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Stigma of Mental Illness
Transcript of Stigma of Mental Illness
Stigma in the Media
Does it exist?
How does it exist?
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
Significant research on stigma of mental illness among
Limited research on stigma of mental illness among
mental health professionals
Importance of Systemic Stigma
Mental health professionals serve as
in regards to mental health issues
People with mental illness encounter mental health professionals when they are in
People with mental illness depend on mental health professionals for
How mental health professionals’ view people with mental illness can have a significant
Some evidence for
less stigmatizing attitudes
of mental health professionals vs. non-mental health professionals
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)
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
- 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.
- Hugo (2001) found that mental health professionals were
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
: people with borderline personality disorder in particular
Often seen as
to treat, and to
for their condition
Some practitioners and/or programs simply
refuse to treat
(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
: 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
Professionals may label working with this population as
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
used as an adjective (“chronic mental illness”, “the chronic wards”) and a noun (“the chronics”)
to describe people with personality disorders
"Lack of insight”
Use of diagnosis as an adjective or identity label
“The bipolar patient”
“She is schizophrenic”
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.
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
Catherine Zeta Jones
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
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
Research evidence supports that
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.
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.
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.
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.
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.
Antiquity indicates that the ancients Greeks believed people experiencing mental illness had been taken over by angry gods.
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
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.
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 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.
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….
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.
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:
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:
Checking (eg, locks, stove, iron, safety of children)
Counting/repeating actions a certain number of times or until it "feels right"
(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?
Intention of stigma
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).
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
Wilbur Wants to Kill Himself
Mental Illness As
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.
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
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
67% North American households play for an average of eight hours a week
Psychiatric hospitals frequently used as settings
Patients as villains:
Consequences of Stigma
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"
Those participants in the 90th percentile of reported stigma were
more likely than those in the 10th percentile to exhibit
(Link et al., 2001)
in those w/ substance use disorders (Magdelena, 2013)
(Rüsch, Angermeyer, & Corrigan, 2005)
, central of which may be
’ (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
from/discontinuation of treatment and/or support (Cooper, Corrigan, & Watson, 2003; Corrigan, 2004)
reduction in self-esteem
and reinforcement of
(See Change, 2013)
Seen as the “
” 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
"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
Stigma impacts all of society by:
Financial & Economic Impacts
“Mental illness stigma/discrimination was found to impact negatively on
public views about resource allocation
.” (Sharac, Mccrone, Clement, & Thornicroft, 2010)
The Differing Faces of Stigma
Stigma by Diagnosis
unpacking dichotomy between "illness" and "wellness" (Grant & Cadell, 2009)
explicating power relationships
connecting stigma to structural issues
empowering clients (Poole et. al, 2012)
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
, as well as
funding for research.
(Link, Yang, Phelan, and Collins, 2004)
Participants with psychosis and substance dependence were
to report experiences of stigma and were
Participants with anxiety disorders, depression, and personality disorders were more adversely affected by
perceived feelings of stigma
, regardless of there being evidence of discriminatory behaviour
(Dinos et al, 2004)
Different forms of stigma exist, and may carry with them unique, negative impacts:
letting clients tell their own stories
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
. 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?
Essentializing language that sees and says anything but the person first.
the ________, disabled, deaf, blind, mentally ill, addicted
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*
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)
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
patient, resident, consumer, client, disorder
Know your language!
: Latin & Greek roots meaning "to bend or listen" "to recline" - immediately suggests a passive and expert-driven process
“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
put people first, not their disabilities.
For example, remember to say, “person with schizophrenia” rather than “schizophrenic”.
emphasize abilities, not limitations. Terms that are condescending must be avoided.
focus on a disability. Rather, focus on issues that affect the quality of life for everyone - accessible transportation, housing, community supports, etc.
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.
sensationalize a disability. This means not using such terms as“afflicted with”,“suffers from”,“victim of”....and so on.
use generic/stereotype labels/terms. Terms like “the retarded”, “our mentally ill”, etc. are unacceptable.
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
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Those who perceive a link between mental illness and violence less likely to support community care policies (Harper, p. 33).
Definitions and History
Consequences and Language
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.
- lower research
poorer and less organized services
n of those involved.(Sharac, Mccrone, Clement, & Thornicroft, 2010); Diagnostic overshadowing(Abbey et al, 2011)
A consequence in and of itself, the internalization of stigmatizing attitudes and beliefs can have 2 especially detrimental consequences: 1)
(Watson, Corrigan, Larson, & Sells, 2007)
psychiatric symptoms (Livingston & Boyd, 2010)
- 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.