Lecture 13Bernice A. PescosolidoStigma: Concepts, Evidence, andIU’s College Toolbox ProjectWhat Is Stigma?Classic Definition:Stigma is a “mark” – possessing anattribute that reduces a person fromwhole and usual to tainted anddiscounted; person is devalued andconsidered “less than fully human”Stigma = Prejudice (attitudes) +Discrimination (behaviors)Public (cultural context)Self-stigma (internalized)Courtesy (guilt by association)Structural (laws, policies, funding)Provider-based (non-recovery-based)The Public Health Relevance of StigmaGlobal burden of disease (Murray and Lopez, WHO)Projected 2020; DALYs 14.7 neuropsychiatric disorder; 14.7CVDDecreased life chancesCurrent estimates, 25 years, on average decreased life span for individuals treated in the public system (2007, U.S., eight states; 2011Denmark, 16-18 schizophrenic; 12-13 bipolar)Depression (WHO 2012)The leading cause of disability world-wideThe Challenge Claims2004 APA President: “Now that stigma has dissipated…”Two Important Reports:Mental Health: A Report of the Surgeon General (1999)The “foremost obstacle”The “silent disease”The President’s New Freedom Commission on Mental Health(2003)Recommendation 1: Reduce stigmaFoundations: Early ResearchStar 1955, “The Public’s Ideas about Mental Illness”Nationally representative survey data – U. of ChicagoProfound generalized ignorance of mental illnessNegative attitudes surrounding the issues of cause,treatment, and outcomesHigh levels of public sentiment that favored the socialrejection of persons with mental illnessWhat Did We Know by the Time ofthe “Lull”?Stigma = prejudice + discriminationStigma was “real” – could be enumerated qualitatively andquantitativelyHarms self-esteem of people with SMISocial exclusion and isolationReduces access to care and resourcesInadequate funding of research and treatment infrastructuresLabel powerful for stigma, not for “puppet” modelingMedical and public health literature associating DE withstigma demiseSociological Translation – Why Stigma?Fundamental AgendaTheresponse to the onset of illnessTheoretical Framework Network-Episode ModelThe Dilemma Response =“Push” (embeddedness) +“Direction” (cultural context)The Challenge Claims2004 APA President: “Now that stigmahas dissipated…”Some Lessons From the ResurgencePublic is more sophisticated; more open (Phelan et al. 2000; Swindleet al. 2000)Difference between assessment of efficacy and willingness to use(Croghanet al. 2003)Socio-demographics not potent explanatory factors (Schnittker et al.2000)Stigma directed toward children and adolescents lower except forcase of depression (Special Section, Psych Services, May 2007)Most consistent predictors are within the social cultural systems - assessments, labels and experience – not characteristics like race,gender, educationNeuroscience has taken hold in public culture and treatment supportis higher but stigma is stubborn (Pescosolido et al., American Journal ofPsychiatry 2010)Genetic backlash (Phelan 2002; Schnittker2008)Larger cultural context has direct effect on utilization, individualstigmatizing attitudes and self-stigma (Mojtabi et al. 2010; Evans Lacko2011)PSA AssessmentSimulated before/after design in survey format690 subjects between 18-25 years of age (KN panel); 77%completion rateThree stigmatizing attitudeStigma of treatment (3 items)Social Distance (5 items)Devaluation (5 items)Laboratory real-time measurements of reactionsNext Steps: Research AgendaFundamental critique and rethinkingWhat should the messages be?Reconfiguring strategiesReal people, real experiences, real effects (dynamic,longitudinal)New directions – The College Toolbox ProjectMental Health Resources at IUCounseling and Psychological Services(CAPS)- 2 FREE sessions a semester/FREEsexual assault counseling (unlimited)Crimson CORPS – Peer to peer assistanceCulture of Care – programs to learn moreCenter for Human Growth (School of Ed.)– sliding scale for payment for counselingservicesIU Health and Wellness (in the IMU) –aromatherapy, massage, visualization for stress reductionSPH-R 142 1st Edition Lecture 13Bernice A. PescosolidoStigma: Concepts, Evidence, andIU’s College Toolbox ProjectWhat Is Stigma?Classic Definition:Stigma is a “mark” – possessing anattribute that reduces a person fromwhole and usual to tainted anddiscounted; person is devalued andconsidered “less than fully human”Stigma = Prejudice (attitudes) +Discrimination (behaviors)-Public (cultural context)-Self-stigma (internalized)-Courtesy (guilt by association)-Structural (laws, policies, funding)-Provider-based (non-recovery-based)The Public Health Relevance of Stigma-Global burden of disease (Murray and Lopez, WHO)oProjected 2020; DALYs 14.7 neuropsychiatric disorder; 14.7CVD-Decreased life chancesoCurrent estimates, 25 years, on average decreased life span for individuals treated in the public system (2007, U.S., eight states; 2011Denmark, 16-18 schizophrenic; 12-13 bipolar)-Depression (WHO 2012)oThe leading cause of disability world-wide-The Challenge Claimso2004 APA President: “Now that stigma has dissipated…”Two Important Reports:-Mental Health: A Report of the Surgeon General (1999)oThe “foremost obstacle”oThe “silent disease”-The President’s New Freedom Commission on Mental Health(2003)oRecommendation 1: Reduce stigmaFoundations: Early Research-Star 1955, “The Public’s Ideas about Mental Illness”-Nationally representative survey data – U. of Chicago-Profound generalized ignorance of mental illness-Negative attitudes surrounding the issues of cause,treatment, and outcomes-High levels of public sentiment that favored the socialrejection of persons with mental illnessWhat Did We Know by the Time ofthe “Lull”?-Stigma = prejudice + discrimination-Stigma was “real” – could be enumerated qualitatively andquantitativelyoHarms self-esteem of people with SMIoSocial exclusion and isolationoReduces access to care and resourcesoInadequate funding of research and treatment infrastructuresoLabel powerful for stigma, not for “puppet” modeling-Medical and public health literature associating DE withstigma demiseSociological Translation – Why Stigma?-Fundamental AgendaTheresponse to the onset of illness-Theoretical Framework Network-Episode Model-The Dilemma Response =“Push”