Paradigms Lost, Paradigms Found: Lessons Learned in the Fight Against the Stigma of Mental Illness

309 Pages·2022·9.622 MB·English

by  Heather Stuart, Norman Sartorius

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Paradigms Lost, Paradigms Found
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Paradigms Lost,
Paradigms Found
Lessons Learned in the Fight Against the
Stigma of Mental Illness
SECOND EDITION
Heather Stuart, PhD, FRSC, CM
and
Norman Sartorius, MD, MA, PhD, FRCPych
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Library of Congress Cataloging-i n- Publication Data
Names: Stuart, Heather L. author. | Sartorius, N., author.
Title: Paradigms lost, paradigms found : lessons learned in the fight
against the stigma of mental illness / Heather Stuart, Norman Sartorius.
Other titles: Paradigms lost
Description: 2. | New York, NY : Oxford University Press, [2022] |
Preceded by Paradigms lost : fighting stigma and the lessons learned /
Heather Stuart, Julio Arboleda-Flórez, Norman Sartorius. c2012. |
Includes bibliographical references and index.
Identifiers: LCCN 2022003404 (print) | LCCN 2022003405 (ebook) |
ISBN 9780197555804 (hardback) | ISBN 9780197555828 (epub) | ISBN 9780197555835
Subjects: MESH: Mental Disorders—psychology | Attitude of Health Personnel |
Mentally Ill Persons—psychology | Social Stigma | Prejudice | Social Change
Classification: LCC RC454 (print) | LCC RC454 (ebook) |
NLM WM 140 | DDC 616.89—dc23/eng/20220204
LC record available at https://lccn.loc.gov/2022003404
LC ebook record available at https://lccn.loc.gov/2022003405
DOI: 10.1093/ med/ 9780197555804.001.0001
This material is not intended to be, and should not be considered, a substitute for medical or other
professional advice. Treatment for the conditions described in this material is highly dependent on
the individual circumstances. And, while this material is designed to offer accurate information with
respect to the subject matter covered and to be current as of the time it was written, research and
knowledge about medical and health issues is constantly evolving and dose schedules for medications
are being revised continually, with new side effects recognized and accounted for r egularly. Readers
must therefore always check the product information and clinical procedures with the most up- to- date
published product information and data sheets provided by the manufacturers and the most recent
codes of conduct and safety regulation. The publisher and the authors make no representations or
warranties to readers, express or implied, as to the accuracy or completeness of this material. Without
limiting the foregoing, the publisher and the authors make no representations or warranties as to the
accuracy or efficacy of the drug dosages mentioned in the material. The authors and the publisher do
not accept, and expressly disclaim, any responsibility for any liability, loss, or risk that may be claimed
or incurred as a consequence of the use and/ or application of any of the contents of this material.
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Printed by Integrated Books International, United States of America
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In memory of Julio Arboleda- Flórez, colleague,
friend, and partner.
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CONTENTS
Preface xiii
1. Mental Illness– Related Stigma 1
Introduction 1
A Tour of Terms 1
The Stigmatization of Mental Illnesses 3
Stigma as a Consequence of Institutional Psychiatry 4
Stigma as a Consequence of Deinstitutionalization 5
Stigma as a Consequence of Therapeutic Nihilism 8
Three Stigma Mechanisms: Combined and Intertwined 10
Structural Stigma 11
Public Stigma 13
Self- Stigma 15
Summary 17
2. C ultures Count: They Stigmatize and Destigmatize
Mental Illnesses 19
Historical Perspectives on Stigma 19
Ancient Greece (5th to 2nd Century B.C.E.) 20
Middle Ages (5th to 15th Century) 21
The Renaissance (14th to 17th Centuries) 22
The Rational Era (17th and 18th Centuries) 22
The Era of Moral Treatment (19th Century) 23
Gheel, Belgium: A Special Case (600 A.D. to Present) 25
The Village of Aro, Nigeria 26
Perspectives from Non- Western Cultures 26
Islamic Culture 27
Chinese Culture 28
Indian Culture 29
Cross- Cultural Studies 30
Summary 34
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3. Paradigms Found in Fighting Stigma 35
The Enlightened Opportunism Model of Stigma Reduction 35
The Importance of Building Networks 37
The Importance of Targeting Efforts 39
Health Professionals Should Take a Back Seat in Community
Anti- stigma Programs 40
Listening to the Evidence 41
Building Better Theories of Change 42
Improved Mental Health Knowledge Will Not Eradicate Stigma
and May Increase It 43
Mental Illnesses Are Not Like Other Illnesses 44
Neurobiological Explanations Are Stigmatizing 45
What Counts as Success? 46
Principles to Guide Next- Generation Anti- stigma Efforts 46
Put People First 47
Plan for Sustainability 47
Focus on Activities That Change Behaviors 47
Target Activities to Well- Defined Groups 48
Think Big But Start Small 48
Build Better Practices 49
Summary 49
4. Eleven Steps to Build an Anti- stigma Program 51
Step 1: Develop a Program Committee 51
Step 2: Create an Advisory Committee 52
Step 3: Understand the Nature of Stigma 52
Step 4: Canvass Local Needs and Priorities 53
Step 5: Pick Target Groups 54
Step 6: Set Goals and Objectives 56
Step 7: Identify a Program Approach 56
Step 8: Create an Evaluation Plan 58
Step 9: Situate the Program Alongside Other Anti- stigma
Efforts 59
Step 10: Develop a Resource Plan 59
Step 11: Implement the Program 60
Notes on Research Approaches 61
Focus Groups 62
Individual Interviews 63
Surveys 63
Ethical Considerations 64
Communicating Evaluation Results 65
Summary 65
[ viii ] Contents
ix
5. Fighting the Good Fight 66
International Covenants and Legislation 66
The United Nations 67
Universal Declaration of Human Rights— 1948 67
International Covenant on Economic, Social and
Cultural Rights— 1976 68
Principles for the Protection of Persons with Mental
Illness and the Improvement of Mental Health
Care— 1991 69
United Nations Convention on the Rights of Persons with
Disabilities— 2008 70
United Nations Sustainable Development Goals— 2015 71
International Organizations 71
The World Federation of Mental Health— 1948 71
The World Health Organization— 1948 72
The World Psychiatric Association— 1950 75
National Anti- stigma Programs 77
Social Contact 81
Good Storytelling Is a Key Ingredient 83
Programs Targeting Self- Stigma 84
Summary 86
6. Media 88
News Media: Telling or Selling the News? 88
Media Guidelines 90
Are Media Guidelines an Effective Anti- stigma Strategy? 92
Language Change: Semantic Sleight of Hand or Effective
Anti- stigma Strategy? 97
Movies and Madness 98
Engaging the Media for Positive Change 100
News Media 101
Entertainment Media 103
Social Media 104
Summary 105
7. Health Systems 107
Structural Stigma in Mental Health Systems 107
The “Architecture of Madness” 108
Fragmentation of Care 110
Punitive Cultures of Care 111
Inpatient Commitment 113
Outpatient Commitment 115
Seclusion and Restraint 117
Lack of Recovery- Oriented Care 121
Contents [ ix ]