W2-T1 Stigma and Mental Health

Question 1

Define social stigma according to Goffman

Answer 1

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

Question 2

define disorder classification system and characteristics from the early to the mid-20th century in Britain

Answer 2

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

Question 3

define disorder classification system and characteristics from mid to late 20th century in Britain

Answer 3

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

Question 4

what was the outcome of ICD based system

Answer 4

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)

Question 5

define disorder classification system and characteristics from late 20th century to present in Britain

Answer 5

expansion beyond the medical domain, to arrive at a model that encompassed biological, psychological and sociological model

Question 6

According to Darian Leader, how does a ‘commodification (material, data) of the psyche’ mainly manifest?

Answer 6

explosion of diagnoses

from 1-2 dozens (early 20th century) to 360+ (late 20th century)

Question 7

what are the causes of new diagnoses

Answer 7

attribute to drugs companies - secure niche markets for
their products

DSM 5 - cast over unhappiness, personal fortune, and troubling conduct

Question 8

What David Rosenhan’s experiments about

Answer 8

the validity of psychiatric diagnosis

Question 9

describe Rosenhan findings from his experiment

Answer 9

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

Question 10

define the consequence of stigma in treatment

Answer 10

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)

Question 11

what stigma research mainly focuses on

Answer 11

1. focused chiefly on schizo
2. based on attitude surveys and media representations
3. included a few intervention studies
4. excluded direct participation by service users

stigma encompasses problem with knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination)

Question 12

what are the limitations of stigma research

Answer 12

1. academic writing on stigma made few connections with legislation concerning disability rights policy
2. 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
3. notably few direct contributions to this literature by service users
4. underlying pessimism that stigma is deeply historically rooted and therefore difficult to change.
5. stigma theories have de-emphasised cultural factors and paid little attention to issues related to human rights and social structures.

Question 13

define cultural factors in stigma

Answer 13

1. notions of mental illness and explanatory models -
   i.e. symptoms are attributed to supernatural forces
2. Cultural meaning of impairment and manifestation
   i.e. stigma impact on marital prospects may have different impacts in a different society
3. 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

Question 14

define economic factors in stigma

Answer 14

1. poverty and access to healthcare
2. Long associated with the outcome of mental illness
3. determine the context in which stigma is enacted and experienced

Question 15

what are among anti-stigma campaign today

Answer 15

1. Public Awareness Campaign
2. education
3. social interaction
4. media reporting

annual events, celebrity advocates, real-life testimony and case study

Question 16

how mental health professionals and the
system itself implicated in creating and perpetuating stigma

Answer 16

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

Question 17

what are the suggestions for psychiatric reform to help improving stigma

Answer 17

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

Question 18

what are among make time to change projects

Answer 18

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.

Question 19

Make Time to Change Anti stigma Social marketing

Answer 19

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

Question 20

how museums can enable discussion of difficult histories

Answer 20

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

Question 21

Bethlem’s Museum of the Mind illustrated

Answer 21

curated thematically rather than chronologically

encourage exploration of commonalities in experience rather than the linear progression

Answer 22

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.

Question 23

What are suggestions from The Hearing Voices Network to prevent and challenge the stigma surrounding mental illness

Answer 23

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