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Dinh Ho
Professor Devaney
Senior Capstone
6 March 2015
Ending the Stigma on Mental Illness
Falling asleep on the car ride home one evening, I was suddenly startled awake by a text.
The text was sent by Max, a close friend of mine who lives back home, and it asked what my
personal thoughts on suicide were. Initially, I was confused and thought the question was
extremely blunt and seemed to come out of nowhere; however, after a few minutes of
contemplating what I should reply, it occurred to me that something was not right. Immediately
upon figuring this out, I asked what was wrong and what he was doing at that moment. He
admitted to me that he was thinking on the bridge. Because I knew Max and his personal life
extremely well, I was familiar with all of the unfortunate events that he has been through and I
knew that sometimes he would get extremely depressed. Assuming the worst, I attempted calling
him several times, but my call kept going straight to voicemail so I reached out to several other
friends who also lived back home and told them what was happening. Although I had managed
to find help for Max, what happened that night opened my eyes to the idea that anyone I cared
about, whether I knew it or not, could be also suffering from a mental illness, having suicidal
thoughts, and/or take their life at any moment. If Max had not texted me that night, who knows
whether he would still be the happy and well person he is today.
Unfortunately, people like Max who suffer from a form of mental illness may often find
themselves alone and helpless. These individuals can also have a very hard time with discussing
their mental health state with others for a variety of reasons. One such reason is due to the stigma

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that revolves around mental illness. Although having a mental illness is a legitimate health
problem like diabetes or cancer, only mental illness is known for having a stigma that follows.
Not only do individuals who suffer from mental illness have to take on the symptoms of their
illness, their quality of life is further diminished because of other problems, including stigma.
Mental health problems and illnesses, as summarized by Edward F. Ormston, is the full range of
patterns of behavior, thinking, or emotions that bring some level of distress, suffering, or
impairment in areas such as school, work, social, and family interactions or the ability to live
independently (5). Stigma has the potential to prevent these individuals from seeking medical
treatment and speaking about their condition; furthermore, these individuals can face
discrimination, prejudice, and can even be criticized for having the mental illness. The
consequences of mental illness stigma can potentially end up being devastating for individuals
and their loved ones, which is why stigma is an important issue and needs to be combated
Although there are some opposing views on whether mental illness is a true illness and
there are related stereotypes that continue to persist today, existing research supports the idea that
mental illness stigma is problematic because it can impact the lives of millions of individuals
suffering from a mental illness in a variety of ways. As Overton and Medina point out, one in
four people has or will have suffered from a mental illness at some point in their life (143);
however, despite this being a large population, only about half of these individuals actually
receive any treatment for their illness (Statistics). Research has shown that stigma may contribute
to this, such as in a study conducted by Bathje and Pryor (2011), which investigated the effects
of public stigma on self-stigma and treatment seeking attitudes. It was concluded that stigma
definitely played a role in an individuals decision in seeking help for their mental health

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problem. Other research has focused on the negative consequences of mental illness stigma,
including the clinical implications on the individual, and the effect on the ability for an
individual to do things like rent a home or become employed. Research has also focused on
suggesting possible solutions towards combating mental illness stigma, like increasing the role of
federal legislation, encouraging psychological treatments vs. medication, and creating antistigma campaigns. Additionally, Corrigan and Rao (2012) advocate the use of disclosure and
peer support in an effort to create personal empowerment among those who suffer from a mental
Mental illness stigma is a problem because it negatively affects the lives of individuals
suffering from a mental illness by perpetuating stereotypes and discrimination that prevents those
affected from seeking proper care and from living normal lives. For these reasons, it is extremely
important to be able to understand the role of stigma in dealing with a mental illness and how to
deal with it properly. In order to combat the effects of mental illness stigma effectively, personal
empowerment needs to be reinforced because it allows individuals to take better control over
their lives, to seek the help they deserve, and to live life more enjoyably.
In order to first understand the effects of mental illness stigma and the importance of
ending this stigma, the terms mental illness and stigma need to be clear. Mental illness, or mental
disorder, is defined as being a mental or bodily condition marked primarily by sufficient
disorganization of personality, mind, and emotions to seriously impair the normal psychological
functioning of the individual (Mental). Individuals with any form of mental disorder such as
depression, schizophrenia, anxiety disorder, or obsessive-compulsive disorder, suffer from a
variety of symptoms that can have a strong impact on the way they live. Not only do normal
daily activities become harder, but the quality of life for the individual tends to decrease. It is

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quite evident in our society that people with a mental illness are not often get treated the same
way as people without a mental illness. In fact, even though mental health is just as important to
ones well-being as the health of their body, mental illness has always been a source of
discrimination and results in the affected individual becoming more stigmatized and
encountering specific setbacks.
The term stigma originates from the Greek word stizein, which during ancient times
described a mark on the flesh of slaves or criminals that was created by being burned, cut, or
tattooed with a sharp stick. The mark was meant to serve as a distinguishing feature on these
individuals so that others would know who they were and that they had low social status. The
Latin derivative of stizein became synonymous with a mark of infamy and disgrace (ArboledaFlorez and Stuart 459). Currently, in social terms, stigma refers to a set of negative and often
unfair beliefs that a society or group of people have about something (Stigma). The act of
labeling someone in order to identify social undesirables has been used throughout history. Such
examples include ordering an individual to wear a certain symbol on their clothing like a scarlet
letter or the Star of David. While it is true that individuals with a mental illness were not
distinguished in this same way in ancient Greece, Greek mythology has always shown an
association between madness and dangerousness (Arboleda-Florez and Stuart 459). Typically in
these Greek myths, the person with the mental illness, like Sophocles Ajax or Euripedes Medea,
is depicted as being shameful, humiliating, angry, jealous, murderous/violent or vengeful, and
ends up being banished from his/her home. These stereotypes of mental illness persist even
today, and before the creation of asylums, it was common for mentally ill patients to be thrown
out of their homes (Arboleda-Florez and Stuart 459). The common belief about people with
mental illness during the Middle Ages was that they were living examples of the weakness of

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humankind [and were] the result of being unable to remain morally strong (Overton and
Medina 143). In the 17th century, Christian cultures began to link mental illness with sin and
moral deficiency, and in the 18th century, the dominant discourse on mental illness focused on
linking mental illness with heredity. Today, most people gain their perception of mental illness
through media, which commonly depicts individuals with a mental illness as being
unpredictable, violent, and dangerous (Arboleda-Florez and Stuart 459). These ideas and
portrayals of mental illness only contribute to the injustice faced by those affected and to the
stigma of mental illness itself.
Research has found that the stigma against mental illness is actually a complicated social
mechanism that is made up of four different social-cognitive processes: cues, stereotypes,
prejudice, and discrimination. One social-cognitive process, known as a cue, refers to the act of
acknowledging that something is different about a person. A cue may take different forms and be
something either physical or observable like a psychiatric symptom, an unorthodox physical
appearance, or a deficit in social skills (Overton and Medina 144). Stereotypes are collectively
agreed-upon notions about a group of people that are used to categorize (Overton and Medina
144) and can occur within a persons thought process after they have been cued that something is
different about an individual. Although a person may hold these stereotypes, it does not mean
that they personally believe in them or endorse them; however, if the person did, this would be
known as prejudice (Overtone and Medina 144). Prejudice commonly results in affective
responses, like reflexive disgust and a fear in contamination, which can cause an overwhelming
desire to avoid someone or something that is unacceptable or offensive (Overton and Medina
144). Cognitive and rule-based processes take over after initial reflexive reactions, which allows
the individual to make adjustments to his or her reflexive and subsequent reactions (Overton

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and Medina 144). These adjustments can include changing their initial affective responses of
disgust and fear to ones of pity or courtesy. If these new processes do not engage, then more
emotions are created as a result of prejudice and statements like they are dangerous and Im
afraid of them can occur, which leads to discrimination (Overton and Medina 144).
Discrimination are behavioral responses due to the emotions and beliefs created through
prejudice, like social distancing and avoidance. These four processes (i.e. cues, stereotypes,
prejudice, and discrimination) can develop into two dimensions of stigma: public stigma and
self-stigma (Cummings, Lucas, and Druss 1).
Public stigma refers to how people typically choose to respond to stigmatizing attributes,
and can include cognitive, affective, and behavioral reactions, which in any case, often results as
a form of prejudice if people agree with them (Bathje and Pryor 162). Examples of each reaction
include the stereotypical ideas that people with a mental illness are violent or that those
individuals are responsible for their mental state (cognitive), the sense of fear or pity when one
sees/hear an individual that has a mental illness (affective), and discrimination in social
interaction (behavioral).
The reason why people choose not to associate with those who are mentally ill or are
suspected to be can be further explained by the fact that discrimination against mental illness is
often times a deeply ingrained belief system. This belief system becomes structurally reinforced
by societal attitudes of fear, ignorance, and intolerance (Overton and Medina 145), and can be
so deep-rooted that whenever someone comes into an interaction with a mentally-ill person, it
may lead them to behave in certain ways unconsciously. Furthermore, when the majority group
displays negative behaviors towards the stigmatized group, it continues to perpetuate stereotypes
and build barriers between the groups (Overton and Medina 145). Avoidance is one such

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negative behavior, and can serve different functions: social exchange, maintenance, and
contagion. In social exchange, people may be cued that someone with a mental illness is different
or that they have a lower social status than they do, which may cause them to feel cheated.
This feeling of being cheated can result in them using avoidance to ensure that they will not
interact with someone that offers them little to no social gain (Overton and Medina 145).
Maintenance refers to the preservation of an ideal identity, which is important when creating a
social power structure and in reinforcing group norms and beliefs. This also often leads to the
stigmatized person being blamed for their social situation (Overton and Medina 145). The last
function, contagion, is based on the common myth of mental illness being contagious. This often
results in people acting as if touching or being close to the person with a mental illness can lead
to them developing a mental illness too. Despite there being any actual research that supports this
idea of mental illness being contagious, many people continue to believe it (Overton and Medina
Self-stigma, on the other hand, refers to the internalization of these particular stereotypes
by an individual. If an individual suffering from a mental illness agrees and believes in
stigmatizing ideas about mental illness, he/she may begin to internalize these ideas and apply
them to themselves (Corrigan and Rao 465-466). This, in turn, heightens the chances of them
experiencing loss in self-esteem, self-worth, and self-efficacy heightens and they may develop
feelings of shame, fear, embarrassment, and alienation (Bathje and Pryor 163). These
individuals may also expect to be devalued and face discrimination, which can lead to
demoralization (Bathje and Pryor 163) and can affect the individuals attitude toward seeking
treatment for their mental health problem.

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For any individual suffering from the symptoms of mental illness, seeking help can
make the difference between life and death, so when an individual chooses not to seek help, the
effects can be devastating and potentially fatal. There are several reasons that prevent people
with mental health issues from seeking help, including financial problems, inadequate policies,
and interpersonal relationships (Shrivastava, Johnston, and Bureau 87). Stigma, as Shrivastava et
al. explains, is also a huge contributing factor [research] has shown that stigma plays a
significant role in accessing treatment, continuing treatment, being compliant, and reaching
favorable outcomes and level of functioning; which continues far beyond recovery of a patient
(178). Because of stigma, individuals may avoid treatment for their mental health problem and
will instead choose to suffer from the effects of their mental illness silently and in isolation. One
reason why this occurs can be best explained by label avoidance. In other words, an individual
will choose not to seek help in order to avoid the possibility of being labeled as someone with a
mental illness (Bathje and Pryor 162). Another reason is because the individual wants to save
face and protect his/her self-esteem, which they believe can be done by not accepting help
(Bathje and Pryor 162). In the why try effect, self-stigmatizing individuals avoid seeking
treatment because they have substantially lower levels of self-worth and feel as though, despite
help, they are unable to achieve any life goals (Corrigan and Rao 465).
Thanks to research, a variety of approaches has been created in order to address and
combat the effects of stigma. While it may be true that each approach may have its own set of
flaws and advantages, they all, for the most part, have the same goal in helping individuals with
mental illnesses live without facing the unnecessary symptoms of stigma.
One approach is education, and through this method, facts, statistics, and other accurate
information are used to directly inform the public or specific populations about mental illness,

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correcting any common myths or stereotypes people may have (Overton and Medina 148).
Although education can be helpful in changing attitudes on mental illness, research has shown
that the effects of this methods are not lasting or effective since belief systems are so well
ingrained (Overton and Medina 148). An example of this approach could be through an
informational brochure or public service announcement that addresses misconceptions on mental
illness and provides facts.
The second approach is protest, which involves the act of directly advising people to
challenge existing ideas on mental illness that are not true or to not think about the negative
stereotypes at all. Researchers have found that this approach is not very effective either, and
point out that attempting to suppress these stereotypes in others may have the opposite effect and
can reinforce them instead (Overton and Medina 147-148). Examples of this approach are
campaigning and lobbying.
A third approach in combating the effects of stigma is known as contact or direct
interaction. Compared to the previous two approaches, this one has been shown to be much more
effective in changing both the attitude and behavior of the non-affected individual (Overton and
Medina 148). By increasing the amount of interpersonal contact someone has with a mentally ill
patient, the less likely they are to develop less stigmatizing attitudes and their perception about
the mentally ill improve, especially if the individual with a mental illness is someone who
doesnt reinforce common stereotypes and seems to not be so different from them (Overton and
Medina 148). Contact or direct interaction can be done by facilitating a conversation between at
least one person with a mental illness and one without.
Another approach is legislative reform, which focuses on increasing the role of federal
policy when it comes to mental health issues. Despite having symbolic value, the problem with

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this approach is that because stigma is such a complicated social mechanism stemming from
different components, any legislative change only has the potential of addressing discrimination
as a result of public stigma, not in any other component of stigma like the beliefs or attitudes on
mental illness that the public has (Cummings, Lucas, and Druss 1).
The fifth method, known as advocacy, utilizes previously mentioned approaches and
other techniques to [raise] awareness about the importance of mental health issues and [to
ensure] that mental health is on the national agenda of governments (Arboleda-Florez and
Stuart 462). This approach was created to make sure that the rights and freedom of individuals
with mental illnesses are being protected. This method has been effective in leading to
improvements in mental health issues and in fields like legislation (Arboleda-Florez and Stuart
462). Effective advocacy can be done by supporting and influencing specific public policies and
laws that support ending the stigma on mental illness.
Stigma self-management is the last approach and has been shown throughout research
to be an effective way of mitigating the effects of stigma for individuals who suffer from a
mental illness. In this approach, mental health professionals and mental health services
encourage and support individuals with a mental illness to seek help (Arboleda-Florez and Stuart
462). This method also seeks to empower those individuals so that they can overcome
stereotypes, develop identities outside of their mental illness, and carry out fulfilling and
meaningful lives (Arboleda-Florez and Stuart 462). One way to empower individuals can be
coming out, a technique which allows for the person to own their mental illness and to be able
to openly talk about it (Corrigan and Rao 466). An increasing amount of research has shown that
when individuals reveal their mental illness, they tend to have decreased negative effects of selfstigmatization on their quality of life (Corrigan and Rao 466). This fact alone encourages these

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individuals to move towards achieving their life goals and to persevere despite their illness. As
Corrigan and Rao explain, this method is effective because when people are open, their
condition, and their stress levels over secrecy becomes reduced (466). They may also find peers
or family members who will support them in their endeavors, despite now knowing about their
illness; furthermore, the individual may discover a newfound sense of confidence, power, and
control over their life (Corrigan and Rao 466).
After researching all of the different approaches to combating mental illness stigma, I
determined that the best approach and the one that I found most interesting, relatable, and
effective was personal empowerment (Corrigan and Rao 466)- an approach that is the main focal
point of my capstone end product, which will be a video. Initially, I planned on featuring a few
actual RCHS students who have a form of mental illness and who would be willing to talk about
their personal experience with stigma, the importance of speaking out against it, and advocate
others to seek help. In addition to raising awareness about the effects of stigma, this video would
definitely be an example of personal empowerment in itself since students would be openly
owning their mental health problem and encouraging others to do the same. Although the video
would only be used for educational purposes and its audience would include RCHS staff and
students, it was determined that due to privacy issues, lack of proper documentation and
appropriate paperwork, the idea behind the video would probably not work. Furthermore, it was
harder to find willing students who would be okay having their story featured than I had
originally anticipated. No one I knew wanted to open up and actually admit to having a mental
illness, which is such a huge part of the problem I am trying to combat.
After discovering that my original idea was not feasible, I decided to stick with creating
a video as an end product, but I changed the focus of it. My video illustrates the journey a female

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student goes through when living with depression and how she ultimately overcomes her mental
health problem after discovering the concept of self-empowerment. The video also features
dramatized clips of common stereotypes people tend to associate mental illness with, and clips of
various students providing inspirational messages for viewers who may be struggling from a
mental illness. I know that, for many, mental illness can be a sensitive topic, but it is my goal that
by having a few peers who would be willing to speak out in a video, more will follow suit and
change how we view mental illness.
At the moment, my end product has not been created yet, but once it is, I hope that the
message in my video will speak to others and make mental health a priority to them. Most
importantly, I hope that by creating this end product, I can potentially save a peers life and
encourage someone to seek help even if theyre unsure about what to expect from it. Because of
the research Ive completed for this Senior Capstone paper, I am convinced that personal
empowerment is an effective tactic in mitigating and challenging the effects of stigma, even
though I have not had the opportunity to test it in my finished product yet. If I get the chance to
test the efficacy of my video, I would probably consider approaching the National Alliance on
Mental Illness (NAMI) and letting know them about the time and effort I have dedicated to this
important cause, and how much I support their organization for what they are able to do.
Honestly, I have not thought about the possibility of placing this product on the market because I
am unsure of how exactly that would work, but if this video could potentially reach and affect
others worldwide somehow, I would wholeheartedly support it. After my Senior Capstone project
is finished, I have not decided whether or not I will pursue getting involved with local
organizations that focus on mental health awareness, but as a student who plans on continuing
into medical school, I am confident that I will come across individuals who may have mental

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health concerns and thanks to all the information I know about this topic, I will be able to
provide help for these individuals more thoroughly.
Overall, the long term implication of this project is that the quality of life in individuals
suffering from a mental illness and that of their loved ones can be increased through disclosure,
one method used in achieving personal empowerment. Admittedly, a possibility remains that
disclosure can bring about negative effects and under some conditions, it may not be the best
method to rely on. For example, it could be argued that being open about ones condition could
result in discrimination from others, relapses, and possibly cause the individual to become even
more isolated; however, research has shown that personal empowerment, when used
strategically, is an effective way of combating the effects of stigma. As Corrigan and Rao
explain, empowerment is, in a sense, the opposite of stigma because the individual has a sense of
power, optimism, and control over his/her mental health (466). Furthermore, empowerment is
associated with higher levels of self-esteem, an improved quality of life, and increased support
from friends and family (Corrigan and Rao 466).
One other counterargument that is most commonly brought up against mental illness is
that mental illness itself is a myth and does not truly exist. A well-known proponent of this idea
is Dr. Thomas Szasz, a Hungarian psychiatrist, who wrote the book The Myth of Mental
Illness. Since the 1960s, Dr. Szasz has argued that mental illness is a myth based on several
reasons, which include that disease/illness can only affect the body and that psychiatric
diagnoses are stigmatizing labels that are applied to people who have annoying or offensive
behaviors (Hyland 178). Dr. Szasz also argues that it is unethical to label someone as being
mentally ill and to use this as an excuse to deprive them of their rights, which is referring to the
fact that until the mid-1990s, people who were deemed as mentally ill were often placed in

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asylums unwillingly. Furthermore, Dr. Szasz has discredited his field by saying that
psychologists, psychiatrists, and psychotherapists are those who collude in and exploit the
alleged mythology of counterfeit mental disorders and often (unwittingly or deliberatively)
justify coercion, oppression and pharmacological manipulation of so-called mental patients in
the name of treatments (Hyland 177). In his book, Dr. Szasz also criticizes the fact that in the
American legal system, the insanity defense is used far too often and implies that only certain
people are exempt from punishment and from doing illegal things. Mentally ill as Dr. Szasz
explains, is a term that is used to prevent individuals from taking personal responsibility for their
own actions and the difficulties of life.
Although Dr. Szasz makes several valid points, most of his argument is based on his own
personal opinions and overgeneralizations. In his book The Myth of Mental Illness, Szasz
questioned whether or not the field provided advocacy for the mentally ill or if all it did was
popularize the illness. While it is true that Dr. Szasz was helpful in recognizing that there were
existing mental health professionals that took advantage of their patients and did not keep the
patients welfare as a first priority, it is important to note that not all mental health professionals
are as corrupted and do perform their job with integrity. Dr. Szaszs point that disease/illness can
only affect the body is not true in all cases. For example, syphilis, which is mostly contracted
through sexual activity, is a disease that can affect not only the body of the individual, but also
his/her mental health. Certain infections impact the individuals neurological functioning by
influencing his/her mood and personality. In the case of syphilis, the individual may suffer from
having delusions and paranoia. Furthermore, a variety of research has shown that chemical
imbalances in the brain definitely affect the individual and his/her behavior. Fortunately, research
has also shown that when mental health professionals intervene chemically, it has the potential of

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helping mentally ill patients significantly. As Dr. Jennifer Jones, psychology teacher at Richland
College, explains Schizophrenic individuals usually have high levels of dopamine present, and
its been shown that when you lower the level of dopamine, the patient experiences less
hallucinations. Similarly, lower levels of serotonin can be a cause of anger and depression in
individuals, which is why antidepressants are made to increase levels of serotonin. When Szasz
says that psychiatric diagnoses are stigmatizing labels that are applied to people with annoying or
offensive behaviors, he implies that all people with a mental illness have annoying or offensive
behaviors; furthermore, behaviors that are annoying or offensive depends on the situation and
personal preference. Szaszs argument that its unethical to label someone as being mentally ill is
certainly true; however, if the person is a licensed and qualified psychologist, psychiatrist, or
medical doctor and are allowed to practice in that state, then they do, in fact, have the privilege
to diagnose, not label, a patient or client with a mental illness. The last point Szasz makes that I
mention about the term mentally ill being used to prevent individuals from taking personal
responsibility is simply Szaszs opinion, and one that most psychologists would disagree with.
In retrospect, as I think back to that faithful car ride home, where I first received Maxs
text, I consider for a second what would have happened that night if he had not reached out to me
because he had internalized stigmatization about mental illness. What would I think of myself if
Max had committed suicide that day and I had been the kind of person who was easily affected
by public-stigma and had chosen to avoid Max or discriminate against him based on his mental
health problem? Upon shaking myself from such unbearable thoughts, I remind myself that I am
grateful that those conditions did not exist and that he is, fortunately, still in my life today. The
most significant lesson that I have gained from working on this project is the fact that I
benefitted from personal growth myself. Through the course of this project, I have become more

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mindful of what I say and how I interact with peers and even strangers who may be silently
suffering. I have also gained a heightened sense of compassion and understanding towards those
dealing with a mental health problem, and because I know so much about the baggage that
comes with identifying as a mentally ill person and how senseless and wrong it is to treat this
population the way society often does, I am confident that I will no longer stand idly by when
someone is being treated unfairly because of this.
Although my work in mental illness stigma research does not directly relate to the service
learning I have done with Habitat for Humanity, I have discovered that there are several valuable
transferrable skills that compliment both. Volunteering, in itself, is an important aspect that may
help an individual suffering from a mental illness with improving their self-image. By getting
busy and involved in extra-curricular activities like volunteering, one is allowing his or her own
self to benefit from a sense of fulfillment, happiness, and a positive self-concept which comes
from being able to give back to others in the community. The empowerment the individual gains
from dedicating time to others and being appreciated for it makes the experience even more
enjoyable and motivates them to continue doing it. For the same reasons, this project also relates
to the Richland mission statement of Teaching, learning, and community building, because
through my message of personal empowerment and destigmatizing mental illness, I am
advocating that more information be available on the devastating effects of stigma and how
individuals can seek help for themselves in an effort to enhance the quality for these individuals
and their loved ones.

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Oct. 2014.

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Shrivastava, Amresh, et al. "Clinical Risk Of Stigma And Discrimination Of Mental Illnesses:
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