Paradigms Lost: Fighting Stigma and the Lessons Learned

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.

Table of Contents:
Preface -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 Introduction 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 Journalists Youth Health professionals Members of community neighbourhoods Police Policy makers and legislators Choosing a program approach Creating a program logic model Including people who have experienced a mental illness in program delivery Families 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 Appendix Index

About the Author :
Heather Stuart, PhD, 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-Flórez, MD, ECFMG, LMCC, D. PSYCH., DLF, FRCPC, DABFP, PhD, DLFAPA, FCPA, FACFP, FABFE, FRSM, 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-Flórez 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. He has extensive experience in anti-stigma work and has contributed numerous publications to this area. Norman Sartorius, MD, MA, DPM, PhD, FRCPsychg, 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.

Review :
"Paradigms Lost: Fighting Stigma and the Lessons Learned illustrates the long standing stigma attached to mental illness and its continued prominence today. Although the problem of stigma appears daunting, the authors offer an innovative approach to help combat social exclusion. Their proposed new paradigm constructs an optimistic and practical way to break down the social barriers to recovery." -- Rebecca G. Palpant, Assistant Director, The Rosalynn Carter Fellowships for Mental Health Journalism, The Carter Center Mental Health Program, Atlanta, Georgia "Despite valiant efforts to tear down the stigma of mental illness, it stubbornly remains a hurtful force. That's why a careful look at assumptions of change is needed to go forward. Paradigms Lost does this critically. Stuart, Arboleda-Florez, and Sartorius provide a masterful tour-de-force of the scholarly literature to carefully unpack what we know about stigma so we can move ahead to eliminate its egregious impact. But their book does not end with a review of the science. They then provide a practical, hands-on guide to setting up anti-stigma programs meant to reflect the wisdom of their reviewed paradigms." -- Patrick W. Corrigan, PsyD, Distinguished Professor of Psychology, Illinois Institute of Technology, Chicago, I "This extraordinary book by international experts stands on its head the accepted wisdom about fighting the stigma of mental illness. This is the most important book yet published on what we must do to reduce the insidious and powerful force that can paralyze attempts to improve recovery from psychiatric disorder." -- Prof Richard Warner, MB, MS, Director, Colorado Recovery Inc., Boulder, CO and Department of Psychiatry, University of Colorado, Denver, CO "There are many more similarities than differences among people around the world. Paradigms Lost, a book about lessons learned by authors Stuart, Arboleda-Florez and Sartorius on fighting the stigma of mental illness, is proof of this. With a unique 2 part format that addresses stigma but also personal clinical and field experiences, this book is a historical compendium with a passionate call to action. To help readers move ahead quickly, tip sheets and assessments are included. The boldness of the statements in this book are refreshing and should help fight stigma around the world to improve the lives of people living with mental illness. Hats off to the publishers for recognizing the importance of this work." -- Linda B. Cottler, PhD, MPH, Dean's Professor of Epidemiology, Chair-Department of Epidemiology, University of Florida, College of Public Health and Health Professions, Gainesville, F "Paradigms Lost: Fighting Stigma and the Lessons Learned is simply excellent. The chapters are clearly written and well organized and the material is relevant to the aim of the book, i.e., to inform those wishing to undertake anti stigma programmes. I am sure that it will be a vitally important contribution to the field." -- Prof Graham Thornicroft, Professor of Community Psychiatry, Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK "We are all opposed to the stigma of mental illness, but that is not enough. We needed this book to remind us of what we previously misunderstood, and to reinforce what we now know." -- Michael Smith, The British Journal of Psychiatry