FROM WHENCE COMES MENTAL ILLNESS STIGMA?

PATRICK W. CORRIGAN, AMY C. WATSON & VICTOR OTTATI

ABSTRACT
Background: This paper seeks to answer two fundamental questions: What is
the basis of the current form of mental illness stigma? and Why do western
cultures stereotype people with mental illness as dangerous, incompetent and
blameful, rather than something else?
Material and discussion: We argue that a motivational model called system-
justi®cation offers several bene®ts for answering these questions. System-
justi®cation portrays stigma as a way of making sense of economic and political
differences between the majority and stigmatized subgroups. We contrast
system-justi®cation with two cognitive models of stigma that seem to have
strong support from naõÈve psychology: mental illness stigma results as the
normal perception of a group of people who are dangerous and/or blameworthy
and there is a kernel of truth to the stigmatizing attitudes about people with
mental illness. Although research supporting the latter two models is mixed,
there are signi®cant limitations to the models, as well as concerns that normal
perception and kernel of truth might actually promote stigma.
Conclusions: As an alternative, system-justi®cation combines three paradigms
that suggest its worthiness for future research: 1) a review of historical and eco-
nomic forces that in¯uence social phenomena; 2) the need of humankind to
understand these forces and organize them into a unitary framework; and 3)
the cognitive mechanisms that are essential for this comprehension. Implications
of this model for stigma change are discussed.

Many persons with serious mental illness su€er the impact of stigma. They encounter land-
lords who refuse to rent them apartments, employers who fail to hire them, mental health
professionals who inappropriately hospitalize them, primary care providers who withhold
needed services and/or police ocers who respond with unnecessary force; in many cases
not because of the ways people with mental illness act but rather because of prejudicial beliefs
about them. What does research suggest about why this state of a€airs persists? Survey
research of western cultures describes this kind of prejudice as based on beliefs about danger-
ousness (people with mental illness are violent), competence (people with mental illness
cannot care for themselves) and responsibility (mental illness results from a character ¯aw)
(Corrigan, 1998). Social psychologists have expanded on this descriptive work by explaining
the relationship between these stigmatizing beliefs and discriminatory behavior (Crocker et
al., 1998). Our paper seeks to answer a third, and more basic, set of questions: from
whence come these beliefs? Why does the public continue to view people with mental illness
International Journal of Social Psychiatry. Copyright & 2003 Sage Publications (London, Thousand Oaks and
New Delhi) Vol 49(2): 142±157. [0020±7640 (200306)49:2;142±157;033114]
 CORRIGAN ET AL.: WHAT CAUSES MENTAL ILLNESS STIGMA? 143

as dangerous and incompetent rather than lazy, deceitful or some other characteristic? From
an even broader perspective, how come some groups are stigmatized (e.g. people of color, or
those who are obese, have AIDS or have mental illness) while others may escape such harsh
judgment (e.g. people who are tall or blue-eyed)?
We examine answers to these questions based on justi®cation of the status quo, psycho-
logical processes that contribute to the preservation of existing personal and social arrange-
ments and yield stigma as a product (Jost & Banaji, 1994). Psychological justi®cation o€ers a
motivational model of the processes that comprise stigma; namely, that stereotypes, prejudice
and discrimination serve individual, group or social goals. We make sense of motivational
models by contrasting them with two cognitive paradigms for understanding stigma that
have strong support as naõÈ ve psychologies. 1) What is called mental illness stigma is actually
a normal perception of the bizarre behavior of people with psychiatric disabilities. 2) The cog-
nitive processes that yield stigma result from a kernel of truth. Both cognitive paradigms have
some limitations that suggest the need for the motivational approach we pro€er.
Before discussing each of these research areas, the nature and impact of mental illness
stigma is described. This review includes a social cognitive model of stigma that will serve
as the basis of the remainder of the paper. We then summarize the strengths and limitations
of normal perception and kernel of truth models; despite some empirical support, we also
conclude that these naõÈ ve psychologies may actually promote some stigmas. We contrast
these views with system-justi®cation which combines three paradigms for answering ques-
tions about the genesis of stigma; the historical and economic forces that create social
phenomena; the motivational forces that compel individuals to understand these forces
and the cognitive mechanisms that in¯uence this comprehension process.

COMPONENTS OF A SOCIAL COGNITIVE MODEL OF STIGMA

Viewed as a social cognitive process, stigma comprises three components: stereotypes, preju-
dice and discrimination. Social psychologists view stereotypes as knowledge structures that
are learned by most members of a social group (Judd & Park, 1993; Esses et al., 1994;
Augoustinos et al., 1995; Hilton & von Hippel, 1996; Krueger, 1996; Mullen et al., 1996).
Stereotypes are especially ecient means of categorizing information about social groups.
Stereotypes are considered `social' because they represent collectively agreed upon notions
of groups of persons. They are `ecient' because people can quickly generate impressions
and expectations of individuals who belong to a stereotyped group (Hamilton & Sherman,
1994).
Just because most people have knowledge of a set of stereotypes does not imply that they
agree with them (Jussim et al., 1995). For example, many persons are able to recall stereo-
types about di€erent racial groups but do not agree that the stereotypes are valid. People
who are prejudiced, on the other hand, endorse these negative stereotypes (`That's right; all
persons with mental illness are violent!') and generate negative emotional reactions as a
result (`They all scare me!', `I hate them') (Devine, 1988, 1989, 1995; Hilton & von Hippel,
1996; Krueger, 1996). Prejudice leads to discrimination, the behavioral reaction (Crocker et
al., 1998). Research has documented the behavioral impact (or discrimination) that results
from the stigma of mental illness. Citizens are less likely to hire persons who are labeled
144 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 49(2)

mentally ill (Olshansky et al., 1960; Farina & Felner, 1973; Bordieri & Drehmer, 1986; Link,
1987), less likely to lease them apartments (Page, 1977, 1983, 1995) and more likely to falsely
press criminal charges against them (Sosowsky, 1980; Steadman, 1981).

STRENGTHS AND WEAKNESSES OF TWO COGNITIVE MODELS

From whence does this chain of stereotypes, prejudice and discrimination come? Two cogni-
tive models have attempted to answer this question. First, what is called mental illness stigma
is actually a normal cognitive reaction to perceptions of the bizarre behavior of people with
psychiatric disabilities. The second model is a subtler extrapolation of the ®rst; namely,
mental illness stigma represents a kernel of truth (Allport, 1979 [1954]). Although all
people with psychiatric disability are not dangerous, incompetent or blame worthy, there
may be objective aspects to mental illness in general that serve as the origin of these beliefs.
Let us consider the strengths and limitations of both models brie¯y here.

Stigma as the normal perception of bizarre behavior

Stigma as normal response echoes earlier arguments of Walter Gove (1970, 1975) who said
societal reactions to individuals with mental illness are the natural response to psychiatric
symptoms rather than biased expectations activated by some other source of stigma like
labels. While Gove does not deny that labels generate negative reactions, he discounts
their importance in the `causation' and persistence of psychiatric stigma. Link and colleagues
(1987) reviewed 12 published labeling studies that assessed the relative e€ect of deviant
behavior versus labeling on social rejection. Ten of the 12 studies concluded that aberrant
behavior on the part of the confederate had a statistically signi®cant and more potent
e€ect than labels on subsequent prejudice and discrimination. Four of the 12 studies failed
to ®nd any signi®cant e€ect for labeling. These ®ndings suggest that what some people call
stigma may actually be the accurate perception of the public.
While the above mentioned studies suggest that behavior is more important in determining
rejection than label, Link and colleagues (1987) note a growing body of experiential and
empirical data that imply people with mental illness will experience discrimination regardless
of their behavior. The researchers attempted to understand this discrepancy in their own
study of the relative in¯uence of labeling and behavior in determining social rejection and
acceptance (Link et al., 1987). Although Link and colleagues found objectionable behavior
explained a signi®cant portion of variance, the authors also noted that perceptions of danger-
ousness activated by the mental illness label were as important as behavior in determining
rejection. Additionally, they found that research participants who endorsed beliefs that
individuals with mental illness are dangerous were more rejecting of labeled than non-labeled
persons. Subsequent studies further seemed to support the egregious e€ects of labeling (Socall
& Holtgraves, 1992; Aubrey et al., 1995; Cormack & Furnham, 1998; Link & Phelan, 1999;
Pescosolido et al., 1999).

Stigma represents a kernel of truth

Evidence on the `normal' reaction to perceiving bizarre behavior seems mixed with several
studies showing stigmatizing responses resulting from the symptomatic behaviors of vignettes
 CORRIGAN ET AL.: WHAT CAUSES MENTAL ILLNESS STIGMA? 145

while other prejudices arose solely from the label. How might mixed ®ndings on the `normal
response' hypothesis be explained? Viewing the prejudice and discrimination as a normal
cognitive response is reminiscent of social psychological research that suggests stereotypes
contain a kernel of truth. The tendency for stereotypes to contain a `kernel' (Allport, 1979
[1954]) or `grain' (Campbell, 1967) of truth seems obvious to some researchers given the
anthropological and sociological assumption that groups do in fact di€er. From this perspec-
tive, stereotypes function as rational categories that `grow up from a kernel of truth' (Allport,
1979 [1954], p. 22). Hence, if people with mental illness are, in fact, more bizarre, dangerous,
incompetent and irresponsible than the general population, it is reasonable that these traits
are attributed to the category of mental illness. Assessment of the kernel of truth hypothesis,
therefore, is a matter of assessing `stereotype accuracy'.
Examples of `stereotype accuracy' are apparent in people's perceptions of a variety of
social groups. For example, professional basketball players are stereotyped as tall, and objec-
tive measures con®rm that the average basketball professional is indeed taller than most
people. Nor is stereotype accuracy limited to physical attributes of social groups (Ashmore
& Longo, 1995). More than half a century ago, Vinacke (1949) uncovered evidence of stereo-
type accuracy in students' perceptions of Japanese, Chinese, White, Korean, Filipino,
Hawaiian, Samoan and African American students at the University of Hawaii. Analogous
®ndings have been obtained when examining trait impressions of other ethnic groups (Balk,
1965; Abate & Berrien, 1967; Triandis & Vassiliou, 1967; McCauley & Stitt, 1978; Bond,
1986; McCauley, 1995).
Perhaps the same is true when considering stereotypic perceptions of mental illness. That
is, perhaps people with mental illness really do possess the traits commonly attributed to
them. If this is indeed the case, evidence should reveal that people with mental illness are
at least slightly more dangerous, dirty, homicidal, incompetent, rebellious, irresponsible,
unable to care for themselves and lacking in moral fortitude than the general population
(Nunnally, 1981; Gabbard & Gabbard, 1992; Monahan, 1992; Wahl, 1995; Hayward &
Bright, 1997; Farina, 1998; Link & Phelan, 1999; Corrigan, 2000; Corrigan & Watson, in
press; Corrigan et al., 2002). There are, of course, reasons to question the accuracy of
these stereotyped perceptions. History is ®lled with examples of inaccurate stereotyping
that has served to justify pernicious forms of prejudice and discrimination. Old-fashioned
racist attitudes toward Blacks were bolstered by a belief in their intellectual inferiority.
Early Armenian laborers in southern California were stereotyped as `dishonest', `deceitful'
and `trouble makers'. In all of these instances, however, more objective assessments of
group characteristics failed to con®rm the validity of these stereotypes. For example, La
Piere (1936) found that Armenians in southern California appeared less often in legal cases
and possessed credit ratings that rivaled those of other ethnic groups. Moreover, performance
of Blacks on standardized achievement tests matches that of similar White Americans when
Blacks take these tests under conditions that minimize stereotype threat and its concomitant
evaluation apprehension (Steele & Aronson, 1995). Thus, although some stereotypes contain
a component of accuracy, it is clear that other stereotypes may possess a signi®cant compo-
nent of inaccuracy.

Are stereotypes of people with mental illness accurate?

Stereotypes of a group are often conceptualized as beliefs about the average group member
146 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 49(2)

(Ottati & Lee, 1995). Moreover, stereotypic characterizations of a social group are inherently
comparative. Thus, the belief that `schizophrenics are dangerous' implies that people with
schizophrenia are, on average, more dangerous than the mainstream population. What is
the accuracy of this assertion? Several studies suggest that people with severe mental illness
are more likely to be violent than people without these disorders (Swanson et al., 1990;
Cirincione et al., 1992; Monahan, 1992; Mulvey, 1994; Torrey, 1994; Grossman et al.,
1995; Eronen et al., 1996; Hodgkins et al., 1996). However, the increased risk of violence
associated with mental disorder is modest and comparable to that which is associated with
age, education, gender and previous history of violence in populations that are not labeled
mentally ill (Swanson et al., 1990; Link et al., 1992). Additionally, this risk seems to be limited
to individuals experiencing a speci®c subset of psychotic symptoms ± termed `threat/control-
override' symptoms ± which in¯uence the person's de®nition of a situation (Link & Phelan,
1999). These symptoms may cause an individual to de®ne a seemingly benign situation as
threatening and respond in a self-protective manner, as though a real threat exists. Co-
occurring substance abuse disorders also seem to predict violence (Steadman et al., 1998).
Given this evidence, the extreme fear associated with mental illness stereotype per se, and
its broad application to all persons with mental illness, seems exaggerated. If we choose to
avoid all persons with similar odds-ratios for violence, we would have to stay away from teen-
agers, males and grade school graduates (Link & Phelan, 1999).

Inaccuracies that resort from perceptual biases

There are undoubtedly multiple factors that contribute to inaccurate stereotyping. Errors
that result from kernel of truth may be explained in terms of perceptual biases, processes
that are solely related to cognitive mechanisms and not the truth value of the evidence
(Stangor & Crandall, 2000). Chapman (1967) ®rst labeled this phenomenon illusory correla-
tion based on his basic cognitive research. He found research participants in an observational
learning task reported a correlation in two classes of events that in reality were either not
correlated or associated to an extent far below reported levels. Hamilton and colleagues
(1976, 1981) extended this research to social cognition; they found that negative attributes
are ascribed to minority groups solely based on group size and characteristics. In particular,
minority groups and negative traits will (erroneously) appear related because they occur less
frequently. This result explains the association between people with mental illness and such
negative qualities as dangerousness, incompetence and blame.
Accentuation theories o€er another model for explaining how cognitive biases lead to
stereotypes (Ford & Stangor, 1992; Fyock & Stangor, 1994). According to this view, actual
or misperceived di€erences are exaggerated through cognitive and/or perceptual biases.
These theories do not account for the initial genesis of stigma, but rather how group di€er-
ences are perceptually exaggerated (and hence, maintained) because individuals seek meaning
in these di€erences. For example, people with mental illness are seen as dangerous because
they are locked away in institutions. Cognitive models like these suggest that the cause of
inaccuracies that lead to stereotypes results from perceptual biases. As a result, these
models expand our understanding of stereotypes as well as providing a broad methodology
for testing many of the hypotheses that emerge from this understanding. Unfortunately, these
models are still unable to answer the fundamental question of this paper; why is mental illness
in THIS form and not THAT one? How come the western world frames mental illness in
 CORRIGAN ET AL.: WHAT CAUSES MENTAL ILLNESS STIGMA? 147

terms of dangerousness, blame and incompetence rather than some other constructs?
Alternately, why are people with mental illness viewed as dangerous while other groups
with similar violence rates are not? As argued below, the answer to these questions lies in
better understanding the motivational role of stigma, an issue of psychological justi®cation.

STIGMA REPRESENTS PSYCHOLOGICAL JUSTIFICATION

In this section we review justi®cation models that base the ontogenesis of stereotypes and
prejudice on foundations other than cognition. The speci®c focus here is on the origins of
stigma as contemporaneously perceived. These approaches do not surmise the truth value
on which speci®c stereotypes are formed. There is no assumption, for example, that mental
illness stigma developed out of accurate perceptions of bizarre and dangerous behavior.
Instead, justi®cation models describe the motivations that are served by stereotypes.
Three such motivations have emerged in the literature: ego-justi®cation, group-
justi®cation and system-justi®cation (Jost & Banaji, 1994). Ego-justi®cation suggests that
stereotypes and prejudice develop to protect actions of the self (Katz & Braly, 1935; Adorno
et al., 1950). According to group-justi®cation, stereotypes protect the status of the social
group as a whole, not just the individual (Tajfel, 1981). Both views, however, have signi®cant
diculties answering a key question of this paper; why do these stereotypes (dangerous-
ness, blame, incompetence) about mental illness currently emerge and not others? System-
justi®cation is proposed as an alternative to explain the social functions of stereotypes
(Sidanius & Pratto, 1993; Jost & Banaji, 1994; Jost & Burgess, 2000). Before describing the
bene®ts of system-justi®cation, ego- and group-justi®cations are described more fully.

Ego-justi®cation theories
Psychoanalysts were among the ®rst to write about ego-justi®cation; namely, the self is pro-
tected when internal con¯icts are projected onto stigmatized groups (Freud, 1946; Bettelheim
& Janowitz, 1964). In this way, people are able to shield their self-esteem. Social psychologists
expanded the ego-justi®cation idea beyond personal defense mechanisms to include any func-
tion that protects ideas, images or behaviors that negatively re¯ect the self by projecting these
negative conceptualizations and actions on others (Lippmann, 1922; Katz & Braly, 1935).
Despite its intellectual appeal and omnipresence in the clinical literature, little empirical
evidence has been found to support ego-justi®cation (Sherif & Cantril, 1966 [1947]). There
have been a few studies that provided macro-level support to ego-based hypotheses. For
example, one study showed people of higher socio-economic status were likely to stereotype
poor people as lazy (Ashmore & McConahay, 1975). A second study showed soldiers were
likely to dehumanize (or stigmatize) the enemy as savage and satanic (Bar-Tal, 1989,
1990). Noticeably absent, however, was research at the person level ± e.g. examining whether
the individual's perception of ego threat directly leads to stereotypes. The absence of this kind
of data is ironic given the individual-level of analysis inherent in ego-justi®cation models.
In part, little data supporting ego-justi®cation may re¯ect the psychodynamic psychologist's
disinterest in the research enterprise, at least as framed by experimental social psychologists.
148 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 49(2)

Group-justi®cation models
Tajfel (1981; Tajfel & Turner, 1979, 1986) argued that the group, and not the individual, is the
appropriate level of analysis for social phenomena. The motivation for group-justi®cation is
to support the goals of one's in-group. For example, speci®c stereotypes about a minority
out-group serve to frame the majority in a positive light. All members of the majority are
hard-working; out-group minorities are lazy! Individuals endorse stereotypes as a way of
justifying the actions of others with whom they closely identify. There is substantial research
that supports these assertions (Hogg & Abrams, 1988). Consider, for example, the results of a
meta-analysis of 137 studies on the in-group bias hypothesis (Mullen et al., 1992). In-group
bias is signi®cantly stronger when in-group membership is salient. Moreover, higher status
groups seem to show more in-group bias on relevant attributes (i.e. those characteristics
most important to the group) while lower status groups exhibit more in-group bias on less
relevant attributes.
Using group-justi®cation as an explanation for mental illness stigma is a bit problematic,
however. What exactly is the in-group against which people with mental illness are con-
trasted? The `normal' in-group is a default category that only gains de®nition in the absence
of mental illness. Hence, there is no readily apparent source of in-group motivation to drive
group-justi®cation.

Additional limits to ego- and group-justi®cation

Ego- and group-justi®cation describe the motivations that are sated by stereotypes. However,
there are several conceptual problems with these models that fail to address the central
question of this paper. Implicit in ego- and group-justi®cation is the idea that stereotypes
and prejudice develop against an out-group, not because of any special qualities of that
out-group, but rather because of individual or in-group need. Hence, ego- and group-justi®-
cation do not explain why an individual or in-group would stigmatize people with mental ill-
ness, rather than, for example, people with blue eyes or blond hair. Given that mental illness
is somewhat of a hidden stigma (i.e. an individual may not know a peer has mental illness
unless that peer says so (Corrigan, 2000)), it is unlikely that individuals or in-groups select
mental illness as a justi®ed group because it is convenient.
Ego- and group-justi®cation also fails to explain the form of mental illness stigma.
Researchers have shown some consensus among the public about the nature of mental illness
stigma (Taylor & Dear, 1981; Brockington et al., 1993); i.e. persons with mental illness are
dangerous (and should be avoided) or incompetent and should have an authority make deci-
sions for them. Nothing about ego- or group-justi®cation suggests why dangerousness and
incompetence are identi®ed commonly as core stereotypes while statements about laziness
and sloth are not.

System-justi®cation
Jost and colleagues (1994, 1999; Stangor & Jost, 1997) have identi®ed an even broader target
for justi®cation (beyond the self or group) arguing that stereotypes and prejudice develop to
con®rm the system. Once a set of events produces speci®c social relationships, whether by
historical accident, biological derivation, public policy or individual intention, the resulting
arrangements are explained and justi®ed simply because they exist. These justi®cations
 CORRIGAN ET AL.: WHAT CAUSES MENTAL ILLNESS STIGMA? 149

seem to evolve over time as the result of historic, economic or social pressures. System-
justi®cation has historical roots in classic theories of Marx, Weber and Durkheim on the
need for social systems to seek legitimization. It also parallels more recent theories such as
self-categorization (Turner et al., 1987), just world hypothesis (Lerner, 1980), conservatism
(Wilson, 1973) and social dominance (Pratto et al., 1994; Rabinowitz, 1999; Guimond,
2000). System-justi®cation is provocative as a paradigm because it bridges macro-level socio-
logic/historic variables with the kind of individual level variables de®ned by social cognition.
Jost and Banaji (1994) provide some interesting examples of system-justi®cation. Because
of historical events in the 16th and 17th centuries, Blacks were slaves and Whites were
masters. The system explains this di€erence by stereotyping contemporary Blacks as less
competent and industrious. Women are able to bear children; men are not. In western society,
women are viewed as the caretakers and men the workers and business agents. This di€erence
in the system leads women to being characterized as nurturing while men are viewed as auton-
omous (Eagly & Ste€en, 1984).
How might system-justi®cation account for mental illness stereotypes? During the Middle
Ages, westerners locked away people with mental illness in prisons. Protection of the public
from dangerous people was an implied theme. Beginning in the 19th century, prisons were
replaced with asylums or state hospitals. People who require treatment and institutions are
incompetent and need guardians. Since the deinstitutionalization movement that began in
the 1960s, growing numbers of individuals with mental illness are again ending up in prisons
and jails (Travis, 1997). This kind of historical trend leads to the popular notion that people
with mental illness are dangerous and unable to care for themselves (Corrigan, 2000).
System-justi®cation implies that a speci®c stereotype requires knowledge of past history.
It suggests, for example, that people must recognize the historical role of institutionalization
to systemically justify mental illness stereotypes. Does this mean the impact of system-
justi®cation is limited in people who lack historical knowledge? Not necessarily: system-
justi®cation probably has its greater impetus from contemporary social phenomena that
re¯ect past history. System-justi®cations of African Americans are more likely to arise
from contemporarily manifested social and economic injustices between the races; injustices
that have their roots in slavery and its immediate aftermath. In a similar manner, justi®ca-
tions for mental illness may arise from the obvious institutions that suggest people with
mental illness need to be controlled; e.g. state hospitals and prisons. Note in both cases
that the news media and entertainment industry have a central role in informing the public
about the status quo.

Research support for system-justi®cation

Jost and Banaji (1994) have interpreted ®ndings from a few past studies as supportive of
system-justi®cation. For example, Ho€man and Hurst (1990) came up with an ingenious
way to examine the e€ects of perceptions of social roles on stereotypes. Research participants
were asked to provide trait ratings of two ®ctional groups ± the Orinthians and Ackmians ±
whose occupations were dominated by child raising and city work, respectively. Even this
®ctional social system led to gender stereotypes; the Orinthians were judged to be patient,
kind and understanding while the Ackmians were con®dent and forceful. Stereotypes in no
way re¯ected the objective personality traits of individual Ackmians and Orinthians. Instead
they were based on systemic di€erences between the two groups re¯ected in their occupations.
150 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 49(2)

Subsequent studies like this further support the assertions of system-justi®cations (Ross et al.,
1977; Skrypnek & Snyder, 1982; Jost, 1997; Jost & Burgess, 2000).

Bene®ts of system-justi®cation
The theory of system-justi®cation overcomes many of the problems that resulted from ego-
and group-justi®cation models (Jost & Banaji, 1994). System-justi®cation takes the genesis
of stereotypes beyond individual or in-group goals. Stereotypes do not necessarily arise as
the result of a personal press; there is no external event requiring ego or in-group defenses
in the form of stereotyping others. Looking to the system (instead of individual/in-group
need) for the origin of speci®c stereotypes answers why the form of a speci®c stereotype is
similar across the population. Stereotypes arise as explanations for the system-wide experi-
ence of in-group members. Note the important role of the news media and entertainment
industry as purveyors of system-wide perceptions. Media analyses of ®lm and print represen-
tations of mental illness have identi®ed three common stereotypes: people with mental illness
are homicidal maniacs who need to be feared; they have childlike perceptions of the world
that should be marveled at; or they are rebellious, free spirits (Hyler et al., 1991; Gabbard
& Gabbard, 1992; Mayer & Barry, 1992; Monahan, 1992; Wahl, 1995; Farina, 1998). These
common representations re¯ect the systemic misperceptions of mental illness.
System-justi®cation also resolves some of the problems that result from the idea of kernel
of truth. System-justi®cation does not rely on assumptions about the truth value of a stereo-
type. There is no assertion that persons with mental illness are dangerous or incompetent.
Instead, these stereotypes are the natural explanation for institutions that control people
with mental illness. Hence, system-justi®cation does not reinforce public stereotypes in a
fashion similar to kernel of truth or normal reality. It does not suggest that any aspect of
a stereotype is valid.
Although system-justi®cation provides a psychological explanation for mental illness
stigma, it leaves the ultimate `from whence' question unanswered. System-justi®cation
helps people to cognitively make sense of current di€erences among groups. However, the
model makes no assumptions about the origins of the system that epistemically compels
the person to create stigma. Questions that ultimately answer, `from whence comes
stigma?' are a matter of more macro social science: history, economics and political science.
We brie¯y struggle with ways to combine these diverse methodologies with psychological
approaches in the section below on changing mental illness stigma. Suce it to say here that
system-justi®cation is adequate to resolve questions about the origin of a speci®c stigma
when these questions are limited to the level of how individuals understand stigma in the
contemporary world.

CHANGING THE STIGMA OF MENTAL ILLNESS

One of the reasons investigators seek to explain stigma is to better inform strategies for
changing it. In earlier research, our group highlighted the impact of education and contact
with people with mental illness on prejudicial attitudes (Corrigan & Penn, 1999; Corrigan
et al., 2000; Corrigan et al., 2002). These seem to be appropriate strategies for challenging
the misinformation about mental illness that poses as normal reactions or kernels of truth.
 CORRIGAN ET AL.: WHAT CAUSES MENTAL ILLNESS STIGMA? 151

Education was found to yield mild to moderate changes in attitudes about mental illness. The
e€ects of contact were stronger and broader. Members of the general public who interacted
with a person with mental illness (who mildly discon®rmed the stereotype) exhibited large
changes in stigmatizing attitudes. Moreover, they showed more positive processing of infor-
mation about people with mental illness. Contact has also been shown to have positive e€ects
on helping behavior. Research participants who had contact with people with mental illness
were more likely to sign petitions against anti-stigma activities (Corrigan et al., 1999) and
donate money to advocacy groups (Corrigan et al., 2002).
Some researchers believe that the kinds of challenges to discrete cognitions engendered in
contact and education may not lead to lasting change in system-justi®cations (Jost & Banaji,
1994). Rather, the system itself must change to facilitate parallel justi®cations that re¯ect a
less stigmatizing image (Jost & Banaji, 1994). Or, as other social psychologists have
framed the task, the most e€ective way of changing stereotypes is to alter material reality
(Eagly & Ste€en, 1984; Haslam et al., 1992; Banaji & Greenwald, 1994). According to this
perspective, changes in the political and economic relationships among social groups lead
to improvements in corresponding labels and stereotypes.
This notion is historically evinced in the evolution of social relationships and stereotypes
in key American groups. Consider, for example, how several historical events marked the
changing place of African Americans in the United States: Lincoln's emancipation proclama-
tion (1863), repudiation of the Ku Klux Klan (1930), Johnson and Johnson establish
successful business (1943), Jackie Robinson stars in the Major Leagues (1947), a quarter of
a million Americans march on Washington for racial justice (1963), the Civil Rights Act
passes (1964) and Toni Morrison wins the Pulitzer Prize (1988). In the process, attitudes
about Blacks changed from one of slaves to passive sharecroppers to successful business
people, athletes and authors. Although substantial prejudice and discrimination against
African Americans persists, many of the barriers to education, employment, housing and
prestige are crumbling.
Connecting these socio-economic events with change in attitudes and behavior is a
methodological quagmire that requires the integration of sociological, psychological and his-
torical strategies. Guimond (1995, 2000; Guimond & Palmer, 1996) has developed a research
paradigm that seems to approach this integration. He has examined the change in a person's
values and attitudes as the individual passes through college or military training. In the
process, social roles change as do perceptions of the system. For example, one study
showed that values changed as participants became more socialized (Guimond, 1995).
More compelling to the assertions about system-justi®cation and stigma was a study on
Canadian Francophones (the minority culture) and Anglophones (the majority) undergoing
a four-year military training program. At the end of that time both the Anglophones and the
Francophones were more likely to endorse the notion that the economic gap between the two
cultures was legitimate (Guimond, 2000). Methodologists need to continue to examine ways
to integrate diverse research paradigms to answer questions about system-justi®cation.
As is evident in this political and economic evolution, policy makers have an important
role in changing the system (and subsequent justi®cations). For example, the Civil Rights
Act, along with the Voting Rights Act of 1965, had a major e€ect on racial roles. Consider
the impact of the Americans with Disabilities Act (ADA) signed into law by George Bush
in 1990. It has put employment practices for people with disabilities (including mental illness)
152 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 49(2)

on the same playing ®eld as considerations of race and gender. Namely, employers are
learning that discrimination because of mental illness, like ethnicity, is heinous and will
not be tolerated. Moreover, the ADA introduced the idea of reasonable accommodations;
employers must consider restructuring their job practices so that people with mental illness
can successfully meet the demands of the position. Future research needs to adopt the
kind of socio-historical and psychological strategies discussed earlier to see if policies like
the ADA (as well as the Fair Housing Act of 1968/1988, which has similar important impli-
cations for residential opportunities) lead to changes in stigmatizing attitudes and behaviors.

CONCLUSIONS

Both cognitive and motivational answers have been posed to the question, from whence
comes mental illness stigma? The two cognitive models reviewed in this paper ± normal
reaction to perceived bizarre behavior and kernel of truth ± were found empirically lacking
in some regards and actually thought to promote stigma in others. We acknowledge that
this is an incomplete picture of social cognitive models of stigma but selected these two
because of their importance as a naõÈ ve psychology of stigma cognition; i.e. the way in
which the average person might perceive how stigmas are understood. Given these limita-
tions, we turned to motivational explanations that in¯uence this naõÈ ve person's cognition
and found system-justi®cation to provide a theoretically provocative and empirically sup-
ported model that helps us to understand why stigma is in this form for that population.
System-justi®cation integrates three social paradigms: 1) both past and current historical
and economic forces that in¯uence social phenomena; 2) the need of humankind to under-
stand these forces and organize them into a tangible picture; and 3) the cognitive mechanisms
that are essential for this comprehension. Note that system-justi®cation combines motiva-
tional and cognitive approaches to this important social question.
System-justi®cation provides an exciting heuristic with avenues for stigma research that
diverge in several directions. Hence, further development of this paradigm will bene®t
from a variety of di€erent theories and methods. Like other macro-theories of this sort how-
ever, system-justi®cation also provides some signi®cant challenges. For example, social
science has not easily bridged the sociological processes suggested by historical and economic
forces with the individual-level phenomena of psychology (Liska, 1990; Newman, 2001). Nor
has research thus far used the breadth and depth of information on social cognition to better
understand the justi®cation of stigma. However, the mix of these three paradigms provides a
conceivably fruitful avenue for understanding the origins of mental illness stigma in particu-
lar, and prejudice and discrimination in general.

ACKNOWLEDGEMENT

This paper was made possible, in part, by NIMH grant MH-62198 and the Chicago Consor-
tium for Stigma Research. We would like to thank Ken Rasinski for helpful comments on
earlier versions of the paper.
 CORRIGAN ET AL.: WHAT CAUSES MENTAL ILLNESS STIGMA? 153

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Patrick Corrigan, PsyD, University of Chicago Center for Psychiatric Rehabilitation, IL, USA
Amy C. Watson, PhD, University of Chicago Center for Psychiatric Rehabilitation, IL, USA
Victor Ottati, PhD, Loyola University, Chicago, IL, USA
Correspondence to Patrick Corrigan, PsyD, University of Chicago Center for Psychiatric Rehabilitation, 7230 Arbor
Drive, Tinley Park, IL 60477, USA.
Email: [email protected]