Stigma and Discrimination of Mental Illness

In “Physician Burnout Calls for Legal Intervention” (November-December 2019), Sharona Hoffman calls for a “requirement” in the form of a “mandate that health care employers measure physician wellness using the [Maslach Burnout Inventory] (or another reliable tool) and report outcomes to [the Centers for Medicare and Medicaid Services]” (p. 9). Such a requirement would be unlawful under the Americans with Disabilities Act’s rules on prohibited medical examinations of employees.

Sharona Hoffman’s response to my letter states “employers may require periodic job-related medical examinations of all employees ‘in positions affecting public safety.’ As I argued in my commentary, doctors, to whom patients entrust their health every day, have safety-critical jobs.”

This comparison is inapt. As Ilene N. Moore, Screening Older Physicians for Cognitive Impairment: Justifiable or Discriminatory, 28 HEALTH MATRIX 95, 140 (2018) recently explained: “any interpretation suggesting that that physicians are in a position affecting public safety is not supported by the statutory language of the ADA, the EEOC Enforcement Guidance, or EEOC correspondence. Only one federal law defines some physicians as public safety officers: physicians who serve as part of a public rescue squad or ambulance as defined by the Omnibus Crime Control and Safe Streets Act of 1968.” (internal citations omitted).

Eating disorders in males are understudied, underrecognised and misunderstood. Despite evidence that males constitute 25-33% of diagnoses of anorexia and bulimia nervosa, and up to 50% of diagnoses of binge eating disorder, limited research has focused on the “male experience” of eating and body image concerns. In addition, researchers and clinicians have only recently begun to focus on the role that muscularity plays in males with eating and body image psychopathology. We present evidence that disordered eating behaviours are increasing more rapidly in men than in women, particularly with regard to binge eating. We further present a clinical comparison of men with anorexia nervosa and muscle dysmorphia (“reverse anorexia”) and review community-held attitudes and beliefs about people with these conditions. We conclude with a discussion of clinical treatment guidelines for males with eating disorders. This workshop will (1) present an overview of the evidence base pertinent to males with eating disorders, (2) evaluate evidence for the prevalence of disordered eating amongst males, compare the phenomenology of muscle dysmorphia and anorexia nervosa, and review the stigmatization of males with anorexia nervosa and muscle dysmorphia. Finally, this workshop 3) details treatment guidelines for clinicians working with males.

Baril, Alexandre (2018). « Conférence d’honneur : “Vivre avec” la mort : développer une éthique de la reconnaissance et de la responsabilité envers les personnes suicidaires », The Poetics and Ethics of “Living With”: Indigenous, Canadian and Québécois Feminist Production Today/Les poétiques et éthiques du « vivre avec » : Productions féministes autochtones, canadiennes et québécoises de nos jours, Colloque organisé par le Canadian Literature Centre of the University of Alberta, Banff Centre, Banff, 13 octobre.

Meritocratic worldviews that stress personal responsibility, such as the Protestant ethic or general beliefs in a just world, are typically associated with stigmatizing attitudes and could explain the persistence of mental illness stigma. Beliefs in a just world for oneself ("I get what I deserve"), however, are often related to personal well-being and can be a coping resource for stigmatized individuals. Despite these findings in other stigmatized groups, the link between worldviews and the stigma of psychiatric disorders is unknown. We measured just world beliefs for self and others as well as endorsement of the Protestant ethic in 85 people with schizophrenia, schizoaffective or affective disorders and 50 members of the general public. Stigmatizing attitudes toward people with mental illness (perceived responsibility, perceived dangerousness, general agreement with negative stereotypes) were assessed by self-report. Using a response-latency task, the Brief Implicit Association Test, we also examined guilt-related implicit negative stereotypes about mental illness. We found a consistent positive link between endorsing the Protestant ethic and stigmatizing self-reported attitudes in both groups. Implicit guilt-related stereotypes were positively associated with the Protestant ethic only among members of the public. Among people with mental illness, stronger just world beliefs for self were related to reduced self-stigma, but also to more implicit blame of persons with mental illness. The Protestant ethic may increase (self-)stigmatizing attitudes; just world beliefs for oneself, on the other hand, may lead to unexpected implicit self-blame in stigmatized individuals. Public anti-stigma campaigns and initiatives to reduce self-stigma among people with mental illness should take worldviews into account.

Purpose: Community Health Centres (CHCs) are an essential component of primary health care (PHC) in Canada. This article examines health providers’ understandings and experiences regarding stigma toward mental health and substance use (MHSU) issues, as well as their ideas for an effective intervention to address stigma and discrimination, in three CHCs in Toronto, Ontario.
Methods: Using a phenomenological approach, we conducted twenty-three interviews with senior staff members and peer workers, and three focus groups with front-line health providers. A hybrid approach to thematic analysis was employed, entailing a combination of emergent and a priori coding.
Results: The findings indicate that PHC settings are sites where multiple forms of stigma create health service barriers. Stigma and discrimination associated with MHSU also cohere around intersecting experiences of gender, race, class, age and other issues including the degree and visibility of distress. Clients may find social norms to be alienating, including behavioural expectations in Canadian PHC settings.
Conclusions: Given the turmoil in clients’ lives, systematic efforts to mitigate stigma were inhibited by myriad proximate factors that demanded urgent response. Health providers were enthusiastic about implementing anti-stigma/recovery-based approaches that could be integrated into current CHC services. Their recommendations for interventions centred around communication and education, such as training, CHC-wide meetings, and anti-stigma campaigns in surrounding communities.

Higher income societies have moved from institutional to community-based care for people experiencing mental illness. However, stigma and discrimination persists and undermines help-seeking, recovery and life chances. Mental illness prevalence is higher amongst communities that face multiple prejudices and disadvantages within society, including black and minority ethnic communities who may experience migration trauma, racism, acculturation and adverse social circumstances. This study examines beliefs, stigma and the effectiveness of existing national mental health campaigns with Pakistani, Indian and Chinese heritage communities in Scotland, UK, using community based participatory research. Community organisers were trained and supported to co-facilitate focus groups with 87 people using a range of languages. Whilst diversity within and between communities was apparent, important trends emerged. People with mental illness experience high levels of stigma from communities. Families experience significant associated stigma. This shame combines with culturally inappropriate services to reduce help seeking from mental health services, friends and families. Existing anti-stigma campaigns have failed to reach or engage with communities due to a combination of practical issues such as the use of inappropriate language, imagery and media, but also due to assuming western medical concepts of illness. Participants suggested a new model for national campaigns placing greater emphasis upon community development, cultural events, positive contact and dialogue with families, faith leaders and youth groups. National anti-stigma programmes must develop more effective partnerships with communities or risk magnifying existing inequalities.Despite a range of national programmes to address stigma towards people with mental illness, it remains as the major barrier to social inclusion for people with mental illness living in communities. Stigma is particularly severe if people have a mental illness and are also economically disadvantaged or face multiple stigmas. By adopting Community Based Participatory Research (CBPR) approaches with three black and ethnic minority communi- ties in Scotland, this study makes the case that stigma can only be understood and effectively addressed with reference to its socio-cultural context.

Sexualidade de indivíduos com histórico psiquiátrico e que estão internados em uma Instituição Psiquiátrica, que loucura é essa ? Será que esta sexualidade existe? Os profissionais da área, como a encaram ? A sociedade, como olha estes indivíduos e sua sexualidade? E os pacientes, como vêem e representam sua sexualidade ?
... meu olhar perdido, atravessa minha sexualidade que repousa sem sentido entre minhas mãos ... Marcadas mãos ... contidas, pelas vossas ordens ... vossos recalques ...
Apesar de se discutir muito sobre tais questões, poucas soluções efetivas têm sido apresentadas de forma a desenvolver e/ou promover condições e programas, que possam permitir um avanço concreto do processo de educação sexual, ou ainda a criação de grupos de discussão entre os pacientes à respeito de sua sexualidade.
A atividade sexual entre pacientes psiquiátricos institucionalizados tem sido tema de grande preocupação entre os profissionais de saúde mental. Contudo, pouco se conhece e se discute realmente sobre a sua sexualidade. Preocupado em conhecer os processos determinantes desta sexualidade, para melhor compreender estes sujeitos, buscamos através das representações sociais daqueles que passam pela experiência de internação em uma Instituição Psiquiátrica, o amálgama para melhor entendê-los e contextualizá-los.

Although FASD is first and foremost a health issue, it is a consideration in the justice system because individuals with FASD have contact as victims, witnesses and offenders. This chapter will draw on research with justice professionals to argue that there is an ethical need, and indeed an obligation, for appropriate training to better prepare police to work with clients that have FASD. By illustrating the ways in which many frontline workers misunderstand FASD, coupled with the stigma associated to FASD, this chapter argues that individuals with FASD have unique needs and the stakes in the justice system are simply too high to not have appropriate training in place to meet those needs.

Aim. The purpose of this study was to compare the frequency of social stigma experiences reported by patients with schizophrenia and by people with other health problems. Method. The stigma subscale of the Consumer Experiences of Stigma Questionnaire (CESQ) was administered to patients with schizophrenia (n=153), recurrent depression (n=31), drug dependence (n=30), alcohol dependence (n=39), hematological malignancies (n=31), or cardiovascular disorders (n=33). Results. Multiple regression analysis showed that schizophrenia patients experienced stigmatization signifi cantly more often than did respondents diagnosed with hematological malignancies or cardiovascular disorders. Moreover, patients with schizophrenia were found to experience stigma at a level similar to that in patients with depression or alcohol dependence, but lower than that experienced by drug addicts. Conclusions. The study fi ndings confi rm that the stigma of schizophrenia is stronger than that associated with physical illnesses. However, people with schizophrenia were not found to experience stigmatization more often than people with other severe mental disorders.

This text examines the contemporary conceptualisation of the term 'Outsider art' with reference to an exhibition at The Ian Potter Museum of Art, Melbourne and the international conference 'Contemporary Outsider Art: The Global Context', 23-26th October that took place at The University of Melbourne.

Stigma is an important barrier to seeking psychological services worldwide. Two types of stigma exist: public stigma and self-stigma. Scholars have argued that public stigma leads to self-stigma, and then self-stigma is the primary predictor of attitudes toward seeking psychological services. However, this assertion is largely limited to U.S. samples. The goal of this research was to provide a first step in understanding the relationship between public stigma, self-stigma, and attitudes toward seeking psychological services in international contexts (N = 3,276; Australia, Brazil, Canada, Hong Kong, Portugal, Romania, Taiwan, Turkey, United Arab Emirates, and United States). Using structural equation modeling, we found that self-stigma mediated the relationship between public stigma and attitudes toward seeking services among college students in each country and region. However, differences in path strengths emphasize the need to pay attention to the role of public and self-stigma on...

The purpose of the research that forms the basis of this report is to: • explore the issue of self-stigma (often called internalised stigma) from the perspective of people with experience of mental illness • investigate the causes and effects of self-stigma • discuss means of combating self-stigma amongst people with experience of mental illness. As a public health-funded piece of research for the Like Minds, Like Mine programme to counter stigma and discrimination associated with mental illness, this work directly contributes to approach six of the programme’s national plan for 2007–2013 (Ministry of Health 2007). The findings of this work will help national and regional Like Minds, Like Mine providers to address self-stigma through resource development, education, and training initiatives.

Aim

As the population ages, the problem of dementia increases and affects a growing number of people. People with mental illness are known to be stigmatised and this has been the subject of numerous studies. There have been contradictory studies assessing the stigma attached to dementia, and the majority focus on stigma at a social level and the public perception of people with dementia. There have been a number of projects that included a study group of people with dementia. However, to date, this topic has not been discussed in Poland. Hence, the aim of this paper is to carry out a literature review addressing this issue.

Perspective

The problem of stigma attached to dementia is particularly significant as it affects not only the subject, but also their family, friends and health professionals. As people with dementia develop cognitive impairment and lose their independence, stigmatisation leads to their social isolation, despite their need for care. Stigma has emotional, behavioural and social implications, including diminished self-esteem, a feeling of anxiety and the development of a sense of shame and a fear of the judgement of others. Family members also deal with the stigma, which manifests itself as embarrassment and anxiety and causes their circle of friends and acquaintances to decrease. Current studies show that professionals can also play a negative role in the process of labelling and stigmatisation of patients.

Conclusion

Stigma is a serious and common problem in dementia. It seems necessary to target this issue in research and social discourse.

The present paper will summarize successive paradigms for the management of mental health, and critique the current dominant approach in Canada. Of particular note, the problems of diagnostic stigma, rigidity, and undervaluation of larger social and structural issues will be critiqued. Finally, adjustments to our current approach and novel strategies will be suggested, as well as some hints toward a society more conducive to mental health. While contemporary psychiatry represents an efficient and moderately effective strategy, it is ultimately working against fundamental flaws in our society; adapting traditional and wholly novel practices may improve efficacy, while we work toward a saner world.

In this study, we explored stigma by association, family burden, and their impact on the family members of people with mental illness. We also studied the ways in which family members coped with these phenomena. We conducted semistructured interviews with 23 immediate family members of people with
mental illness. Participants reported various experiences of stigma by association and family burden. Social exclusion, being blamed, not being taken seriously, time-consuming caregiving activities, and exhaustion appeared to be the predominant
forms of stigma by association and family burden experienced by the participants. The participants used problem-focused and emotion-focused coping strategies, separately or simultaneously, to cope with the negative impact of stigma by association and family burden. The results suggest that family members should have access to services to address these problems. Social, instrumental, and emotional support should be given to family members by community members and mental health professionals.

This article presents the result of research on the perceptions about the
meanings, causes, symptoms and treatments of mental disorders in contemporary Timorese society. To this end, semi-structured interviews were conducted with 48 matan-dook – healers, doctors and mediators between the world of the living and the world of the dead by ancestral customs and practices – in the municipalities of Aileu, Ainaro, Dili, Liquiçá, Los Palos, Maliana, Manatuto, Manufahi and Viqueque. In general terms, mental disorders would have a somatic-psychic-spiritual character and would be the consequence of actions perceived as deviant from the socially established norm, constituting a rupture in the conception of harmony and social order.

Este artigo apresenta o resultado da pesquisa acerca das percepções sobre os significados, causas, sintomas e tratamentos dos transtornos mentais na sociedade timorense contemporânea. Para tal, foram realizadas entrevistas semiestruturadas com 48 matan-dook – curandeiros, médicos e mediadores entre o mundo dos vivos e o dos mortos, de acordo com os costumes e práticas ancestrais – nos municípios de Aileu, Ainaro, Dili, Liquiçá, Los Palos, Maliana, Manatuto, Manufahi e Viqueque. Em termos gerais, os transtornos mentais teriam um carácter somático-psíquico-espiritual, e seriam a consequência de ações percebidas como desviantes da norma socialmente estabelecida, constituindo-se em uma ruptura na concepção de harmonia e ordem social.

Stigma toward individuals with eating disorders is common and well-documented. Individuals with eating disorders regularly report experiencing stigma associated with perceptions that they are to blame for their illness, that their illness is trivial compared to other conditions, or that they are engaging in disordered behavior to gain attention. These stigmatizing attitudes toward eating disorders are also reported by the general public and healthcare professionals, including those who treat eating disorders. Treatment of these illnesses at all levels of care often include paternalistic approaches such as coercion and compulsion that can have both adverse and advantageous consequences. While there are ethical, clinical, and legal justifications for these treatment approaches, this study provides a novel exploration of the relationships between stigma toward individuals with eating disorders and coercive and compulsive treatment. This was accomplished using a survey methodology to assess the attitudes and treatment practices of treatment providers across the United States. The results of this study suggest that there is no significant relationship between treatment providers’ attitudes toward individuals with eating disorders and coercive or compulsive treatment methods. Implications for clinical practice and future research are discussed and center on the need for additional inquiry to better understand the complexities of these two variables in light of the ongoing debate concerning the risks and v benefits of coercive and compulsive treatment.

Gendered perceptions of the stigma associated with mental health care, an analysis of the social construction of gender and mental health care stigma, exploration of intersectional issues, and proposed solutions to reducing and eliminating stigma.

Men and women have their differences. In recent times, we have come to respect our differences more. In health, our differences may be a matter of life and death. Research has shown that women are more likely than men to visit the doctor or hospital (Payne, 2006, p. 76). Is this due to women having more health problems or a higher degree of openness to seeking and receiving treatment? In the field of mental health, the data is striking. Men are far less likely to seek counseling than women (Cox, 2014), especially if they are depressed or suicidal. According to Cox, this may be due to self-stigma, gender role conflict, and psychological openness (2014).

Whatever the reasons are, it is as pervasive as it is dangerous. A slew of recent mass shootings perpetrated by mentally ill individuals has recharged the national conversation about mental health stigma. People do seem to be discussing it as a national priority, but what can be done? First, it must be understood. Where is the stigma coming from? Who or what is perpetuating it? How does it relate to the social construction of gender? There is a strong likelihood that mental health stigma is even held and perpetuated amongst medical practitioners, counselors, and those in medical and mental health. What could that mean for potential mental health patients?

Social and perceived stigma are dangerous and destructive, and prevent people from seeking treatment. Psychological symptoms of mental illness are seen as threatening and uncomfortable, and cause people to treat those with mental illness and dangerous or unpredictable pariahs. This paper will explore these issues, especially from a gendered lens, and pose both explanations and proposed solutions to combating the epidemic of stigma.

This research work identifies and suggests relationships between mental illness and adult animated TV series, produced by television streaming platforms, specifically I address mental illness in the original Netflix series BoJack Horseman. In the methodological approach, carried out from the field of cultural studies, auto ethnography, visual research and seriality studies are mixed to account for the coexistence, which could be said to be necessary, of mental illness as a lived experience —in this case, of a woman and her family—, with that of mental illness as an animated experience — of fiction, starring a horse—, a coexistence in which the presence of women is, in my opinion, a key part in explaining what the critics, specialists and followers consider one of the achievements of the TV series: treating mental illness avoiding common stigmas, and doing it in a transmedia and transnational media environment.
The inclusion of mental illness in the television productions of Netflix, HBO and Amazon has increased in the last ten years, along with mental illness as an institutionalized and medical experience in companies and universities, beyond the family context. BoJack Horseman is one of the productions that treats mental illness as an experience in which numerous people who are diagnosed with mental disorders, to varying degrees, are recognized. In the series, most of the characters that are diagnosed are women, of the same genealogical line who share genetic inheritance and question the meaning of life, motherhood, abortion, success and happiness. What I suggest is that the animated women in the series had everything to do with the team of female directors, creators, filmmakers, producers and illustrators who were part of BoJack Horseman and who reoriented and modified their own diagnoses of mental illness, and took them to their creative works in a therapeutic and public process, which broadened the discussion about mental illness on the television screen and outside of it. From the field of cultural studies, this observation is about women who took agency over their own mental illness diagnoses.
Keywords: mental illness, BoJack Horseman, Netflix, media cultures, agency-women.

People with mental illness are not the sole recipients of stigmatisation; their immediate family members may be subjected to stigma by association. Through semi-structured interviews, we investigated experiences of stigma by association among 23 immediate family members of people
with mental illness. Participants reported experiencing stigma by association from community members, mental health professionals, and civil servants. Familial relationship, co-residence, and the gender of participants appeared to play a role in their stigma experiences; parents and spouses
reported different manifestations of stigma by association than siblings and children, participants who lived together with their family member with mental illness reported increased experiences of stigma by association, and in contrast to male participants, female participants reported others thinking they are overprotective and as such perpetuated, maintained, or sustained their family members’ mental illness. The relevance of these factors points to the need for tailored education and emotional support provision to family members of people with mental illness. Moreover, inservice training for mental health professionals should include the development of relevant social skills that enable the recognition of familial relationships and roles, and family members’ fears, concerns, and problems.

Self-stigma detracts from the wellbeing, self-esteem, and social connectedness of adults with mental health disorders. Although emerging research has indicated that self-stigma may have similar consequences for parents of children with mental health disorders, currently we lack a comprehensive description of how parents experience self-stigma. To address this, we investigated parents' lived experiences of self-stigma using a descriptive qualitative approach. Directed by interview questions informed by a parent-based participatory action research group (n = 4), we conducted individual semi-structured interviews with 12 parents of children (aged 5–13) diagnosed with emotional and/or behavioural disorders. Data obtained from interviews with 11 mothers was coded and thematically analysed. Five themes were found: (1) the 'good parent' ideal, (2) awareness of external stigma, (3) outcomes of external stigma (social avoidance and self-doubt), (4) self-stigma (believing self-doubt and external stigma), and (5) refuting self-stigma. Our findings show that parents of children with mental health disorders experience self-stigma. However, because it leads to a diminished sense of being a good parent, the self-stigma is of a different type to that which has been described for adults with mental illness. This has important implications for the conceptuali-sation and assessment of parent self-stigma as research in this area moves forward.

“I regret that only now, in my last annual meeting speech, am I telling you about my own struggles. My fear of being judged negatively and the dark shadow of stigma nearly kept me from seeking help.”

2018 Association of American Medical Colleges President and CEO Darrell Kirch, MD

The aim of this study was to investigate how individuals;who had been victims of school bullying;perceived their bullying experiences and how these had affected them;and to generate a grounded theory of being a victim of bullying at school. Twenty-one individuals;who all had prior experiences of being bullied in school for more than one year;were interviewed. Qualitative analysis of data was performed by methods from grounded theory. The research identified a basic process of victimising in school bullying;which consisted of four phases: (a) initial attacks;(b) double victimising;(c) bullying exit and (d) after-effects of bullying. Double victimising refers to a process in which there was an interplay between external victimising and internal victimising. Acts of harassment were repeatedly directed at the victims from their social environment at school – a social process that constructed and repeatedly confirmed their victim role in the class or the group. This external victimising affected the victims and initiated an internal victimising;which meant that they internalised the socially constructed victim-image and acted upon this image;which in turn often supported the bullies’ agenda and confirmed the socially constructed victim-image. The findings also indicate the possible positive effect of changing the social environment.

The aim of this thesis is to find out why integrating art therapy for depression in museums is in its infancy stage despite its relevance to the social inclusion model in museum education and the therapeutic role of the modern museum. The research explores the different types of barriers for the incorporation of art therapy for people with depression, classified in four areas: museums, art therapy, mental health and education. Moreover, the potential relationship between museums and therapy, as identified by the key stakeholders, is presented.

Keywords: museums, art therapy, depression, mental health, social inclusion, education

The present research traces the ideas of madness and divine madness, together with their differences and similarities, through the Black Books of Swiss psychologist and psychiatrist Carl G. Jung (1875-1961). The Black Books, which were published in 2020, are the manuscript notebooks in which Jung documented his fantasies between 1913 and 1932, as part of his self-experiment with the collective unconscious. Jung’s Red Book, more well-known and published in 2009, was based on the entries written in the former.
Firstly, the thesis elaborates on the character of Jung and how his upbringing and personal life led him to the writing of the Black Books, the Red Book, and how this shaped his later professional work. Secondly, the concept of madness is discussed as a construct in Western History. In the discussion, some of history’s many theories and narratives in which madness has been constructed and conceptualized are presented. This follows a red thread through history in the uncovering of the historical idea of madness and its connection to the divine, one which is weaved intricately through ancient myth, philosophy and medicine, religious lore, the subjective tales of those who lived through it, and the works of those who sought its rationalization and objectivization. The historical contextualization of (divine) madness then forms the framework in which Jung’s understanding of madness and divine madness is explained and presented in his Black Books, Red book, and professional work. This journey takes the reader through Jung’s own “myth” – one filled with moments of struggle, fear, hesitation, but also bliss, insight, and psychological healing. It is through the Black Book fantasies, the Red Book’s commentary, and his professional work that the understanding of Jung’s concept of madness and its divine counterpart becomes visible - an understanding based on the principle of balance, self-discovery, and creative expression. As a last step before the conclusion, it goes deeper on the connection between madness and creativity in Jung’s work, as well as, current academic research. In the conclusion, it is then explained how the idea of ‘madness’ – which has been used in Western history and medicine as a term for the demarcation of a broad scope of so called abnormal mental states (psychopathology) – is challenged by Jung’s work. According to a Jungian understanding, ‘madness’ is argued as only applicable to those mental states in which the experiencer suffers as a result of said mental state to the extent that one’s life is significantly impaired. ‘Divine madness,’ on the other hand, is argued as more akin to genuine religious experience, devoid of personal psychopathology. In addition, the present research presents an understanding in which the potentiality of divine madness lays hidden within pathological madness – a potentiality which can be revealed through the psychological healing on the road towards self-discovery.

Background: Although there is a substantial body of research on the stigma associated with mental illness, much of the extant research has not explicitly focused on the concept of prejudice, which drives discriminatory behaviour. Further, research that has investigated prejudice towards people with mental illness has conceptual, theoretical and psychometric limitations. To address these shortcomings, we sought to develop a new measure, the Prejudice towards People with Mental Illness (PPMI) scale, based on an improved conceptualisation and integration of the stigma and prejudice areas of research.

The label of mental illness is a demonizing indictment which gives power to one group [of professionals] over another [patients and caregivers], by way of its ability to pathologize human behavior. What is the basis of this nomenclature and how accurately can it map human distress? Does this categorization serve any purpose besides creating categories that then become ‘treatable’ via pharmaceutical interventions? Does it really end up treating people and help them reclaim their lives in any manner? From a social constructionist perspective this paper offers a critique of the current DSM based knowledge, and questions the hegemony of professionals in dealing with situations beyond their control.

Few attempts have looked beyond the effects of witchcraft related stigma to consider the socio-cultural factors that shape the experience of development disorders, particularly for Autism Spectrum Disorder (ASD). Common patterns of beliefs about the cause of developmental disorders exist across societies, and illnesses, but accusations of witchcraft do not exist in all regions where these beliefs occur.  Globalisation stressors, such as urbanisation and poverty are known facilitators of stigma,  but context specific constructions and meanings ascribed to individuals also influence the resulting stigma processes; however their interactivity are not fully understood. Conducting this study found that most autism-related stigma literature neglects to sufficiently incorporate understandings of stigma as being embedded in local cultural value systems.  This thesis therefore calls to improve collaborations between social development and heath policy-making to address this gap; specifically to provide culturally relevant policy and health intervention strategies to those in need. Whilst the existing paucity of data make this thesis inadequate for accurately analysing patterns, the significance of this research lies not only in its pioneering interpretations but also its aims to identify areas for further data gathering and analysis.

Nowadays in Japan, ignorance, prejudice and discrimination towards individuals with a mental disorder, a concept here defined as “stigma”, is relatively strong and therefore regarded as a serious problem in today’s society. In this thesis, I aim to approach the roots and background of this problem from a cultural historical perspective. Consequently, stigmatization of the mentally disordered will not be researched from a psychological viewpoint, but by looking at cultural tendencies and historic events in Japan before 1868. Hence the research question that this dissertation addresses: throughout premodern Japanese history, how were people with a mental disorder (mis)treated, and how was this stigmatization or non-stigmatization represented in and influenced by culture, especially literature?

Not few prominent scholars have dwelled on the topic of “madness”, as mental disorders have often been called, taking into account both historical and cultural aspects of the phenomenon. Nevertheless, the stigmatizing attitude and behavior of the Japanese towards “lunatics” or “the mad” has not been documented thoroughly. Moreover, the word “stigma” has only recently entered the Japanese vocabulary in the form of a newly coined foreign word. Because of its virtual absence in previous academic work, I focus primarily on key words characterizing types of stigmatization. Furthermore, I indirectly extract manifestations of stigma from various sources to reconstruct changes in stigmatizing attitudes and behavior throughout premodern Japanese history. As far as I am aware, this is the first attempt of researching stigmatization surrounding mental disorders from a cultural historical perspective instead of “madness” as a subject in itself.

First of all, the rather abstract concepts of “mental disorder” and “stigma” need to be defined, after which I give an explanation for their use throughout this research paper. Based on several surveys, I will then demonstrate how people with a mental disorder are stigmatized around the world, and in particular in Japan, as well as the negative effects and problems this type of stigma causes. Concerning the topic of mental disorders and “madness”, I provide in chapter two a concise overview of the state of the art in the West as well as in Japan, followed by an explanation of the research method and the applied methodology, i.e. the dichotomous concepts of hare and ke as introduced by Yanagita Kunio.

The third chapter is the main part consisting of three subchapters, each chronologically describing the stigmatization of individuals with a mental disorder during a specific era in premodern Japanese history. Every subchapter illustrates (non-)stigmatization by giving examples borrowed from various domains, or historic and cultural sources. In the first subchapter, I will explain the general vision on “madness” during ancient times in Japan. By analyzing and interpreting works on “madness” in representative classical literature, I link the relatively positive attitude towards people with a mental disorder to certain concepts prevalent in indigenous Shinto religion. The second subchapter introduces several examples from literature, in particular from the theatrical arts in Medieval Japan. I discuss how the general vision of “madness”, previously based on religion, undergoes a transition towards a more stigmatizing attitude provoked by a secularization of the Japanese society on one hand, and preserves a highly stylized, still non-stigmatizing form of “madness” confined to the field of arts on the other hand. The third subchapter describes the background against which stigmatization is reinforced during early modern times in Japan. I explain the important role both progress in medicine and folk belief played simultaneously. Apart from an overview of laws used to restrict the freedom and rights of people with a mental disorder, examples of non-stigmatization will be discussed as well.

Throughout this thesis, the genesis, history and transformation of mental stigma in Japan will be explained by means of several examples illustrating the general conception of “madness” for every premodern period. The coherence of transitions in those conceptions will become clear by constant reference to the applied methodology of hare and ke. The fourth chapter will abstract the examples and provide a summarizing explanation for the strong existence of discrimination, ignorance and prejudice towards the mental disordered in Japan. The concluding remarks are followed by the bibliography and appendices.

In 2017, a National Task Force on Lawyer Well-Being comprised mostly of representatives from lawyer assistance programs (LAPs) issued a report recommending “modify[ing] the rules of professional conduct to endorse well-being as part of a lawyer’s duty of competence.” This Article evaluates one of the premises underlying the report’s recommendations: “[t]o be a good lawyer, one has to be a healthy lawyer.” A review of medical studies and evidence offered by LAPs and others in support of these claims indicates that there is no empirical evidence that substance use and other mental health disorders “are leading causes of malpractice suits and ethical disciplinary actions against attorneys.” Further, medical evidence strongly suggests that many lawyer well-being interventions currently being proposed offer little to no mental health benefits and are more likely to prevent than encourage treatment engagement.

This Article then evaluates professional well-being (or wellness) policies, communications, and ideology, focusing specifically on discrimination based on mental health disorders and disabilities. It contends that lawyer well-being policies and communications are likely to result in biased appraisals of lawyers under the American Bar Association’s Model Rules of Professional Conduct 1.1, 1.16(a)(2), and 8.3(a), and act as a subterfuge for violating the Americans with Disabilities Act. It also discusses the potential for well-being policies to create and sustain hierarchy, and result in discretionary systems of discipline and social control over the private conduct of legal employees. Finally, it concludes with recommendations to reinforce the employment rights of legal employees; eliminate the role of LAPs and associated entities in providing education about mental health and well-being; improve protections from unwarranted mental health inquiries and evaluations; and reject lawyer well-being policies and derogatory rhetoric that put people with mental health disorders and disabilities down.

Introduction
Alcoholism is mentioned as one of the most important social problems, and alcohol dependent persons are socially excluded and stigmatised. The aim of the discussed study was to evaluate the perception of alcohol dependent persons starting outpatient treatment, as well as to consider whether alcohol dependent persons and outpatient clinics are subjects of the social stigma. Evaluation was performed on patients and therapists at two outpatient alcohol treatment clinics in Warsaw and the local community.

Materials and methods
The qualitative research methodology was used. Interviews with a standardised list of desired information were applied to therapists and patients. In two different communities 64 interviews were conducted.

Results
In the respondents’ opinion, alcohol dependent persons are stigmatised. The discrediting attributes are alcohol drinking, maintaining abstinence and alcohol treatment in outpatient clinic. The general image of alcoholics consists in low social and financial status, neglected appearance and lifestyle. Taking treatment is the last resort, because it is the moment that the label alcoholic adheres to a drinker. It is strengthened by the therapist who diagnoses alcohol addiction. Despite attempts to correct the stigma through therapy and changes in lifestyle, the general image of alcoholics does not change. This label remains even after the end of treatment. Patients fear that disclosure of treatment will label their families. In the opinion of therapists, the stigma also affects the workers of the outpatient clinics as employees of worse category institutions. The neglect of the addiction treatment sector is a clear manifestation of this labelling.

Streszczenie

Wprowadzenie
Alkoholizm traktowany jest jako jeden z ważniejszych problemów społecznych, a osoby uzależnione są społecznie wykluczone i stygmatyzowane. Omawiane w artykule badanie miało na celu ocenę postrzegania osób uzależnionych od alkoholu, które podjęły leczenie, ocenę postrzegania systemu leczenia uzależnień, jak również rozpoznanie, czy osoby leczące się i same placówki podlegają społecznej stygmatyzacji. Oceniającymi byli pacjenci i terapeuci dwóch placówek leczenia uzależnień: z wielkiej aglomeracji, tj. z Warszawy, i ze społeczności lokalnej.

Materiał i metoda
W badaniach zastosowano metodologię jakościową, technikę swobodnego wywiadu ze standaryzowaną listą poszukiwanych informacji. Narzędziami badawczymi były dwa rodzaje dyspozycji do wywiadów – dla terapeutów i pacjentów poradni. W dwóch placówkach funkcjonujących w odmiennych społecznościach przeprowadzono 64 wywiady.

Wyniki
W ocenie badanych osoby uzależnione od alkoholu są stygmatyzowane. Atrybutem dyskredytującym jest zarówno picie, utrzymywanie abstynencji, jak i leczenie w poradni odwykowej. Wizerunek osoby uzależnionej od alkoholu związany jest z niskim statusem społecznym i majątkowym, wyglądem oraz stylem życia. Podjęcie leczenia traktowane jest przez osobę uzależnioną jako ostateczność, gdyż dopiero wtedy otrzymuje etykietkę alkoholika. Tę etykietkę utrwalają terapeuci, stawiając diagnozę uzależnienia. Mimo prób korekty piętna przez udział w terapii i zmianę stylu życia, obraz społeczny osoby uzależnionej nie ulega poprawie. Etykietka alkoholika utrzymuje się nawet po zakończeniu leczenia. Badani obawiają się, że przez ujawnienie faktu podjęcia leczenia ich najbliżsi również będą stygmatyzowani.
W ocenie terapeutów stygmatyzacja dotyka także pracowników lecznictwa uzależnień jako osób zatrudnionych w instytucjach gorszej kategorii. Widocznym przejawem stygmatyzacji jest zaniedbanie tych placówek.

Objective. To examine whether self-stigma of seeking psychological help and being male would be associated with an increased likelihood of having an undiagnosed eating disorder.

Method. A multi-national sample of 360 individuals with diagnosed eating disorders and 125 individuals with undiagnosed eating disorders were recruited. Logistic regression was used to identify variables affecting the likelihood of having an undiagnosed eating disorder, including sex, self-stigma of seeking psychological help, and perceived stigma of having a mental illness, controlling for a broad range of covariates.

Results. Being male and reporting greater self-stigma of seeking psychological help were independently associated with an increased likelihood of being undiagnosed. Further, the association between self-stigma of seeking psychological help and increased likelihood of being undiagnosed was significantly stronger for males than for females.

Discussion. Perceived stigma associated with help-seeking may be a salient barrier to treatment for eating disorders – particularly among male sufferers.