Resisting The Stigma of Mental Illness

Resisting the Stigma of Mental Illness
Author(s): Peggy A. Thoits

Source: Social Psychology Quarterly, Vol. 74, No. 1 (MARCH 2011), pp. 6-28
Published by: American Sociological Association
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ASSA
AMERICAN SOCIOLOGICAL ASSOCIATION
Social Psychology Quarterly

74(1) 6-28
Resisting the Stigma of © American Sociological Association 201 1
DOI: 10.1177/0190272511398019
Mental Illness http://spq.sagepub.com
USAGE
Peggy A. Thoits1
Abstract
The relationship between stigmatization and the self-regard of patients /consumers with m
tal disorder is negative but only moderate in strength , probably because a subset of pers
with mental illness resists devaluation and discrimination by others. Resistance has seldom
been discussed in the stigma and labeling literatures, and thus conditions under which ind
viduals are resistant have not been identified. I define resistance as opposition to the impo
tion of mental illness stereotypes by others and distinguish between deflecting ("that's no
me") and challenging resistance strategies. Individuals should be more likely to employ res
tance strategies when they have: past experience with stigma resistance; past familiarity
an ill family member or friend; symptoms that are non-severe or controlled; treatment e
rience in settings run by consumers; initially high levels of psychosocial coping resou
and multiple role-identities. Incorporating resistance into classic and modified labeling the
ories of mental illness highlights the personal agency of labeled individuals, missing
cially in classic labeling theory.
Keywords
stigma, mental illness, resistance, coping
People who have been labeled mentally has been paid in the stigma and label-
ill have acquired a stigma - an attri- ing literatures to the forms that stigma
bute that is "deeply discrediting" resistance can take or the conditions
(Goffman 1963:3), accompanied by ster- under which it is probable. My purpose
eotyping, rejection, status loss, discrim- is to delineate two types of resistance
ination, and low power (Link and and identify contingencies that make
Phelan 2001). Most theorists assume resistance to stigma more likely, with
that stigmatization almost inevitably mental illness as my case in point
results in self-devaluation or low self- (although these concepts and contin-
esteem, but unexpectedly, the evidence gencies also may apply more broadly
for this presumption is contradictory to other types of stigma).
(Crocker and Major 1989; Crocker,
Major, and Steele 1998; Major and Indiana University
O'Brien 2005). I will argue that an
Corresponding Author:
appreciable percentage of labeled indi-
Peggy A. Thoits, Department of Sociology, 744
viduals resist stigma and stereotyping Ballantine Hall, 1020 E. Kirkwood Avenue, Indiana
rather than accept or adapt to it. University, Bloomington, IN 47405
Surprisingly little theoretical attention Email: pthoits@indiana.edu
Resistance to Stigma 7
THEORETICAL BACKGROUND: other people. These stereotypes are

SYMBOLIC INTERACTIONISM AND learned early in life and are reinforced
LABELING over time in ordinary interaction
and by caricatures in the media.
Symbolic interactionism in general and Stereotyped expectations lead "normals"
labeling theories in particular clearly (Goffman 1963) to block labeled individ-
suggest that social devaluation will uals from returning to conventional
produce seZf-devaluation. The key pro- activities and to reward them for behav-
cess linking society and the self in this iors that conform to the mental patient
approach is "taking the role of the role (Goffman 1961). Observing them-
other" (Cooley 1902; Mead 1934): we selves acting in accordance with stereo-
see ourselves as meaningful social typed expectations, and highly sensitive
objects (who we are) and appraise our when in crisis to the cues provided by
goodness, worthiness, and competence others, labeled persons conclude that
(how good we are) through the eyes ofthey must be mentally ill and accept
significant others and from the stand-the mental patient role as an identity.
point of the wider community. BecauseSubsequent episodes of stress further
the meanings of social objects and social impair labeled individuals' ability to
acts are culturally shared (Blumer 1969; control their behavior, repeatedly vali-
Mead 1934), an undesirable category ordating their own and others' views of
label applied by others to the self their illness and incompetence. In short,
becomes an undesirable social identity. labeling and differential treatment by
That identity in turn results in self- other people produces a "mentally ill"
devaluation (Goffman 1963), or, in identity and self-devaluation.
more contemporary terms, produces Link's modified labeling theory (Link
"self-stigmatization" (Corrigan and 1987; Link et al. 1989) elaborates and
Watson 2002; Corrigan and Calabrese extends this traditional approach. In
2005) or "internalized stigma." this argument, labeled individuals
Grounded in symbolic interactionist themselves can inadvertently start
thought, classic labeling theory arrives a self-fulfilling process. Like Scheff,
at the same prediction. Classic labeling Link holds that societal members learn
theory holds that individuals who have and are fully aware of the stigma of
been categorized by other people as devi- mental illness, know the stereotyped
ant come to view themselves as deviant ways in which "crazy" people are
(Becker 1963; Kitsuse 1962; Scheff thought to behave, and understand
1966; Schur 1971), especially when that most people are likely to devalue,
they are formally classified by powerful reject, and discriminate against persons
agents of social control. Accepting a devi- with mental illness on these grounds.
ant identity occurs because labeled indi- When individuals enter mental health
viduals take the perspective of others treatment, they become labeled as "men-
and define themselves as others do tal patients." At that point, mental illness
(Goffman 1963), or, more complexly, stigma and stereotypes become personally
because labeling sets off a self-fulfilling
relevant and threatening; these attitudes
prophecy that results in identity and adop-
beliefs might easily be applied to
tion. According to Scheff (1966) themselves.
once Fearing devaluation and
individuals have been classified as men- rejection, patients/consumers attempt to
tally ill, stereotypes about mental illness
ward off such consequences by using one
become activated in the imaginations of or more of three coping strategies: secrecy
8 Social Psychology Quarterly 74(1)
about their patient history "The mentally ill" are believed to be as

("passing"
normal [Goffman 1963]), withdrawal unpredictable, irrational, dangerous,
from interactions with all but close family bizarre, incompetent, and unkempt, and
or friends, and educating others aboutthese stereotypes have persisted and
mental illness. Negative consequences fol- even strengthened from the 1950s to
low. The label itself creates a sense of dif- the present, along with a steady desire
ferentness and shame, diminishing self-to keep social distance from such people,
esteem and making social encounters despite educational campaigns (Link et
tense. Coping efforts, particularly with-al. 1999; Martin, Pescosolido, and Tuch
drawal, can backfire, increasing social2000; Pescosolido et al. 1999, 2010;
isolation, discouraging pursuit of employ-Phelan et al. 2000; Rabkin 1980; Stout,
ment, and increasing demoralization. Villegas, and Jennings 2004; Wahl
These stressors in turn make labeled indi-
1995). In laboratory studies, desire for
viduals more vulnerable to recurrences of social distance is evident in awkward
disorder. In short, attempts to avoid interactions and negative ratings of per-
devaluation and discrimination generatesons believed to have had mental health
problematic social and economic circum-problems (Crocker et al. 1998; Link and
Phelan 2010). High percentages of for-
stances that perpetuate the risk of disor-
dered episodes, which in turn may fur-mer and current patients in mental
ther undermine self-worth. hospitals - from 50 to 95 percent - are
Unlike traditional labeling theory, aware of the stigma attached to psychiat-
modified labeling theory does not ric disorder and expect devaluation and
assume that persons with mental illness discrimination on this basis (Link 1987;
accept their official categorizations asLink et al. 1989; Link et al. 1997;
self-descriptive. As Goffman (1963) Rosenfield 1997; Wahl 1999b; Wright,
points out, stigmatized persons may Gronfein, and Owens 2000). Similar per-
not identify with a social label person- centages report actual experiences of dis-
ally but still must deal with the inter- crimination (Jenkins and Carpenter-
personal difficulties created by a discred- Song 2005; Link et al. 1997; Wahl
iting public identity conferred by other 1999b; Wright et al. 2000). Independent
people. Interpersonal encounters with of patients' psychiatric symptoms, hav-
normals are fraught with risk and anxi-ing a label and perceiving stigma are
associated with several negative out-
ety; stigmatized persons almost inevita-
bly discover limits to normals' accep- comes: smaller and less supportive social
tance, reminded that they are networks (Link et al. 1989; Perlick et al.
different, undesirable, and unworthy 2001); less income and higher unemploy-
(Goffman 1963). Hence, damage to self- ment (Link 1982, 1987; Link, Mirotznik,
esteem should follow from the acquisi- and Cullen 1991); greater demoralization
tion of a stigmatizing label, regardless and depressive symptoms (Link 1987;
of whether that label has been internal- Link et al. 1991, 1997); and lower subjec-
ized or simply bestowed. tive quality of life and overall satisfaction
(Rosenfield 1997; Markowitz 1998). In
short, an abundance of evidence shows
EVIDENCE FOR THE LINK BETWEEN
STIGMA AND SELF-ESTEEM
that a stigmatized label and expectations
and/or experiences of social rejection sig-
Numerous studies have documented nificantly diminish the life quality and
life chances of consumers, countering
negative beliefs held by the American
earlier assertions that stigma has only
public about persons with mental illness.
Resistance to Stigma
minor self-helpshort-liv
or group for persons with manic-
ces for depression,
patients' perceptions of devaluation- l
discrimination
influence of and self-esteem
their were
1980, correlated -.34 (Hayward
1982). Import et al. 2002).
tently Among patients in
show private and outpa-
that lo
efficacytient psychiatric
are treatment
the for schizo- c
through phrenia,
whichperceived stigmatization was
dev
nation correlated -.28 with
are tied general self- to
(Kleim et al. 2008; Markowitz 1998; efficacy (Kleim et al. 2008; Vauth et al.
Rosenfield 1997; Wright et al. 2000; 2007). These modest correlations indi-
Yanos et al. 2002). cate that some individuals who perceive
Given the predictions of labeling the- high levels of societal rejection neverthe-
ories and the well-documented negative less have high self-worth while others
consequences of stigma, one would who see little societal rejection have
expect sharp differences in self-esteem low self-regard anyway. Corrigan and
between persons with and without seri- Watson (2002) have called this "the
ous disorders as well as strong correla- paradox of self-stigma": although
tions between perceived/experienced a majority of consumers of mental
discrimination and low self-regard. But health services suffer self-derogation
this is not what studies show (Corrigan as a consequence of perceived or
and Watson 2002; Corrigan, Watson, experienced discrimination, a subset
and Barr 2006; Hayward and Bright instead reacts energetically and with
1997; Hayward et al. 2002; Kleim et al. righteous anger, while still others
2008; Link et al. 2001, 2002; Link, remain indifferent.
Castille, and Stuber 2008; Markowitz This paradox differs from another dis-
1998, 2001; Rosenfield 1997; Wright et cussed in the broader stigma literature.
al. 2000; Yanos et al. 2002). To be sure, Most studies show stigmatized individu-
virtually all studies report a significant als do not differ from non-stigmatized
negative association between perceived persons in self-esteem, while other
or experienced stigmatization and investigations find stigmatized persons
patients' self-esteem and/or generalized have significantly higher self-esteem
self-efficacy, even when prior levels of than normals do, contrary to intuition
these factors and the severity of and theoretical arguments (Crocker
respondents' symptoms have been con- and Major 1993; Crocker et al. 1998;
trolled. But the inverse relationships Major and O'Brien 2005). The vast
between stigma and self-regard are sur-bulk of this broader literature, however,
prisingly modest in strength. For exam- examines persons with visible stigmas
ple, in a sample of Clubhouse1 partici- (e.g., skin color, physical and learning
pants with serious disorders, perceived disabilities, developmental delays). In
devaluation-discrimination was corre- contrast, people with histories of mental
lated -.25 with global self-esteem disorder have an invisible stigma
(Link et al. 2008). Among members of a(except when their symptoms are florid,
or an institutional setting gives their
*A Clubhouse is a community mental health status away). Mental illness is also con-
program focused on recovery, run by current
sidered a "moral" stigma (Goffman
and former consumers. It provides work and
social opportunities to persons with severe or per-
1963), indicating a blemish of character
sistent mental illness, and is modeled on or failure of self-control (although with
Fountain House in New York. medicalization and geneticization, this
view of disorder may be softening). mental illness, filing appeals against

Moral stigmas are more discrediting discrimination, and persisting in
than bodily or membership (e.g., ethnic, efforts to gain work or insurance
religious) stigmas (Corrigan 2000; despite barriers. Eighteen percent of
Crocker et al. 1998; Goffman 1963; Wahl's sample said that directly chal-
Jones et al. 1984; Weiner, Perry, and lenging stigma raised their self-esteem
Magnusson 1988). In contrast to persons or sense of empowerment. In other
with observable marks that are not studies, when patients with major
their responsibility, individuals depression
known and schizophrenic disor-
to be previously or currently hospital- ders were asked what they would do
ized for disorder are at greater in risk
the of
face of others' discomfort, from
devaluation and rejection and thereby 65 to 85 percent endorsed educating
at higher risk of self-derogation. others about mental illness/psychiatric
The nature of mental illness stigma, treatment (Link et al. 1989, 2002), and
then, may explain why there is a con-81 percent of Clubhouse respondents
sistent, modest inverse relationship with serious disorders agreed that it
between perceived prejudice/discrimi- was better to confront stigmatizing
nation and self-esteem in consumer behavior than to ignore it (Link et al.
studies, in contrast to findings 2002). in theThus, appreciable percentages
broader stigma literature.2 of current or former consumers of ser-
vices indicated actual resistance to
EVIDENCE FOR RESISTANCE TO

or willingness to resist derogation
STIGMA
and discrimination by other people.
Despite the enormous percentage
How common is resistance to mental ill- gaps in these studies between what
ness stigmatization and stereotyping? people said they did and what people
Frequencies are difficult to find in thesaid they were prepared to do, Link
literature; most studies report meanand colleagues (2002) found that
scores on scales, which are parsimoni- willingness to challenge stigma was
ous but less informative for my purpo- significantly and positively associated
ses. A handful of articles offer sugges-with respondents' self-esteem ( r = .22,
tive percentages: in interviews with p < .05), consistent with the effects of
National Alliance for the Mentally 111 challenging mentioned by Wahl's
consumers, Wahl (1999a) found that respondents.
21 percent took some corrective action There are other, more subtle hints of
in response to stigma experiences, resistance found in the mental illness
including attempts to educate persons
literature. About 50 percent of hospital-
who made disparaging remarks about ized patients with severe disorders did
not characterize themselves as mentally
ill at an initial interview (Doherty 1975;
2Crocker, Major, and their colleagues focus on
self-esteem contrasts between stigmatized and
Estroff et al. 1991; Warner et al. 1989;
non-stigmatized groups (women versus men, see also Weinstein 1983). Between 35
blacks versus whites, etc.), while mental illness and 45 percent of Clubhouse respond-
studies usually scrutinize the association ents disagreed that they felt different
between social rejection and self-esteem within or ashamed because of their illness or
patient groups. Mental illness researchers seem
to presume (rather than demonstrate) that
hospitalization (Link et al. 2002).
patients/consumers have lower self-esteem than About 40 percent of Clubhouse members
"normals." distanced themselves from other people
Resistance to Stigma 1 1
are commonly endorsing

with mental illness, used: challenging, con-t
that their problems
fronting, or fighting
were a harmful
differe
force or
those of most mental patients (Link influence, and deflecting, impeding, or
et al. 2002; Quadagno and Antonio refusing to yield to the penetration of
1975). About 25 percent of an outpatienta harmful force or influence.3 These
Veterans Administration sample withare intentional, agentic responses to
serious mental illness showed high lev-possible harm; the first involves push-
els of stigma-resisting beliefs (e.g., "I ing back with a force of one's own while
can have a good, fulfilling life, despitethe second involves deliberately block-
my mental illness") (Ritsher and ing an outside force so that it glances
Phelan 2004). So there are indications away or falls back - one guards or hard-
that subsets of individuals resist inter- ens the self rather than engaging in
nalizing stigma, which in turn helpsconflict.4 To distinguish between the
preserve or even enhance self-esteemtwo, I refer to them as challenging
and a sense of personal control. The and deflecting types of resistance
degree of internalized stigma is moder- (sometimes with other synonyms, for
ately to strongly correlated with low variability). I propose that both forms
self-esteem and/or self-efficacy, with r's of resistance serve to protect the self
ranging from .42 to .59 across studies against devaluation, but challenging
(Corrigan et al. 2006; Link et al. 2002; opens possibilities for victory in chang-
Ritsher and Phelan 2004; Ritsher, ing others' negative views or actions,
Otilingam, and Grajales 2003; Yanos etwhile deflecting does not. Even when
al. 2008). Conversely, then, the relative efforts are unsuccessful, the courage
lack of internalization is linked to higherand initiative required for confronta-
self-evaluations. tion may reinforce an individual's sense
In sum, there are definite hints in of personal control or empowerment.
the empirical literature that some indi- Thus, confrontational resistance may
viduals reject others' damaging raise self-esteem, while blocking may
remarks and behaviors or refuse to simply maintain a person's self-esteem
see themselves in the ways that the at its current level.
public or acquaintances do. Despite Some preconditions seem necessary
wide variations in samples and meas- for the use of resistance strategies (as
ures across studies, there are also well as other coping strategies).
intimations that resistance can be Because resistance is an agentic
self-protective, perhaps even self- response to devaluation and stereotyp-
enhancing. Thus, it seems sensible to ing, individuals first must have
consider types of stigma resistance acknowledged to themselves that they
and the conditions under which resis- have had a mental health problem and/
tance might be employed by persons
with histories of mental disorder.
3In psychology, the term "resilience" is often
used to refer to the ability to withstand
TWO FORMS OF RESISTANCE: harm (e.g., Bonanno 2004). I view resilience -
CHALLENGING AND DEFLECTING maintaining a stable equilibrium in functioning
in the face of adversity - as an outcome of the
use of resistance strategies.
What is resistance? In general, resis-
The term "resistance" is used in psychology
tance refers to opposition to a harmful
and psychiatry to describe an unconscious
force or influence. There are two defense mechanism, but in this article I focus on
senses in which resistance or opposition
conscious blocking and confronting.
individuals
or that they have been who agree with
in mental broad cul-
health
treatment. In othertural
words,
conceptions they
of mental must
illness and
acknowledge that theendorse
label those
ofconceptions
"mentallyas self-
ill" or "mental patient" isarepotentially
descriptive "self-stigmatized" - they
have accepted
applicable to themselves, and internalized the
regardless of pub-
whether they accept lic's
thisviewscategorization
(Corrigan et al. 2006). At the
as a personal identity or not. They other extreme, persons who disagree
must also understand that it is or could
strongly with public stereotypes of men-
tal illness and reject those images not
become a public identity if their mental
health status were revealed or only as characterizations of themselves
but of
discovered - that is, others have orconsumers
could in general are those
define them as mentally ill or who
as will "challenge" or confront stigma-
mental
tization.
patients (Link et al. 1989). Finally, The three groups that fall in
indi-
viduals must have knowledge of the between reject mental illness stereo-
cultural meanings commonly attached types as self-descriptive, even though
to the mental illness/mental patient they may (or may not) agree with broad
label, again regardless of whether they cultural beliefs about persons with dis-
endorse those meanings or not. order. Individuals who resist with
Meanings include the label's pejorative "deflection" believe that public stereo-
character, stereotyped behavioral types simply "do not characterize me -
expectations, and the possibility thatI'm not like that." In this group, the
discrimination will be directed at its car- potential for harm due to stereotyping
rier. Corrigan et al. (2006) call this "ste- is recognized but dismissed outright as
reotype awareness." These three precon- a viable threat to the self. Another set
ditions distinguish people who use anticipates possible devaluation in
resistance (and other coping strategies)interpersonal interaction and averts it
from individuals who are in denial or with "avoidance": they pragmatically
unaware of their illness or of cultural keep their treatment history secret,
dodge or withdraw from interactions
stereotypes, often because of the illness
itself (Corrigan and Watson 2002).5 with people who might be prejudiced,
These preconditions make the possibil- or socialize primarily with others who
ity of experiencing devaluation and dis-share the same stigma. Finally, persons
crimination "personally relevant," who in have directly experienced the hurt
modified labeling theory terms (Link et rejection and devaluation engage in
of
al. 1989). "self-restoration," shifting their social
I propose that there are five groups of comparisons to other persons with men-
individuals who differ in the stances tal disorder or disinvesting themselves
they take toward the applicability from
andendeavors at which they may fail,
threat of cultural stereotypes (setting among other esteem-restoring strategies
aside persons who are in denial or (seeare
Crocker and Major 1989). The
unaware of their labeled status or of cul- underlying battle imagery involves
tural stereotypes). At one extreme, retreats from threat of attack (for
those who avoid) or attempts to repair
5Persons who deny that they have a mental the damage caused by attack (for those
health problem are resisting the imposition of who restore), in contrast to resistance
a negative label ("there's nothing wrong with
me!"). My focus here is on persons who resist
strategies of fighting back (for those
the stigma attached to a label that they under- who challenge) and guarding the fort
stand could be successfully applied to them. (for those who deflect).
Resistance to Stigma
In sum, I am suggesting that they usually do not in others. Perceiving

patients/consumers cope differently the obvious misfit between one's own
with the threat of stigma through self- symptoms and public images makes it
stigmatizing, deflecting, avoiding, self-straightforward to conclude that "I'm
restoring, and challenging. Individuals not like that - that's not me," or "I'm dif-
undoubtedly use a range of coping strat-ferent from most mental patients"
egies, but their repertoire is likely to (Estroff
be et al. 1991; see also Snow and
typified by one of these orientations. Anderson
In 1987). In self-categorization
what follows, I focus on those who theory terms (Turner et al. 1994), there
deflect and challenge, given that tacticsis a lack of "normative fit" between one's
of stigma resistance and the conditions own characteristics and the category of
under which resistance is probable "mentally ill persons."
have been generally neglected in the lit- A related strategy of resistance is to
erature, as many commentators have maintain that one's history of mental
noted (e.g., Howarth 2006; Prus 1975; disorder is "only one part of me - it
Quadagno and Antonio 1975; Rogers doesn't define who I really am"
and Buffalo 1974; Shih 2004). (Howard 2006). In identity theory terms
(Stryker 1980), a mental illness-related
identity, because of its discrediting char-
Deflecting Strategies acter, should rank low in the individu-
Stigma deflection strategies are usually al's salience hierarchy; it is unlikely to
cognitive in nature. As discussed above, be invoked in one's self-presentation to
individuals who use these blocking strangers or to guide one's choice of
strategies understand that they have activities in free time (Stryker and
a disorder and/or they have been in Serpe 1982; Wright et al. 2000).
treatment, that other people have iden- Because the identity yields few intrinsic
tified (or could identify them) in these or extrinsic rewards, entails greater
terms, and that broad cultural stereo- costs, and garners little support from
types have been (or could be) applied to other people, its rank should be low in
them. But they view those stereotypes the prominence hierarchy of ideal selves
as inapplicable to themselves - as "not (McCall and Simmons 1978). In this
me" (McCall 2003; Snow and Anderson deflection strategy, one's mental illness
1987). There are at least three ways to is "not me" because it is "a small, unim-
decide "that's not me." portant part of me."
First, mental illness stereotypes are A third strategy is to define the
nature of one's problem in terms that
extremely negative in content and imag-
are less discrediting and stereotyped
ery: "crazy people" are bizarre, unpre-
dictable, dangerous, incompetent, and than mental illness: "I'm not mentally
out of touch with reality. These attrib- ill; I've simply had a nervous break-
utes capture the public's imagination of down/am suffering nervous exhaustion/
am anxious/am depressed." The person
the most severe types of disorder, espe-
cially schizophrenia (Estroff et al. acknowledges that he or she has a men-
1991). However, the symptoms of mosttal health problem, but in contrast to
psychiatric disorders, even the most mental illness, it is a temporary, less
severe, do not typically match these serious, more understandable, and
images (Gove 2004; Quadagno and socially more acceptable response to
Antonio 1975) or, if symptoms match stressful life circumstances (Barke,
Fribush, and Stearns 2000; Estroff
in one respect (e.g., irrational thoughts),
et al. 1991; Gove 2004; Quadagno

most patients with mentaland
illness."
Antonio 1975; Rogers and Buffalo Those who make the latter generaliza-
1974). In essence, individuals assert tion are likely to have or to develop
that "my problem is not like that," identification with other patients/con-
instead of "/ am not like that." Public sumers as a collectivity (Corrigan and
Watson 2002; Watson and River 2005),
stereotypes are therefore not applicable
a topic to which I return below.
to the self because those stereotypes per-
tain to mental illness, not to nervous Given that the goal of challenging is to
breakdown or emotional distress. highlight and change prejudice and dis-
When individuals block the applica-crimination, challenging strategies tend
bility of mental illness stigma and ster-to be behavioral rather than cognitive in
eotypes to themselves in one or more of nature. There are several ways to contest
these ways, they dramatically reduce, others' attitudes and acts, varying in
if not eliminate, potential threats totheir levels of directness and assertive-
their self-regard. Moreover, when theyness. I should note that these strategies
encounter explicit devaluation or dis-can have their desired effects only if the
person's history of mental illness is
crimination in interpersonal interaction,
known to others and he or she has shifted
they can attribute these acts to others'
prejudice or ignorance (an external from being "discreditable" to being "dis-
cause) and not to some defect in credited" (Goffman 1963). In contrast,
themselves (Crocker and Major 1989; deflection strategies can be used by indi-
Crocker et al. 1998; Prus 1975; Shih viduals whose stigma is hidden or known.
2004). Deflection renders the person Perhaps the most indirect form of
fairly impervious to stereotype threat. contestation is to behave in ways that
Although self-esteem is not likely to contradict normals' stereotyped expecta-
rise with the use of blocking strategies, tions. Some theorists describe this strat-
it should not shift substantially from egy as compensation or overcompensa-
the level that existed prior to labeling. tion because it involves working hard
to excel at skills or tasks thought to be
difficult to impossible for persons with
Challenging Strategies
particular kinds of stigma to handle
Challenging differs in both obvious and (Crocker et al. 1998; Goffman 1963;
more subtle ways from deflecting. The Major and Eccleston 2005; Shih 2004).
manifest difference is that challenging Behavior that conforms to or even
involves attempting to change other exceeds conventional standards pre-
people's views or behaviors instead of vents normals' expectations of failure
blocking their incursions on self-regard. or continued deviance from coming
To confront is to engage with the biased true (Sato 2001). Invalidating others'
attitudes and actions of others rather beliefs about persons with mental illness
than dismiss them. More subtly, chal- and winning their respect can be grati-
lengers share deflectors' beliefs that fying and can uplift self-regard and
mental illness stereotypes are "not a sense of personal control. (A potential
me," but they add a further qualifica- drawback, however, is that normals
tion by arguing that those stereotypes might see the successful individual as
are "not me because they're wrong." an exception to the rule, undermining
Some (perhaps most) challengers may the goal of this strategy.)
go a step further: Those stereotypes A more direct and assertive form of
are wrong "not only about me but about resistance is educating other people
about the nature of mental illness and confrontation enhances self-esteem and
a sense of control; the more positive
psychiatric treatment (Link et al. 1989).
the outcome of the challenge, the more
The risks attached to this strategy prob-
ably depend on whom the person positive for self-regard. On the other
hand, pride in courageously standing
attempts to teach in his or her social net-
up for oneself or one's group may
work. Close family and friends are less
likely to reject one on the basis of one'senhance self-esteem, regardless of the
status or to take offense from efforts outcome - one has done the right thing
to counter their misapprehensions. at real risk to oneself.
Disclosing to and educating relationally Up to this point, challenging strate-
distant others is more risky, exposing gies employed by individuals have been
one to possible devaluation or defen- the focus. But challenging can also occur
sively hostile reactions to one's efforts. collectively, in the form of advocacy and
Because educating others may be suc- activism by consumer groups aimed at
changing societal beliefs and system-
cessful with intimates but backfire with
level discriminatory practices. Corrigan
non-intimates, it may produce an overall
and Lundin (2001) discuss three strate-
"no effect" on self-regard or other quality
of life outcomes, a finding reported gies in of collective action: contact, educa-
some studies (Link et al. 1991, 2002). tion, and protest. Contact is an educa-
Separating out the targets of individuals'tive strategy; consumers tell personal
educative efforts would clarify whether stories of struggle with mental illness,
and when this strategy has beneficial the hurtful impacts of stigma, and the
consequences for self-esteem. process of recovery to relevant audien-
"Confronting" is more direct and ces (e.g., school classes, religious groups,
assertive than educating. In this strat- agency administrators), with opportuni-
egy, rather than tactfully enlightening, ties for questions and answers. Contact
one actively contests others' erroneous with persons living successfully with or
beliefs and unjust acts. Examples recovering from disorder undermines
stereotypes about mental illness
include disagreeing with a biased state-
(Couture and Penn 2003). Education
ment, objecting to a thoughtless remark,
refers to presentations and other com-
or reproving a tasteless joke about one-
munications (media campaigns, news-
self or people with mental illness in gen-
eral. One might challenge the legitimacy letters, advertisements) about types
of a claim made about oneself or one's of mental illness, its prevalence,
category, question the legitimacy causes, or and effective treatments as
expertise of the claimant making judg- well as information that counters men-
ments, point out others' biases or tal dis-
illness myths. Group protest
criminatory acts, or lodge complaints directly confronts public statements
and bring legal suit, among other made by opinion leaders, representa-
actions (Corrigan and Calabrese 2005; tions in the media, or social or industry
Prus 1975; Rogers and Buffalo 1974; policies that are prejudicial in content
Wahl 1999a). Direct confrontation can or discriminatory in practice.
antagonize others, creating or escalating Participation in collective resistance
interpersonal tensions, increasing the offers a number of advantages for per-
threat of reprisal, and possibly ruptur- sons with histories of mental illness,
ing important social ties (Kaiser 2006). including legitimized anger at injustice;
The perceived balance of benefits and ingroup support and understanding;
costs may determine whether or not shared social and political goals;
opportunities to act on convictions; emergence of their mental health prob-

decreased individual risks; and exercise lems. For example, they may possess
of agency. These advantages should pro- a devalued racial, ethnic, religious, or
mote members' self-esteem, self-efficacy, sexual identity, have a physical impair-
and optimism (a combination of orienta- ment, or are an ex-addict or ex-con.
tions to the self, the world, and the Deflecting or challenging strategies
future often termed "empowerment") that were developed previously to cope
(Corrigan and Calabrese 2005; with an existing attribute can be gener-
Corrigan and Lundin 2001). alized and applied to the stigma of men-
tal disorder. In essence, one transfers
learned coping skills from one discredit-
Conditions for the Use of
ing attribute to the next. Prior resis-
Deflecting and Challenging tance experience thus should heighten
Resistance Strategies the person's likelihood of blocking or
When rejection or discrimination occurconfronting mental illness stereotypes.6
in face-to-face interaction, it may be dif- Past familiarity with mental illness in fam-
ficult to take or sustain a resistant
ily or friends. Many individuals have had
stance. When the individual is altercast
personal experience with a significant
by other people as mentally ill or asother - a partner, family member, or
a mental patient, he or she experiences friend: - who is grappling with mental
pressure to respond in expected ways, health problems. Through interactions
lacks support for his or her preferred with this significant other over time,
identity in the situation, and must individuals realize that his or her symp-
struggle to negotiate shared, mutually toms simply do not match widespread
acceptable definitions of self and other stereotypes about "crazy people."
in the encounter - a struggle that the Information countering erroneous pub-
other party may win due to status lic beliefs is also acquired. Given greater
or power imbalances (McCall and familiarity and knowledge about mental
Simmons 1978; Link and Phelan illness from such experiences, persons
2001). With such pressures, deflecting who then develop mental health
beliefs that "that's not me" may be problems of their own should be
hard to maintain. Educating others quicker to recognize that their symp-
about mental illness stigma and con- toms do not fit stereotypes, predisposing
fronting negative attitudes and behav- them to deflection strategies of resis-
iors may be even more difficult, given tance. Additionally, if they have general-
risks of intensified scrutiny and sanc- ized from their own or their significant
tions, losing credibility and face, and other's stigma experiences to most
alienating interaction partners, among patients/consumers, they should be
other costs (Prus 1975; Kaiser 2006). more inclined to challenge other people's
Five factors, however, may increase disparaging attitudes and behaviors. Of
the likelihood of using deflecting and course, I am assuming here that the
challenging resistance strategies in
stigmatizing interpersonal encounters,
despite these pressures and risks. 6It is possible, however, that individuals' abil-
ities to resist rejection and discrimination may be
overtaxed by the acquisition of an additional
Past experience with stigma resistance. devalued characteristic; if so, prior experience
Individuals may have already had instead will undermine the probability of
experience with stigma prior to the responding with resistance.
initial allow group members

relationship with to compare
the per-ill s
other was close and
sonal incidents caring.
of rejection and stereotyp- If
tionship had ing.
been Sharing such stories could increase or
strained
especially if adisruptive
sense of alienation and helplessness
sympt
among further
relapses caused participants, of course. strains
But if
might instead treatment
have programs are run substan-
distanced th
from the family member
tially or entirely by consumers who are or f
short, the dedicated to promoting recovery,
moderating effects a collec- of
ity with mental
tive identity illness
might emerge fromprobab
views
depend on theandquality
experiences held inof
common.
the rel
with the Identifying with other
significant patients/consum-
other.
ers legitimizes righteous anger in
Characteristics of the illness , illness
career, and treatment setting. The charac-response to stigmatization (Corrigan
and Watson 2002), which in turn can
teristics of the individual's disorder and
motivate
his/her history of treatment and recov- the personal use of challenging
ery should influence whether he/she types of stigma resistance. Commitment
to
resists stigmatization in interpersonal the welfare of patients/consumers as
a group may also inspire participation
interaction. The less serious and more
in
time-limited one's disorder, the greatergroup-devised resistance strategies
one's success in symptom management,for social change (Corrigan and Lundin
or the more complete one's recovery,7 Estroff, Penn, and Toporek 2004;
2001;
the more probable the perception Tajfel
that and Turner 1986; Taylor and
public images simply "don't fit me."Moghaddam 1994).
Conversely, the longer the person has In sum, people who have time-lim-
ited,
been ill, the greater the impairment, or less severe, manageable, and/or
recoverable disorders should be more
the more frequent his or her relapses,
the less plausible this belief will be. likely to resist stigmatizing encounters
The individual's actual symptoms may with deflection strategies. Those with
not match public stereotypes of insanity, severe, persistent mental health prob-
lems who are involved in consumer-run
but an inability to sustain conventional
social roles will signal unreliability or treatment settings should be predis-
incompetence to the self as well as to posed to employ confrontation tactics
other people. in interpersonal encounters and to par-
However, if stigma-deflection strate- ticipate in group-sponsored challenges
gies become less probable with pro- to prejudice and discrimination.
longed or recurrent impairment, the An additional note is required. It
structure of the individual's treatment might seem obvious that people with
non-severe disorders should more often
setting may foster willingness to chal-
lenge stigmatization. Treatment pro- resist stigma with deflection compared
grams that bring patients together (e.g.,people with severe disorders. But to
to
group therapy, inpatient wards, skillsmy knowledge this hypothesis has not
training classes, lodges, clubhouses) been examined. Virtually all studies of
coping with mental illness stigma focus
on convenience samples of patients
7The meaning of "recovery" differs among
with serious disorders who have long
clinicians, researchers, and consumers (Bellack
2006). I use it to refer to independent living in
histories of treatment and multiple hos-
the community with symptoms under stable con- pitalizations, and who are in outpatient
trol or in remission. therapy, organized community mental
health programs, or emotion-focused

advocacy coping (Lazarus of
groups and
consumers. Such samples are fully Folkman 1984), and effective coping
defensible on practical grounds; it is in turn reduces the physical and men-
expensive and time-consuming to gener- tal health consequences of stress expo-
ate representative samples of persons sure (Taylor and Aspinwall 1996).
with moderate and severe disorders Psychosocial resources that have been
who are former or current patients studied
(as most frequently as stress-
in the National Comorbidity Surveys). buffers include self-esteem, a sense of
But when samples are composed control only or mastery over life (general-
of persons with severe mental illness, ized self-efficacy), and social support
variability in stigmatization experiences(Bonanno 2004; Taylor and Aspinwall
and coping responses is attenuated1996; dra-Thoits 1995).
matically. Individuals who suffer from Stress theory clearly suggests that
moderately serious disorders (e.g.,high gen-levels of psychosocial resources
eralized anxiety, dysthymia, agorapho- will moderate the relationship between
bia, obsessive-compulsive, or eatingstressful
dis- demands and coping efforts,
orders) are at risk of devaluation, or in this case, between perceived or
stereotyping, rejection, and discrimina- actual stigmatization and the use of
tion, too, although those threats should resistance strategies. Those with
be less extreme than the stigma directedgreater resources prior to the onset or
at persons with severe disorders. exacerbation of stigmatizing experiences
Existing studies overlook a substantialshould be more likely to employ resis-
proportion of persons who may be tance tactics. People with the least
actively blocking the identity implica- severe, most manageable disorders
tions of their mental health problems, should have lower perceived or experi-
thus underestimating the extent to enced stigma as well as greater psycho-
which stigma resistance in fact occurs. social resources in the first place, a triple
advantage which should produce an
High levels of psychosocial coping re-
sources. As others have pointed out, iterative, escalating process of recovery
devaluation and discrimination are (Markowitz 1998, 2001). Conversely,
those
stressors with which persons must copetriply disadvantaged by severe ill-
ness,
(Major and Eccleston 2005; Miller and greater stigmatization, and fewer
Kaiser 2001; Phelan, Link, and Dovidio coping resources are likely to follow
2008); they are situational demands a downward trajectory.
that harm or threaten the self and Multiple role-identities. People who
prompt cognitive or behavioral possess efforts multiple roles should be more
to readjust (Lazarus and Folkman likely to employ resistance strategies
1984). Perceived prejudice is a persistent
when facing devaluation or discrimina-
or recurrent strain, and discriminatory tion in interpersonal encounters. The
acts are acute negative events with role-identity concept and theory about
identifiable onsets and offsets. Stress the structure of the self suggest three
theory holds that people draw from reasons
their for this.
personal and social resources in order Social
to roles are key sources of
cope with negative events and chronicpersonal identity for most people -
strains (Pearlin 1999). Those with definitions
high of who we are in our own
levels of psychosocial resources are and others' eyes (Stryker 1980; Thoits
more adept at problem-focused and 1992). Roles that individuals accept as
Crocker are
self-descriptive et al. 1998; Major and O'Brien
often term
2005; McCall and Simmons
identities" (McCall and 1978; Miller
Simmo
and Kaiser
Stryker 1980). Most2001; Shih 2004;
peopleThoits ha
ple role-identities 2010; Wright etbecause
al. 2000). One disengages
they
eral positions from ina devalued,
the stressful identity and str
social
which are attached sets of behavioral invests instead in other more rewarding
expectations (e.g., spouse/partner,identities.
par- However, changing one's iden-
ent, employee, student, volunteer, tity hierarchy is not a form of resistance
church member, friend). As mentioned as conceived here (as opposition). In reor-
earlier, theorists have described identi- ganizing one's priorities, one repairs
ties as organized into hierarchies of damage already done to the self rather
salience (Stryker 1980), prominence than parries or blocks potential damage
(McCall and Simmons 1978), psychologi- to the self at the outset. The distinction
cal centrality (Rosenberg 1979), and sub- is subtle; to discriminate empirically
jective importance (Thoits 1992). The between stigma-deflection and self-resto-
higher in such hierarchies, the greater ration, one would need repeated meas-
the likelihood that a role-identity will ures of individuals' role-identity struc-
be enacted (Stryker and Serpe 1982) tures and self-esteem scores over time.
and the more probable a successful iden- Despite the intricacies of disentangling
tity performance will positively influence these two strategies, the distinction
self-esteem (Rosenberg et al. 1995). seems important: a person who resists
Conversely, the less importance attached is relatively invulnerable to stigmatiza-
to a particular identity, the less influence tion while one who repairs has taken
poor role-identity performance will have a "hit" to self-regard and struggles to
on self-regard (Crocker et al. 1998). recover.
Theoretically, as discussed earlier, Multiple roles can have a second,

devalued role-identities such as "men- more indirect effect on the use of
tally ill person" or "mental patient" stigma-deflection strategies. The more
should rank low in individuals' identity conventional roles one holds, the more
hierarchies. The more role-identities an role partners there are in one's life
individual holds, then, the smaller the who are invested in legitimizing and
percentage of the self the illness-related supporting one's performance of conven-
identity represents and the lower the tional behaviors (McCall and Simmons
identity should rank relative to other 1978). The more support for conven-
more valued aspects of the self. Recall tional role-identity enactments, the less
that a strategy of deflection is to assert one's mental illness-related identity
that the experience of mental illness is receives validation, again making it
a "small, unimportant part of me." It fol- "not an important part of me."
lows that the more role-identities pos- However, if a person's symptoms are
sessed, the more able one should be to severe and disrupt conventional role
deflect the stigmatizing remarks or enactments over time, role partners
behaviors of other people. may instead drop their identity support,
It is important to note that deliber- insist that the person is ill, and urge him
ately decreasing the salience/impor- or her (back) into treatment (Estroff et
tance of a problematic role-identity is al. 1991; Thoits forthcoming).
frequently described in the literature Finally, multiple roles can strengthen
as a self-protective or self-restorative the relationship between stigma expo-
strategy (Crocker and Major 1989; sure and the use of resistance strategies
patients
through their positive with serious
effects on conditions
mental are
health. Role-identities promote
unmarried, mental
and substantial percentages
health because they (30
provide
to 50 percent) purpose
are unemployed, sug-
and meaning in life (i.e.,
gestingwho I am),
that a good sup-
proportion may not
be actively
ply behavioral guidance throughparenting either (e.g.,
norma-
tive scripts (how I should Corrigan etbehave), and
al. 2006; Estroff et al.
influence self-evaluations based on the 1991; Jenkins and Carpenter-Song
quality of one's role performance (how 2005; Kleim et al. 2008; Link et al.
worthy and competent I am) (Thoits1989; Vauth et al. 2007; Wahl 1999a).
1983, 1986, 2003). The more identities Nevertheless, variability does exist in
one holds, especially the more volun- the distributions of marital and work
tary (as opposed to obligatory)8 identi- roles. Many other roles that partici-
ties one holds, the greater one's self- pants might hold simply are not can-
esteem, sense of personal control, life vassed in stigma studies (for example,
satisfaction, and happiness, and the parent, relative, friend, boyfriend/girl-
lower one's symptoms of psychological friend, church member, neighbor, vol-
distress (Thoits 2003). The reverse is unteer, student, caregiver). If more
also true: individuals with higher roles were assessed, we might discover
self-esteem, greater personal control, that substantial percentages of
and lower psychological distress patients with mental disorders hold
acquire more role-identities over time, multiple conventional role-identities.
especially more voluntary identities If study samples were broadened to
(Thoits 2003). Role-identity accumula- include individuals who have moder-
tion reflects the exercise of personal ately serious disorders, even greater
agency - deliberate, intentional, goal- variation in role-identity accumulation
oriented action, enabled by actors' should be observed. Such designs
sense of confidence and competence, would allow a better test of whether
yielding further gains in confidence multiple role-identities moderate the
and competence. In essence, persons link between stigmatization and the
with multiple role-identities should use of deflecting and challenging resis-
have greater coping resources with tance strategies.
which to resist the prejudice and dis-
crimination they encounter in social The Dynamics of Stigma Resistance
relations.
Up to this point, I have discussed types
It may seem implausible that individ-
uals with serious mental disorders of stigma-resistance and the conditions
under
would possess multiple role-identities. which they might be employed as
Indeed, most studies show that the though resistance were an individual's
great majority of current or former usual and sole response to reminders
of stereotyping and discriminatory
encounters. This was for expositional
8Voluntary identities are shorter-term role
simplicity only. Like everyone else, per-
relationships that are relatively easy to exit if
sons with a history of disorder typically
their costs begin to exceed their rewards (e.g.,
neighbor, church member, club member). use combinations of coping strategies
(e.g., Link et al. 1989, 2002) and shift
Obligatory identities are longer-term, more affec-
tively intense, and have more demanding mutual strategies over time as situational con-
rights and obligations (e.g., spouse, parent,
tingencies change (e.g., Corrigan and
employee), making these roles more difficult to
exit. Watson 2002; Estroff et al. 1991).
Perhaps theAsmost symptom control common

becomes effective co
tion might be private
and stable, or when full recoverydeflect
is
with secrecy attained, (Goffman individuals who previously
1963; Li
1989) and/or selective disclosure to internalized stigma or predominantly
trusted others (Goffman 1963). Here, employed self-restoration strategies
one both blocks the self-esteem conse- may embrace deflecting resistance tac-
quences of stigmatization and sidesteps tics. Reminders of one's treatment his-
exposure to devaluation that might tory can be blocked with "that's not me
require additional deflecting. Such com- now/that's an unimportant part of me
binations may be especially characteris- now/I no longer have that problem."
tic of individuals with mild to moder- Persons who had moderately serious
ately serious disorders who previously disorders should be most likely to
were or are now in treatment. They make this change. In terms of social
know they are not mentally ill per se, identity theory (Tajfel and Turner
but just in case others might impose 1986; Taylor and Moghaddam 1994),
that label, they keep their history secret this shift reflects an individual's "social
or carefully guarded. Those whose men- mobility" from membership in a deval-
tal health status is publically known ued, powerless social group to inclusion
might also combine deflecting resistance in a valued, dominant out-group - in
with subsequent avoidance of persons this case, from "mentally ill" to "normal"
who have stereotyped them or might persons.
do so. Again blocking would be bolstered With effective symptom management
by limiting one's exposure to stigmatiz- or recovery, individuals typically regain
ing encounters. old or add new conventional role-
Individuals who use challenging identities as well as derive from role
resistance strategies are "out" - it would enactment an increasing sense of accom-
be difficult to disconfirm others' plishment and control. As argued ear-
stereotypes or educate/confrontlier, the more role-identities one
others
effectively without self-disclosure. Thus, the less importance one's prior
acquires,
secrecy and selective disclosure identity are not as "mental patient" will carry,
options. Because challenging entails allowing a shift from self-devaluation
interpersonal costs, individuals might or self-restoration strategies to deflect-
additionally engage in one or more avoi- ing resistance.
dant or self-reparative strategies such as Regular association with other con-
associating often with people who do not sumers is another contingency that
stereotype (especially other patients/ might add resistance to the individual's
consumers); comparing themselves to coping repertoire. If association were
patients/consumers who are doing forced by commitment proceedings or
less well than they are (rather than court mandate, psychological reactance
comparing to normals); and attribut- to coercion (Brehm 1966) could generate
ing their failures to other people's deflecting resistance: "I'm not like those
biases against persons with mental ill- other patients." When association with
ness rather than to their own short- other patients/consumers is instead
comings, among other strategies voluntary (see and regularized through
Crocker et al. 1998). participation in a treatment center or
Some tactics should appear or disap- group program, social comparisons
pear from the individual's coping reper- with fellow members may steer the
toire as his or her illness career unfolds. individual in one of two directions:
22
perceiving one's dissimilarity

distinctions. Acceptance of the status
majority of quo the group
is replaced should
by collective resistance.
deflection, while The aboveobserving
contingencies concern the staf
bers treating oneself and other appearance of resistance strategies in
patients in condescending or demean- the individual's coping repertoire.
ing ways may foster challenges to men- Resistance can also wane or vanish
tal illness stereotyping. over time. This is most likely when a dis-
More generally, shifts from internal- order worsens dramatically, frequently
ized stigma or self-restoration tactics to recurs, or becomes persistently dis-
the use of challenging strategies may abling. It becomes increasingly difficult
occur in response to a significant to sustain the belief that mental illness
"encounter," similar to the turning point stereotypes do not apply to oneself, and
often posited in theories of racial iden- symptoms can impair one's abilities to
tity development (see review in confront prejudice and discrimination
Phinney 1993). The encounter is an effectively. The person may abandon
event or series of events that force the resistance strategies and resort primar-
unaware or stigma-accepting individ- ily to avoidance or self-restoration, or
ual to recognize the negative impactshe or she may give up entirely and
of stereotypes and social rejection. self-stigmatize. In sum, as symptom
Theoretically, once differential treat- severity and situational contingencies
ment and its injustices are realized, change over time, individuals' propensi-
the person immerses him or herself in ties to employ deflecting or challenging
learning about the oppressed group's resistance tactics are likely to change
social and cultural situation, identifies in tandem.
with the oppressed group, and eventu-
ally develops a commitment to advanc-
CONCLUDING REMARKS
ing its welfare. If such a developmental
process occurs in the lives of patients I have used tentative and probabilistic
with a mental disorder, the use of chal- language throughout this paper
lenging strategies should emerge after because I have (1) defined a concept
a significant encounter. Entry into a that has not previously been defined
consumer-run program or treatment in the mental illness labeling litera-
setting might constitute one such ture, (2) distinguished between two
encounter, as discussed earlier. This forms of resistance that were not delin-
process has a number of elements in eated before, and (3) identified several
common with the "social change" conditions for resistance that are rarely
response of devalued groups to dis- discussed in the stigma-coping litera-
crimination, as described in social ture. Thus, much here is speculative,
identity theory (Tajfel and Turner although there are hints in existing
1986; Taylor and Moghaddam 1994). studies that at least some propositions
When members of a devalued social would find support.
category perceive that upward social Because resistance was previously
mobility is blocked, that they share undefined, the concept was applied
a collective fate, and that the discrimi- somewhat loosely by authors to a diverse
nation directed at them as a group is of coping strategies, some of which
array
illegitimate and unjustifiable, they might be more specifically classified as
will challenge the norms and social avoidant or restorative in nature, such
policies that have sustained group as shunning persons who are prejudiced
or maintaining withdrawal,that
that have unfortunate
symptom
one's fault (e.g., consequences. Corrigan an
2002; Doherty 1975; Prus 1975; When focusing on resistance as a gen-
Quadagno and Antonio 1975; Rogers eral category of responses to stigma,
and Buffalo 1974; Watson and River attention naturally turns to the issue
2005). By conceptualizing resistance asof when individuals are more or less
opposition to the invasion of devaluationlikely to resist, as opposed to internalize,
and discrimination, I have attempted to avoid, or self-repair. There has been lit-
cast a boundary around the range of cop-tle work on this problem; Corrigan and
ing responses that might be character-Watson's model of stigma responses
ized as resistant. (Corrigan and Watson 2002; Watson
At the same time, I have elaborated and River 2005) is an exception. They
argue - and I have drawn upon this
the concept of resistance by distinguish-
argument - that righteous anger is gen-
ing between blocking/deflecting and con-
fronting/challenging forms - one pri-erated when one both rejects cultural
marily cognitive, the other primarilystereotypes as unjust and identifies
behavioral in manifestation, respec- with other patients/consumers, a combi-
tively. My goal was to add to the coping nation that leads to collective action.
strategies that individuals use to ward However, I have proposed that challeng-
off the consequences of perceived or ing is not limited to actions by groups
experienced stigma, as outlined in mod- but includes confrontational tactics
ified labeling theory (Link 1987; Link that individuals employ on their own.
et al. 1989). Recently, Link and col- Furthermore, in addition to identify-
leagues (2002) themselves expanded ing with other patients/consumers in
their coping responses to include dis- treatment settings, I have specified
tancing and challenging, although theyother circumstances in which the use
have not conceptualized these responses of deflecting and challenging resis-
as resistance per se. Including resistance strategies might be expected
tance tactics helps to advance a key con- (past experience with resisting stigma,
tribution of modified labeling theory: past familiarity with mental illness,
bringing personal agency "back in." In characteristics of the illness and the
classic labeling theory, the individual treatment career, high levels of psy-
is a passive victim, compelled by other chosocial resources, and multiple role-
people's stereotypes and constraining identity involvements). My intention
behaviors to accept a mental patient was to elaborate classic and modified
identity (Quadagno and Antonio 1975). labeling theories, both of which have
In modified labeling theory, persons failed to consider resistance as an
anticipate the negative consequences of important category of stigma response
labeling and attempt to forestall them and, as a byproduct, have neglected
by passing, withdrawing, or educating - the range of conditions under which
acts that clearly reflect the exercise of resistance might occur. Theorists will
agency. In my view, resistance to stigma no doubt add other conditions that
inspire resistance; these preliminary
is especially important to theorize in the
modified labeling process because thoughts are intended to move theory
deflecting and challenging strategiesin that direction.
offer the possibility of sustaining or There is a danger that in focusing on
even improving individuals' self-regard,stigma resistance I have inadvertently
in contrast to other acts, such as implied that societal rejection is less of
20th-century
a problem than it is, that stigma American is Culture."
eas- Journal
of Social History 33:565-84.
ily managed, that resistance is the most
Becker, Howard. 1963. Outsiders. Glencoe,
common or healthiest strategy
NY: Free Press. used by
persons with mental illness,
Bellack, Alan S. 2006. or that
"Scientific and
resistance always hasConsumer
neutral Models ofor posi-
Recovery in
tive consequences for Schizophrenia:
self-esteem, Concordance, Contrasts,
inter-
and Implications." Schizophrenia Bulletin
personal relationships, and
32:432-42.
life chances.
None of these would Blumer,
be appropriate
Herbert. 1969. Symbolic con-Interaction-
clusions. Evidence is undeniable that ism: Perspective and Method. Englewood
derogation and discrimination are both
Cliffs, NJ: Prentice Hall.
Bonanno, George A. 2004. "Loss, Trauma, and
expected and experienced by the vast
Human Resilience: Have We Underesti-
majority of patients/consumers with
mated the Human Capacity to Thrive
a disorder and that stigma creates seri-
After Extremely Aversive Events?"
ous and persistent problems in their American Psychologist 59:20-28.
work and social lives. Data are simply
Brehm, Jack W. 1966. A Theory of
too sparse and measures too diverse Psychological Reactance. San Diego, CA:
Academic Press.
at this point to determine whether
Cooley, Charles Horton. 1902. Human Nature
resistance is frequent or rare, or and Social Order. New York: Scribner's.
whether it is beneficial or harmful Corrigan, Patrick W. 2000. "Mental Health
over the long run. I simply suggest Stigma as Social Attribution: Implications
for Research Methods and Attitude
three things: (1) resistance may help
Change." Clinical Psychology: Science and
to explain why the tie between stigma Practice 7:48-67.
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University Press.
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Mental Illness Label by Psychotic reducing ill health and distress, and the
conditions under which individuals label
Patients: Effects on Functioning."
American Journal of Orthopsychiatry themselves as mentally ill or resist such
59:398^109. labeling by others.

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Resisting the Stigma of Mental Illness

Author(s): Peggy A. Thoits

Social Psychology Quarterly

Mental Illness http://spq.sagepub.com

THEORETICAL BACKGROUND: other people. These stereotypes are

about their patient history "The mentally ill" are believed to be as

view of disorder may be softening). mental illness, filing appeals against

EVIDENCE FOR RESISTANCE TO

are commonly endorsing

In sum, I am suggesting that they usually do not in others. Perceiving

et al. 1991; Gove 2004; Quadagno

opportunities to act on convictions; emergence of their mental health prob-

initial allow group members

health programs, or emotion-focused

Theoretically, as discussed earlier, Multiple roles can have a second,

Perhaps theAsmost symptom control common

perceiving one's dissimilarity

REFERENCES Crocker, Jennifer and Brenda Major. 1989.

Crocker, Jennifer, Howarth, Caroline.

Modified Labeling Theory Approach to Loathing: The Role of 'Disturbing

1996: What Is Mental Illness and Is It to be

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