WHAT SAYS THE DODO BIRD?
Patrick Corrigan
Illinois Institute of Technology
STOP
UNINTENDED
CONSEQUENCES
Everybody
has won and
all must have
prizes!
“THE POOR!”
“THE WEAK!”
“THE LEAST IMPORTANT!”
“Whatsoever you did to the least of my
brethren, that you do unto me!”
Matthew 25
BESTOW“THE POOR!”
“THE WEAK!”
EMPOWER
“THE
LEAST IMPORTANT!”
“Whatsoever you do to the least of my brethren,
that you do unto me!”
John
 Stigma
is Bad
◦ Public stigma
◦ Self-stigma

Not all ways to address stigma work!
◦ Unintended consequences
 Direction
for change
7
 Implications
Suicide
for Stigma and
◦ Research Agenda
◦ Advocacy Agenda
8
9


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
12
13
14
In the movies
16
17
18
In the newspapers
19
20
22
In advertising
23
24
27
In comics
28
29
Benevolence stigma
32
33
34
35
36
37
Trenton State Hospital
has fire.
Roasted
Nuts
39
 DANGER
100%
80%
60%
danger
40%
Phelan, Link et al
20%
0%
1956
1996
40

DANGER
40%
35%
30%
25%
20%
Phelan, Link et al
danger
15%
10%
5%
0%
1956
1996
41

DANGER
40%
35%
30%
25%
20%
Phelan, Link et al
danger
15%
10%
5%
0%
1956
1996
42

DANGER
40%
35%
30%
25%
20%
Phelan, Link et al
danger
15%
10%
5%
0%
1956
1996
2006
43
-----------types----------S
t
r
u stereotype
c
t
u prejudice
r
e
discrimination
s
Public
stigma
Selfstigma
Label
Structural
avoidance stigma
44

STEREOTYPES

PREJUDICE

DISCRIMINATION
◦ All Irish Americans are drunks and
beat their wives.
◦ That’s right. They’re drunks and I
loathe them.
◦ So, don’t: hire, rent, or befriend them
45

STEREOTYPES

PREJUDICE

DISCRIMINATION
◦ People with MI are: weak,
dangerous….
◦ They are bad because: scary,
shameful.
◦ So, don’t: hire, serve, or rent to them
46
-----------types----------S
t
r
u
c
t
u
r
e
s
Public
stigma
Selfstigma
Label
Structural
avoidance stigma
stereotype
prejudice
discrimination
47



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
-----------types----------S
t
r
u
c
t
u
r
e
s
Public
stigma
Selfstigma
Label
Structural
avoidance stigma
stereotype
prejudice
discrimination
50

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
52
53
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 cancer
HIV-AIDS
STIGMA
CURE
Corrigan, (in press)
Stigma, Disease, and Disability
Washington, DC: APA
UNINTENDED
CONSEQUENCES
Everybody
has won and
all must have
prizes!
-------processes--------
Protest Education Contact
v
e
h
i
c
l
e
Mediabased
In vivo
62
KNOWLEDGE IS GOLD:
Educate stigma away!
-------processes--------
Protest Education Contact
v
e
h
i
c
l
e
EDUCATION
Mediabased
In vivo
64
RECOVERY
RECOVERY
HIRE THEM?
RENT TO THEM?
EQUAL HEALTH CARE?





Knowledge: Causal Beliefs
Stigma:
Acceptance
Sixteen representative samples of nationdefined populations
230 to 6000 Ss
Response rates: 65-85%
Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
META-ANALYSIS FINDINGS:
CAUSE
Inherited/Genetic
70
60
50
40
Sz
Dep
30
20
10
0
1990
1994
1998
2002
2006
Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
META-ANALYSIS FINDINGS:
CAUSE
Brain Disease
80
70
60
50
Sz
Dep
40
30
20
10
0
1990
1994
1998
2002
2006
Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
META-ANALYSIS FINDINGS:
ACCEPTANCE
Co-worker
60
50
40
Sz
Dep
30
20
10
0
1990
1994
1998
2002
2006
Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
META-ANALYSIS FINDINGS:
ACCEPTANCE
Neighbor
60
50
40
Sz
Dep
30
20
10
0
1990
1994
1998
2002
2006
Schomerus, Schwann, Holzinger, Corrigan, Grabe, Carta, & Angermeyer, 2011
-------processes-------v
e
h
i
c
l
e
Education
Protest
Contact
PROTEST
Mediabased
In vivo
73
PROTEST:
The Pros and CONs!
Protest
◦Review stigmatizing images
◦Shame on you for thinking
that way
75
76
 Beware
the rebound effect
the white bear
77
NAMI - stigmabusters
The
JASONUT
The SUICIDE
SQUEEZE
The CRAZY
FACE
Located in Campbell and San Jose
California
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
FRANCHISE
OPPORTUNITIES
-------processes--------
Protest Education Contact
v
e
h
i
c
l
e
CONTACT
Mediabased
In vivo
83
CONTACT vs EDUCATION
The Pros and CONs!
Contact
“Meet Bob
Lundin”
85
Bob’s
story
I have
◦ My name is ______ and
a severe mental
illness called schizo-affective disorder
◦ My
childhood was not unusual…
◦ Unfortunately, my mental illness was
It did not go away quickly…
traumatic.
I have achieved
◦ Despite these problems,
several accomplishments.
86


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.
Penetration
44-60%
Impact
MH literacy
Stigma
UNINTENDED
CONSEQUENCES
• Brain Disease
• Benevolence Stigma
CAMPUS
SOLIDARITY
CAMPAIGN
Kristin Kosyluk
-------processes--------
Protest Education Contact
v
e
h
i
c
l
e
MediaMEDIA
based
In vivo
96
SOCIAL MARKETING
Its Promise and Limitations
What a DIFFERENCE a friend makes!
Change a Mind
99
Real Warriors + Real Battles
Real Strengths
MAKETHECONNECTION.NET
Connecting Veterans and their
friends and family members
with information, resources,
and solutions to issues
affecting their health, wellbeing, and everyday lives.
What a DIFFERENCE a friend makes!
Video Games
frequency
32%
31%
31%
30%
30%
29%
frequency
29%
28%
28%
27%
27%
(March 2008)
(May 09
10
3
Website visits
10
4
Odds Ratio
2.81***
10
5
MILLIONS
thousands
10
6
MILLIONS
Just going to the site is not enough
88% left after one
minute!
thousands
10
7
 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
11
1
Fellowships for Mental Health Journalism
2003 .,
2002 .,
SOMETIMES THE STATE’S DEAD MUST TEACH
BEAUTIFUL MINDS CAN BE RECOVERED
Landauer
Harding
…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.
…combining the story of Nobel Laureate John
Nash with the empirical evidence from longterm follow-up research that people with serious
mental illness recover.
Control: Dental Health
11
2
COERCION
11
3
RECOVERY
11
4
HEADLINES
RECOVERY…
Is boring.
11
5
A High-Profile
Executive Job
as Defense
Against
Mental
Illness
Keris Myrick, Oct 22, 2011
11
6
Unimaginable Crimes:
Sin or Sickness
11
7
11
8
JOE BIDEN
Interagency gun control
task force
11
9
Chapter 7
Senseless Crimes:
Sin or Sickness
Implications for Mental Illness
Stigma
Patrick W Corrigan
Amy 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.
12
0
BAD Acts
Immorality -- Sin
Science
12
1
12
2
“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 STIGMA
Patrick W. Corrigan, Amy C. Watson, et al 2004
Psychiatric Services
12
3
Participants who completed the educationabout 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.
12
4
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,
avoid
◦ to
persons with mental illness in social
situations, and
reluctant
◦ to be
illness.
to help persons with mental
12
5


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.
12
6

Post-test and follow-up measures did not
find a significant endorsement of more
resources for mandated treatments or
rehabilitation services.
MANDATED CARE:
NO BETTER



However, we did find a non-significant trend
that indicated that the education-aboutstigma group was more likely than the
education about-violence group to support
funding for rehabilitation services at
the time of follow-up.
COMMUNITY CARE:
MAYBE WORSE
12
7
12
8
12
9
Unintended Consequences
National Consortium
on Stigma and
Empowerment
WWW.NCSE1.ORG
corrigan@iit.edu
13
0
TLC 3
Targeted
Local
Credible
Continuous
Contact
Corrigan, 2011
13
2
Landlords
Health care professionals
Teachers
Legislators
Employers
CHICAGO:
the heart and
brains of Illinois
Does it
play in
PEORIA?
x
ILLINOIS
 City
 Office
 Church,
synagogue, mosque
 School
13
8
Good
stigma
change
 credible
 continuous
139
 Contact
with whom?
 Example
◦ Military (PTSD)
◦ Other enlisted members
 Marines from marines
 Sailors from sailors
140
 Once
is not enough
 And
cannot be carbon
copies
14
1
Targeted
Local
Credible
Continuous
Contact
14
2
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
158
National Center on
Stigma and
Empowerment
www.ncse1.org