Sale on the novel: "Playing the Genetic Lottery"

An email received by the SSNS today from Terri Morgan, author of the novel Playing the Genetic Lottery:

May is Mental Health Awareness month in the United States, and as an author of a novel about schizophrenia and an advocate for reducing the stigmas surrounding mental health issues, I've offering a special on my novel. Would you please share this information with your members? I think they would appreciate hearing about this great discount on a book that validates many of their experiences.

Thanks, Terri

As you know, understanding mental illness is one of the big keys to reducing the stigmas that surround it. The stigmas that prevent people from talking about mental illness, and even worse, prevent people from seeking help when they need it. One out of every four people will be affected by mental health issues at one point in their lifetime.

In my mind, that makes it even more urgent to educate people about mental illnesses and dispel many of the myths and misconceptions surrounding it.

As the author of a novel about schizophrenia, I worked hard to weave in accurate information about mental illness and the impact it has on families into my book in an effort to raise compassion for people who are living with mental illness and reduce some of the stigmas.

That's why I'm offering a special price to people who download my novel, Playing the Genetic Lottery, during the month of May in honor of Mental Health Awareness Month in the United States. From May 1-31, people can download my book, which is a fictional memoir about a woman who grew up with two parents living with mental illness, for just CDN $1.01. To take advantage of this special, please click here.

For more information about the novel, please check out my website at terrimorgan.net.

Why reduce the price by 2/3rds? Because reducing the stigmas, to me, is more important than making a few extra dollars on each sale.

Also see:

Book Review by Ashley Smith

Playing the Genetic Lottery | Psych Central

Flawed reasoning

A letter to the editor published in today's edition of The Chronicle Herald:

There is a flaw in John Roswell’s reasoning when he writes (Jan. 17), “I believe that most people who have experienced psychosis would agree with me that people should be held responsible for their criminal acts, no matter what their state of mind was when they committed the crime.”

It is the accused who ultimately determines whether or not to proceed with a defence of not criminally responsible on account of mental disorder. Therefore, if the accused, once found fit to stand trial, believes that psychosis, for example, is the reason they should be found not criminally responsible, they will instruct their defence counsel to present this argument in court.

With regard to better access to mental health services, many people experiencing psychosis have lost contact with reality to such an extent that they do not believe they are ill. Therefore, they do not seek treatment for their mental disorder, despite the efforts of family and friends to assist them. This is one reason why the Nova Scotia legislature passed the Involuntary Psychiatric Treatment Act in December 2005.

Stephen W. Ayer, Executive Director, Schizophrenia Society of Nova Scotia

Missed point of talk

A letter to the editor posted online today by SouthShoreNow.ca:

I wanted to acknowledge South Shore Now for reporting on an event held several weeks back — the AGM of the South Shore District Health Authority. At this event, I spoke about issues very close to my heart, and engaged in a lively discussion with some very caring and intelligent health-care workers and citizens.

Around the same time, I was asked to speak to a journalism class taught by a friend of mine at the Dartmouth Nova Scotia Community College. I was asked to speak on the representation of mental illness in the media. For this talk, I have chosen to highlight your article, entitled “Mental health advocate calls for collaborative approach to wellness.”

In this article by Keith Corcoran, the credibility of the speaker (myself) is challenged from the very top of the article by the rather sensationalist and jarring placement of the first line, which refers to my contemplation of suicide as a preteen. If such a detail needs to be mentioned (which, given the context of the talk I gave, it doesn’t) it could be somehow contextualized, or even placed further down in the article. It also refers to my experience with schizophrenia in terms that are not the current way to define a person who has been given said diagnosis.

Mr. Corcoran decided to refer to me as a “schizophrenic with a history of anorexia, anxiety and depression.” Unlike the other experiences, the schizophrenia piece of my life was not delegated to my history, but was instead how I was principally defined. I am an artist, a registered counsellor and psychotherapist intern, a public speaker and a person with a lived experience of schizophrenia — not a “schizophrenic.”

Indeed, my mental illness was the gateway to my understanding the mental health system from the inside, and was the reason I decided to become a clinician myself, but it was not the point of my talk at the AGM that night. The point of my talk was to help clinicians to remember why they got into the helping profession in the first place, to give my humble perspective, and to think about some directions we might take to keep ourselves in touch with why we continue to choose to help others.

It was essentially about mindfulness for mental health professionals. And although I made a provocative joke in my speech hinging on a concept that was omitted from this article, I would be careful in the future about the paraphrasing of critical statements about persons’ experiences with mental health care.

By missing the point of my talk, and by defining me as an illness first, person second, you have not only hurt me, but have hurt all of the other people who fight against the stigma of mental illness every day in your area. And for those who are already prejudiced about those who experience mental illness, well, you have given them one more juicy tidbit to gossip about.

LAURA BURKE

Halifax

Photovoice

From the Center for Psychiatric Rehabilitation at Boston University:

Voices of Recovery is a combination of stories and Photovoice, which includes a photograph and a short narrative explaining the personal meaning behind the picture from the photographer’s point of view.

Also see:

Photovoice

Eliminating stigma and removing barriers to access [to treatment]

Please click on the image to magnify it.

Source document

Glenn Close, Jessie Close, and Calen Pick speak about stigma, prejudice, and discrimination

Also see:

Bring Change 2 Mind

Stop Blaming Me for my Daughter's Mental Illness

An article posted on April 12th by The Huffington Post - Canada:

By Susan Inman (pictured)

As the parent of someone with a severe schizoaffective disorder, I'm used to being viewed with suspicion. Sometimes the pathologizing gaze occurs in unexpected places. Following the publication of an article I wrote for B.C. Teacher about the importance of educating staff in schools about mental disorders, a fellow teacher asked me if I knew what we'd done to cause my daughter's illness.

The unjustified suspicion of mental health professionals can be even more damaging. When we took our floundering teenage daughter to a credentialed counseling psychologist, we knew nothing about severe mental illnesses. As it turned out, neither did she. Her training included no material on psychotic disorders. Instead, it focused on psychodynamic theories, which look for the causes of current problems in people's early childhood experiences. Her misguided assumptions, fed by her training, led to chaos in the early years of our daughter's illness and to an unnecessarily long and dangerous psychotic episode.

Even with recent decades of robust research in neuroscience, parental caregivers of people with psychotic disorders soon learn that their interactions with the mental health system will be filled with blame. Many mental health clinicians in Canada, like our daughter's counselor, have had no science-based training on schizophrenia or bipolar disorder. Too often their interactions with families weaken the bonds that the illnesses have already frayed.

Psychiatry, for most of the 20th century, used the theories of Freud, which were never based on evidence-based research, to develop elaborate ways of blaming parents for schizophrenia. The Canadian Psychiatric Association now explicitly describes schizophrenia as a treatable brain disorder that is not caused by poor parenting.

Our relationship with our daughter's psychiatrist has been extraordinary. I believe it is responsible for her unexpected recovery. When the psychiatric team at Vancouver's St. Paul's Hospital first met her, she was one of the most severely psychotic teenagers they had ever seen. From the time that one member of this team, our daughter's current psychiatrist, began to work with her, he listened carefully to our input as we navigated the arduous path to her stability.

Even with this history of mutual respect, my husband and I were stunned recently when we were discussing strategies for managing any difficulties that might emerge during an upcoming trip. He stopped the discussion, looked at us, and said, "You guys are such great parents!"

I'm immersed in a community of parental caregivers in Vancouver and have been asking if anyone has ever been told anything like this. The answer is, "Never." These friends, who constantly inspire me with their energy, dedication and resourcefulness in advocating for their struggling children, find it hard to imagine hearing this kind of supportive response. Instead, my question is usually greeted with yet another account of the wounding of families by the mental health system.

Some parents do receive much-needed support from their own family physicians, who also provide primary healthcare to their often unstable sons and daughters. For many years, both my husband and I have freely vented, grieved, and tried to problem solve with the informed and compassionate help of our family doctor.

In recent years, the Canadian Psychiatric Association and the College of Family Physicians of Canada have begun an active collaboration including an annual Shared-Care conference. Much of the focus has been on helping family physicians become more knowledgeable in responding to the serious mental illnesses they are increasingly being asked to manage.

The upcoming Shared-Care conference in Vancouver offers richly informative sessions for family physicians. However, I don't see any sessions that provide family physicians opportunities to share their often considerable expertise in helping parents survive their daunting tasks. Fortunately, this kind of conference does invite informal communication on just these kinds of overlooked topics. Since family caregivers for people with severe mental illnesses save the healthcare system money, new ways of supporting them are well worth considering.

Photo credit

Stereotypes of mental disorders differ in competence and warmth

A February 21st posting by Neuroskeptic:

Please click on the image to magnify it.

Fighting "the stigma of mental illness" is big business at the moment. But does "the stigma" really exist?

As I said back in 2010:

There is a stigma of schizophrenia, and there's a stigma of depression, etc. but they're not the same stigma. We're told it's a myth that "the mentally ill are violent" - [but] no-one thinks depressed or anorexic people are violent. They think (roughly) that people with psychosis are. They have other equally silly opinions about each diagnosis, but there's no monolithic "stigma of mental illness".

Now a paper has come out which explores this idea in some detail: Stereotypes of mental disorders differ in competence and warmth. The title says it all : people have stereotypical views of people suffering from different mental disorders, but these stereotypes vary substantially.

To read the entire post, please click here.

Image credit

Also see:

Stereotypes of mental disorders differ in competence and warmth

Amanda Tetrault speaks at a Media Symposium

From the YouTube posting:

Amanda Tetrault, photographer, shares her personal experience with mental illness at the King's College media symposium.

Amanda Tetrault created a photographic book about her relationship with her father called Phil and Me. She shares her story from a lifetime with a father who lives with severe schizophrenia through captivating photographs.

Also see:

Phil and Me

Michael Kimber at the University of King's College media symposium

From the YouTube posting by the Mental Health Commission of Canada:

Michael Kimber, a King's College graduate, speaks about his personal experience with mental illness at the King's College media symposium.

Michael Kimber suffers from intense anxiety and isn't afraid to tell anyone. He writes about his experience in a personal, heart-felt and riveting blog and receives thousands of hits daily. Today Michael is still blogging, writing a book, and continuing to attract attention on the impact of stigma and mental health.

The Canadian Medical Association Awards Medal of Honour to Dr. Austin Mardon

An August 16th media release from the Canadian Medical Association:

OTTAWA, Aug. 16, 2011 /CNW/ - The Canadian Medical Association (CMA) will present the 2011 CMA Medal of Honour to Dr. Austin Mardon, PhD, who has demonstrated outstanding public commitment to raising awareness of mental health issues and diminishing the stigma and discrimination faced by Canadians living with mental illness.

"The CMA Medal of Honour recognizes personal contributions to the advance of medical research and education," said CMA President Dr. Jeff Turnbull. "Dr. Mardon has worked tirelessly to help Canadians better understand the issues around mental illness. In courageously talking openly about his own experiences, he is truly making a difference in coaxing mental illness out of the shadows in this country."

Diagnosed with schizophrenia at the age of thirty, Dr. Mardon uses his own experience and his road to recovery in advocating in the areas of stigma, service delivery, awareness and education. He tries to improve the lives of those with schizophrenia through public education. His efforts have led him meet with politicians, clergy, academics and others in positions to effect change. He has influenced public policy in Alberta through his service as vice-chair of the Alberta Disabilities Forum steering committee and as chair of its low-income working group; as a member of the Premier's Council on the Status of Persons with Disabilities; as an addiction and mental health committee member of Alberta Health's service integration working group; and as chair of the Edmonton Champions' Centre advisory committee. He also was instrumental in winning changes to Alberta's income assistance program for the severely handicapped.

"I have put my experiences out there for all to see, but it hasn't been easy and for some people it's impossible," said Dr. Mardon. "My goal continues to be to see the unfair and debilitating stigma our society holds against the mentally ill wiped out for all time."

Austin Mardon, PhD, has been a public educator and tireless advocate for the mentally ill, particularly those with schizophrenia, since he was diagnosed with that illness in 1992. At the time he was a promising graduate student and Antarctic explorer, and the diagnosis of schizophrenia could have ended his academic career and severely limited his prospects in life. Instead, he survived many setbacks through his sheer determination to continue his studies, to make a difference, to contribute to society, and to help others.

Dr. Mardon graduated with a major in geography from the University of Lethbridge in 1985. The following year, at age 24, he was investigating meteorite impacts 170 km from the South Pole as a junior field member on an Antarctic meteorite recovery expedition sponsored by NASA and the National Science Federation. He received the U.S. Antarctic Service Medal for his work. However, the extreme hardships of the expedition affected him mentally and physically. While he went on to earn masters degrees in science (South Dakota State University) and education (Texas A&M University) and published a number of articles and books, his health issues persisted. At the age of 30 he was diagnosed with schizophrenia.

Although some of his abilities are compromised by the disease, he earned a PhD in geography from Greenwich University, Australia; continued his remarkable publication record, including articles in both Science and Nature; was elected an International Fellow and Corresponding Fellow of the Explorers Club of New York; and was inducted into the International Academy of Astronautics.

Equally impressive has been his work on behalf of the mentally ill. In addition to giving countless interviews to the media on the topic of mental illness, he has published articles about faith and schizophrenia, homelessness, medication, and income support. He has provided leadership as a member of the board of directors of both the Edmonton and Alberta chapters of the Schizophrenia Society, and for a number of years he was coordinator of the Alberta Mental Health Self-Help Network.

"I hope to soon see the day when schizophrenia is treated like any other disease and is finally detached from the stigma that makes a difficult burden to bear even worse," added Dr. Mardon.

Dr. Mardon has received a number of awards, including the Order of Canada (2007). Others include: the Flag of Hope Award (2001) and the Bill Jefferies Family Award (2007) of the Schizophrenia Society of Canada; the Distinguished Alumni Award of the University of Lethbridge (2002); the Presidents Award of the Alberta chapter of the Canadian Mental Health Association (2002); the C.M. Hincks Award from the national division of the Canadian Mental Health Association (2007); and the Medal of Honour of the Alberta Medical Association (2010).

A popular member of the Speakers' Bureau of Alberta, Dr. Mardon has publicly assisted the medical profession by supporting development of policy positions that have helped medical providers treat those with mental illness.

Dr. Mardon is the 28th recipient of the CMA Medal of Honour, the highest award bestowed upon someone who is not a member of the medical profession. He will receive the award at a ceremony at the D.F. Cook Recital Hall, Memorial University, in St. John's, N.L., on Aug. 24 as part of the CMA's 144th annual meeting.

For further information:

Lucie Boileau, Manager, Media Relations
Tel: 613-731-8610 or 1-800-663-7336 ext. 1266
Mobile: 613-447-0866
lucie.boileau@cma.ca

Photo credit

Also see:

Austin Mardon to receive honorary Doctor of Laws degree from University of Alberta

Austin Mardon on Schizophrenia

Attitudes improving towards mental illness, survey shows

Quoting Marjorie Wallace (pictured), chief executive of the U.K. mental health charity Sane:

"If we aspire to end the stigma surrounding mental illness, we must not rely simply on educational campaigns, but must also provide the care and treatment people need at times of crisis, in order to prevent the tragedies that so often colour the public's view."

To read the entire article, please click here.

Understanding Severe Mental Illness

A January 11th posting by the National Institute of Mental Health:

By Thomas Insel (pictured)

When a tragedy occurs like the shooting in Tucson this past weekend, all of us seek an explanation. While there remain many questions, a leading hypothesis is that the suspect has a serious mental illness (SMI), such as schizophrenia. The topic of violence and mental illness is never an easy discussion: with issues such as stigma, incarceration, public safety, and involuntary treatment in the mix. There is a legitimate concern that talking about violence and mental illness in the same sentence increases the likelihood that people with serious illness will be further marginalized and less likely to receive appropriate care. But tragic events, whether at a Safeway in Tucson or a classroom at Virginia Tech, require us to address this uncomfortable subject with the science available.

Is violence more common in people with SMI? Yes, during an episode of psychosis, especially psychosis associated with paranoia and so-called “command hallucinations”, the risk of violence is increased. People with SMI are up to three times more likely to be violent and when associated with substance abuse disorders, the risk may increase much further (1). But, mental illness contributes very little to the overall rate of violence in the community. Most people with SMI are not violent, and most violent acts are not committed by people with SMI. In fact, people with SMI are actually at higher risk of being victims of violence than perpetrators. Teplin et al found that those with SMI are 11 times more likely to be victims of violent crime than the general population (2).

The most common form of violence associated with mental illness is not against others, but rather, against oneself. In 2007, the most recent year for which we have statistics, there were almost 35,000 suicides, nearly twice the rate of homicides. Suicide is the 10th leading cause of death in the United States (3). Although it is not possible to know what prompted every suicide, it is safe to say that unrecognized, untreated mental illness is a leading culprit.

Treatment may be the key to reducing the risk of violence, whether that violence is self-directed or directed at others. Research has suggested that those with schizophrenia whose psychotic symptoms are controlled are no more violent than those without SMI (4). It’s likely that treatment not only helps ease the symptoms of mental illness, but also curbs the potential for violence as well.

As we learn more about the circumstances surrounding the tragedy in Tucson, we should be working harder to ensure people with SMI receive the care they need. Early intervention offers the best hope to prevent more tragedies in the future.

For more information on SMI and other mental health statistics, please visit NIMH’s Statistics page.


References

1. Swanson JW. Mental disorder, substance abuse, and community violence: an epidemiological approach. In: Monahan J, Steadman HJ, eds. Violence and mental disorder: developments in risk assessment. Chicago: University of Chicago Press, 1994:101-36.


2. Teplin et al. Crime victimization in adults with severe mental illness. Archives of General Psychiatry. 2005 Aug. 62. 911-921.


3. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). www.cdc.gov/ncipc/wisqars.


4. Steadman HJ, Mulvey EP, Monahan J, et al. Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Arch Gen Psychiatry 1998;55:393-401.

Photo credit

Culture shift needed in society, system

An opinion piece published in today's edition of The Chronicle Herald:

By Marilla Stephenson (pictured)

In the end, who failed Howard Hyde?

Perhaps, to some degree, we all did.

There is really no way to dress up the realities of mental illness. It is not pretty, and it can be a very tough challenge to support people in crisis. The people who live closest to those who suffer from mental illnesses are victims of the illnesses, too.

There is also no way to disguise or excuse how our society has continued to respond to people who experience mental illnesses. The stigmas are clear and well understood, even by young children in our schools. The branding begins early.

Hyde is the Dartmouth man who died in custody in 2007. He suffered from schizophrenia. The police were told of his mental illness when he was taken into custody over allegations of domestic abuse. He later died after an intense struggle with prison guards.

Provincial court Judge Anne Derrick released the fatal inquiry report into Hyde’s death on Wednesday. She firmly rejected a previous finding by a pathologist that he had died due to a condition termed "excited delirium."

Derrick dismissed that finding as a "red herring" that did not exist in Hyde’s case.

She also found that while the repeated use of a Taser on Hyde during his time in police custody "worsened the situation," it was not the cause of his death. She did, however, remind justice officials that so-called stun guns are to be used as an alternative to lethal force rather than as a front-line option to subdue suspects who are emotionally disturbed.

His death was accidental, Derrick found, but it came as a direct result of his struggle with prison guards.

In the comprehensive list of 80 recommendations, Derrick tossed the ball firmly into the hands of the provincial government.

She begins by calling for the establishment of a long-promised, but still absent, mental health strategy. It is clearly not by accident that this basic framework is at the top of the list as a necessary building block from which other improvements would naturally evolve.

The judge also calls on the province to increase funding for mental health, but not to do it by reallocating funds from within the existing envelope of health-care funding. This reflects the fact that mental health issues have for too long languished on the list of health-care priorities.

We are left with a fractured, often inaccessible mental health system where vanishing waiting lists are proudly waved around by government as proof of treatment for patients. Improvements are being made, and Derrick’s report makes note of policy changes that have already occurred in the justice system in the wake of Hyde’s death.

But it is hard to comprehend that none of the guards involved in the struggle with Hyde minutes before he died had any training to help them deal with prisoners who suffer from mental illness.

One seemingly innocuous recommendation, No. 49 on Derrick’s list, speaks volumes. Directed at justice system staff and other front-line officials who are in contact with prisoners who suffer from mental illness, it is brief and to the point:

"Training should have, as its overarching purpose, the development of a culture of respect and empathy for persons with mental illness in the justice system."

This is a statement that reaches beyond the justice system and into our society as a whole. While mountains have been moved in reducing the acceptance of stereotypes linked to mental illnesses, many of the most basic government services — justice and health among them — are still handcuffed by systemic ignorance.

The judge called for alternatives for people with mental illness who come in conflict with the law, and says the responsibility reaches well beyond the justice system.

"As the evidence before the inquiry has vividly illustrated, grasping this nettle is not just the responsibility of the justice system; creativity and commitment to change are required of the health system and the community, too."

The principles of respect and empathy provide a good place from which to start.

( mstephenson@herald.ca)

Also see:

Howard Hyde Inquiry Ignores Ableism As Cause of Death


Photo credit

The Jack Project - Mental Health First Aid Canada - Youth Course

Also see:

The Jack Windeler Memorial Fund

Last March, Jack Windeler, a first-year student at Queen’s University, died of suicide. To help others, Jack’s family and friends have raised $300,000+ for the Jack Windeler Memorial Fund, administered through Kids Help Phone. The focus is on youth mental health to

1. educate ‘emerging adults’ aged 16-20 as they transition from high school to college/university, and


2. to build a micro-site to counsel youth who are suffering.(supported by Kids Help Phone counsellors)

Jack’s high school (Ridley College) and university (Queen’s) are leading efforts by providing training in “Mental Health First Aid”, which teaches skills so you can help someone who is developing or experiencing a mental health problem. The goal is to broaden the approach across Canada.

Progress in the Elimination of the Stigma of Mental Illness

From the November 2010 edition of The American Journal of Psychiatry:

Changing Views of Mental Illness?

Public awareness of the neurobiology of mental illness increased between 1996 and 2006, yet the stigma associated with several major mental disorders did not decline. Pescosolido et al. (p. 1321) found that persons who have a neurobiological conception of schizophrenia or depression actually had increased likelihood of aversion or fear in their rating of vignettes of individuals with these illnesses. The perception of alcohol dependence as refl ecting "bad character" rose from 49% to 65% of survey respondents. Support for treatment increased, however, and in an editorial, Goldman (p. 1289) suggests that the outcome of the study would have been different if the vignettes had included individuals who have recovered from mental illness.

An editorial published in the November 2010 edition of The American Journal of Psychiatry:

By Howard H. Goldman, M.D., PH.D. [pictured]

Pescosolido and colleagues report on an interesting and informative study of public attitudes toward mental illness in this issue (1). They are the preeminent group of investigators working with the General Social Survey, a repeated survey of social attitudes of cross-sections of the U.S. population. Their data provide an empirical analysis of public attitudes toward mental illness using well-designed vignettes as stimulus material. The investigators systematically vary the characters in the vignettes to control for a range of sociocultural and demographic characteristics that might influence attitudes. However, the abnormal behaviors depicted in the vignettes, which present individuals with behavioral features of mental disorders, are both the strength and the weakness of the study.

The investigation tests the hypothesis that between the two observational time points—1996 and 2006, when mental health supplements to the General Social Survey were administered-public attitudes changed to favor a more scientific understanding of mental illness and that this change in understanding in turn is associated with two changes in attitudes. One putative change in attitude, associated with a more scientific—particularly a more neurobiological—conception of mental illness, is an increase in recommendations from those surveyed that the individuals in the vignettes should seek treatment. The other putative change is a decline in social stigmatizing attitudes about the individuals in the vignettes, particularly among respondents who view the illness as a manifestation of a neurobio-logical abnormality. Consistent with this hypothesis, those who attribute the abnormal behaviors to mental illness and those who increasingly view mental disorders as neurobiological are now more likely to endorse a referral for treatment. Contrary to the hypothesis, however, those with a more neurobiological understanding are also more likely to endorse socially stigmatizing and distancing attitudes about the people represented in the vignettes.

A theory of stigma reduction that motivates many of the antistigma interventions is that changes in attitudes about mental illness favoring a scientific understanding of specific disorders increase help-seeking behavior and that increased help-seeking behavior will lead to treatment that will reduce distress and dysfunction, promote recovery, and secondarily reduce social stigmatization. The mechanism for reduced social stigma is secondary to the effect of treatment in reducing the signs and symptoms of mental illness, which people perceive as alien and threatening. Thus, the behaviors are the source of stigmatization, and treatment makes them less visible or eliminates them. This recovery after treatment is not represented in the General Social Survey study vignettes. The responses to the vignettes tell us how people feel about individuals with active mental illness—not how they would feel about the more relevant vignette of an individual who has recovered from a mental illness. Admittedly, it is difficult to assess attitudes about an individual who has recovered from mental illness, because that individual has little or none of the abnormal behaviors manifest in the illness. A vignette of a normally behaving person who professes a previous history of mental illness would be the proper stimulus to determine the social stigma associated with an individual who has been successfully treated for a mental disorder. Indeed, the authors point out in the paper's discussion that the 1999 U.S. Surgeon General's report cautioned that acceptance of neurobiological causation alone might cause a backlash of stigma if it were not coupled with successful treatment of mental illness.

Despite this limitation, the study does tell us about some important attitudes and moderators of public opinion. The authors offer a wise warning that neurobiological explanations might not be a panacea for reducing stigma, but they may overstate the likelihood that such an approach will be stigmatizing. Given that many mental illnesses are only partially treated with current psychopharmacological and psychological interventions, widespread acceptance of a neurobiological understanding of mental illness may nonetheless usefully encourage further research funding and more financial support of treatment, as in the enactment of mental health parity legislation. We may not have eliminated social stigmatization of symptomatic individuals with mental illness, but improved treatment has helped many of them to make their symptoms and dys-function less visible and less problematic. Perhaps accordingly, we have seen dramatic increases in research funding, more service use, and better insurance coverage for treatment of mental disorders.

Footnotes

Editorial accepted for publication August 2010

Dr. Goldman reports no financial relationships with commercial interests.

Address correspondence and reprint requests to Dr. Goldman, Editor, Psychiatric Services, and Professor, University of Maryland School of Medicine; hh.goldman@verizon.net (e-mail).

Reference

1. Pescosolido BA, Martin JK, Long JS, Medina TR, Phelan JC, Link BG: "A disease like any other"? a decade of change in public reactions to schizophrenia, depression, and alcohol dependence. Am J Psychiatry 2010; 167:1321–1330 [Abstract/Free Full Text]

"A Disease Like Any Other"? A Decade of Change in Public Reactions to Schizophrenia, Depression, and Alcohol Dependence

The abstract of an article published in the September 15th edition of The American Journal of Psychiatry:

By Bernice A. Pescosolido [pictured], Ph.D., Jack K. Martin, Ph.D., J. Scott Long, Ph.D., Tait R. Medina, M.A., Jo C. Phelan, Ph.D., and Bruce G. Link, Ph.D.

From the Schuessler Institute for Social Research and the Department of Sociology, Indiana University; and the Mailman School of Public Health, Columbia University, New York.

Objective:

Clinicians, advocates, and policy makers have presented mental illnesses as medical diseases in efforts to overcome low service use, poor adherence rates, and stigma. The authors examined the impact of this approach with a 10-year comparison of public endorsement of treatment and prejudice.

Method:

The authors analyzed responses to vignettes in the mental health modules of the 1996 and 2006 General Social Survey describing individuals meeting DSM-IV criteria for schizophrenia, major depression, and alcohol dependence to explore whether more of the public 1) embraces neurobiological understandings of mental illness; 2) endorses treatment from providers, including psychiatrists; and 3) reports community acceptance or rejection of people with these disorders. Multivariate analyses examined whether acceptance of neurobiological causes increased treatment support and lessened stigma.

Results:

In 2006, 67% of the public attributed major depression to neurobiological causes, compared with 54% in 1996. High proportions of respondents endorsed treatment, with general increases in the proportion endorsing treatment from doctors and specific increases in the proportions endorsing psychiatrists for treatment of alcohol dependence (from 61% in 1996 to 79% in 2006) and major depression (from 75% in 1996 to 85% in 2006). Social distance and perceived danger associated with people with these disorders did not decrease significantly. Holding a neurobiological conception of these disorders increased the likelihood of support for treatment but was generally unrelated to stigma. Where associated, the effect was to increase, not decrease, community rejection.

Conclusions:

More of the public embraces a neurobiological understanding of mental illness. This view translates into support for services but not into a decrease in stigma. Reconfiguring stigma reduction strategies may require providers and advocates to shift to an emphasis on competence and inclusion.

Posting of this abstract is for the purposes of research into social predudice and stigma.

Also see:

Study: Mental illness stigma entrenched in American culture; new strategies needed

Americans still not tolerant of the mentally ill

Mental Illness Stigma Entrenched in American Culture; New Strategies Needed, Study Finds


Photo credit

Spring 2010: Stigma and discrimination in health care

Please click on the image to magnify it.

To download the entire issue (PDF), please click here.

Behind the Scenes

Also see:

www.bringchange2mind.org

Cartoonists should be careful how they portray mental health

An article published in today's edition of The Guardian:

It's not political correctness gone mad. Some things really should be unsayable

By Beatrice Bray [pictured]

Newspaper cartoons can be great. They can say the unsayable. They have licence to push the boundaries of taste. Their images can resonate for years. But Martin Rowson's cartoon "Dressing-up box" (Comment & Debate, 29 March) overstepped the mark.

Rowson had fun depicting different Conservative politicians in fancy dress. They are shown like kids in the playroom. But as one Tory lifts Mrs Thatcher's moth-eaten blue dress, he shouts: "Hey everybody! This is the 'psychotic yet tough union basher' cozzie!"

The use of the word "psychotic" was offensive. You may think this political correctness gone mad, but if you are ill, or have been, you need words to describe your experience to yourself and to others. If for you these words are negative, you will hate yourself. Language can make or break your happiness.

That is why mental health activists do not like psychiatric terms being used as abuse. We want to show the public how to use terms like "schizophrenia", "psychosis" and "bipolar" in the correct way.

For starters, do not use the word "schizophrenia" when you don't mean mental illness – as when, a few years ago, an MP on a Commons committee claimed there was "schizophrenia" within the BBC.

And please allow individuals an identity apart from their illness, so always say "a person with schizophrenia" rather than "a schizophrenic".

In general usage the word "paranoia" means an undue sense of suspicion. It does not mean illness. The psychiatric term "paranoia" involves an extreme sense of persecution.

"Psychosis" is another escapee into the fashionable world. In the street sense it implies wackiness, but some of us need it to report distressing symptoms to doctors in life-threatening crises. We are not always believed.

There are attempts to banish such ambiguity. "Bipolar" is a new term which was introduced to replace the stigmatised "manic depression". This creates a chance to reinvent the illness, but already the new label is becoming tarnished. You cannot separate words from their popular meanings. You have to change attitudes and behaviours as well as words.

Rowson's cartoon is testament to this, even though he does not sound like the kind of man who would want to disfranchise those of us with severe mental health problems.

We were not Rowson's target: Margaret Thatcher was. But just to complicate matters we are now championing the honour of Thatcher even though some of us are leftwingers. We do not think that Thatcher, a dementia sufferer, should face misused words of abuse.

In the mental health world we try not to offend. At conferences we agree to avoid insulting each other with derogatory terms. We are glad that the main party leaders have copied us. All three have signed a compact, drafted by the all-party parliamentary mental health group, on the use of language. This is the first time such an agreement has been reached. It would be appropriate if journalists and cartoonists were to respect this compact.

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