פטריק קוריגן
TRANSCRIPT
Knowledge Database
• Presentation for the lecture of: Patrick Corrigan, USA
• Topic of lecture: Erasing the Stigma of Mental Illness: What Says the Dodo Bird?
• The lecture was given at the 6th International Conference on Disabilities Beit Issie Shapiro - Israel
• Year: 2015
Erasing the Stigma of Mental Illness
Patrick CorriganIllinois Institute of Technology
What Says the Dodo Bird?
STOP
What is stigma?
How might it be fixed?◦ Unintended consequences
Contact-based approaches
BLENDING◦ Social Cognitive Approaches◦ Health Services Research Approach
Goals
UNINTENDED CONSEQUENCES
Everybody has won and all must have
prizes!
Everything Works
Psychoanalysis
UnintendedConsequences
What do we do?
Cognitive Therapy
Social Justice
BEAT RACISM
X
DON’T ASKDON’T TELL
BEAT HOMOPHOBIA
Pope Francis I Inaugural MassMarch 19, 2013
“THE POOR!”“THE WEAK!”
“THE LEAST IMPORTANT!”
Pope Francis I Inaugural MassMarch 19, 2013
“THE POOR!”“THE WEAK!”
“THE LEAST IMPORTANT!”“Whatsoever you do to the least of my brethren, that you do unto me!” John
BESTOW
EMPOWER
WHAT IS STIGMA?
15
16
17
19
People with mental illness are homicidal maniacs
In the movies
20
21
22
People with mental illness are homicidal maniacs
In the newspapers
23
25
26
People with mental illness are homicidal maniacs
In advertising
27
30
31
People with mental illness are homicidal maniacs
In comics
32
35
Benevolence stigma
36
37
38
39
40
Trenton State Hospital has fire.
Has Stigma Changed?
DANGER
Phelan, Link et al
43
0%10%20%30%40%50%60%70%80%90%
100%
1956 1996
danger
Has Stigma Changed?
DANGER
Phelan, Link et al
44
0%5%
10%15%20%25%30%35%40%
1956 1996
danger
Has Stigma Changed?
DANGER
Phelan, Link et al
45
0%5%
10%15%20%25%30%35%40%
1956 1996
danger
Has Stigma Changed?
DANGER
Phelan, Link et al
46
0%5%
10%15%20%25%30%35%40%
1956 1996 2006
danger
47
Public stigma
Self-stigma
Label avoidance
Structural stigma
stereotype
prejudice
discrimination
Structures
-----------types-----------
48
STEREOTYPES◦All Irish Americans are drunks and beat their wives.
PREJUDICE◦That’s right. They’re drunks and I loathe them.
DISCRIMINATION◦So, don’t: hire, rent, or befriend them
49
STEREOTYPES◦People with MI are: weak, dangerous….
PREJUDICE◦They are bad because: scary, shameful.
DISCRIMINATION◦So, don’t: hire, serve, or rent to them
50
Public stigma
Self-stigma
Label avoidance
Structural stigma
stereotype
prejudice
discrimination
Structures
-----------types-----------
The Egregious Effects of Public Stigma:Its Impact on SOCIAL INCLUSION
Lost employment Subpar housing Worse health care
Worse educational opportunities Diminished legislative support Alienated faith communities
Coercive treatment
WORSE HEALTH CARE
PTCA: percutaneous transluminal coronary angioplasty Druss et al., 2000
You do not wipe away the scars of centuries by saying: Now you are
free to go where you want, and do as you desire, and choose the leaders
you please.
June 14, 1965
Affirming attitudes and actions
ERASING STIGMA IS NOT ENOUGH
People with mental illness recover.
They should determine all their goals and interventions to reach those goals.
Actions: ◦ Reasonable accommodations◦ Community supports
Affirming Attitudes
STOP
EASY STUFF:Just change the words!Just cure the disease!
Leprosy to Hansen’s Disease
Dementia to Alzheimer’s
Mental Retardation to Intellectual Disability
Mania to Bipolar Illness
Just Change the Words!
Japan: Seishin-Bunretsu-Byo to togo shitco sho
Korea: Jeongshin-bunyeol to Johyun-byung
Hong Kong: Jing Shen Fen Lie to Si Jue Shi Tiao
Singapore, China
The East Asian Experience
“mind split disease” “integration disorder”
“attunement disorder”“mind splitted disorder”
“dysfunction of thought and perception”
“splitting of the mind”
Sartorius et al., 2014
The Data◦ Japan: mixed findings (Takashi et al., 2009, 2011)◦ Relationship between name recognition and
recovery (Sato in preparation, 2014)◦ Hansen’s Disease (Oliveria et al., 2003; Van Brakel et al., in press)
Perpetuates the difference
Prejudice and discrimination more than words.◦ MODERN RACISM
.
Just Change the Words!
It Looks easy:
NIMH and other funders decrease supportAdvocacy groups: No longer a problem
KNOWLEDGE IS GOLD:Educate stigma away!
75% US school districts 43 countries
RESEARCH
Uncertain effects No effects RTI (1994) Cal Dept Ed (1995) U Maryland (1998)SIGNIFICANT effects APA (1999) Indiana U (1992)
Mental Illness is a Brain Disorder!
RECOVERY
Mental Illness is a Brain Disorder!
RECOVERY
HIRE THEM?RENT TO THEM?EQUAL HEALTH CARE?
Meta-Analysis: Knowledge and Stigma
Knowledge: Causal Beliefs Stigma: Acceptance
Sixteen representative samples of nation-defined populations
230 to 6000 Ss Response rates: 65-85%
Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
0
10
20
30
40
50
60
70
1990 1994 1998 2002 2006
SzDep
Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
Inherited/Genetic
META-ANALYSIS FINDINGS: CAUSE
0
10
20
30
40
50
60
70
80
1990 1994 1998 2002 2006
SzDep
Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
Brain Disease
META-ANALYSIS FINDINGS: CAUSE
0
10
20
30
40
50
60
1990 1994 1998 2002 2006
SzDep
Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
Co-worker
META-ANALYSIS FINDINGS: ACCEPTANCE
0
10
20
30
40
50
60
1990 1994 1998 2002 2006
SzDep
Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
Neighbor
META-ANALYSIS FINDINGS: ACCEPTANCE
PROTEST:The Pros and CONs!
72
Protest◦Review stigmatizing images
◦Shame on you for thinking that way
73
74
Beware the rebound effect
the white bear
Wonderland2000
NAMI - stigmabusters
The JASONUT
The CRAZY FACE
The SUICIDE SQUEEZE
Located in Campbell and San Jose California
Psycho Donuts: Tasteless
Join the national on-line food fight.
Help turn lemon donuts into lemonade.
Join the national on-line food fight.
Help turn lemon donuts into lemonade.
examiner.comI'm an advocate of equal rights and a more tolerant world toward all people of different races, religion, gender, and sexual orientation; but that is it. Any thing else is just moronic. Stan Rezaee, Aug, 2009
FRANCHISEOPPORTUNITIES
CONTACT vs EDUCATIONThe Pros and CONs!
81
Contact
“Meet Bob Lundin”
82
Bob’s story◦ My name is ______ and I have a severe
mental illness called schizo-affective disorder
◦ My childhood was not unusual…
◦ Unfortunately, my mental illness was traumatic. It did not go away quickly…
◦ Despite these problems, I have achieved several accomplishments.
Meta-Analysis:
Contact vs Education DV’s
◦ Overall◦ Attitudes◦ Behavior
> 38,000 Ss 79 studies; 13 RCTs
Corrigan, Michaels et al., 2012
Mean effect sizes: RCTs only
p<.05
attitudes0
0.1
0.2
0.3
0.4
0.5
0.6
educationcontact
*
***
***
k=136
Mean effect sizes:Pre-Follow-up
TargetedLocalCredibleContinuousCONTACT
TLC
87
Corrigan, 2011
Who should targets be?
TargetsLandlordsHealth care professionalsTeachersLegislators Employers
What is local?
LOCAL
x
CHICAGO: the heart and brains of Illinois
ILLINOIS
Does it play in
PEORIA?
CityNeighborhoodsWhat defines a neighborhood?
Faith-based communities
93
Local
94
Good stigma change credible
continuous
Contact with whom?
Example◦Military (PTSD)◦Other enlisted membersMarines from marinesSailors from sailors
Credible
95
Once is not enough
And cannot be carbon copies
Continuous
96
The GRAND PLAN
Come out everyone
Come out everywhere
the Grand Plan
Come out Mad
Come out Proud
Thurgood Marshall
Effect
COMING OUTPROUD
to erase the stigma of mental illness
LGBT agenda◦ Confusing◦ Objectionable
◦Honest, Open, Proud
What’s in an name?
CHICAGO
Passive
COMING OUT PROUD◦assertive
Disclosure?
Disease Identity
DONT BE A MENTAL PATIENT
Human Identity
EMBRACE WHO YOU ARE
Three Lessons
◦Consider the pros and cons of disclosing
◦There are different ways to disclose
◦Telling your story
Honest,Open,Proud program
2 RCTs
HOP Cntrl3.63.8
44.24.44.64.8
55.2
PrePost3-wk F-up
Disclosure Benefits
2X3 ANOVAF=4.70, p<.01
N=100Rusch et al., 2014
p<.05
HOP control HOP control9
10
11
12
13
14
15
16
17
prepostfollow-up*
*
**
HARMAPPLY
SELF STIGMA
*
Corrigan et al., in press
HOP control HOP control15
16
17
18
19
20
21
22
23
prepostfollow-up
± p<.10 * p<.05 ** p<.01
COPING RESOURCESSTIGMA HARM
**
+
+*
**
What are the pros and cons of disclosing?◦ Which vary by setting: work, vs family vs faith-
based comm
What are rarely safe ways to come out?
What is your story?
www.HOPprogram.org
Honest, Open, Proud
theADVOCATE’S AGENDA
“I must fight in the open!”
Clifford Beers - 1909
117
“Let our first act every morning be to make the following resolve for the day: I shall not fear anyone on earth. I shall fear only God. I shall not bear ill will toward
anyone. I shall not submit to injustice from anyone. I shall conquer untruth by truth. And in resisting untruth, I shall put up with all suffering. ”
Mahatma Gandhi
National Consortium on Stigma and Empowermentwww.ncse1.org
Honest,Open,Proud to erase the stigma of mental illnesswww.hopprogram.org