The Mark of Shame: Stigma of Mental Illness and an Agenda for Change »

Stephen P. Hinshaw is Professor and Chair, Department of Psychology, University of California-Berkeley.

Millions of people and their families are affected by mental illness; it causes untold pain and severely impairs their ability to function in the world. In recent years, we have begun to understand and develop a range of effective treatments for mental illness. Even with this shift from moralistic views to those emphasizing the biological and genetic origins of mental illness, punitive treatment and outright rejection remain strong. Public attitudes toward mental illness are still more negative than they were half a century ago, and the majority of those afflicted either do not receive or cannot afford adequate care. As a result of all of these troubling facts, applying the term "stigma" to mental illness is particularly appropriate because stigma conveys the mark of shame borne by those in any highly devalued group.

Mental illness tops the list of stigmatized conditions in current society, generating the kinds of stereotypes, fear, and rejection that are reminiscent of longstanding attitudes toward leprosy. Mental disorders threaten stability and order, and media coverage exacerbates this situation by equating mental illness with violence. As a result, stigma is rampant, spurring family silence, discriminatory laws, and social isolation. The pain of mental illness is searing enough, but adding the layer of stigma affects personal well being, economic productivity, and public health, fueling a vicious cycle of lowered expectations, deep shame, and hopelessness.

In this groundbreaking book, Stephen Hinshaw examines the longstanding tendency to stigmatize those with mental illness. He also provides practical strategies for overcoming this serious problem, including enlightened social policies that encourage, rather than discourage, contact with those afflicted, media coverage emphasizing their underlying humanity, family education, and responsive treatment.

The Mark of Shame is a deeply inspiring and passionate work that is realistic and filled with hope. It combines personal accounts with information from social and evolutionary psychology, sociology, and public policy to provide messages that are essential for anyone afflicted or familiar with mental illness.

Doody Review Services

Reviewer:Steven T. Herron, MD(University of Arizona Health Sciences Center)
Description:This book addresses both historical perspectives of psychiatric disorders and societal responses to the issues surrounding them, as well as the stigma associated with mental illness.
Purpose:The author's main goal is to learn the "complex, troubling, and intensely interesting" reasons for the stigma by "weighing evidence thoughtfully and scientifically," without a dispassionate approach to the problem.
Audience:This work is geared primarily for mental healthcare providers or those who have a desire to better understand psychiatric disorders and their consequences.
Features:The first few chapters address various perspectives on mental disorders and the emergence of stigma associated with these conditions, while the remaining chapters offer some practical recommendations for future research in this area and suggestions for overcoming the stigma encountered by these populations. The book is extensively referenced and includes further clarification and annotating in the "Notes" section at its conclusion.
Assessment:After recently reviewing another book with a similar bent (including numerous chapters discussing methods to confront the discrimination of individuals with mental disorders), I found this book offering a more historical perspective on the issue, with fewer personal accounts to assist readers in appreciating the struggle faced by individuals with mental health issues. This provides readers with a more sterile and scientific view of the challenges facing mental health advocates, which in many cases is not necessarily detrimental to the presentation of the material. Particularly thought-provoking is the chapter related to media portrayals of individuals with psychiatric disorders, including examples of powerful interventions by groups attempting to illustrate the prejudice many hold against the mentally ill, as well as suggestions for marketing strategies to eliminate the bias against the population. The book further illustrates the sad and troubling fact that those with mental illness remain second-class citizens despite their ever-growing numbers in the general population.

1 What is mental disorder and what is stigma? 3

2 Perspectives from social psychology, sociology, and evolutionary psychology 28

3 Historical perspectives on mental illness and stigma 53

4 Modern conceptions of mental disorder 73

5 Evidence from scientific investigations 93

6 Indicators of stigma from everyday life 115

7 Stigma of mental illness : an integration 140

8 Research directions and priorities 157

9 Overcoming stigma I : legislation, policy, and community efforts 176

10 Overcoming stigma II : media and mental health professionals 202

11 Overcoming stigma III : families and individuals 217

12 Concluding issues 232