Shame, blame, and contamination: A review of the impact of mental illness stigma on family members

Abstract

In his classic text, <citeref rid="b19">Goffman (1963</citeref>) defined courtesy stigma as the negative impact that results from association with a person who is marked by a stigma. Family members of relatives with mental illness are frequently harmed by this kind of stigma. Using a social cognitive model of mental illness stigma, we review ways in which various family roles (e.g., parents, siblings, spouses) are impacted by family stigma. We distinguish between public stigma (the impact wrought by subsets of the general population that prejudge and discriminate against family members) and vicarious stigma (suffering the stigma experienced by relatives with mental illness). Results of our review suggest parents are blamed for causing their child's mental illness, siblings and spouses are blamed for not assuring that relatives with mental illness adhere to treatment plans, and children are fearful of being contaminated by the mental illness of their father or mother. The current body of literature suggests several important directions for future research including identification of stereotypes in addition to shame, blame, and contamination that harm family members; developing rigorous research methods that validate the link between stigmatizing attitudes and discriminatory behaviors; and testing programs that help to erase the various manifestations of family stigma.