1 I.AM.Me. “I accept me for me!” So why can’t you? Break the Circle of Stigma Is a peer-operated, mental health education organization, dedicated to providing.

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II..AAMM..MMee. . “I accept me for me!”“I accept me for me!”

So why can’t you?So why can’t you?

Break the Circle of StigmaBreak the Circle of StigmaIs a peer-operated, mental health education Is a peer-operated, mental health education

organization, dedicated to providing self-help and organization, dedicated to providing self-help and recovery-oriented community programs.recovery-oriented community programs.

Break the Circle of Stigma is funded in part by the NYS Office of Mental Health through the Erie County Department of Mental Health, Spectrum Human Services and through grants, donations and fundraising efforts.

I.AM.Me. Is a collaborative community partnership program between Break the Circle of Stigma and Restoration Society Inc.

Contact Information: James Rohl – Director, 66 Englewood Avenue, Buffalo, NY 14214.

Phone: 835-1919 ext. 21, Email: [email protected], Website: www.breakthecircleofstigma.org

Restoration Society Inc. 66 Englewood Avenue, Buffalo, NY 14214.

Phone: 832-2141, Website: www.restoration-societyinc.org

Copyright 2008 Break the Circle of Stigma

Presented by:

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II..AAMM..MMee. . “I accept me for me!”“I accept me for me!”

So why can’t you?So why can’t you?

Break the Circle of Stigma partnered with many Break the Circle of Stigma partnered with many mental health customers, staff, organizations and mental health customers, staff, organizations and other community members in developing this other community members in developing this presentation.presentation.

I wish to personally thank everyone for their I wish to personally thank everyone for their encouragement, support and positive influence in making encouragement, support and positive influence in making this presentation possible.this presentation possible.

Jim RohlJim Rohl

A Partnership:

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II..AAMM..MMee. . Purpose of Presentation…Purpose of Presentation…

To increase understanding of stigma and related To increase understanding of stigma and related terminology.terminology.

To increase the awareness and understanding of the To increase the awareness and understanding of the subjective experiences of stigmasubjective experiences of stigma

To positively impact societal beliefs that stigma does To positively impact societal beliefs that stigma does impede recovery and quality of life.impede recovery and quality of life.

To increase understanding of how stigma impedes To increase understanding of how stigma impedes recovery and quality of life.recovery and quality of life.

To inspire, motivate and implement positive social and To inspire, motivate and implement positive social and system reform.system reform.

To encourage customers, peers, service providers and To encourage customers, peers, service providers and other community members to speak out against stigma, other community members to speak out against stigma, discrimination, prejudices and other social injustices.discrimination, prejudices and other social injustices.

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II..AAMM..MMee. . Expected Outcomes…Expected Outcomes…

Helps to encourage clinicians and other service providers to Helps to encourage clinicians and other service providers to include stigma as a verifiable goal in treatment and recovery include stigma as a verifiable goal in treatment and recovery options and expected outcomes.options and expected outcomes.

Helps to encourage and initiate change in public opinion by Helps to encourage and initiate change in public opinion by addressing how stigma impedes recovery and quality of life.addressing how stigma impedes recovery and quality of life.

Helps to encourage more individual’s with mental health Helps to encourage more individual’s with mental health diagnoses and problems to seek treatment and help.diagnoses and problems to seek treatment and help.

Helps organizations to create and establish new initiatives to Helps organizations to create and establish new initiatives to support customers, employees, students, etc., who have a support customers, employees, students, etc., who have a mental health diagnosis.mental health diagnosis.

Helps to encourage the creation of new programs, community Helps to encourage the creation of new programs, community initiatives and partnerships to address stigma and stigma initiatives and partnerships to address stigma and stigma related concerns.related concerns.

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II..AAMM..MMee. . Terminology and Terminology and Definitions…Definitions…

STIGMASTIGMA::1.1. A social process that exists of elements of labeling, stereotyping, separation, A social process that exists of elements of labeling, stereotyping, separation,

status loss, and discrimination that occurs in a power situation that allows them status loss, and discrimination that occurs in a power situation that allows them (Link & Phelan).(Link & Phelan).

2.2. A social process or related personal experience characterized by exclusion, A social process or related personal experience characterized by exclusion, rejection, blame or devaluation that results from experience or reasonable rejection, blame or devaluation that results from experience or reasonable anticipation of an adverse social judgment about a person or group. In health anticipation of an adverse social judgment about a person or group. In health related stigma, this judgment is based on an enduring feature of identity related stigma, this judgment is based on an enduring feature of identity conferred by a health problem or health related condition (Weiss and conferred by a health problem or health related condition (Weiss and Ramakrishna).Ramakrishna).

INTERNALIZED STIGMA:INTERNALIZED STIGMA:The devaluation, shame, secrecy, and withdrawal triggered by applying negative The devaluation, shame, secrecy, and withdrawal triggered by applying negative stereotypes to oneself stereotypes to oneself (Corrigan, 1998).(Corrigan, 1998).

STEREOTYPE:STEREOTYPE:The belief that all members of a group possess the same characteristics or traits The belief that all members of a group possess the same characteristics or traits exhibited by some members of that group.exhibited by some members of that group.

DISCRIMINATION:DISCRIMINATION:Unjustifiably different treatment given to different people or groups Unjustifiably different treatment given to different people or groups (Manser & (Manser & Thompson, eds., 1999 Combined Dictionary Thesaurus, Edburgh, Chambers).Thompson, eds., 1999 Combined Dictionary Thesaurus, Edburgh, Chambers). Any Any measure entailing a distinction among persons depending on their confirmed or measure entailing a distinction among persons depending on their confirmed or suspected health status suspected health status (Carael et. al., 2000).(Carael et. al., 2000).

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II..AAMM..MMee. . Stigma Impedes Recovery by Eroding an Stigma Impedes Recovery by Eroding an Individual’s:Individual’s:

SOCIAL STATUS • SOCIAL NETWORK • SELF-ESTEEM

All of which contribute to poor outcomes, including:

UnemploymentUnemployment IsolationIsolation Delayed Treatment-Delayed Treatment-

seekingseeking Treatment-refractory Treatment-refractory

symptomssymptoms

Prolonged Course of Prolonged Course of Treatment and RecoveryTreatment and Recovery

Avoidable Avoidable HospitalizationsHospitalizations

Information based on: University of California, Postprints, “Internalized stigma of mental illness: psychometric properties of a new measure 2003, Jennifer E.

Boyd, University of California San Francisco.

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II..AAMM..MMee. . I am notI am not a mental a mental illness!illness!

i am a father, a i am a father, a mother, a brother mother, a brother and a sister…and a sister…

i am a teacher, a i am a teacher, a construction construction worker, and a worker, and a manager…manager…

i am an artist, a i am an artist, a writer, a poet and a writer, a poet and a musician…musician…

i am a unique, i am a unique, successful and successful and talented talented individual…individual…

i am Jim, Tasha, or i am Jim, Tasha, or Mary… My name is Mary… My name is not bipolar or not bipolar or schizophrenia or…schizophrenia or…

i am your friend, i am your friend, your neighbor… your neighbor… and, i am your and, i am your equal.equal.

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II..AAMM..MMee. . I haveI have Mental Illness…Mental Illness…

Mental Illness includes such disorders as Mental Illness includes such disorders as schizophrenia, schizo-affective disorder, schizophrenia, schizo-affective disorder, bipolar disorder, major depressive bipolar disorder, major depressive disorder, obsessive compulsive disorder, disorder, obsessive compulsive disorder, panic and other severe anxiety disorders, panic and other severe anxiety disorders, autism and pervasive developmental autism and pervasive developmental disorders, attention deficit/hyperactivity disorders, attention deficit/hyperactivity disorder, borderline personality disorder, disorder, borderline personality disorder, and other severe and persistent mental and other severe and persistent mental health disorders that affect the brain, and health disorders that affect the brain, and subsequently the whole body.subsequently the whole body.

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““These disorders can profoundly disrupt These disorders can profoundly disrupt how I think and feel, my moods and how I think and feel, my moods and actions, and my ability to relate to others actions, and my ability to relate to others and my capacity for coping with the and my capacity for coping with the demands and challenges of life.”demands and challenges of life.”

Mental Health Disorders affect people of Mental Health Disorders affect people of all walks of life…including people of all walks of life…including people of different age, race, religion and income. different age, race, religion and income. Mental illness is not the result of personal Mental illness is not the result of personal weakness, lack of character, or poor weakness, lack of character, or poor upbringing.upbringing.

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II..AAMM..MMee. . I haveI have Mental Illness, Mental Illness, and…and…

““I ACCEPT IT!I ACCEPT IT!””

So…why can’t you?So…why can’t you?

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II..AAMM..MMee. . Top 10 Myths About Mental Top 10 Myths About Mental IllnessIllness

Misconceptions about mental illness are pervasive, and Misconceptions about mental illness are pervasive, and the lack of understanding can have serious consequences the lack of understanding can have serious consequences for millions of people who have psychiatric illness (mental for millions of people who have psychiatric illness (mental illness), according to the National Alliance for Research on illness), according to the National Alliance for Research on Schizophrenia and Depression (NARSAD). The largest not-Schizophrenia and Depression (NARSAD). The largest not-for-profit organization raising and distributing funds for for-profit organization raising and distributing funds for psychiatric research, NARSAD surveyed mental health psychiatric research, NARSAD surveyed mental health professionals nationwide to determine the most common professionals nationwide to determine the most common myths about mental illness. NARSAD received 102 myths about mental illness. NARSAD received 102 responses from the experts, which included members of responses from the experts, which included members of NARSAD’s Scientific Council and Psychiatrists around the NARSAD’s Scientific Council and Psychiatrists around the country. country.

Source: PRNewswire, October, 2001

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II..AAMM..MMee. . Top 10 Myths About Mental Top 10 Myths About Mental IllnessIllness

““Misconceptions about mental illness Misconceptions about mental illness contribute to the stigma, which leads contribute to the stigma, which leads many people to be ashamed and many people to be ashamed and prevents them from seeking help,” prevents them from seeking help,” said Constance Lieber, NARSAD said Constance Lieber, NARSAD President. “Dispelling these myths is President. “Dispelling these myths is a powerful step toward eradicating a powerful step toward eradicating the stigma and allaying the fears the stigma and allaying the fears surrounding brain disorders.”surrounding brain disorders.”


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II..AAMM..MMee. . Top Ten Myths About Mental Top Ten Myths About Mental IllnessIllness

Myth #1: Myth #1: Psychiatric disorders are not true medical illnesses like heart disease and diabetes. People who have mental illness are just “crazy.”Fact: Brain disorders, like heart disease and diabetes, are legitimate medical illnesses. Research shows there are genetic, biological, environmental and developmental causes for psychiatric disorders, and they can be treated effectively.

Myth #2:Myth #2: People with a severe mental illness, such as schizophrenia, are usually dangerous and violent.Fact: Statistics show that the incidence of violence in people who have a brain disorder is the same that it is in the general population. Those suffering from a psychosis such as schizophrenia are more often frightened, confused and despairing than violent.


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Myth #3: Myth #3: Mental illness is the result of bad parenting.Fact: Most experts agree that a genetic susceptibility, combined with other risk factors, leads to a psychiatric disorder. In other words, mental health disorders may have a physical cause.

Myth #4:Myth #4: Depression results from a personality weakness or character flaw, and people who are depressed could just snap out of it if they tried hard enough.Fact: Depression has nothing to do with being lazy or weak. It results from changes in brain chemistry or brain function, and medication and/or psychotherapy often help people recover.


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Myth #5: Myth #5: Schizophrenia means split personality, and there is no way to control it.Fact: Schizophrenia is often confused with multiple personality disorder (more commonly known as Dissociative Identity Disorder). Actually, schizophrenia is a brain disorder that robs people of their ability to think clearly and logically. The estimated 2.5 million Americans with schizophrenia have symptoms ranging from social withdrawal to hallucinations and delusions. Medication has helped many of these individuals to lead fulfilling, productive lives.

Myth #6:Myth #6: Depression is a normal part of the aging process.Fact: It is not normal for older adults to be depressed. Signs of depression in older people include a loss of interest in activities, sleep disturbances and lethargy. Depression in the elderly is often undiagnosed, and it is important for seniors and their family members to recognize the problem and seek professional help.


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Myth #7: Myth #7: Depression and other illnesses, such as anxiety disorders, do not affect children or adolescents. Any problems they have are just a part of growing up.Fact: Children and adolescents can develop severe mental illnesses. In the United States, one in ten children and adolescents has a mental disorder severe enough to cause impairment. However, only about 20 percent of these children receive needed treatment. Left untreated, these problems can get worse. Anyone talking about suicide should be taken very seriously.

Myth #8:Myth #8: If you have a mental illness, you can will it away. Being treated for a psychiatric disorder means an individual has in some way “failed” or is weak.Fact: A serious mental illness cannot be willed away. Ignoring the problem does not make it go away, either. It takes courage to seek professional help.


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Myth #9: Myth #9: Addiction is a lifestyle choice and shows a lack of willpower. People with a substance abuse problem are morally weak or “bad”.Fact: Addiction is a disease that generally results from changes in brain chemistry. It has nothing to do with being a “bad” person.

Myth #10:Myth #10: Electroconvulsive therapy (ECT), formerly known as “shock treatment,” is painful and barbaric.Fact: ECT has given a new lease of life to many people who suffer from severe and debilitating depression. It is used when other treatments such as psychotherapy or medication fail or cannot be used. Patients who receive ECT are asleep and under anesthesia, so they do not feel anything. Break the Circle of Stigma and our partners do not necessarily endorse the use of ECT.


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II..AAMM..MMee. . Some days…Some days…

i am so tired i can’t i am so tired i can’t get out of bed…get out of bed…

i am so sad and i i am so sad and i cry for no reason… cry for no reason…

i am feeling so i am feeling so lonely, trapped and lonely, trapped and scared…scared…

i am hopeless and i am hopeless and feel like giving up…feel like giving up…

Artwork: Molly Rich

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II..AAMM..MMee. . Some days…Some days…

i am tired of taking i am tired of taking medications…medications…

i am tired of the i am tired of the side effects…side effects…

i am feeling ugly i am feeling ugly because i have because i have gained so much gained so much weight…weight…

i am afraid people i am afraid people will find out, and will find out, and then what…?then what…?

I need patience in I need patience in finding the right finding the right meds to manage meds to manage my symptoms.my symptoms.

Many people need Many people need meds for various meds for various reasons, right?reasons, right?

I try hard not to let I try hard not to let the hurtful the hurtful judgments of others judgments of others stop my recovery!stop my recovery!

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II..AAMM..MMee. . STOP!STOP! I am notI am not mentally mentally ill!ill!

i am not mentally ill, i am not mentally ill, nor psycho, crazy, nor psycho, crazy, insane, or…insane, or…

i am not lazy, dumb, i am not lazy, dumb, or retarded…or retarded…

i am not violent, nor i am not violent, nor am i a criminal…am i a criminal…

i am not helpless…i am not helpless…

When you label me When you label me or call me hurtful or call me hurtful names it only names it only makes me feel makes me feel worse.worse.

Do not assume to Do not assume to know something know something about me. Ask me!about me. Ask me!

Doing for me and Doing for me and not with me not with me teaches me teaches me helplessness. helplessness.

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Mental Illness is treatable. Most people with Mental Illness is treatable. Most people with serious mental illness may need medication serious mental illness may need medication to help manage symptoms, but also rely on to help manage symptoms, but also rely on supportive counseling, self-help groups, supportive counseling, self-help groups, intensive psychiatric rehabilitation, drop-in intensive psychiatric rehabilitation, drop-in centers, rehabilitation club houses and other centers, rehabilitation club houses and other alternatives. Some people may require alternatives. Some people may require assistance with housing, vocation, income assistance with housing, vocation, income and other community services in order to and other community services in order to achieve their highest level of recovery and to achieve their highest level of recovery and to reclaim their lives so devastated by mental reclaim their lives so devastated by mental illness.illness.

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II..AAMM..MMee. . STOP!STOP! Please listen to Please listen to me…me…

Stigma is disrespect!Stigma is disrespect!

Stigma is bigotry!Stigma is bigotry!

Stigma is discrimination!Stigma is discrimination!

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II..AAMM..MMee. . Stigma is…Stigma is…

Stigma is not just the use of the Stigma is not just the use of the wrong word or action, it is disrespect. wrong word or action, it is disrespect. Stigma is the use of negative and Stigma is the use of negative and categorizing language to identify people categorizing language to identify people with mental illness. Stigma is a formidable with mental illness. Stigma is a formidable barrier preventing individuals and families barrier preventing individuals and families from getting the help they so desperately from getting the help they so desperately deserve and need due to the fear of being deserve and need due to the fear of being discriminated against. Stigma, unveiled, discriminated against. Stigma, unveiled, is a lack of compassion and love for one is a lack of compassion and love for one another. another.

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The use of this language The use of this language wrongfully suggests and reinforces wrongfully suggests and reinforces “social selection” or grouping. To “social selection” or grouping. To the stigmatized person, this is a the stigmatized person, this is a placement of disgrace; for all placement of disgrace; for all social categorization results in an social categorization results in an “outcast of the norm” “outcast of the norm” or illness or illness first ideology.first ideology.

II..AAMM..MMee. . Stigma is…(con’t.)Stigma is…(con’t.)

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Stigma can be choice: one’s personal and Stigma can be choice: one’s personal and negative choice to consciously mark an negative choice to consciously mark an individual as less than equal. Stigma is a individual as less than equal. Stigma is a socially induced and predetermined socially induced and predetermined judgment: a mark of shame and disgrace, judgment: a mark of shame and disgrace, leading to inequality, disdain and ostracism.leading to inequality, disdain and ostracism.Stigma can also result from communication Stigma can also result from communication and behaviors triggered by our unconscious and behaviors triggered by our unconscious habits. Our choice to stigmatize often habits. Our choice to stigmatize often occurs do to a combination of cultural occurs do to a combination of cultural perceptions and triggers.perceptions and triggers.

II..AAMM..MMee. . Stigma is continued…Stigma is continued…

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Stigma is control: thinking it is better Stigma is control: thinking it is better to cast aside that which we fear or do to cast aside that which we fear or do not understand, than to let it disrupt not understand, than to let it disrupt the safe and ordered little world we the safe and ordered little world we need to believe exists in order to feel need to believe exists in order to feel in control.in control.

II..AAMM..MMee. . Stigma is continued…Stigma is continued…

TAKE A MINUTE TO TAKE A MINUTE TO REALLY THINK ABOUT IT!REALLY THINK ABOUT IT!

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One in five Americans suffers from One in five Americans suffers from a diagnosable mental illness in any a diagnosable mental illness in any given year, yet only one-third given year, yet only one-third actually receive treatment. Why? actually receive treatment. Why? The answer is… The answer is…

II..AAMM..MMee. . Stigma fact…Stigma fact…

STIGMASTIGMA

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Stigma is the Stigma is the absence of love for absence of love for our fellow man.our fellow man.

Stigma is disrespect.Stigma is disrespect. Stigma is a personal Stigma is a personal

choice to wrongfully choice to wrongfully judge another.judge another.

Stigma is the use of Stigma is the use of negative labels to negative labels to identify a person identify a person with mental illness.with mental illness.

Stigma is the use of Stigma is the use of hurtful words when hurtful words when describing a person describing a person with mental illness.with mental illness.

Stigma is a social virus Stigma is a social virus that preys on the that preys on the socially unaccepted.socially unaccepted.

Stigma is so strong Stigma is so strong that it places that it places “a wall of “a wall of silence”silence” and fear and fear around the topic of around the topic of mental illness.mental illness.

II..AAMM..MMee. . More than just words… More than just words…

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Many people would rather tell their Many people would rather tell their employers that they have employers that they have committed a crime and were in jail, committed a crime and were in jail, than admit to being in a psychiatric than admit to being in a psychiatric hospital. Why? The answer is… hospital. Why? The answer is…

II..AAMM..MMee. . Stigma fact…Stigma fact…

STIGMASTIGMA

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Prevents people from Prevents people from being able to openly, being able to openly, honestly and safely honestly and safely discuss their issues discuss their issues surrounding mental surrounding mental illness.illness.

Discourages families Discourages families and friends from and friends from seeking help for the seeking help for the individual due to the individual due to the fear of being rejected fear of being rejected by their neighbors and by their neighbors and social circle.social circle.

Discourages many Discourages many people from remaining people from remaining in treatment.in treatment.

Interferes with Interferes with recovery by helping to recovery by helping to establish and reinforce establish and reinforce a belief system based a belief system based on the stigmatized on the stigmatized views of society.views of society.

Discourages people Discourages people from actively pursuing from actively pursuing and achieving their and achieving their goals and dreams.goals and dreams.

II..AAMM..MMee. . Stigma is a barrier that Stigma is a barrier that also… also…

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II..AAMM..MMee. . Stigma is a barrier that Stigma is a barrier that also… also…

Discourages social acceptance, Discourages social acceptance, inclusion and equality – leading to inclusion and equality – leading to fear, mistrust and isolation.fear, mistrust and isolation.

Stigma is reinforced by the Stigma is reinforced by the self-perpetuating circle of self-perpetuating circle of

misconception and fear spread misconception and fear spread throughout society. This action throughout society. This action continuously reinforces internalized continuously reinforces internalized

stigma and is extremely detrimental to stigma and is extremely detrimental to all individuals in society.all individuals in society.

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II..AAMM..MMee. . Stigma results in…Stigma results in…

Fear, mistrust and Fear, mistrust and violent behaviors violent behaviors towards individuals towards individuals with mental illness.with mental illness.

Reputed, repressed Reputed, repressed and rejected points and rejected points of view directed of view directed about and towards about and towards the character of the the character of the individual.individual.

Inadequate health Inadequate health insurance coverage.insurance coverage.

External rejection External rejection from friends, family from friends, family and church, and church, neighbors, employers, neighbors, employers, co-workers, co-workers, caregivers, etc.caregivers, etc.

Discrimination and Discrimination and violations of our basic violations of our basic human rights.human rights.

Violations of the Violations of the “American with “American with Disabilities Act.”Disabilities Act.”

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II..AAMM..MMee. . Stigma results in…Stigma results in…

Poor ethics, judgment, Poor ethics, judgment, treatment, and best treatment, and best practices by health practices by health providers.providers.

Damage to the overall Damage to the overall well-being of society.well-being of society.

Loss of employment, Loss of employment, housing, education, housing, education, finances, social status, finances, social status, religious affiliation, religious affiliation, and so much more…and so much more…

Loss of personal Loss of personal identity, often identity, often leading to confusion leading to confusion about one’s role in about one’s role in family and society.family and society.

Feelings of rejection, Feelings of rejection, loneliness, denial loneliness, denial and depression.and depression.

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Four of the leading causes of disability worldwide are Four of the leading causes of disability worldwide are mental disorders. Among developed nations, including mental disorders. Among developed nations, including the United States, major depression is the leading cause the United States, major depression is the leading cause of disability. Also near the top of the rankings are bi-of disability. Also near the top of the rankings are bi-polar disorder (manic-depressive illness), schizophrenia, polar disorder (manic-depressive illness), schizophrenia, and obsessive-compulsive disorder.and obsessive-compulsive disorder.The direct cost of mental health services, which include The direct cost of mental health services, which include spending for treatment and rehabilitation, is spending for treatment and rehabilitation, is approximately $69 billion in the United States. Indirect approximately $69 billion in the United States. Indirect costs, which refer to lost productivity at the workplace, costs, which refer to lost productivity at the workplace, school, and home, are estimated at $78.6 billion.school, and home, are estimated at $78.6 billion.

II..AAMM..MMee. . Important fact!Important fact!

Mental Illness is Real!Mental Illness is Real!Source: PRNewswire, October, 2001

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II..AAMM..MMee. . Major causes of Stigma…Major causes of Stigma…

Lack of education and Lack of education and awareness of mental awareness of mental illness.illness.

Caused and reinforced by Caused and reinforced by the media and the media and entertainment industries. entertainment industries. They sensationalize mental They sensationalize mental illness and often present illness and often present individuals with mental individuals with mental illness as dangerous and illness as dangerous and violent.violent.

Stereotypes – members of Stereotypes – members of society can form fixed society can form fixed mental pictures due to fear mental pictures due to fear of the unknown, which are of the unknown, which are then held in common to all then held in common to all individuals.individuals.

Some people choose to Some people choose to be ignorant.be ignorant.

Lack of grace, faith, Lack of grace, faith, hope, compassion, hope, compassion, empathy and love empathy and love towards one another.towards one another.

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II..AAMM..MMee. . Major causes of Stigma…Major causes of Stigma…

Uneasiness – stigma Uneasiness – stigma emerges when people emerges when people feel awkward or uneasy feel awkward or uneasy when talking about when talking about unusual behaviors unusual behaviors associated with some associated with some individuals who have individuals who have mental illness.mental illness.

Fixed and prejudiced Fixed and prejudiced ideology transferred, or ideology transferred, or inherited from one to inherited from one to another.another.

Sociological differences – Sociological differences – culture, race, ethnicity, culture, race, ethnicity, religion, politics, resulting religion, politics, resulting in categorization, in categorization, segregation, and segregation, and discrimination.discrimination.

Culture Shock – when Culture Shock – when people are subjected or people are subjected or exposed to an exposed to an environment without environment without adequate preparation, adequate preparation, stigma can and usually stigma can and usually occurs.occurs.

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II..AAMM..MMee. . So…are you still listening?So…are you still listening?

STIGMA IS A CHOICE! STIGMA IS A CHOICE!

MENTAL ILLNESS IS NOT!

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II..AAMM..MMee. . How can you choose to prevent How can you choose to prevent stigma…stigma…

Educate yourself: Education Educate yourself: Education helps to eliminate the fear helps to eliminate the fear associated with mental associated with mental illness, paving the way for illness, paving the way for improved understanding improved understanding and acceptance of all and acceptance of all individuals diagnosed with individuals diagnosed with mental illnessmental illness

Choosing to be better Choosing to be better informed about mental informed about mental illness will help you to resist illness will help you to resist and better evaluate the and better evaluate the inaccurate stereotypes so inaccurate stereotypes so common in today’s world.common in today’s world.

Obey the laws of the Obey the laws of the Americans with Disability Act Americans with Disability Act (ADA): The ADA prohibits (ADA): The ADA prohibits discrimination against people discrimination against people with disabilities in all areas of with disabilities in all areas of public life – including housing, public life – including housing, employment and public employment and public transportation.transportation.

Insist the media be Insist the media be accountable: Speak out against accountable: Speak out against inaccurate and stereotyped inaccurate and stereotyped information. Write, call or information. Write, call or email individuals or email individuals or organizations, and let them organizations, and let them know your concerns. Provide know your concerns. Provide them with accurate information them with accurate information to use.to use.

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Be compassionate and Be compassionate and respectful towards all respectful towards all people: Do not make people: Do not make assumptions or judgments assumptions or judgments based on misinformation or based on misinformation or lack of knowledge. All lack of knowledge. All people regardless of their people regardless of their disability deserve to be disability deserve to be treated with respect, treated with respect, compassion and love. compassion and love.

Think about the person, not Think about the person, not the label. Use language the label. Use language that refers to the person that refers to the person first, such as: Juan has first, such as: Juan has bipolar disorder, or Sue has bipolar disorder, or Sue has a mental illness. Never use a mental illness. Never use the term the term “the mentally ill.”“the mentally ill.”

Never refer to people as Never refer to people as “nuts, insane, psycho, or “nuts, insane, psycho, or crazy.” crazy.” These labels are These labels are dehumanizing and hurtful to dehumanizing and hurtful to the individual.the individual.

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Recovering from a mental Recovering from a mental disorder is extremely disorder is extremely

difficult!difficult! Please don’t make Please don’t make

it harder!it harder!

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II..AAMM..MMee. . Do you now understand?Do you now understand?

Acceptance and support leads to recovery!Acceptance and support leads to recovery!

Love the person, hate the illness!

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Recognize and appreciate the Recognize and appreciate the strengths of the person.strengths of the person.

Openly congratulate the person Openly congratulate the person on his/her accomplishments. on his/her accomplishments.

By sharing and communicating By sharing and communicating the successes and victories of the successes and victories of individuals with mental illness individuals with mental illness with others, you are helping to with others, you are helping to positively change their mental positively change their mental image and attitude towards image and attitude towards others.others.

Our focus changes from Our focus changes from negative or deficit based to negative or deficit based to positive and strength based.positive and strength based.

Positive support helps Positive support helps individuals to regain and individuals to regain and strengthen self-esteem and strengthen self-esteem and confidence often lost or confidence often lost or weakened from their weakened from their experiences with mental experiences with mental illness.illness.

Bob is working extremely hard at his recovery!

Terry returned to work after 5 years!

Tremaine went back to school!

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II..AAMM..MMee. . Communicate with others!Communicate with others!

When you communicate the When you communicate the acceptance, support, strengths and acceptance, support, strengths and success of individuals with mental success of individuals with mental

illness to others…illness to others…

YouYou are helping to are helping to Break the Circle of Break the Circle of

StigmaStigma

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Recognize the contributions Recognize the contributions to society by individuals with to society by individuals with mental illness.mental illness.

Individuals with mental illness Individuals with mental illness have and continue to make have and continue to make great contributions to society.great contributions to society.

Appreciate the Appreciate the ““Real Life Real Life Stars”Stars” who have shown an who have shown an enormous amount of courage enormous amount of courage and strength in overcoming and strength in overcoming their personal hardships.their personal hardships.

BobBob has reclaimed his role has reclaimed his role of fatherhood.of fatherhood.

MarisolMarisol has overcome many has overcome many barriers to her recovery and barriers to her recovery and now is driven by passion now is driven by passion and purpose.and purpose.

““People with Mental Illness People with Mental Illness Enrich our Lives.”Enrich our Lives.” (NAMI, (NAMI, http://www.nami.org)http://www.nami.org)

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II..AAMM..MMee. . People with Mental Illness Enrich our People with Mental Illness Enrich our Lives.Lives.

Abraham LincolnAbraham Lincoln – – The revered sixteenth President The revered sixteenth President of the United States suffered from severe and of the United States suffered from severe and incapacitating depression that occasionally led to incapacitating depression that occasionally led to thoughts of suicide, as documented in numerous thoughts of suicide, as documented in numerous biographies by Carl Sandburg.biographies by Carl Sandburg.

Brooke ShieldsBrooke Shields – – Talks about her disabling post Talks about her disabling post partum depression in her book “Down Came the partum depression in her book “Down Came the Rain: My Journey Through Postpartum Depression.’Rain: My Journey Through Postpartum Depression.’

John KeatsJohn Keats – – The renowned poet’s mental illness is The renowned poet’s mental illness is documented in documented in “The Dynamics of Creation”“The Dynamics of Creation” by by Anthony Storr and The Broken Brain: Anthony Storr and The Broken Brain: “The Biological “The Biological Revolution in Psychiatry”Revolution in Psychiatry” by Nancy Andreasen, M.D. by Nancy Andreasen, M.D.

NAMI/People with Mental Illness Enrich Our Lives NAMI/People with Mental Illness Enrich Our Lives http:.//www.nami.org)http:.//www.nami.org)

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John Forbes Nash Jr.John Forbes Nash Jr. – – Has a lifetime history of Has a lifetime history of schizophrenia but is now doing very well, as has been schizophrenia but is now doing very well, as has been documented in the book documented in the book “A Beautiful Mind”“A Beautiful Mind” and the and the academy award-winning movie of the same name.academy award-winning movie of the same name.

Ernest HemingwayErnest Hemingway – – The Pulitzer-winning novelist’s The Pulitzer-winning novelist’s suicidal depression is examined in “The True Gen: suicidal depression is examined in “The True Gen: An An Intimate Portrait of Ernest Hemingway by Those Who Intimate Portrait of Ernest Hemingway by Those Who Knew Him” Knew Him” by Denis Brian.by Denis Brian.

Patty Duke Patty Duke – – The Academy Award-winning actress told The Academy Award-winning actress told of her bipolar disorder in her autobiography and made-of her bipolar disorder in her autobiography and made-for-TV movie, for-TV movie, “Call Me Anna” “Call Me Anna” and A Brilliant Madness: and A Brilliant Madness: “Living with Manic-Depression Illness” “Living with Manic-Depression Illness” co-authored by co-authored by Gloria Hochman.Gloria Hochman.

NAMI/People with Mental Illness Enrich Our Lives (http:.//www.nami.org)NAMI/People with Mental Illness Enrich Our Lives (http:.//www.nami.org)Schizophrenia.com (Schizophrenia.com (http://www.schizophrenia.com/family/Famous.htmlhttp://www.schizophrenia.com/family/Famous.html. .

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TremaineTremaine – – Has a long-time history of anxiety and Has a long-time history of anxiety and depression, but is now doing much better. He is depression, but is now doing much better. He is back in school, learning new computer skills, feeling back in school, learning new computer skills, feeling more comfortable in social settings and exhibiting more comfortable in social settings and exhibiting confidence and leadership.confidence and leadership. Tremaine brings calm Tremaine brings calm to the chaos surrounding our lives.to the chaos surrounding our lives. Thank you.Thank you.

RickRick – – Has struggled long and hard to overcome Has struggled long and hard to overcome many obstacles in his life and recovery, and exhibits many obstacles in his life and recovery, and exhibits an inner strength seldom seen in today’s world. His an inner strength seldom seen in today’s world. His intellect, insight and compassion for others leads his intellect, insight and compassion for others leads his volunteer efforts.volunteer efforts. Rick enriches the lives of Rick enriches the lives of those around him. those around him. Thank you.Thank you.

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II..AAMM..MMee. . I haveI have Mental Illness…andMental Illness…and

I have a question for I have a question for YOUYOU and for and for OTHEROTHER people who have it too. people who have it too.

Do You Do You Have the Hope and Have the Hope and Self-determination Self-determination

to Recover? to Recover?

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II..AAMM..MMee. . Are you determined to recover?Are you determined to recover?

Do you accept the fact that your mental health disorder is real?

Do you have knowledge about your mental health disorder?

Do you understand how your disorder is affecting your life; your feelings, thoughts, behaviors and beliefs?

Do you understand how your disorder is affecting the environment around you?

Do you take responsibility for your current mental state, including your symptoms?

Do you use your disorder as an excuse for the problems and challenges you face in your life?

Do you choose to follow the medical advice of your doctor for treatment of your mental health disorder and/or other physical problems?

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II..AAMM..MMee. . Are you determined to recover?Are you determined to recover?

Do you actively participate in your treatment and recovery plan/s?

Do you allow yourself to be dependent on the mental health system and other “supports” for your well-being and to make major life decisions for you?

Do you partner with your doctor with regard to prescribed medication designed to help manage your symptoms?

Do you search out and find out how others cope with symptoms or difficulties on a day-to-day basis?

Do you learn, apply and practice coping skills and recovery strategies that you have chosen for yourself?

Do you try to be a role model for other people who have mental illness and are working hard to recover?

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II..AAMM..MMee. . Do you believe you can recover?Do you believe you can recover?

Do you believe that you have a right to a Do you believe that you have a right to a satisfying, joyful and purposeful life?satisfying, joyful and purposeful life?

Do you believe that you can and will fulfill Do you believe that you can and will fulfill your desires, dreams and goals?your desires, dreams and goals?

Do you believe that you can and will Do you believe that you can and will recover from mental illness?recover from mental illness?

Do you believe that there are people who Do you believe that there are people who truly want to see you succeed and are truly want to see you succeed and are

willing to help?willing to help?

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II..AAMM..MMee. . “I think…thus I believe!”“I think…thus I believe!”

Internalized stigma creates Internalized stigma creates a complex set of thoughts a complex set of thoughts and beliefs that negatively and beliefs that negatively impacts your recovery and impacts your recovery and quality of life, examples of quality of life, examples of these effects, are…these effects, are…

ExpectationsExpectations ActionsActions ReactionsReactions InhibitionsInhibitions AvoidanceAvoidance Loss of confidenceLoss of confidence Social withdrawalSocial withdrawal And a And a “Why Try”“Why Try”

attitude”attitude”

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II..AAMM..MMee. . “I think…thus I believe!”“I think…thus I believe!”

This attitude usually develops within a person after repeated This attitude usually develops within a person after repeated experiences of rejection resulting in the anticipation of failure.experiences of rejection resulting in the anticipation of failure.

““Why should I even bother to try…”Why should I even bother to try…”

““It seems like every time I try, It seems like every time I try,

I experience hurt, distress,I experience hurt, distress,

embarrassment or humiliation.”embarrassment or humiliation.”

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II..AAMM..MMee. . Internalized stigma can result in…Internalized stigma can result in…

Avoidance

““If I started dating again she would eventually find If I started dating again she would eventually find out about my mental illness and break up with out about my mental illness and break up with

me!”me!” Withdrawal

““I think they know something is wrong with me…I think they know something is wrong with me…they gossip, avoid me, and don’t call or invite me they gossip, avoid me, and don’t call or invite me

out with them anymore!out with them anymore! Reactions

““I have an intense embarrassment about my I have an intense embarrassment about my behaviors after I come out of a state of behaviors after I come out of a state of

depression, mixed state or mania.”depression, mixed state or mania.”

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II..AAMM..MMee. . Internalized stigma can result in…Internalized stigma can result in…

Expectations““They probably thought I was mad or would do They probably thought I was mad or would do

something like attack them.”something like attack them.” Loss of Confidence

““I feel there is no point in applying for jobs I feel there is no point in applying for jobs because my applications would fail. People because my applications would fail. People

like me can’t work.”like me can’t work.” Actions

““When I was homeless, I think it was an When I was homeless, I think it was an advantage, because when I was homeless advantage, because when I was homeless

that’s how I got my new apartment and the that’s how I got my new apartment and the most help.”most help.”

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II..AAMM..MMee. . “Control leads to disempowerment!”“Control leads to disempowerment!”

This attitude usually develops within a person after repeated This attitude usually develops within a person after repeated experiences resulting from perceived or actual encounters experiences resulting from perceived or actual encounters of concernment, distrust, loss of control, threats or force.of concernment, distrust, loss of control, threats or force.

““Why should I even bother, I am just Why should I even bother, I am just too darned tired to try to fight it.” too darned tired to try to fight it.”

““I know that control is only formally taken away from I know that control is only formally taken away from me while I am subject to compulsory legal powers, me while I am subject to compulsory legal powers, usually during periods of involuntary admission to a usually during periods of involuntary admission to a psychiatric hospital.”psychiatric hospital.”

““But, even when admitted on a voluntary basis, I am But, even when admitted on a voluntary basis, I am not really free to leave as I wish. Sometimes there is not really free to leave as I wish. Sometimes there is an implied or actual threat that if you try to be an implied or actual threat that if you try to be discharged against the advice of medical staff, you can discharged against the advice of medical staff, you can be legally detained.”be legally detained.”

““From a provider point of view it is a mixed message of From a provider point of view it is a mixed message of blending care, concern, and force or threat.”blending care, concern, and force or threat.”

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II..AAMM..MMee. . “Where is the respect?”“Where is the respect?”

This attitude usually develops within a person after repeated This attitude usually develops within a person after repeated experiences resulting from perceived or actual encounters of experiences resulting from perceived or actual encounters of

disregard, being viewed as irrational or otherwise disrespected.disregard, being viewed as irrational or otherwise disrespected.

““Why should I even try when I am Why should I even try when I am looked down upon?”looked down upon?”

““My views are often not taken seriously by staff and are My views are often not taken seriously by staff and are often disregarded if they do not coincide with mental often disregarded if they do not coincide with mental

health professionals.”health professionals.”

““My opinions are not viewed as rational because I am My opinions are not viewed as rational because I am usually perceived as being irrational.”usually perceived as being irrational.”

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II..AAMM..MMee. . “I feel so powerless!”“I feel so powerless!”

This attitude usually develops after repeated This attitude usually develops after repeated experiences resulting from perceived or actual experiences resulting from perceived or actual

encounters of struggling to be heard and to make encounters of struggling to be heard and to make independent and substantial life changes.independent and substantial life changes.

““Why should I even try when no one Why should I even try when no one wants to hear what I have to say?”wants to hear what I have to say?”

“So long as users of mental health services are subject to involuntary interventions in supposedly voluntary

services, the power differential between consumers and professionals will remain real and continue to be an

overwhelming obstacle to any kind of real equality in decision-making.”

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II..AAMM..MMee. . Powerlessness!Powerlessness!

Power differentials often occur among mental health Power differentials often occur among mental health service providers, staff and individuals who are diagnosed service providers, staff and individuals who are diagnosed

with mental illness. They also occur elsewhere in the with mental illness. They also occur elsewhere in the community: individuals with perceived or actual authority community: individuals with perceived or actual authority

intentionally or unintentionally, abusing their power. intentionally or unintentionally, abusing their power.

People with serious mental illness can have a very difficult time People with serious mental illness can have a very difficult time being heard.being heard.

Thinking and feeling as though they actually do not have the Thinking and feeling as though they actually do not have the power to make real and substantial change in their lives.power to make real and substantial change in their lives.

Discriminatory actions whether actual or perceived: Discriminatory actions whether actual or perceived: discrimination tends to stick in the memory of service users discrimination tends to stick in the memory of service users and may override the benefits that treatment, rehabilitation and may override the benefits that treatment, rehabilitation and recovery services offer.and recovery services offer.

Reinforcing self or internalized stigma which interferes or Reinforcing self or internalized stigma which interferes or prevents free activity, expression and functioning.prevents free activity, expression and functioning.

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II..AAMM..MMee. . Powerlessness can trigger…Powerlessness can trigger…

Actual or perceived powerlessness can trigger Actual or perceived powerlessness can trigger spontaneous and delayed mental, emotional, physical spontaneous and delayed mental, emotional, physical and spiritual reactions that interfere with treatment, and spiritual reactions that interfere with treatment,

recovery and positive, purposeful and lasting change.recovery and positive, purposeful and lasting change.

Results in negative or poor communicationResults in negative or poor communication Confusion and loss of focusConfusion and loss of focus Emotionally driven communication and physical Emotionally driven communication and physical

actionsactions Increased symptomsIncreased symptoms Social and internal withdrawal (escapism, isolation)Social and internal withdrawal (escapism, isolation) Fight or flight responsesFight or flight responses

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II..AAMM..MMee. . Powerlessness can trigger…Powerlessness can trigger…

Actual or perceived powerlessness can trigger Actual or perceived powerlessness can trigger spontaneous and delayed mental, emotional, physical spontaneous and delayed mental, emotional, physical and spiritual reactions that interfere with treatment, and spiritual reactions that interfere with treatment,

recovery and positive, purposeful and lasting change.recovery and positive, purposeful and lasting change.

Habitually driven or compulsive responses such Habitually driven or compulsive responses such as; irrational thoughts, nail biting, fidgeting, as; irrational thoughts, nail biting, fidgeting, smoking, excessive eating/not eating, gambling, smoking, excessive eating/not eating, gambling, pornographic viewing, drugs and alcohol.pornographic viewing, drugs and alcohol.

Attention seeking communication and behaviors Attention seeking communication and behaviors (innate need to feel wanted, valued and desired(innate need to feel wanted, valued and desired

Loss of confidence, trust, hope, belief and faith Loss of confidence, trust, hope, belief and faith in oneself, others, treatment and other service in oneself, others, treatment and other service providers.providers.

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II..AAMM..MMee. . I haveI have Mental Illness…andMental Illness…and

I have another question for I have another question for YOUYOU and for and for OTHEROTHER people people

who have mental illness.who have mental illness.

Are You Are You Contributing to Contributing to

Stigma?Stigma?

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II..AAMM..MMee. . How could you be contributing to How could you be contributing to stigma?stigma?

Do you label, categorize, stereotype or judge other people with mental illness, yet expect people in society not to do the same to you?

““I’m not like Bob, he is a schizophrenic and I’m not like Bob, he is a schizophrenic and

drug addict – and by the way…I am working drug addict – and by the way…I am working

hard to recover, Bob is not!”hard to recover, Bob is not!”

Do you blame your mental illness for the negative behaviors you choose to display to others?

““It’s not my fault that I get angry or yell at It’s not my fault that I get angry or yell at others, it is just a part of my illness!”others, it is just a part of my illness!”

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Do you deny that your mental illness is real and blame it on poor upbringing, personal weakness or other factors?

““I am the direct result of bad parenting and if only I am the direct result of bad parenting and if only my parents would have done a better job I my parents would have done a better job I

wouldn’t be having these problems.”wouldn’t be having these problems.”

Do you take responsibility for the symptoms associated with your individual mental health disorder?

““This is just who I am – Bipolar!…you know, This is just who I am – Bipolar!…you know,

““mentally ill.” mentally ill.” I get kind of crazy sometimes and I get kind of crazy sometimes and do weird things, but that’s just me.”do weird things, but that’s just me.”

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Do you understand your particular mental health disorder and know how it affects your life?

““The doctor doesn’t tell me anything! I don’t The doctor doesn’t tell me anything! I don’t even know what my diagnosis is! How can I be even know what my diagnosis is! How can I be

expected to know?”expected to know?”

Do you know what medications you are on and what they are expected to help you with?

““I can’t remember what they are! Besides, I I can’t remember what they are! Besides, I don’t even think they are working! That’s why don’t even think they are working! That’s why

I don’t take them all the time!”I don’t take them all the time!”

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Are you working hard to recover and to reclaim your life so that you can once again be a contributing member of society?““Look! I have a mental illness and will be on Look! I have a mental illness and will be on

medication for the rest of my life. How can I be medication for the rest of my life. How can I be expected to go back to work? And, by the way expected to go back to work? And, by the way

I am on SSI/SSD and public assistance…so I I am on SSI/SSD and public assistance…so I have nothing to worry about!”have nothing to worry about!”

Do you believe that learning to manage your illness requires hope, self-determination, dedication and time?The only thing I need is the right medication!The only thing I need is the right medication!Then I can get back to the way my life was.Then I can get back to the way my life was.

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II..AAMM..MMee. . Do I really affect people’s perceptions of Do I really affect people’s perceptions of me?me?

Is it possible that I can negatively Is it possible that I can negatively influence how other people perceive influence how other people perceive me? me? YES!YES!

Is it possible that through my actions Is it possible that through my actions and behaviors I leave myself vulnerable and behaviors I leave myself vulnerable to misunderstanding? to misunderstanding? YES!YES!

Is it possible that through my actions I Is it possible that through my actions I contribute to the stigma that encircles contribute to the stigma that encircles people with mental illness?people with mental illness?

YES…YES…YES…YES…YES…YES…YES…YES…YES…YES…YES…YES…YES!YES!

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CONNECTING WITH YOURSELF AND OTHERSCONNECTING WITH YOURSELF AND OTHERS

Learning to affect positive change within yourself and Learning to affect positive change within yourself and others is a process of re-connecting with your natural or others is a process of re-connecting with your natural or true self. true self.

It is a process of letting go of ego and often of control, and It is a process of letting go of ego and often of control, and choosing a new path – a new intention, one driven by choosing a new path – a new intention, one driven by discipline, wisdom, love and surrender. It is through this discipline, wisdom, love and surrender. It is through this new intention that we can successfully connect with others new intention that we can successfully connect with others allowing the natural process of change to occur and be allowing the natural process of change to occur and be sustained.sustained.

II..AAMM..MMee. . What is YOUR Intention?What is YOUR Intention?

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II..AAMM..MMee. . Breaking the circle of stigma that Breaking the circle of stigma that surrounds people with mental illness is surrounds people with mental illness is the…. the….

RESPONSIBILITY OF RESPONSIBILITY OF EVERYONE!EVERYONE!

Recipients of mental health disorders Mental health treatment and recovery programs Friends and family members Media Government The entire community The entire world

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II..AAMM..MMee. . Now do you understand?Now do you understand?

Breaking the circle of stigma, Breaking the circle of stigma, just like recovering from mental just like recovering from mental

illness…illness… REQUIRES A TEAM REQUIRES A TEAM

EFFORT!EFFORT!Let’s all get on the Let’s all get on the

same team!same team!

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II..AAMM..MMee. . We can all put things right!We can all put things right!

““To put the world right in order,To put the world right in order,

We must first put the nation in order;We must first put the nation in order;

To put the nation in order,To put the nation in order,

We must first put the family in order;We must first put the family in order;

To put the family in order,To put the family in order,

We must first cultivate our personal We must first cultivate our personal life;life;

We must first set our hearts right.We must first set our hearts right.ConfuciousConfucious

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II..AAMM..MMee. . Thank You!Thank You!

Break the Circle of Stigma and everyone who helped to Break the Circle of Stigma and everyone who helped to put this presentation together, would like to thank you put this presentation together, would like to thank you for the opportunity to share it with you. Special thanks for the opportunity to share it with you. Special thanks

to my friend and editor Dana Murphy.to my friend and editor Dana Murphy.

James Rohl

Phone: 716-835-1919 ext. 21 Email: [email protected]

For More Information on Stigma:AD Council – www.adcouncil.org

ADS Center – www.stopstigma.samhsa.gov

Break the Circle of Stigma – www.breakthecircleofstigma.org

Center for Mental Health Services – www.mentalhealth.org/stigma

National Alliance on Mental Illness – www.nami.org

National Mental Health Awareness Campaign – www.nostigma.org