The Paradox of Self Stigma in Serious Mental Illnes

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DESCRIPTION (provided by applicant): Many people with mental illness may personally respond to stigma by self-stigmatizing. Self-stigma (defined as lowered self-esteem and diminished self-efficacy that result from believing the various stereotypes that exist about mental illness) has been shown to undermine adherence to empirically-sound treatment programs as well as derail the pursuit of rehabilitation goals. The personal reaction to stigma is a fairly complex experience however, best understood as a paradox. Some people with mental illness respond to psychiatric stereotypes with diminished self-esteem and self-efficacy. Others, however, are energized by stereotypes and respond with righteous anger. A third group seems to be relatively indifferent to the experience altogether. We propose two studies in this exploratory/developmental grant application to better understand self-stigma and our model of paradox. In STUDY 1, we develop and evaluate a measure of self-stigma in people with serious psychiatric disability. Test items reflect the three components of self-stigma: awareness of the stereotype, application of the stereotype to one's self (stereotype self-concurrence), and having self-concurrence lead to diminished self-esteem and self-efficacy (self-concurrence esteem decrement). We use Link's (1987; et al., 2001) Devaluation-Discrimination Measure as the scale to assess stereotype awareness and add corresponding items that evaluate stereotype self-concurrence and self-concurrence esteem decrement. In a preliminary stage of development, fifty research participants with serious mental illness will complete the test twice; subsequent item analysis will yield a more psychometrically sound measure. In the second stage, a sample of 70 other participants with serious mental illness will be administered the revised version of the scale along with measures of self-esteem, self-efficacy, depression, social cue perception, disease awareness, and thought disorder. In STUDY 2, effects of perceived legitimacy and in-group identification on self-stigma will be assessed. Seventy adults with serious mental illness will be administered the Measure of Self-Stigma in Mental Illness. They will also complete measures of the perceived legitimacy of mental illness stereotypes and in-group identification with people labeled mentally ill. A measure of righteous anger will also be collected. Findings from the proposed research will provide a necessary first step in designing strategies for helping people cope with self-stigma.