Journal of Mental Health (June 2003) 12, 3, 235 – 248

Stigma and disclosure: Implications for of the closet

PATRICK W. CORRIGAN1 &ALICIAK.MATTHEWS2

1Center for Psychiatric Rehabilitation & 2Department of Psychiatry, University of Chicago, Chicago, Illinois, USA

Abstract Background: There are costs and benefits for people with psychiatric disorders to decide to disclose publicly these disorders. Aims: The and 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. Keywords: mental illness, stigma, coming out, gays

Dealing with the stigma of mental Advocates and researchers agree that illness by coming out of the closet one way to challenge the stigma of mental illness is through contact. Mem- Harvey Milk, the first openly gay bers of the general public are more likely supervisor of San Francisco, once said, to diminish prejudicial attitudes and ‘I would like to see every gay lawyer, discriminating behaviors when they have every gay architect come out, stand up contact with people with mental illness. and let the world know. That would do This parallels a basic finding about more to end overnight than change in racial prejudice; namely, the anybody could imagine.’ (cited in Herek, white majority decreased prejudice and 1996, p. 213). when they had contact

Address for Correspondence: Patrick Corrigan, 7230 Arbor Drive, Tinley Park, IL 60477, USA; Tel: 708 614- 4770; Fax 708 614-4780; E-mail: [email protected]; www.stimgaresearch.org

ISSN 0963-8237print/ISSN 1360-0567online/2003/030235-14 # Shadowfax Publishing and Taylor & Francis Ltd DOI: 10.1080/0963823031000118221 236 Patrick W. Corrigan & Alicia K. Matthews with people of color (Johnson & John- illness, we will briefly review the litera- son, 2000; Jones et al., 2000). The ture on the relationship between social experience of mental illness stigma differs contact and stigma. Here we review the from in that the stigma of mental three ways of changing public stigma – illness may be hidden while the signs that protest, education, and contact – and the yield racial discrimination are largely body of evidence on the strengths and manifest. Hence, the experience of men- weaknesses of each. Briefly, protest tal illness is like many other groups in strategies highlight the injustice of spe- which members may hide their associa- cific stigmas and lead to a moral appeal tion, groups including minority subsets for people to stop thinking that way. of , educational attain- Education strategies have largely focused ment, and social status (Corrigan & on replacing the emotionally charged Lundin, 2001). myths of mental illness (e.g., people with Despite the ability of many individuals mental illness are dangerous!) with facts to conceal their sexual orientation, the that counter the myths (e.g., on average, gay and lesbian community has discov- people with mental illness are no more ered that their community benefits when dangerous than the rest of the popula- individuals choose to disclose their sexual tion). Although research suggests that orientation. In this article, we argue that these interventions might lead to mild the community of people with mental change in attitudes (Holmes et al., 1999; illness may similarly benefit from disclos- Keane, 1991; Morrison, 1980; Penn et al., ing their illness to the public at large. We 1994) and limited change in behavior assert that what is known about ‘coming (Corrigan et al., in press), research has out’ in terms of sexual orientation may shown contact to yield the best changes provide hypotheses and methods that in , prejudice, and discrimina- might guide future research in this area tion. as it relates to mental illness. However, it Contact effects are understood in terms should be noted that in comparing the of familiarity. Research shows that experiences of sexual minorities to those members of the general public who are with mental illness, we are in no way more familiar with individuals labeled implying that any aspects of gay, lesbian, mentally ill are less likely to endorse bisexual, or orientations prejudicial attitudes (Holmes et al., 1999; represent a psychiatric disorder. A sec- Link & Cullen, 1986; Penn et al., 1994, ond, equally important point also needs 1999). Moreover, members of the general to be made. In stating that homosexu- public who interact with a person with ality is not a psychiatric disorder, we mental illness as part of an anti-stigma have reinforced the notion that being program show significant changes in mentally ill is in someway morally wrong. their attitudes (Corrigan et al., 2001). A Assertions like these are equally unjust subsequent study has shown that attitude and need to be corrected. change that results from contact main- tains over time and is related to a change How contact changes stigma in behavior (Corrigan et al., 2003). In a similar vein, Herek (1986) and Herek & Before we juxtapose the experiences of Capitanio (1996) observed that contact sexual minorities to those with mental between homosexuals and heterosexuals Coming out of the closet 237 diminished stigmatizing attitudes among majority. On one hand, naı¨ve psycho- heterosexuals. Hence, he concluded that logical notions might suggest that coming out (one way to facilitate con- homosexuality (and mental illness) tact) has significant value for diminishing distinguishes a unique category from the stigma experienced by gay men and the rest of the population (straights or . Given that many gays and non-mentally ill). They are frequently lesbians have benefited from decisions described as binary groups (Cover, 2000): regarding coming out, it is not unreason- a person is either straight or gay, able, given the similarities, that people mentally ill or sane. This kind of duality with mental illness can benefit from these is false and accentuates the ‘we versus lessons. Some of these lessons, and their they’ qualities that augment stigma (Link relevance for people with mental illness, & Phelan, 2001). Similarly, the boundary are reviewed here. between mental illness and ‘normal’ is gray. First, epidemiological research sug- Parallel societal experiences gests that the prevalence rate of major mental illnesses is as high as 20% thereby In this paper, we seek to better under- debunking the idea that mental illness is stand ways which people might manage a rare occurrence (Narrow et al., 2002). the stigma of mental illness by comparing Second, and more germane to the point their experiences to gays, lesbians, and here, many of the characteristic symp- bisexuals. For this enterprise to be toms of mental illness are quite common fruitful, we must first demonstrate that at subclinical levels. Hence, like gay the comparison is valid. First, the mark versus straight, a clear distinction be- that signals the stigma of homosexuality tween the sane and mentally ill is not and of mental illness is not readily borne out by the data. transparent. Goffman (1963) distin- Another commonality is the way in guished stigmatized groups like these which experiences with stigma emerge in from groups whose stigmatizing mark is the two communities. This similarity can readily observed (e.g., skin color). This be understood by contrasting it to the notion may seem contrary to naı¨ve experiences of those whose stigma is psychological notions that gays and readily manifest from birth. For example, people with mental illness are easily members of stigmatized ethnic minority recognizable. Members of the general groups are born into families and com- public may list several cues that are munities who typically bear the same thought to be characteristic of each marks, are aware of potential prejudice group but in fact lead to mistaken that results from the stigma, and provide identification. For example, labeling ef- guidance for how to respond to preju- feminate men as gay will lead to false dice. Conversely, the life experiences that positives (Brookey, 2000). Similarly, tag- result in someone calling themselves gay ging eccentric or unkempt people as or mentally ill typically occur in adoles- mentally ill leads to erroneous identifica- cence and young adulthood rather than tions (Corrigan, 2000). at birth (Fisher & Akman, 2002; Weiser Yet another commonality lies in the et al., 2001). Consequently, sexual mino- vagaries of categorical distinctiveness rities and individuals with mental illness between the stigmatized group and the often undergo a developmental process 238 Patrick W. Corrigan & Alicia K. Matthews that is different from their primary care much of the twentieth century, some providers and larger support systems. At mental health professionals believed the worst, family members and others homosexuality could be cured through ostracize the person who is struggling intensive psychotherapy. Most social with either their gay or mentally ill scientists and health care professional identity (Savin-Williams, 2001). More now recognize gays and lesbians as an commonly, parents and other mentors alternative sexual orientation that is not are unable to provide any clarity to their an appropriate target of psychotherapy experiences. (Davies & Neal, 2000). In some ways, Finally, both groups have been stig- parallels between the experiences of matized because of similar, society-wide sexual minorities and the mentally ill misperceptions. In earlier times, homo- diminish here. As noted above, mental sexuality and mental illness were both illnesses have appropriately continued to viewed in moral terms. Homosexuality be construed by the psychiatric commu- represented a volitional decision to opt nity as medical conditions (American for a sinful lifestyle (Zachary, 2001). Psychiatric Association, 1987, 1994, Mental illness embodied the demon- 2000) while sexual orientation has not. possessed individual who did not have The parallel between homosexuality and sufficient moral backbone to hold off mental illness also diminishes when con- Lucifer (Kinzie, 2000). The nineteenth sidering issues related to treatment. and twentieth centuries replaced the Although there are several mental health religious models with views that medica- survivor groups that question the legiti- lized the conditions (Duberman, 1993; macy of psychiatric treatment (Crossley, Foucault, 1980). The DSM-I defined 1998), empirical research generally sug- homosexuality as a sexual deviation gests that most people with mental illness involving pathological behavior (Amer- are better able to accomplish life goals ican Psychiatric Association, 1952). when receiving evidence-based pharma- DSM-II cut the category of sociopathic cotherapy and psychosocial services personality disturbances from the defini- (Drake et al., 2001). Hence, unlike gays tion but continued to list homosexuality and lesbians, treatment may play an among deviant sexual practices (Amer- important role in the lives of many ican Psychiatric Association, 1968). At people with major mental disorders. the same time, most of what has been One other difference seems to emerge considered to be major mental illnesses between sexual minorities and people (e.g., schizophrenia) have been defined as with mental illness; embracing their medical conditions (American Psychia- identity. Most advocates and researchers tric Association, 1952, 1968, 1980). Note agree that essential to the psychological that homosexuality per se was removed well-being of gays, lesbians, and bisex- as a psychiatric disorder from DSM-III uals is embracing their sexual orientation (American Psychiatric Association, 1980) (Besner & Spungin, 1995). At first while mental illnesses obviously are the appearances, the parallel does not seem only focus of the diagnostic manual. to hold for people with mental illness. Implicit in the medicalizing of a Rare would be the suggestion that a phenomenon is the idea that it can be person needs to embrace their illness. corrected through treatment. During Instead, it seems from the perspective of Coming out of the closet 239 patient and doctor that the number one five stages (Brady & Busse, 1994; Cass, goal of membership in the mental illness 1979, 1984; Sophie, 1985). We extrapo- group is to get out of it. Some clinicians late these stages here to issues related to and advocates assert, however, that a identity development for people with necessary part of recovery is identifying mental illness. the role that one’s experience with mental During the first two stages – identity illness plays in defining the self (Fisher, confusion and comparison – people begin 1994; Mosher & Burti, 1992). Despite the to question their sanity. They are aware reasonableness of this perspective, a re- of their psychiatric symptoms and feel view of the literature yielded no empirical alienated from the seemingly ‘normal’ studies on identity development among population. Slowly, people in this situa- people with mental illness. tion learn to tolerate this new identity Despite the paucity of information and seek out others with mental illness. about identity development among peo- At the identity acceptance stage of ple with mental illness, there is an identity development, people decide to important literature on disease insight disclose to trusted others. Concern and that may be relevant here (Amador & fear about one’s mental illness may be Kronengold, 1998; McEvoy, 1998). replaced by acceptance or pride. Some However, the professional literature people become immersed in the culture of mostly views mental illness as a pathogen consumer, survivor, and ex-patient that interferes with identity development. groups (Frese & Davis, 1997; Trainor et This difference in viewpoints is ripe for al., 1997). Moreover, there is a rejection conceptual development and empirical of values in the dominant culture; one testing in two ways. First, does mental way this shows is the anti-psychiatry illness as an experience have significance movement (Crossley, 1998). Finally, the for identity development in ways other relative extremism of identity pride ob- than disruption? If yes, then second, served during the immersion stage is what models might explain identity and replaced by identity synthesis such that identity development in people with the person’s identity as mentally ill mental illness? Some models of identity becomes only one aspect of their identity. development relevant to gays and les- Cass’ (1979) model of identity integra- bians are reviewed in the next section as tion assumes statements like ‘I am gay possible candidates. and proud of it!’ are an essential element of developing a healthy self-concept. It is Lessons learned on coming out still unclear whether a parallel exists in mental illness: ‘I am mentally ill and Researchers studying sexual minorities proud of it.’ Is this a necessary part of the have developed a series of models that self that needs to be recognized and represent identity development in this included into an integrated view of one’s population (McCarn & Fassinger, 1996; self? An alternative way to view state- Rosario et al., 2001; Vincke, 1999). One ments like ‘I am mentally ill and proud of model with a fair amount of empirical it!’ may be as a necessary political support has described the process of assertion. Namely, because people with integrating a lesbian and gay identity mental illness are discriminated by the into the self-concept by dividing it into majority, they may need to identify their 240 Patrick W. Corrigan & Alicia K. Matthews similarities as a stigmatized group to cause of its common bond with mental obtain greater social power. In this case, illness’) to about me (‘I am supportive an identity model like Cross’ (1971) may because of my mental illness’). In the last be illustrative of the development pro- stage of Cross’ model – internalization- cess. Several studies have empirically commitment – the identity statements validated aspects of his paradigm (Hall yield affective products including right- et al., 1972; Mio & Iwamasa, 1993; eous anger and self-love. Parham, 1989; Ponteretto & Sabnani, 1989; Ridley et al., 1994). Cross’ model Benefits and costs to disclosing seeks to map identity development in African Americans as they move from a What are the advantages and disad- ‘Negro’ identity, which included some of vantages to coming out of the closet? the majority groups stereotypes, to a Once again, we would argue that many of ‘Black’ identity which represents views the consequences to coming out of the that emerge from the African American gay closet are similarly applicable to the community. Once again, we explain the experiences of people with mental illness. model in terms of how it might apply to Costs and benefits are listed in Table 1. people with mental illness. Perhaps most sobering among the risks During the pre-encounter stage, people of coming out for sexual minorities is with mental illness are unaware of their bodily harm. The news media regularly political plight and of the way that reports on hate crimes based on sexual assumptions by the seemingly ‘normal’ orientation. The case of Matthew She- majority influence attitudes about them. pard is perhaps best known. This 21- The subsequent encounter stage brings year-old gay male was beaten to death into awareness these subtle assumptions outside of Laramie, Wyoming in 1998. in two ways. First, people experiencing Unfortunately, this is not a rare occur- early signs of significant psychiatric rence. Results of one study showed 41% symptoms are challenged by their view of a sample of lesbians and gay men of normalcy. Second, people struggling reported being victims of a bias-related with psychiatric symptoms encounter crime and another 9.5% reported an advocates who are out of the closet and attempted bias crime against them seemingly dealing with the prejudice that (Herek et al., 1997). Data provided by mental illness entails. These challenges Human Rights Watch (2001) has shown lead to immersion where some people that more than 80% of gay and lesbian steep themselves in the consumer-ex- students report incidents of name-calling patient-survivor movement. This immer- and other forms of verbal harassment in sion leads to hostility towards the ‘nor- a single year. mal’ majority and rejection of psychiatric On one hand, there does not seem to services. During the internalization be a facile comparison between these phase, ideas that are learned as the result kinds of hate crimes and the experiences of interacting with the consumer-ex- of people with mental illness. There is patient-survivor community become part no body of evidence clearly suggesting of the person’s self-identity. People tran- that people with mental illness who sition from statements about them (‘The come out are victims of crime in consumer community is supportive be- retaliation for their ‘mentally ill’ life Coming out of the closet 241

Table 1: Summary of costs and benefits of coming out of the gay closet

Benefits Costs Psychological well being Physical harm . Increased self-esteem . Decreased distress Diminished risky behavior Social avoidance by others Facilitate interpersonal relations Social disapproval Enhance relatedness to key institutions like Self-consciousness and self-fulfilling work prophecies

style. Alternatively, some advocates be- psychiatric conditions are less likely to lieve violence against people with mental obtain or maintain jobs because of illness comes in a more subtle form stigma (Corrigan & Watson, 2002). (Chamberlin, 1998; Fisher & Ahern, Despite the disadvantages, benefits to 2000). Namely, the prescription of coer- disclosing a stigmatized status exist. cive and/or mandated treatments, such Perhaps key among these is the removal as involuntary commitments and man- of the stress that results from having to dated medication, has been perceived as no longer keep a secret on such an a violent measure by some people with important part of one’s identity (Rosario mental illness. Research has shown that et al., 2001). Research by Daniel Wegner some people with mental illness experi- and colleagues (Wegner & Lane, 1995) ence mandated or coercive treatment as has examined the deleterious effects of harmful and abusive (Svensson & Hans- secrets for people with concealable stig- son, 1994). mas. Labeling it the secrecy cycle, There are other examples of less Wegner and colleagues found that at- violent, but still punitive, consequences tempts at secrecy activate a set of to disclosing. Many members of the cognitive processes that lead to an general public may choose to avoid obsessive preoccupation with the secret. people who have come out as gay. Coming out negates the need for con- Experiences of social disapproval may cealment and therefore helps the person negatively impact the self-esteem of avoid the secrecy cycle. people who are out. Of even greater Among sexual minorities, diminished concern, disclosing one’s sexual orienta- stress that results from coming out leads tion may translate into job and housing to better relationships with one’s partner discrimination (Ragins & Cornwell, (Beals & Peplau, 2001) and improved job 2001). Although specific statistics have satisfaction (Day & Schoenrade, 1997, been difficult to gather, mounting evi- 2000). Moreover, people who come out dence suggest that gays and lesbians report greater support from their families suffer employment discrimination (Jen- (Kadushin, 2000). Further, as a group, nings, 1994; Olson, 1987; Weaver v Nebo sexual minorities have embraced coming School District, 1998). A similar pattern out as beneficial for the political and has been found for people with mental socio-economic needs of their commu- illness. Individuals who are disclose their nities. As such, advocacy groups repeat- 242 Patrick W. Corrigan & Alicia K. Matthews edly urge individual gays and lesbians to the homophobic majority will diminish come out at all levels. their prejudice. (6) Finally, Cain noticed Although the benefit for the stigma- that disclosure sometimes serves a spon- tized community seems clear, the impact taneous function. Examples include on- on individuals within that community is the-spot decisions or slips of the tongue. less transparent. There are no algorithms Cain (1991) noted that just as there are that suggest how the costs and benefits of reasons why people opt to disclose, so coming out will add up to affect an there are functions that keep people in individual. Hence, the individual must the closet. Called concealment, four consider these advantages and disadvan- examples are described below. (1) Often tages for themselves in deciding whether times, people believed that disclosure was or when to disclose. In the next section, neither appropriate nor relevant to the several levels of disclosure, and its impact situation. For example, several people on people making the disclosure decision, reported it would be improper to share are reviewed. their sexual orientation with parents who have discouraged any discussion whatso- Different levels of disclosure ever on sexual matters. (2) Some people opt to conceal their homosexuality out of Cain (1991) interviewed 38 gay men to deference to a significant other. Age was determine decision rules for coming out. often cited as reason to defer and not tell The author asserts that people choose to someone (e.g., aging grandparents). (3) disclose their gay orientation because it Some people stay in the closet because meets at least one of six needs. (1) they lack the necessary emotional re- Research has shown that maintaining a sources to face the challenge of disclo- secret about an important aspect of one’s sure. For example, they do not have the identity is inversely related to psycholo- stress management skills or support to gical well-being (Rosario et al., 2001). handle the disapproval and anger they Hence, disclosing the secret serves the may experience from others when they therapeutic purpose of enhancing one’s come out. (4) Finally, some people opt self-esteem. (2) Disclosing may enhance not to disclose because of concerns that closeness in relationships that were dis- people in positions of power (e.g., tant because of the secret. (3) employer) might use the information Sometimes people disclosed as a way to against them. resolve interpersonal problems. One spe- In an ethnographic study of 146 people cific example with relevance to mental with mental illness, Herman (1993) iden- illness was coming out to avoid constant tified several specific ways in which questions about one’s whereabouts when people might disclose. Based on our covertly involved in the gay world (or work with mental health advocates (Cor- mental health community). (4) Preventive rigan & Lundin, 2001), we summarized disclosures attempt to avoid worse out- her observations into five specific levels comes that might occur by accidentally of disclosure. According to Herman discovering that a person is gay. (5) Some (1993), at the most extreme level, people people opt to publicly announce their may stay in the closet through social sexual orientation because they believe avoidance. This means keeping away the more people that are out, the more from situations where people may find Coming out of the closet 243 out about one’s mental illness. Instead, ing from these lessons, perhaps one way they only associate with other persons to deal with prejudice and discrimination who have mental illness. Others may is to find words that are less pejorative to choose not to avoid social situations but describe a stigmatized group. An alter- instead to keep their experiences a secret. native approach is to reappropriate An alternative version of this is selective stigmatizing labels. In the latter instance, disclosure. Selective disclosure means a stigmatized group revalues what was a there is a group of people with whom negative label by referring to itself in private information is disclosed and a terms of that label (Galinsky et al., 2003). group from whom this information is Queer is an example of this phenomenon kept secret. While there may be benefits in the gay community. In 1990 four of selective disclosure such as an increase members of ACT-UP dubbed itself in supportive peers, there is still a secret Queer Nation with the slogan ‘We’re that could represent a source of shame. here. We’re Queer. Get used to it.’ What People who choose indiscriminant disclo- used to be a disrespectful way of referring sure abandon the secrecy. They choose to to sexual minorities has been embraced disregard any of the negative conse- by the community. There is some evi- quences of people finding out about their dence of label reappropriation in the mental illness. Hence, they make no consumer survivor community too. Per- active efforts to try to conceal their haps the best example is MadNation. mental health history and experiences. Established in 1997, MadNation now Broadcasting one’s experience means comprises more than 800 members educating people about mental illness. ‘working for social justice and human The goal here is to seek out people to rights in mental health’ (www.networks- share past history and current experi- plus.net/fhp/madnation/announce.htm). ences with mental illness. Broadcasting Galinsky et al. (2003) identified several has additional benefits compared to benefits to label reappropriation. Perhaps indiscriminant disclosure. Namely, it most obvious, the public can no longer fosters their sense of power over the use the term against the group. Secondly, experience of mental illness and stigma. reappropriation implies that deviance or abnormality is not a bad thing. Lastly, Ways in which coming out has been the reappropriation of a term like queer supported or mad actually becomes a source of Although the decision to come out is a pride. In turn, this kind of pride enhances personal one, disclosure has been facili- the self-esteem of individuals who will- tated by a variety of institutions and ingly wear it. social movements. Three of these are Advocacy and support groups summarized below: A second social phenomenon that The reappropriation of stigmatizing labels facilitates disclosure is the advocacy and Several examples to diminish the effect support groups made up of people who of a bad label are apparent from the are out. Among sexual minorities, these commercial world where businesses have groups sometimes adopt a reappro- sought to escape prejudice by changing priated name and become a resource in their names (e.g., Valujet morphed into the community. Groups like these pro- Air Tran after a major accident). Learn- vide a range of services including support 244 Patrick W. Corrigan & Alicia K. Matthews for those who are just coming out, from what is frequently considered the recreation and shared experiences which most justified position (e.g., publicly out- foster a sense of community within a ing a conservative politician who takes an larger hostile culture, and advocacy/ anti-gay stand on important public is- political efforts to further promote gay sues) to the least (e.g., outing a private pride (Kates & Belk, 2001). citizen who keep all facets of his or her life Several forces have converged over the private). In a parallel fashion, people past century to foster consumer-operated active in the mental illness community services for persons with psychiatric might opt to out individuals in the closet disabilities. Some reflect dissatisfaction about their psychiatric problems. There with mental health services that disem- have been examples of the psychiatric power persons by providing services in problems of famous people being dis- restrictive settings. Others represent a closed for political agenda. Perhaps best natural tendency of persons to seek known of these was Thomas Eagleton’s support from others with similar pro- experiences with depression which were blems. Recently, a variety of consumer- leaked to the press. Senator Eagleton, a operated service programs have devel- democrat from Missouri, was George oped including: drop in centers, housing McGovern’s running mate in the 1972 programs, homeless services, case man- general presidential election. In this in- agement, crisis response, benefit acquisi- stance, however, outing Eagleton was not tion, anti-stigma services, advocacy, to serve mental health pride but to research, technical assistance, and em- increase prejudice. Similarly, there is not ployment programs (Van Tosh & del yet any empirical evidence that outing has Vecchio, 2000). Results of a qualitative somehow diminished either prejudicial evaluation of consumer operated pro- attitudes or discriminatory behaviors grams showed that participants in these toward gays. This needs to be the focus programs reported improvements in self- of future research. reliance and independence; skills and knowledge; and feelings of empow- Conclusion erment (Van Tosh & del Vecchio, 2000). Future research needs to isolate the For the gay and lesbian community active ingredients of consumer-operated coming out has significant advantages at services that lead to positive change. the individual and community level. We Outing argued in this paper that the experiences A third phenomenon related to disclo- of stigma are similar for gays/lesbians and sure is outing. In the past decade, some people with mental illness. Hence, what gay and lesbian advocates have called for the gay community has learned about outing people in the closet as a way to coming out may inform a similar move- advance an anti-prejudice agenda. Outing ment in the community of people who means publicizing the fact that a specific identify themselves as mentally ill. In the person is gay or lesbian when that person process, the research that has examined has actively tried to stay in the closet. some of the questions related to identity Outing generates strong ethical debate development and disclosure in the gay (Chekola, 1994; Mayo & Gunderson, community may inform similar experi- 1994; McCarthy, 1994) and may vary ences in people with mental illness. 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