Stigma and disclosure: Implications for coming out of the closet

Background: There are costs and benefits for people with psychiatric disorders to decide to disclose publicly these disorders. Aims: The gay and lesbian community has struggled with the same tension and their discoveries about coming out may prove useful for the disclosure concerns of persons with mental illness. Methods: Lessons learned about coming out by the gay and lesbian community include a variety of models that map the stages for successfully coming out; e.g., identity confusion, comparison, identify acceptance, immersion, and identity synthesis. Navigating these stages requires consideration of the costs and benefits of disclosure; we review some of these including social avoidance and disapproval as key costs and improved psychological well-being and interpersonal relations as benefits. Conclusions: The paper ends with a review of levels of disclosure for people who opt to come out. Declaration of interest: This paper was made possible in part by MH62198-01 from the National Institute of Mental Health.

[1]  J. Rabinowitz,et al.  Association between nonpsychotic psychiatric diagnoses in adolescent males and subsequent onset of schizophrenia. , 2001, Archives of general psychiatry.

[2]  Carla J. Groom,et al.  THE REAPPROPRIATION OF STIGMATIZING LABELS: IMPLICATIONS FOR SOCIAL IDENTITY , 2003 .

[3]  R. A. Schultz-Ross.  Psychiatry and Religion: The Convergence of Mind and Spirit , 2001 .

[4]  J. Morrison.  The public's current beliefs about mental illness: Serious obstacle to effective community psychology , 1980, American journal of community psychology.

[5]  Nancy J. Herman,et al.  RETURN TO SENDER , 1993 .

[6]  L. Hansson,et al.  Patient satisfaction with inpatient psychiatric care , 1994, Acta psychiatrica Scandinavica.

[7]  R. Michels,et al.  Diagnostic and Statistical Manual of Mental Disorders, 3rd ed , 1981 .

[8]  N. Crossley.  R. D. Laing and the British anti-psychiatry movement: a socio-historical analysis. , 1998, Social science & medicine.

[9]  M. Armstrong.  Don't Call Me Nuts! Coping With the Stigma of Mental Illness , 2003 .

[10]  J. Chamberlin.  Citizenship rights and psychiatric disability. , 1998 .

[11]  V. Cass,et al.  Homosexual identity formation: Testing a theoretical model , 1984 .

[12]  C. Barker,et al.  The Benefits of Mutual Support Groups for Parents of Children With Disabilities , 2001, American journal of community psychology.

[13]  Carl Keane,et al.  Socioenvironmental Determinants of Community Formation , 1991 .

[14]  E. Goffman.  Stigma; Notes On The Management Of Spoiled Identity , 1964 .

[15]  G. Kadushin.  Family Secrets , 2000, Social work in health care.

[16]  Bruce G. Link,et al.  Contact with the mentally ill and perceptions of how dangerous they are. , 1986, Journal of health and social behavior.

[17]  J. Sahs.  Textbook of Homosexuality and Mental Health , 1996 .

[18]  L. Mosher,et al.  Relationships in rehabilitation: When technology fails , 1992 .

[19]  K. A. Johnson,et al.  High-risk behavior among gay adolescents: implications for treatment and support. , 2000, Adolescence.

[20]  高橋 葉子.  World Report ニューヨーク , 2001 .

[21]  T. Parham,et al.  Cycles of Psychological Nigrescence , 1989 .

[22]  D. Fisher,et al.  Health care reform based on an empowerment model of recovery by people with psychiatric disabilities. , 1994, Hospital & community psychiatry.

[23]  D. Fisher,et al.  Personal Assistance in Community Existence (PACE): An Alternative to PACT , 2000, Ethical Human Sciences and Services.

[24]  J. Ponterotto,et al.  “Classics” in Multicultural Counseling: A Systematic Five-Year Content Analysis , 1989 .

[25]  S. Kates,et al.  The Meanings of Lesbian and Gay Pride Day , 2001 .

[26]  P. Lynch,et al.  Toward a diversity hypothesis: Multidimensional effects of intergroup contact. , 2000 .

[27]  Nancy E. Day,et al.  The relationship among reported disclosure of sexual orientation, anti-discrimination policies, top management support and work attitudes of gay and lesbian employees. , 2000 .

[28]  J. Sophie.  A critical examination of stage theories of lesbian identity development. , 1986, Journal of homosexuality.

[29]  D. Davies,et al.  Therapeutic perspectives on working with lesbian, gay, and bisexual clients , 2000 .

[30]  P W Corrigan,et al.  Three strategies for changing attributions about severe mental illness. , 2001, Schizophrenia bulletin.

[31]  Rob Cover.  First Contact: Queer Theory, Sexual Identity, and “Mainstream” Film , 2000 .

[32]  Nancy E. Day,et al.  Staying in the closet versus coming out: Relationships between communication about sexual orientation and work attitudes. , 1997 .

[33]  R. Brookey.  Saints or Sinners: Sociobiological Theories of Male Homosexuality , 2000 .

[34]  Charlotte I. Spungin,et al.  Gay And Lesbian Students: Understanding Their Needs , 1995 .

[35]  Dc Washington.  Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. , 1994 .

[36]  R. Bolton,et al.  Gay Identity and the Experience of Gay Social Stress1 , 1999 .

[37]  P W Corrigan,et al.  Changing attitudes about schizophrenia. , 1999, Schizophrenia bulletin.

[38]  M. Olson.  A study of gay and lesbian teachers. , 1987, Journal of homosexuality.

[39]  W. Cross.  The Negro-to-Black Conversion Experience. , 1971 .

[40]  F. Frese,et al.  The consumer–survivor movement, recovery, and consumer professionals. , 1997 .

[41]  D. Penn,et al.  Dispelling the stigma of schizophrenia: what sort of information is best? , 1994, Schizophrenia bulletin.

[42]  V C Cass,et al.  Homosexual identity formation: a theoretical model. , 1979, Journal of homosexuality.

[43]  M. Drake.  Diagnostic and Statistical Manual of Mental Disorders (3rd ed. rev.) , 1988 .

[44]  J. McEvoy,et al.  The relationship between insight in psychosis and compliance with medications. , 1998 .

[45]  D. Regier,et al.  Revised prevalence estimates of mental disorders in the United States: using a clinical significance criterion to reconcile 2 surveys' estimates. , 2002, Archives of general psychiatry.

[46]  C. R. Ridley,et al.  Multicultural Training , 1994 .

[47]  Bruce G. Link,et al.  Dispelling the stigma of schizophrenia: II. The impact of information on dangerousness. , 1999, Schizophrenia bulletin.

[48]  R. Drake,et al.  Implementing evidence-based practices in routine mental health service settings. , 2001, Psychiatric services.

[49]  Insight and Psychosis , 1990, British Journal of Psychiatry.

[50]  K. Boydell,et al.  Beyond the service paradigm: The impact and implications of consumer/survivor initiatives. , 1997 .

[51]  G. Herek,et al.  Hate Crime Victimization Among Lesbian, Gay, and Bisexual Adults , 1997 .

[52]  P. Corrigan,et al.  Don't Call Me Nuts : Coping with the Stigma of Mental Illness , 2001 .

[53]  J. Mio,et al.  To Do, or Not to Do , 1993 .

[54]  R Smith,et al.  The Coming-Out Process and Its Adaptational and Health-Related Associations Among Gay, Lesbian, and Bisexual Youths: Stipulation and Exploration of a Model , 2001, American journal of community psychology.

[55]  S. Brady,et al.  The Gay Identity Questionnaire: a brief measure of Homosexual Identity Formation. , 1994, Journal of homosexuality.

[56]  P. Corrigan,et al.  Challenging two mental illness stigmas: personal responsibility and dangerousness. , 2002, Schizophrenia bulletin.

[57]  L. A. Peplau,et al.  Social Involvement, Disclosure of Sexual Orientation, and the Quality of Lesbian Relationships , 2001 .

[58]  R. Cain,et al.  Stigma management and gay identity development. , 1991, Social work.

[59]  R. Savin-Williams,et al.  Mom, Dad. I'm Gay. How Families Negotiate Coming Out , 2000 .

[60]  M. Foucault,et al.  Herculine Barbin: Being the Recently Discovered Memoirs of a Nineteenth-century French Hermaphrodite , 1980 .

[61]  James W. Pennebaker,et al.  Emotion, disclosure, & health. , 1995 .

[62]  G. Herek.  On Heterosexual Masculinity , 1986 .

[63]  Ruth E. Fassinger,et al.  Revisioning Sexual Minority Identity Formation , 1996 .

[64]  W. S. Hall.  Stages in the Development of A Black Identity. , 1972 .

[65]  John P. Capitanio,et al.  "Some of My Best Friends" Intergroup Contact, Concealable Stigma, and Heterosexuals' Attitudes Toward Gay Men and Lesbians , 1996 .

[66]  B. R. Ragins,et al.  Pink triangles: antecedents and consequences of perceived workplace discrimination against gay and lesbian employees. , 2001, The Journal of applied psychology.