31 Corrigan / How Clinical Diagnosis Might Exacerbate the Stigma of Mental Illness CCC Code: 0037-8046/07 $3.00 ©2007 National Association of Social Workers How Clinical Diagnosis Might Exacerbate the Stigma of Mental Illness Patrick W. Corrigan ฀ Stigma can greatly exacerbate the experience of mental illness. Diagnostic classification frequently used by clinical social workers may intensify this stigma by enhancing the public’s sense of “groupness” and “differentness” when perceiving people with mental illness. The homogeneity assumed by stereotypes may lead mental health professionals and the public to view individuals in terms of their diagnostic labels. The stability of stereotypes may exacerbate notions that people with mental illness do not recover. Several strategies may diminish the unintended effects of diagnosis. Dimensional approaches to diagnosis may not augment stigma in the same manner as classification. Moreover, regular interaction with people with mental illness and focusing on recovery may diminish the stigmatizing effects of diagnosis. KEY WORDS: diagnosis; DSM; empathy; stigma Autistic children never play normally with other children.They often do not respond normally to their mothers’ affections or to any tenderness. (Freedman, Kaplan, & Sadock, 1976, p. 449) The sociopath persistently violates the rights of oth- ers, shows indifference to commitments, and encounters conflict with the law. (Rathus, 1984, p. 451) T hese quotes are two examples of how the use of diagnostic terms can sometimes worsen the stigma of mental illness. Stigma can significantly undermine the quality of life of people with mental illness. The social opprobrium that results from stigma can rob people labeled men- tally ill of a variety of work, housing, and other life opportunities commonly enjoyed by adults in the United States. It can also prevent some people who might otherwise benefit from clinical services from pursuing treatment in an effort to avoid the label. One important part of the system of care—clinical diagnosis—may strengthen the stereotypes that lead to stigma. Diagnosis may intensify both the “group- ness” and the “differentness” aspects governing public perceptions of people with mental illness. THE PROBLEM OF THE STIGMA OF MENTAL ILLNESS Stigma harms people with mental illness in three ways: label avoidance, blocked life goals, and self-stigma. Label Avoidance Epidemiological research has consistently shown that the majority of people who might benefit from mental health care either opt not to pursue it or do not fully adhere to treatment regimens once begun. As an example, consider people with schizophrenia, the group that might be construed as being most in need of services. Results from the Epidemiologic Catchment Area Study showed that only 60 percent of people with schizophrenia participated in treat- ment (Regier, Narrow, Rae, & Manderscheid, 1993). Taking into account symptom severity, Narrow and colleagues (2000) found that people with serious mental illness were no more likely to participate in treatment than those with relatively minor disorders. The National Comorbidity Survey showed similar results (Kessler et al., 2001); fewer than 40 percent of respondents with a serious mental illness such as schizophrenia had received medical treatment in the past year. Research has suggested that many people choose not to pursue mental health services because they do not want to be labeled a “mental patient” or suffer the prejudice and discrimination that the label entails. Results from the Yale arm of the Epidemiological Catchment Area data showed negative attitudes about mental health inhibit service use in those at risk of a psychiatric disorder (Leaf, Bruce, Tischler, & Holzer, 1987). Findings from the National Co- morbidity Survey identified stigmatizing beliefs