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Stigma of Mental Illness

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on 15 November 2015

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Transcript of Stigma of Mental Illness

Language & Stigma
Stigma in the Media
Systemic Stigma
Overview
Literature review
Does it exist?
Forms
How does it exist?

References
Resisting Stigma
Overview
In the media
In the mental health field
Anti-stigma campaigns and initiatives
Effectiveness of anti-stigma efforts
Stigma of Mental Illness: From Roots to Growth
Literature Review
Significant research on stigma of mental illness among
general public

Limited research on stigma of mental illness among
mental health professionals
Importance of Systemic Stigma
Mental health professionals serve as
role models
and
leaders
in regards to mental health issues

People with mental illness encounter mental health professionals when they are in
crisis
and most
vulnerable

People with mental illness depend on mental health professionals for
understanding
and
support

How mental health professionals’ view people with mental illness can have a significant
impact
on their
recovery

Varied Findings
Some evidence for
less stigmatizing attitudes
of mental health professionals vs. non-mental health professionals
Varied Findings
Other evidence for
similar or even more stigmatizing attitudes
of mental health professionals vs. non-mental health professionals
Reasons for Variations in Findings
Only 19 published studies from 2004 to 2009 (Wahl & Aroesty-Cohen, 2010)
Example:
Grausgruber, Meise, Katschnig, Schony, and Fleischhacker (2007) found that various mental health professionals and relatives of people with mental illness exhibited
more positive views
than the general public regarding all aspects of schizophrenia that were examined:

Attribution of causes of schizophrenia
Perceived success of treatment
Perceived dangerousness of schizophrenia patients
Willingness to have social contacts with schizophrenia patients

Example
- Nordt et al. (2006) demonstrated that both the general public and mental health professionals indicated a
greater desire for social distance
from a person with schizophrenia than from a person with depression or no psychiatric symptoms. They also found that mental health professionals, particularly psychiatrists, had
more negative stereotypes
about people with schizophrenia than the general public.
Example
- Hugo (2001) found that mental health professionals were
less optimistic
than the general public about prognosis and long-term outcomes. The experience of professionals with people with mental illness when they are unwell may have led to these attitudes.
Location of study (therefore, cultural impacts)
How mental illnesses were defined in study (mental illness in general vs. specific illnesses)
Which mental health professionals were included in study


Hugo (2001) found that medical staff were less optimistic about long-term outcomes than other professional groups
Work setting of mental health professions in study (community-based setting vs. psychiatric hospital)
Variation in Parameters of Studies
Forms of Systemic Stigma
Therapeutic pessimism and lowered expectations
Avoiding or delaying telling clients re: diagnosis
Discrimination in hospitals and other parts of the public health system
Mental health specialization is devalued within professional disciplines
Hospital/in-patient settings
Systemic Stigma
Example
: people with borderline personality disorder in particular

Often seen as
manipulative
,
difficult
to treat, and to
blame
for their condition
Some practitioners and/or programs simply
refuse to treat
Less attention
(research and specialized treatment) compared to that of other serious and persistent mental illnesses like bipolar disorder and schizophrenia

Fearing the news will be too frightening or demoralizing
Example
: hospital emergency wards

Not well received (long wait times, insensitive treatment, viewed as less of a concern than physical health problems); therefore, subjected to further
humiliation
and
trauma

Professionals may label working with this population as
difficult
and
unrewarding

Results in
associative stigma
felt by professionals who work in mental health

Examples: occupational therapy, nursing, medicine

Use of physical and chemical restraints
Use of isolation rooms

Insensitive use of psychiatric jargon
Examples
:
“Chronic”
used as an adjective (“chronic mental illness”, “the chronic wards”) and a noun (“the chronics”)
“Axis 2’s”
to describe people with personality disorders
“Low/high-functioning”
“Inappropriate”
“Non-compliant”
/
"Treatment-resistant”
/
"Lack of insight”


Use of diagnosis as an adjective or identity label
Examples
:
“The bipolar patient”
“She is schizophrenic”


Statistical Rarity

Traits, whether physical eg. height, weight or psychological are distributed throughout the population in the shape of a curve, whereby most of the population clusters in the middle of distribution and fewer individuals fall outside the curve.
Definitions of Mental Illness
Social Norms and Social Deviance
Social groups typically establish guides of norms for behavior. Behaviors that deviate from these norms threaten the cohesion of the group and are seen as dysfunctional and detrimental. This pressures social groups or communities to identify perpetrators of atypical behaviors and assign them to a subgroups that do not belong with the mainstream population.
Moral Transgression
Personal Impairment and Ecological Views
Mental illness is determined by the impairment of the behaviors themselves.

Identifies mentally disturbed behaviors as causing significant problems for the person’s social, occupational, academic functioning as well as personal relationships and general well being.

From this perspective , pathology or mental disturbance is located neither in the person not in the social context but rather the relationship between the two.

From this perspective, deviance is viewed as a statistical rarity.Those that who fall outside of the normal curve, are literally defined as ‘ab-normal’.
In the Media: Notable People
Sinead O'Connor
Stephen Fry
Catherine Zeta Jones
Brooke Shields
Emma Thompson
Demi Levato
Margaret Trudeau
Clara Hughes
Serena Ryder
In the Media:
Film, Television and Print
Next to Normal: A musical about a family's struggle with bipolar disorder
Examines the ways that the medical model has shape how we view mental health, and gives people with lived experience control over media representation
Video Games
Print Media
In the Field
Dr. Patricia Deegan
Psychologist, professor, and advocate
Dr. Kay Redfield Jamieson
Clinical psychologist, professor, and author
Dr. Elyn Saks
Law professor, specializes in mental health law
Dr. Patrick Corrigan
Advocate, professor, and author
Dr. Jennifer Poole
Social worker, professor (at Ryerson University)
Anti-Stigma Campaigns and Initiatives
Bell Let's Talk and Clara's Big Ride
CMHA's Ride Don't Hide
National Stigma Clearinghouse
Effectiveness
Research evidence supports that
direct contact
is key to challenging stigma vs. emphasizing the biological nature of mental illness (Davis, 2014)
When deviant behaviors are extremely threatening to the group, often the individual is labeled as having some kind of mental condition. The behavior is ascribed as being the result of some out of control force rather than having anything to do with the social norms or standards themselves.
Thus the idea that “no one in their right mind” would intentionally choose to deviate from the social groups prescribed norms and therefore they must be functionally disturbed.


Behavior that deviates from social norms is viewed as fundamentally evil or wrong.

This has been the prevailing perspective throughout human history, most notably in white/western culture.

From this standpoints individuals deviating from the social norm are not only excluded from the community but often punished physically.

Throughout history aberrant behavior was often perceived as the doing of evil spirits or demons.
Medical Model
Based off the analogy of mental illness being akin to medical illnesses.

The symptoms of behavioral and mental in nature and the affected organ is the brain.

The Medical Model is intent on moving away from understanding mental illness in the cultural or social realms and into the scientific domain.

Harmful Dysfunction
A relatively new model, it argues that aberrant behavior should not be considered mentally dysfunctional, unless it distinctly violates social norms or creates significant impairment towards the functioning in question.

Within this perspective social and personal judgements are necessary in defining behavior as abnormal.

Problems with this model is that some behaviors that violate social norms or hinder functioning are in fact naturally useful. For example, anxiety around snakes or other venomous animals.


Developmental Psychopathology
Works under the pretext that mental illness is fluid and dynamic and emerges in phases and stages.

Attempts to explain mental disturbance as complex and interactive with personal and environmental influences.

Official Interpretation of Mental Illness
Most text emphasize some combination of social deviance, statistical abnormality and personal impairment.

Moral models are not used contemporaneously and there is a growing trend towards Developmental Psychopathology.

As we all know the DSM-V is the current reference for diagnosis of mental disorders.

(Hindshaw,2007)

Criticism of this model is that there is considerable clinical judgement in evaluating the extent of the impairment the individual is experiencing.

Also the kind of social environment impacts a person’s ability to function. If two individuals who are equally struggling and one is placed in a supportive caring environment and the other in a harsh and severe setting, you will likely see a significant difference in their presentation.


The key issue with this model is that types of mental and behavioral “disturbance” must still be based and evaluated by one or all of the previous models. This model does not explain how we conceptualize ‘normal’ and ‘abnormal’ behavior?



Developmental Psychopathology attempts to incorporate elements of personal impairment, ecological components, medical models as well as harmful dysfunction model.

It works towards integrating these models with an emphasis on the emergence of mental dysfunction from previous developmental states while acknowledging the constant interplay of biological and environmental influences.

Suggest a model for mental illness that does not rely on social or medical emphasis alone to define and examine mental health. Rather it ascertains that mental disorder is complex and multi-faceted.


(Davis, 2014)
Ancient Eras
Trephination
Ancient Greece
Antiquity indicates that the ancients Greeks believed people experiencing mental illness had been taken over by angry gods.
6th Century
Scientific Inquiry
Around 6th Century BC, Hippocrates along with his many other scientific and medical advances, began to explore the concept that the brain was the locus of thought not the soul.
Medieval Period (5th to 16th Century
With the rise of Christianity the conceptualization of Mental Illness followed the model of
Moral Transgression.
1900-1960’s
WWI had a significant impact on how society views mental disorder.
The large number of soldiers returning from the war experiencing PTSD or “shell shock” made society realize that anyone under stress could experience mental illness. The population wanted to care for the returning soldiers so the number of institutions increased. These institutions generally had a high standard of care and were altruistic in nature.

The History of Mental Health and Stigma
The individual would continue living with these burr holes. It is theorized that they were believed to be releasing demons or evil spirits the were occupying the subject, most likely because they were demonstrating unusual behavior.
Archeologists have found skulls up to 5,000 years old in which the individuals had holes intentionally burrowed into them while they were still living.


Most individuals exhibiting milder behaviors who had family to care for them were kept at home and away from public persecution.
However individuals with more disruptive behavior were often ridiculed, exiled and and frequently publicly executed.
It has been argued that Grecian persecution of mental illness was the foundation of modern day Western societal values of mental illness
There began to emerge the process of classifying and evaluating abnormal behavior and thought processes
Hippocrates proposed the concept of bodily humors i.e., Blood, Phlegm, Black Bile and Yellow Bile. He argued that mental illness was the result of excess amounts of black bile within the system.
Mental Illness was associated with demonic or divine possession . Most people exhibiting behaviors or thought processes deviating from the social norm were tortured and executed by burning at the stake or hanging.
During the Witch Craze those with mental illness were particularly targeted by the church.

At this time almost all advances or demonstrations of humane treatment of mental illness halted as those who studied Science and Medicine were branded witches and heretics themselves.
Around the 1300's we begin to see the building of Asylums. However these more resembled prisons and were not humane.
Bethlem Hospital or
notoriously referred to at "Bedlam" is England's first mental health hospital built in 1246.
It was known for it's appalling living conditions, abuse and inhumane methods of containing and treating it's wards.
It was common for patients to be put on display for the public to watch for a small fee
Enlightenment 18th century
Philippe Pinel, a french physician, and William Tuke an Englishman both proposed that those who behaved in strange and unexplainable ways did so because they had mental illness.

Both men in their respective countries pioneered a movement referred to as “Moral Treatment”. This encompassed decent living conditions, prohibition of restraints and isolation and the perspective that kindness, respect and dignity were paramount in establishing mental wellness.

Many institutions were built in this period, they were usually referred to as “Lunatic Asylums”. This period also saw the emergence of psychiatry as a medical discipline.

Across Canada, the U.S. and Europe large institutions were built in this period.
They were usually self-contained and built in isolated areas, usually outside a metropolitan city.
Patients, once admitted would usually spend the rest of their lives there.
Treatment attempts focused on occupational and industrial therapy, ie many patients would be responsible for work duties. There was also a strong social and recreational component.
Most patients remained isolated from their families and communities

Many psychiatric treatments which have since fallen into disfavor were common at this time. Such as hydrotherapy, insulin coma and psychosurgery (lobotomy).
Due to overcrowding, institutions became places of custody rather than treatment.
Physical and chemical restraints were used regularly.
At this time there was severe neglect, abuse and disorder.
The former model of “ Moral Treatment” was no longer being upheld. It is from this time period we get a lot of media images portraying being “committed” as resulting in being placed in a horrific circumstances and that people suffering from mental illness will be shamed, tortured and segregated.

Deinstitutionalization
1960’s to present

Trend towards deinstitutionalization because:
Institutions were recognized as non-therapeutic environments
Studies in Canada, the U.S. and Europe all showed that the negative impact of long term institutionalization was significant.
Recent advances in psychopharmacology

Aftermath of Deinstitutionalization
Unfortunately inadequate funding was provided towards community supports and treatment. Most communities were unprepared to support individuals being discharged.

This resulted in : a high frequency of relapse and high readmission rates into hospitals,
the “revolving door syndrome”, where patients would be admitted to hospital, stabilized and then discharged into inadequate care within the community, only to return to hospital.
Increased homelessness
Increased criminal behavior

Around WW2, institutions became overcrowded due to a rapid growth in population. The quality of care was significantly decreased by funding cuts due to wartime expenses coinciding with a greater number of admissions.

In 1950, in Canada there were over 66,000 patients in psychiatric hospitals (Retrieved from Interim Report of The Standing Senate Committee On Social Affairs, Science And Technologyhttp://www.parl.gc.ca/Content/SEN/Committee/381/soci/rep/report1/repintnov04vol1-e.pdf)

The number of patients in psychiatric hospitals outnumbered the number of patience in general hospitals.

Phases of Deinstitutionalization

1st phase: Discharging long term patients into either psychiatric wards in general hospitals or into communities (which were relatively unprepared).

2nd phase: A focus on the need to expand mental health care into the community.

3rd and current phase: Integrating mental health services and supports and enhancing their efficacy.

1970-1980’s
During this time an attempt at building better support programs within the community was initiated.
The belief was that there needed to be a more balanced approach in dispersing funds for mental health services between facility-based treatment and community mental health care and support.
The need for case management to ensure coordination of services in a community based delivery system.

Where are we now?
From the 1990’s on there has been an emphasis on enhancing the effectiveness and integrating mental health supports.
A push towards “ best practice” or evidence based practice is a direct response to policy makers receiving pressure for more productive and accessible services from clients, family members and the community.

In most provinces the model of mental health service delivery is a varied range of integrated community services working in conjunction with psychiatric unit based in general hospitals.

My compatriots can let you know how that is all going….
1970's-present
Here we see the role of social worker strongly emerge within the mental health field.
Social workers became key in supervising community placements, outreach, working as a member of an interdisciplinary team and being a front line advocate for clients.
It appears that one of the contributing factors of Social Work developing as a profession was the need for community based case management and advocacy for those with mental illness shortly after the process of deinstitutionalization.

Mental Health Cross-Culturally
There is no doubt that mental illness and perceptions of it are not the same cross culturally.

Firstly there is the phenomenon of culture-bound syndromes. These are disorders that are only found in particular societies.
This demonstrates that mental illness is impacted by culture and therefore culture cannot be excluded when assessing, diagnosing or treating.

Varma et al., 2009
In general indigenous cultures tend to perceive mental illness as less abnormal and more a fundamental component of the individual.
Since societies are usually smaller, the concept of what is normal and abnormal is far less emphasized by the majority, as the majority is a small group of people.
Furthermore, indigenous cultures tend not to be as rigid in the roles and expectations of individuals as industrialized cultures. There is more room for acceptance of aberrant behavior.

From an Aboriginal Worldview, mental wellness is seen as holistic, meaning a person’s mental health is determined by their environment, relationships, physical health and spirituality.
Therefore an individual within the community mental wellness was seen as a shared responsibility.

A distinct theme cross culturally around perceptions of mental illness are that societies that are Individualistic in nature tend to try and treat or control those with mental health issues.
In contract, Collectivist societies are more apt to hide or segregate individuals from the greater population. Usually within families or small communities.
Schizophrenia
According to the DSM-5, (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) Schizophrenia is a disorder in which a person will experience gross deficits in reality testing, manifested with at least two or more the following symptoms, which must be present for at least one month (unless treatment produces symptom remission):
At least one symptom collectively referred to as positive symptoms: 1.Delusions- strange beliefs and ideas which are resistant to rational/logical dispute or contradiction from others. 2.Hallucinations- typically auditory, or less frequently, visual. 3. Disorganized Speech- incoherence, irrational content. 4. Disorganized or Catatonic behavior- repetitive, senseless movements, or adopting a pose which may be maintained for hours. The individual may be resistant to efforts to move them into a different posture, or will assume a new posture they are placed in.
5. Negative symptoms- flat affect, amotivation, anergia, failure to maintain hygiene (American Psychiatric Association, 2013).
Obsessive Compulsive Disorder
characterized by distressing, intrusive obsessive thoughts and/or repetitive compulsive physical or mental acts.
Common obsessions include the following:
Contamination
Safety
Doubting one's memory or perception
Scrupulosity (need to do the right thing, fear of committing a transgression, often religious)
Need for order or symmetry
Unwanted, intrusive sexual/aggressive thought
Common compulsions include the following:
Cleaning/washing
Checking (eg, locks, stove, iron, safety of children)
Counting/repeating actions a certain number of times or until it "feels right"
Arranging objects
Touching/tapping objects
Hoarding
Confessing/seeking reassurance
List making
(American Psychiatric Association, 2013).
Antisocial Personality Disorder
APD (Antisocial Personality Disorder, diagnosis assigned to individuals who habitually violate the rights of others without remorse (American Psychiatric Association, 2013). People with Antisocial Personality Disorder may be habitual criminals, or engage in behavior which would be grounds for criminal arrest and prosecution, or they may engage in behaviors which skirt the edges of the law, or manipulate and hurt others in non-criminal ways which are widely regarded as unethical, immoral, irresponsible, or in violation of social norms and expectations.

The terms sociopath and psychopath are used interchangeably with this disorder.
Common Diagnosis Portrayed in Pop Culture
Scientific Revolution in the 17th century
General public view saw those with mental disturbances as akin to beasts or children, lacking fundamental humanity.
It was often believed that mental illness was a self-inflicted state brought on by an excess of passion.

These values were used as justification for poor treatment such as physical restraints and confinement.
Common treatments were bloodletting and purging.

It should be noted that there were asylums being built outside of Europe at this time and that they provided more compassionate care than their European counterparts.Indication of this was institutions built in Cairo and Baghdad.

In Europe, there was some level of care administered by the clergy for those exhibiting milder disorders.

Humanitarian movement moved to the United States.

Late 1800’s and early 1900’s Sigmund Freud introduced psychoanalysis.

Emergence of a more scientific approach.

Widespread treatments across Europe, Canada and the U.S. were the use of electroconvulsive therapy, psychosurgery and psychopharmacology.

Positive vs Negative?
Making Meaning
Intention of stigma
Audience interpretation
Accuracy of representation
Why Media Matters
Mass media primary source of information on mental illness (Harper, p. 87).
Patients in psychiatric hospitals watch more television on average than the heavy-viewing public (Harper, p. 105).
The Other
Film must establish visual boundaries between "sane" and "insane."
"The banality of real mental illness comes in
conflict with our need to have the mad
identifiable, different from ourselves"
(Cross, p. 131).
Mental Illness in the Biopic
Madness linked to brilliance
Gender and racial implications

Tied to Western liberalism

Great individuals will thrive in the face of adversity
Mental Illness and Humour
Overall, popular media does a "poor job depicting mental illness, with misinformation frequently communicated, unfavourable stereotypes predominating, and psychiatric terms used in inaccurate and offensive ways" (Wahl, p. 13).
POPULAR FILM AND TELEVISION
NEWS AND REALITY MEDIA
VIDEO GAMES
LOVE
as
"Cure"
Wilbur Wants to Kill Himself
(2002)
Mental Illness As
Violence
Psychiatrist: I can't stop searching for Michael Myers until I'm certain it's dead.

Police officer: You're talking about him like he's some kind of animal.

Psychiatrist: He was my patient for fifteen years. It became an obsession with me until I realized there was
nothing within him, neither conscience nor reason, that was even remotely human.
News Media
Stereotypes and lurid headlines to gain readers
Racialization of Mental Illness
in the Media
1960s: Civil Rights and Black Power movement
Drapetomania: pathologize behaviour of people held in slavery
Schizophrenia framed as an African American condition: currently diagnosed at 5 times the rate of other populations
"Protest Psychosis"
Malcolm X diagnosed by FBI
News Coverage of Vince Li
"A Look into the Diseased Mind of a Repentant Killer"
"Crown Does Not Oppose Letting Greyhound Bus Beheader off Mental Hospital Grounds"
"Bus Beheader Deserves Expanded Privileges, Hearing Told"
Survey of representations in media:
3/4 people identified as having a mental illness were either unmarried or of unspecified marital status
More than half had no clear occupation
"They are not part of the usual fabric of society, home and work" (Wahl, p. 43).

He enjoyed what he did but will never admit to the truth. These people are possessed and will do it again.
I'll give you one guess as to what I think should be done with people such as this.
The first thing the voices tell the schizophrenic is the medication is poison.
This is a good example of how to beat the weak kneed justice system. Yeah, this guy is a sicko.
We keep dangerous animals in cages.
A month later the patient is standing behind a young girl near the edge of the subway platform and the voices tell him she is Satan come to Earth.
Mental illness used as a cause for public acts of violence
ex. coverage of Elliot Rogers shootings
Less likely when perpetrator is a person of colour - can be "linked" to terrorism
ex. coverage of shooting in Ottawa
Reality Media
Video Games
67% North American households play for an average of eight hours a week
Psychiatric hospitals frequently used as settings
Patients as villains:
"Sanity meters"
Arkham Asylum
Manhunt 2
Don't Starve

Consequences of Stigma
Labelling
Stereotyping
Division: Us & Them
Exclusion & Isolation
Discrimination & Loss
"Asides (sic) from those extremely close to me, few people
know about the mental illness I've struggled with most of
my life. The stigma around mental illness silences me; I'm
afraid being public about will affect the way future employers, friends and strangers view me. I need them to see me. Sometimes I feel like those with mental illness can't stand up for ourselves because people only see the diagnosis, not the person anymore.
It means a lot when someone people respect, adore, and admire does, and not just before, but with us
, until we can stand up on our own and be seen as just as valid in our fight for our lives."


(Georgia Straight 'Confessions' , 2014, Oct 5)
Consequences: The Research
"Opening Minds: Talking About Mental Illness"
Self-Esteem/Self-Worth
Those participants in the 90th percentile of reported stigma were
7-9x
more likely than those in the 10th percentile to exhibit
low self-esteem
(Link et al., 2001)

Negatively affects
“psychological well-being”
in those w/ substance use disorders (Magdelena, 2013)

Significantly decreased
self-esteem
(Rüsch, Angermeyer, & Corrigan, 2005)

Increased
negative emotions
, central of which may be
‘shame
’ (Scheff, 1998)

Decreased hope, self-esteem, empowerment (Livingston & Boyd, 2010)

School-based anti-stigma program
Media watch organization
Organizes boycotts and anti-stigma campaigns
Consequences: The Research
Compromised Support
Disconnection
from/discontinuation of treatment and/or support (Cooper, Corrigan, & Watson, 2003; Corrigan, 2004)

Occurs through
reduction in self-esteem
and reinforcement of
social exclusion
(See Change, 2013)

Seen as the “
primary barrier
” to recovery (United States Department of Health Services, 1999)

It is the
fear of stigma
itself that is regarded as the barrier to seeking health services (Rüsch, Angermeyer, & Corrigan, 2005)

Consequences: The Research
Social Impacts
"Limiting access to housing and employment
Damaging social relationships and social participation
Reducing self-esteem and dignity
Reinforcing a lack of control and influence in how services are designed and delivered
Perpetuating the abuse of human rights"
(See Change, 2013)


Social Work and Stigma
Micro
Macro
Stigma impacts all of society by:
Financial & Economic Impacts
“Mental illness stigma/discrimination was found to impact negatively on
employment
,
income
,
public views about resource allocation
and
healthcare costs
.” (Sharac, Mccrone, Clement, & Thornicroft, 2010)
The Differing Faces of Stigma
Stigma by Diagnosis
Strengths Perspective:
holistic practice
valuing adversity
unpacking dichotomy between "illness" and "wellness" (Grant & Cadell, 2009)
Anti-Oppressive Practice
explicating power relationships
connecting stigma to structural issues
empowering clients (Poole et. al, 2012)
Intersectionality
attending to diversity
looking for commonalities
race, class, gender, age and culture
Loss of status and discrimination of opportunity lead to limitations in options for
housing
,
employment
, as well as
funding for research.
(Link, Yang, Phelan, and Collins, 2004)

Participants with psychosis and substance dependence were
most likely
to report experiences of stigma and were
most affected
by them

Participants with anxiety disorders, depression, and personality disorders were more adversely affected by
patronizing attitudes
and
perceived feelings of stigma
, regardless of there being evidence of discriminatory behaviour
(Dinos et al, 2004)
Restoring Narratives
Different forms of stigma exist, and may carry with them unique, negative impacts:
letting clients tell their own stories
rejecting labels
reflexivity (Butler, Ford & Tregaskis, 2007)
Campaign for access to care, housing, meaningful employment and social services
Participatory Action Research (ex. PEER)
"I regret not going to the hospital. I listened to too many people and I suddenly thought 'I am going to be labelled a loony.' I wasn't aware obviously because it hadn't happened to me before so I was...yes it did stop me from going there."
Work within existing movements
Oppose the commodification of health
"Because people don't understand, if they know that I've been off work because of mental ill health they may choose to use somebody else rather than me."
Reframe stigma as "Sanism"
"I've had moments when I was talking to someone quite happily, mentioned the sheer fact that I suffer from mental health problems and I turned to talk to someone else and their back turned, they're heading for the door literally."
Acknowledge activism of consumer/survivors
Why this part of the conversation...?
Stigmatizing language is
pervasive
. It is used in social situations, workplaces, online, and medical/service environments everyday.
Historically, language has been used to address disabilities, while often essentializing - putting a person’s condition or experience before their personhood. (Longmore, 1985; Shattel, 2009)
Chances are, each of us has used it today...
“But if thought corrupts language, language can also corrupt thought.”

-
George Orwell, '1984'
Language: Its Effects
People with lived experience directly report being negatively affected by stigmatizing language (Mood Disorders Association of Ontario, 2013)
Rachel Smith (2007) posits that stigmatizing language is used to accomplish the following:

(a) to distinguish people,
(b) to categorize distinguished
people as a separate social entity,
(c) to imply a responsibility for receiving placement
within this distinguished group and their associated peril, and
(d) to link this distinguished group to physical and social peril.

What kind of language is stigmatizing?
Categorical Homogenization
Essentializing language that sees and says anything but the person first.

(eg.
the ________, disabled, deaf, blind, mentally ill, addicted
)
Medical Labels
(eg.
patients, cases, sick with, afflicted by, suffering from
)

→ leads to expectation and reinforcement of ‘victim role’ and of needing external assistance (Longmore, 1985)
Specific Labels attached to substance use*
(eg.
addict, junkie, abuser, user, clean/dirty
)

Problematic as it essentializes and dehumanizes, placing focus on symptomatic behaviour over root causes.

(National Alliance of Advocates for Buprenorphrine Treatment, 2008)
Military Metaphors
(eg.
front lines, fight the good fight, battle, fighter, AWOL, in the trenches, boots on the ground
)

Who are we fighting? Where is this imaginary enemy? How do you think people accessing services feel about this kind of language?
Commonly Used Language
(eg.
patient, resident, consumer, client, disorder
)

Know your language!

Client
: Latin & Greek roots meaning "to bend or listen" "to recline" - immediately suggests a passive and expert-driven process
STIGMA
“By describing a treatment as a battle and a [person] as a combatant, we set an inherently adversarial tone, and dichotomize outcomes into victory and defeat. Changes in medication regimens become
setbacks or retreats, … [or]
mark the end of struggle,
the battle lost.”
(Khullar, 2014, Aug 7)
SO! What can we do to be more aware of our language?
Language Really Matters
Always
put people first, not their disabilities.
For example, remember to say, “person with schizophrenia” rather than “schizophrenic”.
Always
emphasize abilities, not limitations. Terms that are condescending must be avoided.
Never
focus on a disability. Rather, focus on issues that affect the quality of life for everyone - accessible transportation, housing, community supports, etc.
Never
portray successful persons with disabilities as “superhumans”. This carries unrealistic expectations for others and is patronizing to those who accomplish something of importance or significance.
Never
sensationalize a disability. This means not using such terms as“afflicted with”,“suffers from”,“victim of”....and so on.
Never
use generic/stereotype labels/terms. Terms like “the retarded”, “our mentally ill”, etc. are unacceptable.
Never
use a psychiatric diagnosis as metaphors for other situations.
(Manitoba Schizophrenia Society, 2008)

Harper, S. (2009). Madness, Power, and the Media: Class, Gender and Race in Popular Representations of Mental Distress. New York: Palgrave MacMillan.

Hinshaw, S. (2007). The mark of shame stigma of mental illness and an agenda for change. Oxford: Oxford University Press.

Hugo, M. M. (2001). Mental health professionals’ attitudes towards people who have experienced a mental health disorder. Journal of Psychiatric & Mental Health Nursing, 8(5), 419-425. doi:10.1046/j.1351-0126.2001.00430.x

Khullar, D. (2014, Aug 7). The trouble with medicine’s metaphors. The Atlantic. Retrieved from http://www.theatlantic.com/health/archive/2014/08/the-trouble-with-medicines-metaphors/374982/

Kirby, M., & Keon, J. (2004, November 1). Mental Health, Mental Illness and Addictions. Retrieved October 23, 2014, from http://www.parl.gc.ca/content/sen/committee/381/soci/rep/report1/repintnov04vol1part3-e.htm Social Work Practice in Mental Health. (n.d.). Retrieved October 29, 2014, from http://www.casw-acts.ca/en/social-work-practice-mental-health

Link, B. G., Struening, E. L., Neese-Todd, S., Asmussen, S., & Phelan, J. C. (2001). Stigma as a barrier to recovery: The consequences of stigma for the self-esteem of people with mental illnesses. Psychiatric Services, 52(12), 1621-1626.

Link, B. G., Yang, L. H., Phelan, J. C., & Collins, P. Y. (2004). Measuring mental illness stigma. Schizophrenia Bulletin, 30(3), 511-541.

Livingston, J. D., & Boyd, J. E. (2010). Correlates and consequences of internalized stigma for people living with mental illness: a systematic review and meta-analysis. Social science & medicine, 71(12), 2150-2161.

Longmore, P. K. (1985). A note on language and the social identity of disabled people. American Behavioral Scientist, 28(3), 419-423.

Magdalena, K. (2013). Substance Use Related Stigma: What we Know and the Way Forward. Journal of Addictive Behaviors Therapy & Rehabilitation, 2(2) doi:10.4172/2324-9005.1000106




Manitoba Schizophrenia Society. (2008). Stigma: Language matters. Retrieved from http://www.mss.mb.ca/docs/Stigma.pdf

Mental Health Commission of Canada (2012). Together Against Stigma: Changing How We See Mental Illness: A report on the 5th international stigma conference. Ottawa: Canadian Human Rights Commission.
Mood Disorders Association of Ontario. (2013). Do words hurt: Stigma & language focus group: Summary sheet. Retrieved from http://www.mooddisorders.ca/sites/mooddisorders.ca/files/downloads/stigma_language_research_summary_june_2013.pdf

National Alliance of Advocates for Buprenorphrine Treatment. (2008). The words we use matter. Reducing stigma through language. Retrieved from http://www.naabt.org/documents/NAABT_Language.pdf

Nordt, C., Rossler, W., & Lauber, C. (2006). Attitudes of mental healtth professionals toward people with schizophrenia and major depression. Schizophrenia Bulletin, 32(4), 709-714. doi:10.1093/schbul/sbj065

Poole, J., Jivraj, T., Arslanian, A., Bellows, K., Chiasson, S., Hakimy, H., Pasini, J., & Reid, J. (2012). Sanism, “mental health”, and social work/education: A review and call to action. Intersectionalities: A Global Journal of Social Work Analysis, Research, Polity and Practice. 1, 20-36.

Rüsch, N., Angermeyer, M. C., & Corrigan, P. W. (2005). Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. European Psychiatry, 20(8), 529-539.

Scheff, T. J. (1998). Shame in the labeling of mental illness (pp. 191-205). Shame. Interpersonal Behavior, Psychopathology, and Culture. New York Oxford: Oxford University Press.

See Change. (2013, July 29). The effect of stigma. Retrieved from http://www.seechange.ie/the-effect-of-stigma/

Sharac, J., Mccrone, P., Clement, S., & Thornicroft, G. (2010). The economic impact of mental health stigma and discrimination: a systematic review. Epidemiologia e psichiatria sociale, 19(03), 223-232.

Shattel, M. (2009). Stigmatizing language with unintended meanings: “Persons with mental illness” or “mentally ill persons”? Issues in Mental Health Nursing, 30(3), 199.


Abbey, S., Charbonneau, M., Baici, W., Layla Dabby, M. D., Gautam, M., & Paré, M. (2011). Stigma and discrimination. Canadian Journal of Psychiatry, 56(10).

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edition).Washington, DC: American Psychiatric Association.

Butler, A., Ford, D., & Tregaskis, C. (2007). Who do we think we are? Self and reflexivity in social work practice. Qualitative Social Work; 6; 281.

Confessions. (2014, Oct 5). We get closer everyday, but we’re not there yet. Retrieved from http://www.straight.com/confessions/1410/we-get-closer-every-day-were-not-there-yet

Cooper, A. E., Corrigan, P. W., & Watson, A. C. (2003). Mental illness stigma and care seeking. The Journal of nervous and mental disease, 191(5), 339-341.

Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist, 59(7), 614.

Cross, S. (2010). Mediating Madness: Mental Distress and Cultural Representation. New York: Palgrave MacMillan.

Davis, S. (2014). Community mental health in Canada: Theory, policy, and practice. Vancouver, BC: University of British Columbia Press.

Dinos, S., Stevens, S., Serfaty, M., Weich, S., & King, M. (2004). Stigma: the feelings and experiences of 46 people with mental illness Qualitative study. The British Journal of Psychiatry, 184(2), 176-181.

Fink, P. (1992). Stigma and mental illness. Washington, DC: American Psychiatric Press.

Gallagher, B. (1980). The sociology of mental illness (3rd ed.). Englewood Cliffs, N.J.: Prentice-hall.

Grant, J.G. & Cadell, S. (2009). Power, pathological worldviews, and the strengths perspective in social work. Families in Society. 90(4) 425-430.

Grausgruber, A. A., Meise, U. U., Katschnig, H. H., Schöny, W. W., & Fleischhacker, W. W. (2007). Patterns of social distance towards people suffering from schizophrenia in Austria: A comparison between the general public, relatives and mental health staff. Acta Psychiatrica Scandinavica, 115(4), 310-319. doi:10.1111/j.1600-0447.2006.00882.x

Sheryl Crow
Matthew Good
Jim Carrey
Roseanne Barr
DMX
Those who perceive a link between mental illness and violence less likely to support community care policies (Harper, p. 33).
Stigmatizing?
Normalizing?
Outline

Definitions and History
Media
Systemic Stigma
Consequences and Language
Resisting Stigma

Side note: Some content
may be upsetting. Some descriptive language is drawn from the literature and may not reflect the practices and opinions of the presenters.

Structural/Systemic Stigma
- lower research
funding
;
poorer and less organized services
;
devaluatio
n of those involved.(Sharac, Mccrone, Clement, & Thornicroft, 2010); Diagnostic overshadowing(Abbey et al, 2011)
Self-Stigma -
A consequence in and of itself, the internalization of stigmatizing attitudes and beliefs can have 2 especially detrimental consequences: 1)
Lower self-esteem
&
self-efficacy
(Watson, Corrigan, Larson, & Sells, 2007)
2)
Worsened
psychiatric symptoms (Livingston & Boyd, 2010)
Peripheral Stigma
- Those close to people living with mental illness experience related, associative stigma - can lead to similar discrimination and social exclusion (Sharac, Mccrone, Clement, & Thornicroft, 2010)
Smith, R. A. (2007). Language of the lost: An explication of stigma communication. Communication Theory, 17(4), 462-485.

United States Department of Health Services. (1999). Mental health: A report of the surgeon general. National Institute of Mental Health.

Uri, A. (1997). Social Work in Mental Health: Trends and issues. Social Work in Health Care, 25(3), 1-9.

Varma, V. (2009). Culture, personality, and mental illness: A perspective of traditional societies. New Delhi: Jaypee Brothers Medical.

Vicary, D., & Westerman, T. (n.d.). 'That's Just The Way He Is': Some Implications Of Aboriginal Mental Health Beliefs. Advances in Mental Health, 103-112.

Wahl, O. (1995). Media Madness: Public Images of Mental Illness. New Jersey: Rutgers University Press.

Wahl, O., & Aroesty-Cohen, E. (2010). Attitudes of mental health professionals about meental illness: A review of the recent literature. Journal of Community Psychology, 38(1), 49-62. doi:10.1002/jcop.20351

Watson, A. C., Corrigan, P., Larson, J. E., & Sells, M. (2007). Self-stigma in people with mental illness. Schizophrenia bulletin, 33(6), 1312-1318.
Full transcript