applicant more when they were exposed to SMI symptoms before an SMI label. Conversely, when the SMI label was present, participants stigmatized the DP applicant more when they were exposed to an SMI label before SMI symptoms. Understanding the processes underlying SMI stigma has important ramifications for SMI stigma reduction. Because behaviors of SMI appear to signal a diagnosis even in the absence of an SMI category, then stigma interventions intended to help the mentally ill should address the influence of behavioral symptoms. Because stigma expression appears to be influenced by PC, methods to investigate SMI stigma that are less vulnerable to PC motivations should be undertaken.
