Chapter 3
Replacing Stigmatizing Beliefs and Behaviors with Affirming Attitudes and Actions that Advance Recovery and Self-Determination
Chapter Overview
The stigma of mental illness can be as disabling as the symptoms of the psychiatric disorder themselves. We describe stigma as occurring at the public and self-levels. Public and self-stigma are understood by social cognitive constructs including stereotypes, prejudice, and discrimination. The goal of changing public stigma, for example, is to decrease hurtful impact of these constructs on the personal life goals of the person with mental illness. But as many advocates note, changing the troubling effects off stigma is not enough. Stigma change is most effective when the public replaces stigma with affirming attitudes. Affirming attitudes represent the optimism of recovery, the current vision of up-to-date service programs. They include positive beliefs about mental health and corresponding services. Despite recurring symptoms, people can achieve their life goals with hope and self-determination. Attitudes are not enough; equally important are affirming attitudes such as reasonable accommodations. What can one’s community do to accommodate the person’s pursuit of their goals? The chapter then dives deeply on how a person might replace prejudice and discrimination with affirming attitudes. Education and contact are two approaches that have been well-studied for stigma change and promoting affirming attitudes and actions.
Video
Watch co-author Patrick W. Corrigan introduce Chapter 3. He shares his academic background and explains the chapter’s focus on two key areas: the impact of stigma on individuals with serious mental illness and strategies for fostering supportive community environments.
Reflective Questions
Designed to encourage critical thinking, real-world application, and meaningful discussion.
- How does stigma operate differently at individual, organizational, and societal levels?
- In what ways might well-intentioned professionals unintentionally reinforce stigma?
- How does diagnostic labeling both support and constrain access to care?
Resource Connect
Links to professional standards, policy frameworks, and cross-referenced chapters that support deeper exploration.content.
SAMHSA Recovery Principles
Substance Abuse and Mental Health Services Administration. (2012). SAMHSA’s working definition of recovery: 10 guiding principles of recovery (Publication No. PEP12-RECDEF). The principles include hope, person-driven recovery, multiple pathways, holistic care, peer support, relationships, culture, trauma responsiveness, strengths and responsibility, and respect.
Contact-Based Stigma-Reduction Research
- Corrigan, P. W., Morris, S. B., Michaels, P. J., Rafacz, J. D., & Rüsch, N. (2012). Challenging the public stigma of mental illness: A meta-analysis of outcome studies. Psychiatric Services, 63(10), 963–973. This meta-analysis compares protest, education, and contact-based approaches to reducing public stigma.
- Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., Rose, D., Koschorke, M., Shidhaye, R., O’Reilly, C., & Henderson, C. (2016). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. The Lancet, 387(10023), 1123–1132. The review identifies social contact as particularly effective for improving stigma-related knowledge and attitudes in the short term, while noting that evidence for sustained effects is more limited.
Cross-reference: Chapter 1 – Lived Experience; Chapter 2 – Recovery and Beyond
Further Resources
Suggested readings, research areas, and materials for extended learning.
Foundational Stigma Research
Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness. World Psychiatry, 1(1), 16–20. The article distinguishes public stigma from self-stigma and explains how stereotypes, prejudice, and discrimination restrict opportunities and undermine recovery.
Conceptualization of Stigma
Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385. Link and Phelan conceptualize stigma as the convergence of labeling, stereotyping, separation, status loss, and discrimination within a context of unequal social, economic, and political power.
Peer-Reviewed Literature on Structural Stigma
- Hatzenbuehler, M. L., Phelan, J. C., & Link, B. G. (2013). Stigma as a fundamental cause of population health inequalities. American Journal of Public Health, 103(5), 813–821. The authors examine the psychological and structural pathways through which stigma produces and reproduces health inequalities.
- Hatzenbuehler, M. L. (2016). Structural stigma: Research evidence and implications for psychological science. American Psychologist, 71(8), 742–751. Structural stigma is defined as societal conditions, cultural norms, and institutional policies that constrain the opportunities, resources, and well-being of stigmatized populations.
National Anti-Stigma Campaign and Communication Toolkits
- National Alliance on Mental Illness. (n.d.). NAMI StigmaFree Workplace. The initiative offers organizational resources addressing mental-health awareness, supportive workplace culture, access to assistance, and nonstigmatizing communication.
- Substance Abuse and Mental Health Services Administration. (2026). Mental Health Awareness Month digital toolkit. The toolkit provides educational materials and shareable content that organizations and communities can use to promote mental-health awareness, recovery, and help-seeking.
- Mental Health Commission of Canada. (2015). HEADSTRONG: Planning a youth anti-stigma summit—Toolkit. This implementation guide uses contact-based education and youth leadership to help schools and communities organize anti-stigma activities