Stigma, agency and recovery amongst people with severe mental illness

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Study explored behavioral and psychological strategies of stigma management and control in a group of people in recovery from severe mental illness. Participants were recruited from small-scale congregate housing units (recovery communities) for people in recovery, provided by a public mental health agency. Regular focus groups were conducted at these communities, augmented by in-depth participant observation. The grounded theory approach was used to analyze the data collected over a five-year period. The results are discussed in four areas: (1) sources of stigma, (2) behavioral strategies to prevent stigma, (3) psychological strategies to prevent stigma, and (4) peer support as a mediator of stigma. A key finding of this study is that stigma and discrimination were not perceived as commonly experienced problems by participants. Instead, stigma and discrimination were perceived as omnipresent potential problems to which participants remained eternally vigilant. This fear of stigma led participants to engage in various behavioral and psychological strategies to prevent the actual experience of stigma. Most notable among these measures was a concerted and self-conscious effort to behave and look “normal”, through dress, appearance, conduct, and demeanor. In this endeavor, participants possessed and deployed a degree of agency to prevent, avoid or preempt stigma and discrimination. These behavioral and psychological strategies of normalization appeared to be consolidated within the recovery communities, which provided physical shelter and highly-valued peer support. This fostered participants’ ability to face and embrace the outside world with confidence, pride and dignity.

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