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Conceptualizing Stigma and Barriers to Care 61
skills club during plant closings in the Detroit area. The program was for people at
risk of family violence, alcohol abuse, and depression after losing their job. Price
evaluated their skills and did some behavioral workshops to help them get jobs. As
part of this program he did a recruitment experiment. First, he pinned three by five
inch cards to the union wall that said, “The program is available. Call this number.”
Second, he gave a speech at the union to talk about the program. Third, he went to
unemployment lines and twisted arms to get people to attend the program. Price
conducted three separate experiments with the three groups of recruits.
The first experiment was a complete failure because anybody who responded
to the three by five cards was going to do really great whether or not he had his
program. They were the aggressive people. The people who he had to drag in failed
because they were going to fail no matter what. It was the people in the middle who
he had the effect on. It is the idea that there is some gradient across which screening
and intervention is going to work and you can maximize that program.
DR. ESTROFF: I have a question for Bruce Link and Bernice Pescosolido about
the overall state of discrimination, or stigma. How do we parse in the monumental
shift to guilty and mentally ill from guilty but mentally ill, and the increased deployment
of both outpatient treatment and forced treatment in terms of public attitudes
and stigma
DR. PESCOSOLIDO: There has not been a dramatic change. There may have
been a small decline in terms of Americans’ willingness to support coerced medication,
but not other forms of coerced treatment. Even in 1996 when we asked about
four different forms of coercion and we had people who did not meet criteria, 10%
of Americans were still willing to use legal means to coerce those individuals into
treatment. The fear/danger coercion issue is a particularly American thing. I think it
is dangerous, and I worry about some of the messages that are put out by the Treatment
Advocacy Center. One of the things they argue is that if we show Americans
that some of these people are dangerous the public will be willing to put more money
into services. Well, we were able to do some analysis in 1996 that shows that there
is absolutely no relationship between associating danger and increased funds or
treatment resources for people.
DR. ESTROFF: My question was more about if the effects of stigma are effecting
the institutional change in how we view the deservedness, or lack thereof, of people
who have psychiatric disorders in terms of the switch to guilty and mentally ill.
DR. LINK: This may not directly answer the question, but the thing about the
increase in spontaneous mentions of dangerousness from 1950 to 1996 was that it
was all written down and we could see exactly what people said. I thought maybe
Sue Estroff’s idea was that the coercion of treatment would stimulate the stigma.
The most common phrasing in 1996 was ‘dangerous to self or others.’ When we put
forward the idea about coercion people understand it and they parrot it back when
they talk about what they think mental illness is.
DR. PESCOSOLIDO: I think Sue Estroff’s question is too sophisticated for the
American public. The American public is smart, I do not want to be misinterpreted.
But the notion is that anybody who does anything really bad is sick and people do
not make the distinction with legal issues. I ask people all the time about Jeffrey Dahmer
and the woman who drowned her kids and people see no distinction whatsoever.
DR. ESTROFF: But these statutes do not say that. They say you are bad and
sick but your sickness does not mitigate your badness the way it did under guilty
but mentally ill.