MENTAL ILLNESS Stigmatized

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MENTAL ILLNESS Stigmatized
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Defining Mental Illness

• some psychiatrists argue that mental illness are
  concrete, real, and objective
• mentally healthy people with integrated
  personalities
• objectivists define mental illness as behaviour
  that exceeds community tolerance and is
  inappropriate to the circumstances
• relativists argue that mental illness does not
  exist because culturally relative and abstract

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Perspectives on Mental Disorder

• physiologists and physicians investigate and
  treat genetic, anatomical, and chemical origins
  of mental distress
• psychologists and psychiatrists see mental
  illness as an intra-psychic problem, the
  origins of which can be located in childhood when
  the personality is being formed
• some sociologists focus on structural factors
  involved in the production of stress while others
  focus on the labelling process and the negative
  impacts of social stigma

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Sociological Theories of Mental Illness

• The Medical Model
• The medical model of mental illness is the idea
  that mental disorders are symptoms of psychic
  disturbances that have medically treatable
  causes
• Conflict and Anomie Interpretations
• Conflict approaches focus on the importance of
  work in the lives of individuals
• Mertons theory of anomie addresses the
  relationship between low socioeconomic status and
  mental disorders
• Symbolic Interactionist and Labelling
• When people violate fundamental rules that fall
  into the category of natural behaviour, they run
  the risk of being designated by onlookers as
  unnatural or ill
• The designation of residual rule violation as a
  mental disorder is affected by a series of
  contingencies

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Classifications of Mental Illness

• Disorders first evident in infants, children, and
  adolescents
• Mental retardation, various learning and
  communication disorders
• Delirium, dementia, and amnestic an other
  cognitive disorders
• Substance related disorders
• Schizophrenic disorders
• Personality disorders
• Anti-social personality disorders (psychopathy or
  sociopathy)
• Mood disorders
• Anxiety disorders
• Somatoform disorder
• Dissociative disorders
• Sexual and gender identity disorders
• psycho-sexual dysfunction
• Sadists and masochists
• Eating disorders
• Disorders of impulse control

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The Demographic Distribution of Mental Disorders

• Sex
• women, since the end of WWII, are more
  susceptible than men to mental disorder
• Marital Status
• being single increases the chances of mental
  disorder
• Geographic Mobility
• tendency for foreign born people to be
  over-represented among mentally ill
• Rural-Urban Residence
• rates of mental illness appear to be marginally
  higher in urban than in rural settings
• Age
• chances of being treated for mental disorder
  increase with age
• Social Class
• Interest in the importance of social class in the
  development of mental illness

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The Experience of Treatment

• 2 primary expectations placed upon caregivers
• Treatment
• Control (often takes precedence over
  rehabilitation)
• In the 1960s, mental institutions were total
  institutions (Goffman)
• For many, the experience of being cut off from
  the outside world for prolonged periods creates
  dependency syndrome
• Hierarchy of authority psychiatrists,
  psychologists/social workers, nurses, ward aides
• Mental hospitals have some advantages
• Some mental hospitals have employed inhumane
  practices such as isolation and electro-shock as
  punishments rather than treatments

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Cured?

• Long hospital stays encourage dependency, which
  increases the likelihood of re-admission
• Patients often must demonstrate that they are
  cured
• Positive attitudes on the part of the patients
  family important to the release of a patient
• Difficult to avoid relapse on the outside
• Ex-patients need somewhere to go and something to
  do
• Having a job important, especially if the work is
  meaningful, boosts self-esteem, and puts the
  patient into contact with healthy others

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Myths of Mental Illness

• People with mental illness are violent and
  dangerous
• People with mental illness are poor and/or less
  intelligent
• Mental illness is caused by a personal weakness
• Mental illness is a single, rare disorder

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Stigma

• the process by which the public, or an individual
  themselves, labels human differences, ascribes
  meaning to these differences through stereotypes,
  which in turn denies life opportunities to those
  labeled through the exertion of power

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Signals ? Stereotypes ? Discrimination

• Signals (skill deficit, appearance, labels,
  psychiatric symptoms)
• That person talking to himself on the park bench
  must be crazy
• Signals lead to stereotypes
• Crazy people are dangerous
• Stereotypes lead to discrimination
• Im not going to allow crazy people like that to
  move into my neighborhood
• But

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Public Stigma vs. Self Stigma

• Public Stigma
• Stereotype Negative belief about a group
  (dangerousness, incompetence, character weakness)
• Prejudice Agreement with belief and/or negative
  emotional reaction (fear or anger)
• Discrimination Behavior response to prejudice
  (work or housing opportunities withheld)

• Self Stigma
• Stereotype Negative belief about the self
  (character weakness, incompetence)
• Prejudice Agreement with belief and/or negative
  emotional reaction (low self-esteem, low self-
  efficacy)
• Discrimination Behavior response to prejudice
  (fails to pursue goals)

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Impact of Self Stigma

• a person may experience diminished self esteem,
  self efficacy, and confidence.
• Kathleen Gallo
• I perceived myself, quite accurately, as having
  a serious mental illness and therefore as having
  been relegated to what I called the social
  garbage heap...

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Reactions to Self Stigma

• Develop the negative stereotype through
  socialization
• Believe they will be rejected and devalued ?
  withdraw from connections and opportunities
• Avoidance behavior viewed as socially awkward ?
  communication less frequent
• Anticipation of rejection

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Reactions to Self Stigma

• Oppose the societal beliefs and positive
  self-perceptions emerge (energized by the stigma
  to righteous anger)
• Lash out in anger and do not give into these
  beliefs by acting against them or resisting the
  ideas and treatment

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Public Stigma

• Employment
• Housing
• Health
• Criminal Justice System
• Education
• Insurance
• Child Welfare System

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Impact of Public Stigma Employment

• Less than 15 of people with serious and
  persistent mental illness are employed
• Unemployment rates are 3-5 higher
• fulfills an essential contribution to personal
  satisfaction, health, and well-being
• Employment is therapeutic and can reduce the
  symptoms of mental illness

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Impact of Public Stigma Housing

• Often in low income with substandard housing and
  high crime rates due to lack of income
• Compete with other low income applicants that are
  considered more suitable
• People with serious mental illness often lack the
  social and coping skills to obtain permanent and
  adequate employment and housing, however, stigmas
  attached to the mentally ill inflate this
  inability

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Stigma Interacts with the Criminal Justice System

• If an officer sees a mentally ill person showing
  signs of psychosis they are more likely to arrest
  them if they have committed a crime.
• Officers are less likely to believe and help a
  victim of crime.
• Often when someone whom is mentally ill tries to
  assist police officers by giving a statement of a
  crime it will often be disregarded due to the
  officers perception of them.

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Fighting Stigma

• Use respectful language
• Provide professional development opportunities
  for staff regarding diversity, mental health
  issues, and fostering an inclusive work
  environment
• Become an advocate
• Teach others about mental illness

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Coping with Stigma

• Get appropriate treatment
• Surround yourself with supportive people
• Make your expectations known
• Dont equate yourself with your illness
• Share your own experiences
• Monitor the media
• Join an advocacy group

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Changing public stigma

• Incompetent. Crazy. Irresponsible. Dangerous.
  Psycho. Unpredictable.
• At fault for their illness. Unlikely to recover.
  Looney. Dumb. Awkward.
• Crazed Killers. Rebellious.

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Strategies for Change

• 1) Protest
• shame on you for holding disrespectful ideas
  about mental illness
• StigmaBusters ? organization looking into public
  media discrimination against people with mental
  illness
• Rebound effect ? dont tell me what to think

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Strategies for Change

• 2) Education
• replace stereotypes with factual information
• by contrasting myths with facts
• not to make people experts but to crumble myths
• Different approaches
• better understanding less likely to endorse
  stigma and discrimination

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Strategies for Change

• 3) Contact
• having contact and developing a relationship and
  understanding of someone with a mental illness
  can change/reduce ones perception of those with
  a mental illness
• this is best if the contact is structured and
  frequent

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Case Study Being Sane in Insane Places

• eight sane people gained secret admission into 12
  different hospitals
• Each went to a different hospital and complained
  of hearing voices that were unfamiliar and of the
  same sex as themselves
• Immediately after admittance, the pseudo-patients
  ceased pretending symptoms and behaved as he/she
  would normally
• All were discharged in an average of 19 days,
  with diagnosis of schizophrenia in remission

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Case Study The Duke Family

• Bill (50), Winnie (48), Sammy (27), Cindy (23)
• Cindy also has four young children
• All suffer from some type of mental disability
• Sizeable extended families and large network of
  friends/acquaintances, most of which are mentally
  challenged
• labelled as disabled/disreputable, but they do
  not attach the same meanings to disability labels
  as found in larger society

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Case Study The Duke Family

• Four factors related to the Dukes ability to
  avoid the stigma
• Family stands in between individual members and
  programs or agencies provides a ready set of
  interpretations of their experiences
• Values are shared and reinforced by a large
  network of family and friends, and they
  experience a high degree of contact with them
• None of the Dukes or members of their network are
  full-time clients of the human services agencies
  they are not engulfed in the separate subculture
  perpetrated by institutions, etc.
• Competence is a relative concept they are not
  normal, but they are competent enough to meet
  demands of day-to-day life as they experience it

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Discussion

• Schizophrenia, for instance, is more highly
  stigmatized than depression is. It's routinely
  mocked and is less likely to generate compassion.
  Depression, on the other hand, is less often
  ridiculed, perhaps because an onslaught of
  advertising for antidepressant medications has
  made the disorder more mainstream and more
  acceptable.
• Do you agree with this interpretation regarding
  schizophrenia being less likely to generate
  compassion?

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Discussion

• Words like "crazy," "cuckoo," "psycho," "wacko"
  and "nutso" are just a few examples of words that
  keep the stigma of mental illness alive. These
  words belittle and offend people with mental
  health problems.
• News stories sometimes highlight mental illness
  to create a sensation in a news report, even if
  the mental illness is not relevant to the story.
  Advertisers use words like "crazy" to convey that
  their prices are unrealistically low and to
  suggest the consumer can take advantage of them.
• http//www.youtube.com/watch?vC0BFzvjkDcc
• What was your reaction to the video? What are
  your first impressions when you hear an add using
  some of that language? Do they appear to you to
  be derogatory? Do you think you would feel
  differently if you had a mental illness yourself?