Paradigms Lost: Fighting Stigma and the Lessons Learned

Hardcover | May 28, 2012

byNorman Sartorius, Heather Stuart, Julio Arboleda-Florez

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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 presentsreasons 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 aremost 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 theperspective 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 illnessare 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 ofweaknesses 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.

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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 presentsreasons why it should be replaced with a ne...

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 Universit...

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Format:HardcoverDimensions:304 pages, 9.25 × 6.12 × 0.98 inPublished:May 28, 2012Publisher:Oxford University PressLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:0199797633

ISBN - 13:9780199797639

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Table of Contents

1. Introduction - The nature and nurture of stigmaThe origins and meaning of stigmaConsequences of stigma for people with a mental illnessConsequences for family membersConsequences of stigma for mental health systems and societiesAnti-stigma initiatives are growing2. Paradigm 1: Developed countries have eradicated systemic discrimination on the grounds of mental illnessMental health developmentEmployment InequityNIMBYISM, homelessness, and the inverse care lawMedia depictions and public tolerance3. Paradigm 2: In developing countries, people with mental illnesses are not stigmatizedExploding the mythStigma in other culturesIslamic culturesChinese cultureIndian culture4. Paradigm 3: The fight against stigma must be based on well-developed long term specific and comprehensive plansA case for enlightened opportunismNetworks of practiceNetwork governance and leadershipGeneral principles, rather than specific plans guide anti-stigma activities5. Paradigm 4: Scientific evidence will best define the targets of anti-stigma workEvidence-based advocacyEvidence is in the eye of the beholderTo be successful, programs must target local needsTo be successful programs must build better practices6. Paradigm 5: Mental health professionals should lead anti-stigma programsMental health professionals are worthy targets of anti-stigma programsStigma in general health care settingsMental health systems as agents of social controlWhat can mental health professionals do differently?7. Paradigm 6: Improving knowledge about mental illnesses will reduce stigma and discriminationThe nature of prejudiceCan prejudice respond to nuggets of knowledge?What about mental health literacy?Anti-stigma programs as purveyors of medical knowledge8. Paradigm 7: An anti-stigma program is successful if it changes attitudesThe knowledge-attitude-behaviour continuum'What we dont know about prejudice reductionHow much change is change?When are anti-stigma programs successful?Environments are not just containers9. Paradigm 8: Community care for the mentally ill will destigmatize mental illness and psychiatryStigma as a consequence of institutionalizationStigma as a consequence of community careStigma as a social barrier to recovery10. Paradigm 9: Campaigns are an excellent way of reducing stigmaThe cause de jourCan social inclusion be sold like soap?11. Paradigm 10: Anti-stigma programs should be built on the premise that mental illness is like any other illnessForced confinement and treatmentAnti-psychiatry sentimentsViolence and unpredictabilityAn illness like any other?12. Paradigm 11: The stigma of mental illness is too deeply ingrained to prevent or reduce itThe importance of fighting backOvercoming NIMBYISMthe Not in My Backyard SyndromeChanging the way emergency departments do businessConnecting with teachers and studentsEngaging the policeCan community projects make a population difference?13. Summary of Part 1Implications for anti-stigma programming paradigms lost14. Getting goingIntroductionDeveloping a program committeeCreating an advisory committeeSetting clear goalsCreating interestAcquiring and monitoring resourcesWriting a successful funding applicationChapter summary and chapter checklist15. Identifying program prioritiesIdentifying program priorities through qualitative investigationFocus groupsSteps in conducting a focus groupTroubleshooting in focus groupsAnalysis of focus group dataIdentifying program priorities using semi-structured interviewsIdentifying program priorities using surveysChapter summary and chapter checklist16. Program developmentPicking target groupsJournalistsYouthHealth professionalsMembers of community neighbourhoodsPolicePolicy makers and legislatorsChoosing a program approachCreating a program logic modelIncluding people who have experienced a mental illness in program deliveryFamililesUsing media wiselyWorking with external media expertsWorking with televisionWorking with radioWorking with the artsPilot testingChapter summary and chapter checklist17. Program monitoring and evaluationUsing qualitative data to monitor program implementationAssessing changeSpecification of program outcomesSetting performance targetsDevising and implementing a data collection planData management and analysisIdentifying lessons learnedEthical issues in evaluationCommunicating resultsChapter summary and chapter checklistBibliography and Suggested ReadingsThe Nature of StigmaEvaluation MethodsWorks CitedAppendix: Inventories of Stigma ExperiencesPersonal Experiences with the Stigma of Mental IllnessFamily Experiences with the Stigma of Mental IllnessAppendixIndex