Stigma and Mental Illness  – A Barrier to Health Seeking ANTHONY STERN, M.D. ALBERT EINSTEIN COLLEGE OF MEDICINE ANNUAL WO...
OVERVIEW <ul><li>I  Stigma, Psychiatric Disorders, and Health Seeking </li></ul><ul><li>II  Stigma and Mental Ilness: A Br...
General Health Care: The Role of Stigma <ul><li>Health Care Facts </li></ul><ul><li>The Links between Stigma and Health Ca...
One U.K. Example of “Label Avoidance”: 2004 GMS (General Medical Services) Contract <ul><li>Patients often would not grant...
STIGMA: The Origins of the Concept <ul><li>Emile Durkheim </li></ul><ul><li>1858-1917 </li></ul>
<ul><li>1895   1893  1912 </li></ul><ul><ul><ul><ul><ul><li>1897 </li></ul></ul></ul></ul></ul>
<ul><li>Erving Goffman </li></ul><ul><li>1922-1982 </li></ul>
<ul><ul><ul><ul><ul><li>1963 </li></ul></ul></ul></ul></ul><ul><li>1961  1959    </li></ul>
Goffman’s Concept of Stigma: Undesirable Differentness <ul><li>“ Stigma is the process by which the reaction of others  </...
Link-Phelan Model of Stigmatization <ul><li>Bruce Link  Jo Phelan </li></ul><ul><li>LABELLING: The identification of diffe...
Link-Phelan Model: The Role of Power <ul><li>“ Access to social, economic and political power”  </li></ul><ul><li>allows t...
 
 
Types of Stigma <ul><li>“ received” stigma: prejudice and discrimination </li></ul><ul><li>“ self-stigma”: internalized fe...
 
 
 
Levels of the Stigmatizing Process (Thornicroft, Hinshaw) <ul><li>COGNITION  -  IGNORANCE AND  </li></ul><ul><li>STEREOTYP...
<ul><li>Patrick Corrigan:  www.stigmaandempowerment.org </li></ul><ul><li>   click on “Publications” and “Resources” </li...
October 2004, American Psychologist:  “How Stigma Interferes with  Mental Health Care”
What causes the failure  to seek or use care? <ul><li>Corrigan: </li></ul><ul><li>STIGMA (“SELF-STIGMA” AND  </li></ul><ul...
Two Factors That May Influence Whether a Person Who Might Benefit From Mental Health Treatment Actually Seeks It Corrigan,...
U. of Michigan Medical Students <ul><li>Depression, Stigma, and Suicidal Ideation in  </li></ul><ul><li>Medical Students <...
<ul><li>&quot;A Disease Like Any Other&quot;? A Decade of Change in  </li></ul><ul><li>Public Reactions to Schizophrenia, ...
Optimism, late 1990’s: scientific knowledge will reduce stigma <ul><li>ASSUMPTION: </li></ul><ul><li>The public understand...
A Comparison of Responses to GSS mental health vignettes, 1996 and 2006 <ul><li>the vignettes describe individuals with sc...
Result and Conclusion <ul><li>“ Holding a neurobiological conception of these disorders increased  </li></ul><ul><li>the l...
The Vicious Cycles of Stigmatization (Sartorius, World Psychiatric Association) <ul><li>affecting individuals </li></ul><u...
Fear and Shame: Three Intertwined Causes <ul><li>Stigma </li></ul><ul><li>Psychiatric Symptoms </li></ul><ul><li>“ Normal”...
A Proposed Model <ul><li>SOCIAL STIGMA </li></ul><ul><li>SELF-STIGMA </li></ul><ul><li>PSYCHIATRIC   </li></ul><ul><li>SY...
SPIRITUAL ROOTS <ul><li>COGNITION (IGNORANCE AND  -  HEAD     STEREOTYPING) </li></ul><ul><li>AFFECT (PREJUDICE)  -  HEART...
How do we learn…? <ul><li>… to care for each other more fully? </li></ul><ul><li>… to respect each other more completely? ...
<ul><ul><ul><ul><ul><li>Martin Buber </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>1878 - 1965 </li></ul></ul></ul...
Buber:  all dialogue depends on   the acceptance of otherness <ul><li>“ Genuine conversation, and therefore every actual  ...
<ul><li>  Henri Nouwen </li></ul><ul><li>  1932 - 1996   </li></ul>
<ul><li>Mother Teresa </li></ul><ul><li>1910-1997 </li></ul><ul><li>“ We treat all people as children of God.” </li></ul><...
<ul><li>Exodus 22:21  (New King James version) </li></ul><ul><li>You shall neither mistreat a stranger nor oppress him,  <...
Internet Resources <ul><li>World Psychiatric Association </li></ul><ul><li>www. openthedoors.com </li></ul><ul><ul><li>www...
Thank you. <ul><li>  [email_address] </li></ul>
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Stern: Stigma and Mental Illness – A Barrier to Health Seeking

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Stigma and Mental Illness – A Barrier to Health Seeking

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  • Emile Durkheim, “The Father of Modern Sociology”
  • Transcript of "Stern: Stigma and Mental Illness – A Barrier to Health Seeking"

    1. 1. Stigma and Mental Illness – A Barrier to Health Seeking ANTHONY STERN, M.D. ALBERT EINSTEIN COLLEGE OF MEDICINE ANNUAL WORLD MENTAL HEALTH DAY OCTOBER 10 TH , 2010 MALAGA, SPAIN
    2. 2. OVERVIEW <ul><li>I Stigma, Psychiatric Disorders, and Health Seeking </li></ul><ul><li>II Stigma and Mental Ilness: A Brief History of the Concept </li></ul><ul><li>III Stigma and Clinical Reality: Three Intertwined Threads </li></ul><ul><li>IV Conclusion: Fighting the Good Fight against Stigma </li></ul>
    3. 3. General Health Care: The Role of Stigma <ul><li>Health Care Facts </li></ul><ul><li>The Links between Stigma and Health Care </li></ul><ul><li>Extrapolations: </li></ul><ul><li>from a fuller understanding of stigma and mental illness </li></ul><ul><li>from studies of difficulties seeking mental health care </li></ul>
    4. 4. One U.K. Example of “Label Avoidance”: 2004 GMS (General Medical Services) Contract <ul><li>Patients often would not grant permission to be enlisted into GP practice SMI registers </li></ul><ul><li>This has hampered the effort to target primary health care for SMI patients </li></ul><ul><li>Andre Tyler, Institute of Psychiatry: “Many of those affected with SMI feel there is </li></ul><ul><li>stigma attached to practice registers and by signing one they will live with this </li></ul><ul><li>permanent record or label.” </li></ul><ul><li>David Yeomans, University of Leeds: “People with SMI are often treated differently </li></ul><ul><li>they are given a mental health label, which is part of the problem in trying to persuade </li></ul><ul><li>patients to register.” </li></ul><ul><li>“ Running on Empty: Building Momentum to Improve Well-Being in Severe </li></ul><ul><li>Mental Illness”, John Abbott et. al., pp. 14-15 </li></ul>
    5. 5. STIGMA: The Origins of the Concept <ul><li>Emile Durkheim </li></ul><ul><li>1858-1917 </li></ul>
    6. 6. <ul><li>1895 1893 1912 </li></ul><ul><ul><ul><ul><ul><li>1897 </li></ul></ul></ul></ul></ul>
    7. 7. <ul><li>Erving Goffman </li></ul><ul><li>1922-1982 </li></ul>
    8. 8. <ul><ul><ul><ul><ul><li>1963 </li></ul></ul></ul></ul></ul><ul><li>1961 1959 </li></ul>
    9. 9. Goffman’s Concept of Stigma: Undesirable Differentness <ul><li>“ Stigma is the process by which the reaction of others </li></ul><ul><li>spoils normal identity” </li></ul><ul><li>The stigmatized person presents evidence of being </li></ul><ul><li>different in an undesirable way: “he is thus reduced in our </li></ul><ul><li>minds from a whole and usual person to a tainted, </li></ul><ul><li>discounted one” </li></ul>
    10. 10. Link-Phelan Model of Stigmatization <ul><li>Bruce Link Jo Phelan </li></ul><ul><li>LABELLING: The identification of differences </li></ul><ul><li>STEREOTYPING: These differences are viewed as negative because of </li></ul><ul><li>prevailing beliefs </li></ul><ul><li>SEPARATING: “Us” and “Them” are disconnected </li></ul><ul><li>DISCRIMINATION: “They” (those labelled) experience status loss leading to </li></ul><ul><li>unequal circumstances </li></ul>
    11. 11. Link-Phelan Model: The Role of Power <ul><li>“ Access to social, economic and political power” </li></ul><ul><li>allows the stigmatization process to occur </li></ul><ul><li>Bruce G. Link and Jo C. Phelan , </li></ul><ul><li>&quot;Conceptualizing Stigma&quot;, Annual Review of Sociology </li></ul><ul><li>Volume 27 (2001), pp. 363-385 </li></ul>
    12. 14. Types of Stigma <ul><li>“ received” stigma: prejudice and discrimination </li></ul><ul><li>“ self-stigma”: internalized feelings of devaluation </li></ul><ul><li>“ structural” or “institutional” stigma: low service use, </li></ul><ul><li>inadequate funding for treatment and research </li></ul><ul><li>“ courtesy” stigma: families, providers, and mental </li></ul><ul><li>health systems for treatment and research </li></ul><ul><li>“ public” stigma: diffuse public attitudes </li></ul><ul><li>“ social ” stigma: public, structural and courtesy </li></ul>
    13. 18. Levels of the Stigmatizing Process (Thornicroft, Hinshaw) <ul><li>COGNITION - IGNORANCE AND </li></ul><ul><li>STEREOTYPING </li></ul><ul><li>AFFECT - PREJUDICE </li></ul><ul><li>BEHAVIOR - DISCRIMINATION </li></ul>
    14. 19. <ul><li>Patrick Corrigan: www.stigmaandempowerment.org </li></ul><ul><li> click on “Publications” and “Resources” </li></ul>
    15. 20.
    16. 21. October 2004, American Psychologist: “How Stigma Interferes with Mental Health Care”
    17. 22. What causes the failure to seek or use care? <ul><li>Corrigan: </li></ul><ul><li>STIGMA (“SELF-STIGMA” AND </li></ul><ul><li>“ LABEL AVOIDANCE”) </li></ul><ul><li>HEALTH ILLITERACY (LACK OF KNOWLEDGE) </li></ul><ul><li>ABOUT ILLNESS AND ABOUT SERVICES </li></ul><ul><li>AVAILABILITY AND ACCESSIBILITY </li></ul>
    18. 23. Two Factors That May Influence Whether a Person Who Might Benefit From Mental Health Treatment Actually Seeks It Corrigan, P. (2004). How Stigma Interferes With Mental Health Care. American Psychologist, 59 (7), 614-625. doi:10.1037/0003-066X.59.7.614 © 2004 American Psychological Association
    19. 24. U. of Michigan Medical Students <ul><li>Depression, Stigma, and Suicidal Ideation in </li></ul><ul><li>Medical Students </li></ul><ul><li>Thomas L. Schwenk, MD; Lindsay Davis, BS; Leslie A. </li></ul><ul><li>Wimsatt, PhD </li></ul><ul><li>JAMA 2010; 304(11):1181-1190. </li></ul>
    20. 25. <ul><li>&quot;A Disease Like Any Other&quot;? A Decade of Change in </li></ul><ul><li>Public Reactions to Schizophrenia, Depression, </li></ul><ul><li>and Alcohol Dependence </li></ul><ul><li>Am J Psychiatry, Published On-Line (“in advance”) </li></ul><ul><li>September 15, 2010 </li></ul><ul><li>Bernice A. Pescosolido, Ph.D., Jack K. Martin, Ph.D., J. </li></ul><ul><li>Scott Long, Ph.D., Tait R. Medina, M.A., Jo C. Phelan, </li></ul><ul><li>Ph.D., and Bruce G. Link, Ph.D. </li></ul>
    21. 26. Optimism, late 1990’s: scientific knowledge will reduce stigma <ul><li>ASSUMPTION: </li></ul><ul><li>The public understanding of mental illness as a </li></ul><ul><li>brain disease will decrease community rejection </li></ul>
    22. 27. A Comparison of Responses to GSS mental health vignettes, 1996 and 2006 <ul><li>the vignettes describe individuals with schizophrenia, </li></ul><ul><li>major depression, and alcohol dependence </li></ul><ul><li>54%  67% attributes major depression to </li></ul><ul><li>neurobiological causes </li></ul><ul><li>similar increases in public endorsement of mental </li></ul><ul><li>health treatment </li></ul><ul><li>no decrease in stigma, as measured by the desire </li></ul><ul><li>for social distance and perceived dangerousness </li></ul>
    23. 28. Result and Conclusion <ul><li>“ Holding a neurobiological conception of these disorders increased </li></ul><ul><li>the likelihood of support for treatment but was generally unrelated </li></ul><ul><li>to stigma. When associated, the effect was to increase, not to decrease, </li></ul><ul><li>community rejection.” </li></ul><ul><li>“ An overreliance on the neurobiological causes of mental illness and </li></ul><ul><li>substance abuse disorders is at best ineffective and at </li></ul><ul><li>worse potentially stigmatizing.” </li></ul><ul><li>Research in Eastern Germany, Germany, Turkey, Russia, and </li></ul><ul><li>Mongolia has revealed similar findings; research in Austria and </li></ul><ul><li>Australia showed no increase or decrease of stigma </li></ul>
    24. 29. The Vicious Cycles of Stigmatization (Sartorius, World Psychiatric Association) <ul><li>affecting individuals </li></ul><ul><li>affecting families </li></ul><ul><li>affecting mental health services </li></ul><ul><li>Reducing the Stigma of Mental Illness , </li></ul><ul><li>Google Books, pp. 3-4 </li></ul>
    25. 30. Fear and Shame: Three Intertwined Causes <ul><li>Stigma </li></ul><ul><li>Psychiatric Symptoms </li></ul><ul><li>“ Normal” Psychology </li></ul><ul><li>(The Human Condition) </li></ul>
    26. 31. A Proposed Model <ul><li>SOCIAL STIGMA </li></ul><ul><li>SELF-STIGMA </li></ul><ul><li>PSYCHIATRIC  </li></ul><ul><li>SYMPTOMS </li></ul><ul><li>SHAME AND FEAR </li></ul><ul><li>STIGMA  </li></ul><ul><li>IMPAIRED SYSTEM  </li></ul><ul><li>LOW </li></ul><ul><li>SELF-ESTEEM </li></ul><ul><li>AND AVOIDANT </li></ul><ul><li>BEHAVIORS  </li></ul><ul><li>IMPAIRED SELF-CARE </li></ul>
    27. 32. SPIRITUAL ROOTS <ul><li>COGNITION (IGNORANCE AND - HEAD STEREOTYPING) </li></ul><ul><li>AFFECT (PREJUDICE) - HEART </li></ul><ul><li>BEHAVIOR (DISCRIMINATION) - DEEDS </li></ul>
    28. 33. How do we learn…? <ul><li>… to care for each other more fully? </li></ul><ul><li>… to respect each other more completely? </li></ul>
    29. 34. <ul><ul><ul><ul><ul><li>Martin Buber </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>1878 - 1965 </li></ul></ul></ul></ul></ul>
    30. 35. Buber: all dialogue depends on the acceptance of otherness <ul><li>“ Genuine conversation, and therefore every actual </li></ul><ul><li>fulfillment of relation between men <and women>, </li></ul><ul><li>means acceptance of otherness.” </li></ul><ul><li>“ Human life and humanity come into being in genuine meetings.” </li></ul><ul><li>The Knowledge of Man: A Philosophy of the Interhuman , transl. Maurice Friedman and Ronald Gregor Smith (Harper & Row, NY, 1965), p. 69 </li></ul>
    31. 36. <ul><li> Henri Nouwen </li></ul><ul><li> 1932 - 1996 </li></ul>
    32. 37. <ul><li>Mother Teresa </li></ul><ul><li>1910-1997 </li></ul><ul><li>“ We treat all people as children of God.” </li></ul><ul><li>“ We have been created to love and be loved.” </li></ul><ul><li>“ Be faithful in small things because it is in them that your strength lies.” </li></ul>
    33. 38. <ul><li>Exodus 22:21 (New King James version) </li></ul><ul><li>You shall neither mistreat a stranger nor oppress him, </li></ul><ul><li>for you were strangers in the land of Egypt. </li></ul><ul><li>Éxodo 22:21   (Reina-Valera 1960) </li></ul><ul><li>Y al extranjero no engañarás ni angustiarás, </li></ul><ul><li>porque extranjeros fuisteis vosotros en la tierra </li></ul><ul><li>de Egipto. </li></ul>
    34. 39. Internet Resources <ul><li>World Psychiatric Association </li></ul><ul><li>www. openthedoors.com </li></ul><ul><ul><li>www.worldpsychiatricassociation.org/sections/stigma </li></ul></ul><ul><ul><li>(over 50 country programs listed) </li></ul></ul><ul><li>US SAMHSA's Resource Center </li></ul><ul><li>www.stopstigma.samhsa.gov </li></ul><ul><li>(over 100 state programs listed) </li></ul><ul><li>Canada Programs: </li></ul><ul><li>www.mentalhealthcommission.ca/English/Pages/OpeningMinds </li></ul>
    35. 40. Thank you. <ul><li> [email_address] </li></ul>
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