Paradigms Lost: Fighting Stigma and the Lessons Learned

ISBN : 9780199797639

Norman Sartorius; Heather Stuart; Julio Arboleda-Florez
240 Pages
164 x 237 mm
Pub date
Jun 2012
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Paradigms Lost challenges key paradigms currently held about the prevention or reduction of stigma attached to mental illness using evidence and the experience the authors gathered during the many years of their work in this field. Each chapter examines one currently held paradigm and presents reasons why it should be replaced with a new perspective. The book argues for enlightened opportunism (using every opportunity to fight stigma), rather than more time consuming planning, and emphasizes that the best way to approach anti-stigma work is to select targets jointly with those who are most concerned. The most radical change of paradigms concerns the evaluation of outcome for anti-stigma activities. Previously, changes in stigmatizing attitudes were used as the best indicator of success. Paradigms Lost and its authors argue that it is now necessary to measure changes in behaviors (both from the perspective of those stigmatized and those who stigmatize) to obtain a more valid measure of a program's success. Other myths to be challenged: providing knowledge about mental illness will reduce stigma; community care will de-stigmatize mental illness and psychiatry; people with a mental illness are less discriminated against in developing countries. Paradigms Lost concludes by describing key elements in successful anti stigma work including the recommended duration of anti-stigma programmes, the involvement of those with mental illness in designing programmes, and the definition of programmes in accordance with local circumstances. A summary of weaknesses of currently held paradigms and corresponding lists of best practice principles to guide future anti-stigma action and research bring this insightful volume to an apt conclusion.


-Part I Eroding Paradigms
Chapter 1
Introduction - The nature and nurture of stigma
The origins and meaning of stigma
Consequences of stigma for people with a mental illness
Consequences for family members
Consequences of stigma for mental health systems and societies
Anti-stigma initiatives are growing
Chapter 2
Paradigm 1: Developed countries have eradicated systemic discrimination on the grounds of mental illness
Mental health development
Employment inequity
NIMBYISM, homelessness, and the inverse care law
Media depictions and public tolerance
Chapter 3
Paradigm 2: In developing countries, people with mental illnesses are not stigmatized
Exploding the myth
Stigma in other cultures
Islamic cultures
Chinese culture
Indian culture
Chapter 4
Paradigm 3: The fight against stigma must be based on well-developed long term specific and comprehensive plans
A case for enlightened opportunism
Networks of practice
Network governance and leadership
General principles, rather than specific plans guide anti-stigma activities
Chapter 5
Paradigm 4: Scientific evidence will best define the targets of anti-stigma work
Evidence-based advocacy
Evidence is in the eye of the beholder
To be successful, programs must target local needs
To be successful programs must build better practices
Chapter 6
Paradigm 5: Mental health professionals should lead anti-stigma programs
Mental health professionals are worthy targets of anti-stigma programs
Stigma in general health care settings
Mental health systems as agents of social control
What can mental health professionals do differently?
Chapter 7
Paradigm 6: Improving knowledge about mental illnesses will reduce stigma and discrimination
The nature of prejudice
Can prejudice respond to nuggets of knowledge?
What about mental health literacy?
Anti-stigma programs as purveyors of medical knowledge
Chapter 8
Paradigm 7: An anti-stigma program is successful if it changes attitudes
The knowledge-attitude-behaviour continuum
'What we dont know about prejudice reduction
How much change is change?
When are anti-stigma programs successful?
Environments are not just containers
Chapter 9
Paradigm 8: Community care for the mentally ill will destigmatize mental illness and psychiatry
Stigma as a consequence of institutionalization
Stigma as a consequence of community care
Stigma as a social barrier to recovery
Chapter 10
Paradigm 9: Campaigns are an excellent way of reducing stigma
The cause de jour
Can social inclusion be sold like soap?
Chapter 11
Paradigm 10: Anti-stigma programs should be built on the premise that mental illness is like any other illness
Forced confinement and treatment
Anti-psychiatry sentiments
Violence and unpredictability
An illness like any other?
Chapter 12
Paradigm 11: The stigma of mental illness is too deeply ingrained to prevent or reduce it
The importance of fighting back
-Overcoming NIMBYISMthe Not in My Backyard Syndrome
Changing the way emergency departments do business
Connecting with teachers and students
Engaging the police
Engaging the media
Can community projects make a population difference?
-Chapter 13 Summary of Part 1
-Implications for anti-stigma programming paradigms lost
-Part II Building Programs Against Stigma and its Consequences
Chapter 14 - Getting going
Developing a program committee
Creating an advisory committee
Setting clear goals
Creating interes
Acquiring and monitoring resources
Writing a successful funding application
Chapter summary and chapter checklist
Chapter 15 - Identifying program priorities
Identifying program priorities through qualitative investigation
Focus groups
Steps in conducting a focus group
Troubleshooting in focus groups
Analysis of focus group data
Identifying program priorities using semi-structured interviews
Identifying program priorities using surveys
Chapter summary and chapter checklist
Chapter 16 - Program development
Picking target groups
Health professionals
Members of community neighbourhoods
Policy makers and legislators
Choosing a program approach
Creating a program logic model
Including people who have experienced a mental illness in program delivery
Using media wisely
Working with external media experts
Working with television
Working with radio
Working with the arts
Pilot testing
Chapter summary and chapter checklist
Chapter 17 - Program monitoring and evaluation
Using qualitative data to monitor program implementation
Assessing change
Specification of program outcomes
Setting performance targets
Devising and implementing a data collection plan
Data management and analysis
Identifying lessons learned
Ethical issues in evaluation
Communicating results
Chapter summary and chapter checklist
Bibliography and Suggested Readings
The Nature of Stigma
Evaluation Methods
Works Cited
Appendix: Inventories of Stigma Experiences
Personal Experiences with the Stigma of Mental Illness
Family Experiences with the Stigma of Mental Illness

About the author: 

Heather Stuart has been working in the field of stigma research for almost 15 years and is the co-founder and current Chair of the Scientific Section on Stigma and Mental Disorders for the World Psychiatric Association. Dr Stuart is Director, Masters of Public Health Program, Department of Community Health & Epidemiology and Associate Director, Queen's/Pan American Health/World Health Organization Collaborating Centre for Training in Psychiatric and Behavioural Epidemiology, both at Queen's University, Ontario, Canada. Dr Stuart is also the Senior Consultant for Canada's Opening Minds national anti-stigma/anti-discrimination initiative. ; Julio Arboleda-Florez is Emeritus Professor, Departments of Psychiatry and of Community Health and Epidemiology and the Inmediate Past Head and Chief-of-Psychiatry at Queen's University in Ontario, Canada. Dr Arboleda-Florez is a leading authority on legal psychiatry and human rights of the mentally ill. He is the Honorary Chair of the Forensic Section and a longstanding member of the Ethics Committee of the World Psychiatric Association, an Honorary member of several national psychiatric associations. ; Norman Sartorius was Director of the World Health Organization's mental health programme from 1977 - 1993, President of the World Psychiatric Association from 1993 - 1999 and has been President of the European Psychiatric Association since 1999. Dr Sartorius holds professorial appointments at the Universities of London, Prague and Zagreb and is Senior Associate of Faculty at Johns Hopkins University in Baltimore, MD. Dr Sartorius is among the world's leading authorities on fighting stigma, co-morbidity of mental and physical illness, public health aspects of psychiatry and psychiatric education.

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