Stigma and mental disorder: Conceptions of illness, public attitudes, personal disclosure, and social policy

The end of the last millennium witnessed an unprecedented degree of public awareness regarding mental disorder as well as motivation for policy change . Like Sartorius, we contend that the continued stigmatization of mental il lness may well be the central issue facing the field, as nearly all attenda nt issues (e.g., standards of care, funding for basic and applied research efforts) emanate from professional, societal, and personal attitudes toward s persons with aberrant behavior. We discuss empirical and narrative eviden ce for stigmatization as well as historical trends regarding conceptualizat ions of mental illness, including the field's increasing focus on genetic a nd neurobiological causes and determinants of mental disorder. We next defi ne stigma explicitly, noting both the multiple levels (community, societal, familial, individual) through which stigma operates to dehumanize and dele gitimize individuals with mental disorders and the impact of stigma across development. Key developmental psychopathology principles are salient in th is regard. We express concern over the recent oversimplification of mental illness as "brain disorder," supporting instead transactional models which account for the dynamic interplay of genes, neurobiology, environment, and self across development and which are consistent with both compassion and s ocietal responsibility. Finally, we consider educational and policy-related initiatives regarding the destigmatization of mental disorder. We conclude that attitudes and policy regarding mental disorder reflect, in microcosmi c form, two crucial issues for the next century and millennium: (a) toleran ce for diversity (vs. pressure for conformity) and (b) intentional directio n of our species' evolution, given fast-breaking genetic advances.