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Psychiatr Rehabil J. 2009 Summer;33(1):18-25. doi: 10.2975/33.1.2009.18.25.

Passing for "normal": features that affect the community inclusion of people with mental illness.

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Yale Program for Recovery and Community Health, Department of Psychiatry, Yale School of Medicine, New Haven, CT 06513, USA.



The purpose of this study was to investigate specific features that indicate to community members that a person has a mental illness and the emotional reactions elicited by these features, in hopes of understanding barriers to the community integration of people living with mental illnesses.


Participants were 15 community members who had considerable experience with people with mental illnesses but no extensive clinical training (e.g., store clerks, landlords, clergy). A mixed qualitative-quantitative design elicited 1) participants' subjective experience of interacting with people with mental illness and 2) participants' ratings of specified features of people with mental illness.


Interpretive phenomenological analysis of qualitative interviews suggested that a person's mental illness was only apparent from afar if s/he was responding to internal stimuli or wearing bizarre or inappropriate clothing. The person's illness usually became apparent through interacting with the community member. Participants reported feeling kind benevolence towards people with mental illness and rated the likelihood of people with mental illness to be threatening or violent as very low. Overall, participants' ratings of features of people with mental illness corroborated qualitative themes.


These data suggest that stigma is not elicited simply by the presence of a person with a mental illness, and that the presence of a mental illness in most cases only becomes apparent through social interaction. Also, these data support conclusions that personal experience with people with mental illness reduces fear and increases benevolence and that personal contact should be integral to community integration and anti-stigma campaigns.

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