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MENTAL ILLNESS STIGMA: AN ETHICAL ISSUE

Mental Illness Stigma: An Ethical Issue

By Priscilla Hernandez
California State University, Long Beach

MENTAL ILLNESS STIGMA: AN ETHICAL ISSUE

ABSTRACT
Stigma is created throughout society by viewing others and creating a stereotype, prejudices, and
negative behaviors towards a certain group, crowd, or an induvial. Stigma becomes an ethical
issue when it interferes with individuals rights when it comes to equality. People who view the
world differently than others if they have a physically or mental disability shouldnt be treated
any different. They have all the capabilities as others using their own skills and resources.
Healthcare providers need to advocate peoples interest come first and focus on Autonomy,
Beneficence, and Non-Maleficence throughout their practice.
Key Words: Stigma, Ethics, Self-Stigma

MENTAL ILLNESS STIGMA: AN ETHICAL ISSUE

We were not paraplegic, quadriplegic or someone with cancer, we were treated like
humans stated by Cheryl Smith who suffered spinal cord injury in 1989. On November 16,
2015 two guest speakers by the names of Cheryl Smith and Tiffany Richardson spoke for the
class REC 453 at California State University of Long Beach. Tiffany Richardson the Lead of
Spinal Cord Center at St. Jude Medical Center, CA and Cheryl Smith shared their personal
experience using Recreation Therapy. Listening about Cheryls experience as a patient growing
and gaining life again by using Recreation Therapy was inspirational and very moving as a future
Recreation Therapist. Listening to Tiffany the Recreation Therapist from her perspective
provides inspiring motives and awareness of the life changing opportunities that I will be able to
give future patients as she as did for Cheryl the women with paraplegia. Their inspiring life story
through using Recreation has shown that Recreation Therapists always believe in the person,
their strengths, and their skills. A metaphor that is always used in classes of my major is Its not
about the disability, its about their capabilities, gives a perfect illustration. Recreation Therapist
strive to provide equal access to all patients no matter what their circumstances are. Healthcare
providers, specifically Recreation Therapist for this paper are to follow the basic principles of
Biomedical Ethics as Virtues such as providing Autonomy, Beneficence, and Non-Maleficence.
Anything interfering with these basic principles are in most cases be subjected to stigmatization.
According to dictionary.com the definition for stigma is a mark of disgrace or infamy; a stain or
reproach, as on one's reputation; a mental or physical mark that is characteristic of a defect or
disease. Unfortunately this definition describes negative characteristics of a person in which
their behavior can lead to aggressive situations such as during adolescent/teenager ages known as
peer stigmatization, also this behavior is given throughout the healthcare work field, and stigma
creates difficulties for patients seeking healthcare services, thus creating ethical issues.

MENTAL ILLNESS STIGMA: AN ETHICAL ISSUE

Peer stigmatization generates a continuous set of negative manifestations over and over
leading a persons life into imbalanced chances at lifes opportunities. Research shows that
rejected children with emotional and behavioral problems are at risk of experiencing adverse
developmental outcomes from educational underachievement and unemployment to delinquency
and problem behavior.As mental health problems persist over time, people are susceptible to
potential lifelong stigmatization, which may have originated in childhood. (Heary, Hennessy, &
Mckeague, 2012) Recreation Therapist are healthcare professionals who can take those rejected
children with emotional and behavior problems by assessing them and creating personalized
assessments. These assessments can give those children a chance to a healthy wellbeing lifestyle
by using Recreation as a therapy form. In order for Recreation Therapist to do this they cant
stigmatize, but sadly so many healthcare professionals, family, friends, classmates, or people in
general are insensitive to those who display abnormal behaviors because they dont
understand or dont realize that it is caused by a mental health problem which is an illness that
can be treated. More importantly not only if they cant be treated they can still live an adaptive
lifestyle. Setting goals for children/adolescents with the intention of opposite stigma intentions
would be to focus on their future achievements in education and in employment. Narrowing
down to what are the possibilities, focusing on their skills at hand, and their interest will look
passed their disadvantaged areas. These disadvantages unfortunately shine through first in the
eyes of people who dont understand the positive outcomes that can be accomplished. When
people dont understand what the person is going through they may think of it as a laughing
matter. Inadequate awareness of the reasons, treatment, and symptoms of psychological
disorders frequently points to commonly inaccurate theories. (HealthMad.com, 2011)
Inadequate awareness opposes the Natural Law Ethical Theory as mentioned in the textbook by

MENTAL ILLNESS STIGMA: AN ETHICAL ISSUE

Eileen E. Morrison and Beth Furlong. All people deserve equal ethics such as to seek only whats
good and avoid what is bad.(Morrison & Furlong, 2013) Focusing on approaching people
without stigma produces good intentions by thriving for the patients interest first. Peers that get
to know the person and not their disability helps produce less peer stigmatization. Overall getting
to know more people grows into a strong network that can benefit the individual and more.
Instead of focusing on the negative so much more can be accomplished by focusing on the
positive. If being positive with any disability, age, or sex was taught to the younger generation
through anti-stigma interventions there could be less negative attitudes towards mental illness
and eventually that younger generation would lead to be advocates for awareness of mental
illness and how to be sensitive in personal matters.
First, negative attitudes towards mental illness are rooted in early childhood, but they
may not fully emerge until puberty. Second, anti-stigma interventions can promote helpseeking behaviors of adolescents who face the risk of a number of mental illnesses
including schizophrenia eating disorders, and obsessivecompulsive disorder.
Researchers therefore have explored using indirect video-based contact as a more feasible
way to reduce psychiatric stigma. (Chan, Mak, & Law, 2009)
Peer stigmatization can lead to potential lifelong stigma unless it is addressed at early age
when negative attitudes can be engrained. Addressing these negative attitudes have been
tested by using video-based contact to reduce stigma. By providing a visual with more
than one perspective gave a positive and successful outcome. (Chan, Mak, & Law, 2009)
Teaching non-stigma interventions at early ages can bring a world of equality for all human
beings no matter what sign of age, health condition, or sex. Bringing a new scope of practice as

MENTAL ILLNESS STIGMA: AN ETHICAL ISSUE

simple as teaching sensitivity not only to the young students but also to healthcare providers can
produce less stigma in healthcare ethics.
There have been many incidences where healthcare providers need to ask their patients
very private matters, but arent sensitive to the patient on their way of approach. Training and
education in ethics, and teaching how to handle complex or stigma associated illnesses, are
necessary for medical providers to experience to enrich their moral practices. Teaching the
public, via meetings about different stigmatizing disorders, may provide assistance in dissolving
related myths. This type of education might alleviate stigma, summon monetary assets, request
community contribution, and aid in finding care for the mentally ill. (Healthmad.com, 201 It is
important to not judge, criticize, or use your own opinions when youre a healthcare professional
in addition attending workshops or furthering your education to learn about ethics will defiantly
provide information on how to handle unethical decisions. Constantly incorporating the
principles of biomedical Ethics such as Autonomy, Beneficence, and Non-Maleficence would be
the golden rules to follow. Healthcare providers shouldnt constantly demonstrate stigmatizing
responses to patients. When healthcare providers reveal their negative attitudes, attributions and
discriminatory behavior this then reflects their work ethics and their community. Public stigma
shapes views of the population as a whole; as part of this population, people with mental illness
will also be influenced by public stigma, which in turn may impact their sense of employability.
(Corrigan & Powell, 2012) Public stigma impacts people with disabilities/mental illness personal
identities and their way of life by limiting their employment chances. People need to work to
fulfill their current income status and their future. Its also important to work because it gives
that person a chance to learn and grow in the field they wish to be successful in. When status of

MENTAL ILLNESS STIGMA: AN ETHICAL ISSUE

mental illness becomes stigmatized it disrupts the possibilities that work can make available thus
creating ethical issues in employment for the individual and for the employer.
The resultant fear and strong reactions from the dangerousness stereotype lead to social
avoidance and a desire to segregate individuals with mental illness to avoid the mistaken
belief that they are protecting themselves from potential violent individuals.(Corrigan &
Powell, 2012)
This dangerous stereotype leads employers to have fear thus segregating individuals from the
hiring process for employment. They may further think that if they even do hire people with
mental illness that they will need to make special accommodations that would then create bias
controversies in the work field among other workers as far as equal treatment for everyone.
Employers need to practice good healthcare ethics by not even thinking of the bad right away.
Automatically the idea is to always follow Autonomy, the Moral Law, and the Will according to
the textbook Heath Care Ethics: Critical Issues for the 21st Century by Eileen E. Morrison and
Beth Furlong states If reason completely determined the will, the action would without
exception take place according to the rule (p19) Keeping in mind ethically the Autonomy of a
person such as always allowing the person to decide for oneself not for employers to decide for
them. If employers are going against autonomy and demonstrating discrimination of an
individual this can cause self-stigma.
Stigma creates difficulties for patients seeking healthcare services resulting from selfstigma formed in time. People with mental illness often internalize negative views about mental
illness, resulting in self-stigma, which is associated with giving up life goals and with
demoralization. Cross-sectional data suggest that empowerment, the conceptual opposite of selfstigma, is associated with lower levels of experienced discrimination across various life

MENTAL ILLNESS STIGMA: AN ETHICAL ISSUE

domains. (Rush, Kawhol, & Bartsh, 2014) The term empowerment is a word that can be a
motivational throughout the work field and can provide benefits for the employer if
empowerment behavior is enforced. All employees no matter what health concern that they may
particularly have employees shouldnt have to feel that self-stigma is internally developing.
When employees arent doing well then the company wont be doing well either. To thrive for a
successful business the employer must focus on their employees. Its biased and unfair for
anyone to be going through turmoil, discrimination, prejudices, or any stereotype targeting in a
work field. People who gain self-stigma would potentially lead to even more health problems
therefore employing virtue ethics can benefits the employee and the employer.
Employing the virtue ethics positioning can aid in the battle of mental illness stigma
because virtues essential to medicine consist of accountability, modesty, bravery,
restraint, unrestricted positive respect, contributions, awareness, dexterity, confidence,
faith, adoration, reverence for patients, honor, selflessness, proficiency and humanity.
(Healthmad.com, 2011)
Battling mental illness stigma is a challenge, but it is defiantly possible. Virtue ethics provides
cushioning to avoid any discomfort on either party. Human beings who encounter others that
view the world defiantly then they do should keep in mind that they may be already going
through self-stigma. Self-stigma could be developed from having been rejected, excluded,
ridiculed, or bullied in the past. This can give those who are experiencing self-stigma the reason
of behaviors such as being anxious or insecure because there view of life is unfortunately
misunderstood and hostile to them. People who are experiencing self-stigma hopefully engage
with individuals that provide understanding and kindness. This will help generate a reach back to
non-stigma by others not ignoring anyone. As a future Recreation Therapist virtue ethics will be

MENTAL ILLNESS STIGMA: AN ETHICAL ISSUE

incorporated when patients seek therapy. Its important for patients to seek help because it will
help them accomplish their goals. Self-stigma may also interfere with the pursuit of such
rehabilitation goals as living independently and obtaining competitive work For example, a
classic study by Link (1982) found that people with diminished selfefficacy that results from
selfstigma were less likely to pursue employment and independent living opportunities.
(Corrigan, Watson, & Barr, 2006) Recreation Therapist will be able to assess individuals and
create goals such as pursue employment and independent living opportunities. Of course each
individual is different so the assessments are going to also be different but the main goal is nonstigma and to reach the goal.
In Conclusion, Stigma is an ethical issue due to producing controversy, inequality, and
discrimination in healthcare work, home, and in the community. Stigma is such a powerful
discrimination that it affects adolescents/teenagers at since learning can be engrained at a young
age. Teaching them to be sensitivity and provide knowledge about the awareness of mental
health illness can help them become advocates in their future for equality for all. Equality for all
also must be provided in the work field. Employers and Employees coming together and working
together makes them stronger when all ends are meet equally in a positive empowered
movement. If ethics arent established difficulties can arise internally such as self-stigma. Selfstigma is very difficult to overcome, but working together as a whole can generate a cure for all
to live a proper well-being in life.

References:

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MENTAL ILLNESS STIGMA: AN ETHICAL ISSUE

Chan, Y. J., Mak, W.W., & Law, S.L. (2009). Social Science & Medicine. Combining education
and video-based contact to reduce stigma of mental illness: The same or Not the Same anti
stigma program for secondrary schools in Hong Kong, 68(8), 1521-1526.
doi:10.1016/j.socscimed.2009.02.016
Corrgian, A., Watson, C. A., & Barr, L. (2006). The Self-Stigma of Mental Illness: Implications
for Self-Esteem and Self-Efficacy. Journal of Social and Clinical Psychology. 25(9). 875-884.
Corrigan, P. W., & Powell, K. (2012). How does stigma affect work in people with serious
mental illnesses? Psychiatric Rehabilitation Journal, 35(5), 381-384.
Heary, C., Hennessy, E., & McKeague, L. (2012). Explicit and implicit stigma towards peers
with mental health problems in childhood and adolescence. Journal of Child Psychology and
Psychiatry, 53, 1054-1062. DOI: 10.1111/j.1469-7610.2012.02580.x
Mental Illness Stigma: An ethical Issue. (2011) Retrieved from: http://healthmad.com/mentalhealth/mental-illness-stigma-an-ethical-issue/2/
Morrison, E. E., & Furlong, B. (2013). Health care ethics: Critical issues for the 21st century.
(3rd ed.). Burlington, MA: Jones & Bartlett Learning.
(R. Tiffany., & S. Cheryl, Shared their personal experiences with using Recreation Therapy,
November 16, 2015).
Rush, N., Nordt, C., Kawhol, W., & Bartsch, B. (2014). Work-Related Discrimination and
Change in Self-Stigma Amond People with Mental Illness during Supported Employment.
65(12). 1496-1498. http://dx.doi.org/10.1176/appi.ps.201400073
Stigma.(n.d.) In Dictionary.com Retrivied from http://dictionary.reference.com/browse/stigma