W2-T1 Stigma and Mental Health Flashcards
Define social stigma according to Goffman
attribute, behaviour, or reputation which is socially discrediting in a particular way causes an individual to be classified by others in an undesirable, rejected, stereotype rather than an accepted, normal one.
discrimination can lead to disadvantages. those who accept discrediting prejudices, and lose self-esteem, leading to feelings of shame, a sense of alienation and social withdrawal
define disorder classification system and characteristics from the early to the mid-20th century in Britain
Lunacy Commissioners’ coding schemes marked a shift from anecdotal (factual) observation to systemic classification:
– aetiology (causes) was distinguished from diagnosis
– causes were identified with input from patients and psychiatrists
– sought to establish medical history of the patients and their family
define disorder classification system and characteristics from mid to late 20th century in Britain
British psychiatry moved toward the WHO’s International Classification of Disease (ICD Based-system)
– a departure from cause and effect dichotomies (separation)
– increasing recognition of varied causes of mental distress
– efforts to classify new diagnoses
what was the outcome of ICD based system
new diagnoses meet with resistance towards a new classification
– several former aetiological factors are being reframed as diagnoses
– conflating (combined) source and symptoms of the
problem (i.e. alcoholism)
– led to wider dissent (argument)
define disorder classification system and characteristics from late 20th century to present in Britain
expansion beyond the medical domain, to arrive at a model that encompassed biological, psychological and sociological model
According to Darian Leader, how does a ‘commodification (material, data) of the psyche’ mainly manifest?
explosion of diagnoses
from 1-2 dozens (early 20th century) to 360+ (late 20th century)
what are the causes of new diagnoses
attribute to drugs companies - secure niche markets for
their products
DSM 5 - cast over unhappiness, personal fortune, and troubling conduct
What David Rosenhan’s experiments about
the validity of psychiatric diagnosis
describe Rosenhan findings from his experiment
Rosenhan and 7 cohorts - none with psychiatric diagnosis admitted to the institution by presenting one symptom - hearing voice. they were diagnosed with schizo, none was judged as sane
Findings: The patient’s actions were taken out of context once admitted: everyday behaviour was misinterpreted and pathologised in line with their given
diagnosis
define the consequence of stigma in treatment
Labelling the disease evokes hostility in social and clinical attitudes and treatment
– prejudice is commonly broadcasted and reinforced by media scandals about dangerous patients (Lewis & Appleby, 1988)
what stigma research mainly focuses on
- focused chiefly on schizo
- based on attitude surveys and media representations
- included a few intervention studies
- excluded direct participation by service users
stigma encompasses problem with knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination)
what are the limitations of stigma research
- academic writing on stigma made few connections with legislation concerning disability rights policy
- most work on mental illness and stigma has been descriptive, overwhelmingly describing attitude surveys or the portrayal of mental illness in the media. Less is known of effective interventions to reduce stigma
- notably few direct contributions to this literature by service users
- underlying pessimism that stigma is deeply historically rooted and therefore difficult to change.
- stigma theories have de-emphasised cultural factors and paid little attention to issues related to human rights and social structures.
define cultural factors in stigma
- notions of mental illness and explanatory models -
i.e. symptoms are attributed to supernatural forces - Cultural meaning of impairment and manifestation
i.e. stigma impact on marital prospects may have different impacts in a different society - Concept of self and personhood
i.e. higher levels of family cohesion may offer
more support but also go along with a more widespread impact of stigma across family members and generations
define economic factors in stigma
- poverty and access to healthcare
- Long associated with the outcome of mental illness
- determine the context in which stigma is enacted and experienced
what are among anti-stigma campaign today
- Public Awareness Campaign
- education
- social interaction
- media reporting
annual events, celebrity advocates, real-life testimony and case study
how mental health professionals and the
system itself implicated in creating and perpetuating stigma
through stereotypical media representation, social prejudice, and stigma acting as a barrier to patient social integration, thereby counteracting their therapeutic efforts, or imbalances in the distribution of resources
mental health professions have legitimate concerns regarding their image and their
position in medicine and society that would warrant a specific focus on anti-stigma programmes on
destigmatising psychiatry
what are the suggestions for psychiatric reform to help improving stigma
improvement in doctor’s attitudes (in regards to listening to the patient and structure of the patient-doctor relationship
increase profile for psychiatry within the medical establishment
reduce the emphasis on the biomedical model including improving access to psycho-social intervention
what are among make time to change projects
community activity and events (people with and without mental health problems)
work with children and young people
grant scheme to fund grassroots
projects led by people with mental health problems,
creation of a support network of people
with experience of mental health problems to take leadership roles in challenging discrimination
within their own communities,
strategic work with organisations from all sectors to improve policy and practice around mental health discrimination,
media engagement to improve reporting and representation of mental health issues
focused work with black and minority
ethnic communities.
Make Time to Change Anti stigma Social marketing
engage public via mass media channel
modest but positive and significant improvement campaign
association between positive intergroup contact
social contact can be effective tool
mass media social marketing most effective on intended behaviour
how museums can enable discussion of difficult histories
acknowledge the varied perspective of the contributor
how dominant views emerge for social and political reasons
– Patients traditionally had little voice in these collections, but recent exhibitions sought to redress this
Bethlem’s Museum of the Mind illustrated
curated thematically rather than chronologically
encourage exploration of commonalities in experience rather than the linear progression
the venue’s displays and website both prominently feature patient narratives, allowing insights into current and historical experiences
incorporating the stories and personal testimony of mental health service users
involving those with lived experience in the development and delivery of learning programmes,
actively seeking to recruit volunteers with lived experience
celebrating the achievements of those who’ve experienced mental ill health through the display of art by service users past and present
supporting the work of the SLaM’s Recovery College by offering a venue for courses and workshops
supporting the work of the Bethlem Gallery and SLaM’s Occupational Therapy departments,
providing a retail outlet for arts and crafts produced on the Bethlem site.
What are suggestions from The Hearing Voices Network to prevent and challenge the stigma surrounding mental illness
seeing mental distress as human and ultimately understandable
keeping the person in the driving seat, giving people the freedom to define their own
experience
supportive communities
research would benefit from a refocusing of attention on mental health discrimination rather
than stigma
– Strengthen evaluations of anti-stigma initiatives
– enable people with mental illness to receive comparable benefit from relevant anti-discrimination legislation as those with physical disabilities
