Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.

Click to enlarge

Price: $29.95

Format:
Hardback 304 pp.
6.125" x 9.25"

ISBN-10:
0199797633

ISBN-13:
9780199797639

Publication date:
May 2012

Imprint: OUP US

Share on Facebook

Paradigms Lost

Fighting Stigma and the Lessons Learned

Norman Sartorius, Heather Stuart and Julio Arboleda-Florez

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.

Readership : Psychiatrists, epidemiologists, human rights activists, medical specialists dealing with stigmatized diseases (e.g. leprosy, tuberculosis, venereal diseases, AIDS), public health specialists, psychiatric social workers, psychologists, psychiatric rehabilitation and occupational specialists, consumer organizations, sociologists.

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
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
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
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
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
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?
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
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
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
10. Paradigm 9: Campaigns are an excellent way of reducing stigma
The cause de jour
Can 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 illness
Forced confinement and treatment
Anti-psychiatry sentiments
Violence and unpredictability
An illness like any other?
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
Can community projects make a population difference?
13. Summary of Part 1
Implications for anti-stigma programming paradigms lost
14. Getting going
Introduction
Developing a program committee
Creating an advisory committee
Setting clear goals
Creating interest
Acquiring and monitoring resources
Writing a successful funding application
Chapter summary and chapter checklist
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
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
Famililes
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
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

There are no Instructor/Student Resources available at this time.

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. 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.

The Mark of Shame - Stephen P. Hinshaw
Shunned - Graham Thornicroft
Living with Mental Illness - Edited by Stephen P. Hinshaw
Voices from the Inside - Edited by David A. Karp and Gretchen E. Sisson
Every Family in the Land - Edited by Arthur H. Crisp

Special Features

Contributes to the fight against discrimination and the prevention of its consequences.
No other book that systematically examines the current paradigms of action in order to reformulate them wherever necessary.
Presents first person experiences with stigma and discrimination.