Lay Summary

We analysed perceived obstacles in accessing social roles for those labelled as “mentally ill”. In addition to stigma, social norms and trends exacerbate exclusion processes, affecting potentials for recognition, recovery and inclusion. These findings are important for public health and the development of anti-stigma strategies.

Background

The so called “second illness” refers to mental illness stigma and its devastating consequences for recovery. Prejudices concerning mental illness are deeply embedded in social and cultural norms marking those affected as tainted and of less value, leading to discrimination, social rejection, and reduced access to social roles. Those associated with the label of mental illness are prone to be defined as “the others” and therefore in danger of having reduced opportunities for participation and recognition. Perceived social norms and associated role expectations determine what is considered to be “a good life”. Perceptions that accomplishments and contributions are recognized by others (positional recognition), as bearers of equal rights (moral recognition) and emotional attention (emotional recognition) expresses the subjective perception of reality and are crucial for self-images. Therefore, we ask: - Which obstacles can be identified in accessing social roles? - What are the perceived social and cultural norms associated with obstacles?

Methods

We use data from three out of five parts of the project Monitoring Public Stigma Austria 1998-2018. In detail results of - focus-groups with experts by experience to identify relevant fields (n=3); - guided interviews for an in-depth understanding of experiences and the rationale behind them (n=20); - a quantitative survey to determine the extent of perceived stigma and discrimination among people with lived experience (n=344).

Results

Stigma as well as societal trends, such as achievement orientation and increasing performance pressure, devaluation of emotions, empathy and compassion, represent obstacles in accessing and carrying out social roles, therefore further compromising social resources crucial for recovery. People fall short in fulfilling their own expectations as well as those implicit in normative rules. In particular, being unemployed, poor or being dependent on welfare goes along with perceptions of being a “non-productive” member of society (positional recognition). This applies to social relationships as well. Certain expectations go along with being a friend, a parent, or a spouse. Not meeting such expectations creates risks that undermine sources of emotional recognition. An additional burden is the constant pressure to justify why expectations may not be fulfilled (moral recognition).

Conclusion

Stigma in relation to perceived norms and social developments further exacerbate the exclusion of people with mental illness. This not only points to the intersectional nature of stigma, but also brings light to societal developments that compromise mental health. These effects ultimately have an impact on all members of society and therefore identify as a public health issue. Anti-stigma strategies should address such common goal issues that bridge group differentiations.