11 1 GENERAL INTRODUCTION and labeling human differences, (2) associating these labels with negative attributes, (3) separating ‘us’ from ‘them’, and (4) status loss and discrimination experienced by the labeled person (18). Another theory of stigma and discrimination by Thornicroft et al. (19) proposes that stigma refers to problems of knowledge (ignorance), attitudes (prejudice), and behavior (discrimination) (figure 1). This theory indicates that stigma starts with a lack of accurate knowledge about MHI. This lack of knowledge can lead to certain attitudes about people with MHI, which are often prejudices. Consequently, these attitudes can lead to behavior, namely discrimination against those with MHI. Figure 1. Stigma and discrimination theory by Thornicroft et al. (19). Mental health stigma exists at different levels. 1) Public stigma: members of the general population endorse prejudice and discrimination against individuals with MHI (20), 2) Selfstigma: this occurs when individuals with MHI internalize these negative stereotypes and prejudices held by the general population (21), and 3) Structural stigma/discrimination: this refers to rules, regulations, and cultural attitudes and values that either intentionally or unintentionally disadvantage individuals with MHI (22). This thesis will include all these different levels of stigma. Another form of stigma, which will not be further discussed in this thesis, is stigma by association, a process through which the companions of stigmatized persons are also discredited (23). Additionally, a distinction can be made between anticipated and experienced stigma, and this thesis will focus on both these types of stigma (24). Anticipated stigma refers to the stigma that people with MHI expect to occur. This may cause the ‘Why try’ effect, which refers to a situation where people refrain from certain behavior, such as applying for a job, because they anticipate stigma to occur (25). Experienced stigma refers to the stigma-related events that have actually occurred, such as being denied employment (26). Furthermore, stigma can occur in different life domains, but research has shown that the work context is a domain in which stigma and discrimination occur most frequently (27).
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