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Patrick CorriganIllinois Institute of Technology
WHAT SAYS THE DODO BIRD?
STOP
UNINTENDED CONSEQUENCES
Everybody has won and all must have
prizes!
“THE POOR!”“THE WEAK!”
““THE LEAST IMPORTANTTHE LEAST IMPORTANT!”!”
“Whatsoever you did to the least of my brethren, that you do unto me!”
Matthew 25
“THE POOR!”“THE WEAK!”
“THE LEAST IMPORTANT!”
“Whatsoever you do to the least of my brethren, that you do unto me!” John
BESTOW
EMPOWER
Stigma is Bad◦Public stigma◦Self-stigma
Not all ways to address stigma work!◦Unintended consequences
Direction for change
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Implications for Stigma and Suicide◦Research Agenda◦Advocacy Agenda
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Funded by the U.S. NIMH since 2001
Collection of more than 20 research and consumer groups from across US
WWW.NCSE1.ORG
corrigan@iit.edu
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In the movies
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In the newspapers
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In advertising
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In comics
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Benevolence stigma
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Trenton State Hospital has fire.
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Roasted Nuts
DANGER
Phelan, Link et al
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DANGER
Phelan, Link et al
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DANGER
Phelan, Link et al
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DANGER
Phelan, Link et al
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Public stigma
Self-stigma
Label avoidance
Structural stigma
stereotype
prejudice
discrimination
Structures
-----------types-----------
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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
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STEREOTYPES◦People with MI are: weak, dangerous….
PREJUDICE◦They are bad because: scary, shameful.
DISCRIMINATION◦So, don’t: hire, serve, or rent to them
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Public stigma
Self-stigma
Label avoidance
Structural stigma
stereotype
prejudice
discrimination
Structures
-----------types-----------
Lost employment Subpar housing Worse health care
Worse educational opportunities Diminished legislative support Alienated faith communities
Coercive treatment
PTCA: percutaneous transluminal coronary angioplasty
Druss et al., 2000
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Public stigma
Self-stigma
Label avoidance
Structural stigma
stereotype
prejudice
discrimination
Structures
-----------types-----------
Decreased self-esteem◦ I am not worthy
Decreased self-efficacy◦ I am not able
Why try?!◦ I am not worthy of a good job◦ I am not able to live alone
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STOP
UNINTENDED CONSEQUENCES
Everybody has won and all must have
prizes!
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
seishin bunretsu to togo shitco sho“mind split disease” “integration disorder”
The Data◦ Japan: mixed findings (Takashi et al., 2009, 2011)
◦ Hansen’s Disease (Oliveria et al., 2003; Van Brakel et al., in press)
Perpetuates the difference
Prejudice and discrimination more than words.◦ MODERN RACISM
Stigma is deserved◦ Because symptoms are abnormal (Gove, 1975)◦ People with mental illness are dangerous (Torrey)
WRONG!◦ Link’s research program on the effects of label
Breast cancerHIV-AIDS STIGMA CURE
Corrigan, (in press)Stigma, Disease, and Disability
Washington, DC: APA
UNINTENDED CONSEQUENCES
Everybody has won and all must have
prizes!
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Protest Education Contact
Media-basedIn vivo
vehicle
-------processes--------
KNOWLEDGE IS GOLD:Educate stigma away!
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Protest Education Contact
Media-basedIn vivo
vehicle
-------processes--------
EDUCATION
RECOVERY
RECOVERY
HIRE THEM?RENT TO THEM?EQUAL HEALTH CARE?
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
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1990 1994 1998 2002 2006
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Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
Inherited/Genetic
META-ANALYSIS FINDINGS: CAUSE
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Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
Brain Disease
META-ANALYSIS FINDINGS: CAUSE
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Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
Co-worker
META-ANALYSIS FINDINGS: ACCEPTANCE
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Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
Neighbor
META-ANALYSIS FINDINGS: ACCEPTANCE
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Protest Education Contact
Media-basedIn vivo
vehicle
-------processes--------
PROTEST
PROTEST:The Pros and CONs!
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Protest◦Review stigmatizing images
◦Shame on you for thinking that way
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Beware the rebound effect
the white bear
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.
I'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
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Protest Education Contact
Media-basedIn vivo
vehicle
-------processes--------
CONTACT
CONTACT vs EDUCATIONThe Pros and CONs!
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Contact
“Meet Bob Lundin”
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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.
Contact vs Education DV’s
◦ Overall◦ Attitudes◦ Behavior
> 38,000 Ss 79 studies; 13 RCTs
Corrigan, Michaels et al., 2012
p<.05
GOAL:Get into treatment.
Get rightful opportunity: work, housing.
Penetration44-60%
Impact
MH literacy Stigma
UNINTENDED CONSEQUENCES
• Brain Disease• Benevolence Stigma
CAMPUS SOLIDARITY CAMPAIGN
Kristin Kosyluk
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Protest Education Contact
Media-basedIn vivo
vehicle
-------processes--------
MEDIA
SOCIAL MARKETINGIts Promise and Limitations
What a DIFFERENCE a friend makes!
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Change a Mind
Real Warriors + Real Battles Real Strengths
Connecting Veterans and their friends and family members with information, resources, and solutions to issues affecting their health, well-being, and everyday lives.
MAKETHECONNECTION.NET
What a DIFFERENCE a friend makes!
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frequency
27%27%
28%28%
29%29%30%
30%31%
31%32%
(March 2008) (May 09
frequency
Video Games
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Website visits
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Odds Ratio 2.81***
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MILLIONS
thousands
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MILLIONS
thousands
Just going to the site is not enough
88% left after one minute!
The possibilities of the population
The possibilities of the population
The need for the grassroots
The possibilities of the population
• 63% text/day• 60 texts
• 39% phone• 35% face to face
Pew Research Center, 2013
MEDIA:Problem or Solution
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2003 .,
SOMETIMES THE STATE’S DEAD MUST TEACH
Landauer
…the tragic story of Billy Owens, a convict with mental illness who stabbed himself to death in an Oregon prison cell surrounded by guards untrained to address his symptoms.
2002 .,
BEAUTIFUL MINDS CAN BE RECOVERED
Harding
…combining the story of Nobel Laureate John Nash with the empirical evidence from long-term follow-up research that people with serious mental illness recover.
Fellowships for Mental Health Journalism
Control: Dental Health
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COERCION
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RECOVERY
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HEADLINES
RECOVERY…Is boring.
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A High-Profile Executive Job as Defense Against Mental Illness
Keris Myrick, Oct 22, 2011
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Unimaginable Crimes:Sin or Sickness
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JOE BIDENInteragency gun control task force
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Chapter 7
Senseless Crimes:Sin or SicknessImplications for Mental Illness Stigma
Patrick W CorriganAmy C Watson
The omnipresent quality of such mind-boggling horror leads us to frequently ask: Are these acts the result of sin or the effect of sickness? The question of sin or sickness is tackled in daily news reports, from the Sunday pulpit, among debating legislators, within behavioral health clinics, and by social scientists. Hoping for quick answers, people look to mental illness as a cause; is this reality or stigma? Senseless crimes offer a different challenge to understanding mental illness and stigma from the argument about violence in the previous chapter. The purpose of this chapter is to deconstruct the idea of senseless crime, and examine its relationship to the public's desire to know why these offenses occur.
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BAD Acts
Immorality -- Sin
Science
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“Laws change for a single reason, in reaction to highly publicized incidences of violence. People care about public safety. I am not saying it is right. I am saying this is the reality. . . . So if you’re changing your laws in your state, you have to understand that”
D.J. Jaffe, 1999
IMPLICATIONS OF EDUCATING THE PUBLIC ON MENTAL ILLNESS, VIOLENCE, AND STIGMAPatrick W. Corrigan, Amy C. Watson, et al 2004Psychiatric Services
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Participants who completed the education-about violence program were
◦ Significantly more likely to report attitudes related to fear and dangerousness,
◦ to endorse services that coerced persons into treatment and treated them in segregated areas,
◦ to avoid persons with mental illness in social situations, and
◦ to be reluctant to help persons with mental illness.
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Participants who completed the education-about violence program were
◦ Significantly more likely to report attitudes related to
fear and dangerousnessfear and dangerousness,◦ to endorse services that coercedcoerced persons into
treatment and treated them in segregated areas,
◦ to avoidavoid persons with mental illness in social situations, and
◦ to be reluctant reluctant to help persons with mental illness.
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Post-test and follow-up measures did not find a significant endorsement of more resources for mandated treatments or rehabilitation services.
However, we did find a non-significant trend that indicated that the education-about-stigma group was more likely than the education about-violence group to support
funding for rehabilitation services at
the time of follow-up.
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Post-test and follow-up measures did not find a significant endorsement of more resources for mandated treatments or rehabilitation services.
However, we did find a non-significant trend that indicated that the education-about-stigma group was more likely than the education about-violence group to support
funding for rehabilitation services at the time of follow-up.
MANDATED CARE: MANDATED CARE: NO BETTERNO BETTER
COMMUNITY CARE: COMMUNITY CARE: MAYBE WORSEMAYBE WORSE
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Unintended Consequences
National Consortium on Stigma and Empowerment
WWW.NCSE1.ORG
corrigan@iit.edu
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TLC 3
TargetedLocalCredibleContinuousContact
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Corrigan, 2011
LandlordsHealth care professionalsTeachersLegislators Employers
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CHICAGO: the heart and brains of Illinois
ILLINOIS
Does it play in
PEORIA?
CityOfficeChurch, synagogue, mosque
School
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Good stigma change
credible
continuous
Contact with whom?
Example◦Military (PTSD)◦Other enlisted membersMarines from marinesSailors from sailors
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Once is not enough
And cannot be carbon copies
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TargetedLocalCredibleContinuousContact
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The GRAND PLAN
Come out everyone
Come out everywhere
Come out Mad
Come out Proud
DON’T BE A MENTAL PATIENT
EMBRACE WHO YOU ARE
Accomplishment◦ Overcoming disability
Who I am◦ Ethnic pride
Authenticity
Three Lessons
◦Consider the pros and cons of disclosing
◦There are different ways to disclose
◦Telling your story
Different communities
Suicide is not a mental illness
Goals: Label Avoidance◦ aka care seeking
Partnership◦ Advocates: stakeholders?◦ Researchers◦ Community-Based Participatory Research
What is stigma:◦ What are the stereotypes?
Suicide attempters are weak, selfish???◦ What is discrimination?◦ What is self-stigma?
What effect does it have on suicide?
Mixed methods approach◦ Content: qualitative (focus groups)◦ Validate: quantitative
Who is the constituency (stakeholder)?◦ People with lived experience◦ Family/friends◦ Providers◦ Competing goals
What’s been done already?◦ Check the literature; research groups
Education, Contact, or something else
Media or in vivo
Who are the targets?◦ People who are potentially suicidal
How to evaluate it?◦ Science (rigor)◦ Program evaluation (feasibility)
Clifford Beers - 1909
“Nothing about us without us!”Judi Chamberlin
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National Center on Stigma and Empowerment
www.ncse1.org
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