shame. This is a research book about the impact of stigma on the lives of people affected by mental illness. How can we help people from being victimized by the prejudice and discrimination that arises from stigma? Stigma has a harmful impact on people with mental illness and their family. In this first chapter we can find the distinction between public stigma (ways in which the general public reacts to a group based on stigma about that group) and self stigma (the reactions which individuals turn against themselves because they are a member of a stigmatized group). There are stereotypes, prejudices and discrimination. Most people know the stereotype “the mentally ill is dangerous” Agreeing with the stereotype is where prejudice comes in and results in discrimination. Prejudice that yields anger can lead to hostile behavior like physically harming a member of a minority group. Angry prejudice may lead to withholding help or replacing healthcare with services provided by the criminal justice system. Fear leads to avoidance so many employers do not want to hire people with mental illness. THE IMPACT ON PEOPLE WITH MENTAL ILLNESS: People with mental illness suffer the greatest impact from stigma. 1- Stigma has a harmful impact on obtaining good jobs and leasing safe housing. People with mental illness are frequently unable to obtain good jobs or find suitable housing because of the prejudice of key members in their communities; employers and landlords. 2- Stigma interacts with violence issues to cause people with mental illness to have a deformed experience with the criminal justice system. Attitudes and beliefs held about mental illness by police officers (police officers are often the first point of contact with the criminal justice system for a person with mental illness) may have significant consequences in terms of safety

and quality of life for both the general public and the individual with mental illness. General health-care system seems to withhold appropriate medical procedures because of mental illness stigma. THE IMPACT ON FAMILY MEMBERS, PROVIDERS AND OTHERS: The prejudice and discrimination experienced by the persons with psychiatric disorders also affects family, providers, and others associated with the person with mental illness. For example some family members experience others trying to avoid them because of their relative. Because of stigma undergraduates are less likely to pursue training in psychiatry and other mental health disciplines, residents and graduate level trainees experience stigma and demoralization as professionals, and actual practitioners feel underappreciated by their patients and by society. THE IMPACT ON THE AT LARGE PUBLIC: Stereotypes about mental illness cause people with mental illness to lose their chance to be successful because they belong to a marked group. Therefore because of society’s ignorance, they are deprived of job and housing opportunities and must be supported by government assistance. Stigma also maintains personal fears; almost everyone worries at sometime in their life about having a “nervous breakdown” THE IMPACT OF SELF STIGMA Self-stigma occurs when individuals assimilate social stereotypes about themselves as persons with mental illness. Self-stigma results in a loss of self-esteem, diminished self-efficacy, and a hesitancy to participate in society at large. Most of them choose not to pursue mental health services because they do not want to be labeled a “mental patient” or experience the prejudice and discrimination that the label entails. UNDERSTANDING STIGMA AT THE SOCIETAL LEVEL Two levels of stigma in society have been identified: institutional policies and social structures. Institutional Policies and Stigma: Generally there is one person (e.g. the CEO of a company) or a group of people in positions of power with a

prejudicial agenda who promote the agenda by enacting policies that discriminate against a group. Social Structures and Stigma: Sociologists have identified structural stigma that develops historically as the result of the economic and political injustices wrought by prejudice and discrimination. This concept has mostly been used to explain racism and sexism. Although there is not clearly a prejudicial group in power maintaining structural stigma; rather, it is the product of historical trends in discrimination. The Role of Affirmative Actions: Affirmative actions are needed to resolve structural discrimination and stigma.