Fighting Stigma
Bob Carolla
Director of Media Relations
National Alliance on Mental Illness
NAMI Natlonal Convention
July 2009
Definitions
Stigma is imposed by others
“Deriving from a condition which the target of the stigma either did not cause or over
which he has little control.” --Gerhard Falck, sociologist, historian
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archaic : a scar left by a hot iron: a brand
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a stigmata plural : bodily marks or pains resembling the wounds of the crucified Jesus
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An attribute, behavior, or reputation which is socially discrediting in a particular way: it causes an
individual to be mentally classified by others in an undesirable, rejected stereotype rather than in
an accepted, normal one.
Definition
U.S Surgeon General’s Report on Mental Health (1999), Chapter One
http://www.surgeongeneral.gov/library/mentalhealth/home.html
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“Stigmatization of people with mental disorders has persisted throughout history. Bias, distrust,
stereotyping, fear, embarrassment, anger, and/or avoidance manifest it. Stigma leads others to
avoid living, socializing or working with, renting to, or employing people with mental disorders,
especially severe disorders such as schizophrenia.
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It reduces patients' access to resources and opportunities (e.g., housing, jobs) and leads
to low self-esteem, isolation, and hopelessness. It deters the public from seeking and
wanting to pay for, care.
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In its most overt and egregious form, stigma results in outright discrimination and abuse. More
tragically, it deprives people of their dignity and interferes with their full participation in society…”
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“Why is stigma so strong despite better public understanding of mental illness? The
answer appears to be fear of violence…but the overall likelihood of violence is low… the
overall contribution of mental disorders to the total level of violence in society is
exceptionally small.”
Perception of Violence
Distancing
US Surgeon General’s Report
“Are people with mental disorders truly more violent? Research supports
some public concerns…but the overall likelihood of violence is low…the
overall contribution of mental disorders to violence is exceptionally small.
One series of surveys found that selective media reporting reinforced the
public’s stereotypes linking violence and mental illness and encouraged
people to distance themselves from those with mental disorders”.
Two Kinds of Stigma
Structural
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Unfair discrimination
Insurance
Housing
Employment
Voting restrictions
Lack of public investment
Lack of access to health care
The Other Kind
Attitudes—popular culture
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News media
Entertainment industry (TV, movies, games)
Advertising
Commercial products
5 Strategies
Each one reinforces others
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Praise
Protest
Personal contact
Public Education
Partnership
Praise
Encourage and reinforce those “who get it right”
• Accuracy
• Balance
• Compassion
• Personal letters
• Letters to editors
• Awards—national, state and local
Protest
NAMI StigmaBusters
www.nami.org/stigma
• Focus on popular culture (TV, etc.)
• Grassroots reports; monthly alerts
• Virtual network
Stigma “Red Flags”
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Context
Inaccuracy
Stereotypes
Portrayed only as antagonists or villains
Linkage to violence
Language (“wacko”; referring to a person)
Devaluation (trivialization)
Butt of jokes
Offensive or insensitive symbols (e.g., straitjackets)
Protest
Personal contact—education
But protest does not necessarily mean changing minds
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Sensitize
Embarrass
Create pressure from others
Cause the source to think twice the next time
Change behavior rather than attitude
Opportunity for a “teaching moment” for broader public
Protests: Pick Battles Carefully
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Priorities
Context
Most outrageous cases
Choose: private vs. public
High public profile may be a “teaching opportunity”
Opportunity for leverage through TV or radio commercial sponsors,
local stores
• Opportunity for positive results
• Don’t make things worse by publicizing something that is mostly
being ignored
Where does humor end and stigma begin?
Protest
Results may be limited or incremental
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Contact—but no more
Apology—but no more
Discontinuation
Makes amends
Partnership
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Be firm, but polite
Private dialogue may be better than public protest
Give an adversary a way to save face
Find a compromise—call it a victory
Crazy for You Bear
Valentine’s Day 2005
Local controversy became national
Media attention = “teaching moment”
Apologized and promised to make no more
But advocates wanted sales to stop immediately
Governor spoke out
Bear sold out
CEO forced off hospital board
Now a $500+ collector’s item on E-bay
Who won?
New Jersey Radio
“She’s a wacko…Give her a straitjacket and tell her to take her happy pills.”
Johnny Shock on the Morning Show
[Not his real name or quote]
• Formal letter to company president and station manager
• Press release or statement (optional)
• Request for meeting
No call for Johnny to be fired
• No call for a boycott
• Letters, e-mails and phone calls
• Contacts to commercial advertisers
• Local business suspended advertising
• Local car dealer called CEO with personal story about his daughter
• Specific requests in meeting: apology and make amends
• Produce and air public service announcements (PSAs)
• Sponsor annual fundraising or public awareness event
Sample Protest Letter
Dear Mr. Station Manager:
I want to protest Johnny Shock’s statement on the Morning Show on May 1, 2008 that used offensive language and
cruel stereotypes about mental illness to make fun of Gov. ABCD’s wife. Mental illness is not a joke. It is a public health issue.
One in four Americans experience mental illness in their lifetimes. The US Surgeon General has declared that stigma and
discrimination are a major reason people often don’t get help when they need it. I cannot believe WXYZ-FM would tolerate
stigma and discrimination against any racial, ethnic or other disability group. Do you make fun of cancer patients?
Add a short personal paragraph: e.g., I have lived with major depression…My son is 15 and lives with bipolar disorder…This is
what stigma has done to my family…Why would WXYZ-FM ever want to make fun of it owns listeners?
Be one of good guys. Johnny Shock should apologize. WXYZ-FM should undo the damage it’s caused.. Help sponsor a public
education campaign about mental illness. Donate PSAs. Interview people about recovery on one of your shows.
Sincerely,
NAMI Member
cc:
NJ Human Rights Commission
Violent Tragedies
Sometimes it’s appropriate to comment
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Respond to media calls
Press release or statement to members
Letters to editors
Op-ed articles
Keep purpose in mind
• Express shared grief and concern
• Provide balanced perspective—reduce stigma
• Focus media attention on broader, deeper issues
Violent Tragedies
Basic message
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We extend our sympathy
It is essential to understand the nature of mental illness and what went wrong
US. Surgeon General has reported that likelihood of violence by people with mental illness is
actually low.
“The overall contribution…to the total level in society is exceptionally small.”
Acts of violence are exceptional. A sign that something has gone terribly wrong.
Questions to ask media to pursue:
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Was there an actual diagnosis?
What was the full medical history?
Did the person—or person’s family—seek treatment? Was it denied or delayed?
Where seen? By whom? How often?
Was treatment coordinated among different professionals? Was there a case manager?
Taking medication? If not, why not?
Substance abuse?
What events may have triggered the psychiatric crisis?
Did family members receive education and support?
Personal contact
The face of mental illness
Consumer presentations
www.nami.org/ioov
NAMIWalks
www.nami.org/walks