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PSYC*3690 Article 30.pdf

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University of Guelph
PSYC 3690
Benjamin Gottlieb

Article #: 30 Title: Recovery and Stigma in People with Psychiatric Disabilities Introduction - the ideas of recovery and stigma have mutual effects on each other - recovery has reintroduced goal directness, hope, and self-determination into comprehensive discussions about mental health and its service system - stigma is a major hurdle to recovery - people with serious mental illness are sometimes unable to achieve important life goals when the public endorses stereotypes about their disorders and discriminates against them as a result - just as stigma impedes recovery, so recovery challenges stigma - stigma is being squelched, as all stakeholders come to understand and adopt the principles of recovery Historical and Theoretical Overview of Recovery - recovery has been described in 2 ways: (1) recovery is understood in terms of outcomes - overcome and live with symptoms and dysfunctions, able to achieve goals such as employment (2) recovery is seen as a process - recovery has reintroduced such important processes as hope and well-being into rehabilitation Recovery as Process - one of the purposes of recovery as a movement was to reject pessimism and re-inject hope into their lives - recovery from this perspective is less concerned about outcomes (whether the person achieves some kind of symptom and disability free endpoint) and more about processes - recovery is more about how a person with mental illness would pursue a meaningful life - an essential element of recovery as a process is empowerment, people must have the power to act on decisions that produce an optimistic future which reflects their personal goals What Are the Harmful Effects of Stigma? - many people who might benefit from services fail to complete the recovery process, either by not obtaining needed services or not fully adhering to treatment regimens Cognitive Behavioural Model of Stigma - stigma associated with mental illness is multidimensional and based on a complex process - this complexity can be best described using a cognitive behavioural model that has 3 components: cognition, affect, and behaviour 1. Stereotypes (cognitive component) - knowledge structure that the public has learned about a marked social group - e.g. stereotypes that people with mental illness are violent or incompetent 2. Prejudice (affect component) - affective reaction regarding a particular group based on endorsing stereotypes about that groups e.g. dangerousness is strongly associated with fear and can be exacerbated by beliefs that people with mental illness are unpredictable 3. Discriminatory Behaviour (behaviour component) - manifests itself in negative actions against the outgroup or exclusively - avoidance e.g. not associating with people with mental illness Types of Stigma - 4 types of stigma is relevant to health conditions and especially mental illness: 1. Public Stigma - occurs when members of the general population endorse prejudice and act in a discriminating manner 2. Self-Stigma - occurs when people internalize the prejudice and discriminate against themselves, has been divided into progressive stages known as the “threes As”: aware, agree and apply - applying or internalizing stereotypes has two harmful effects, cognitively and emotionally, internalizing stigma can hurt self-esteem, and lessens self-efficacy - behaviorally, the three As lead to the “why try” effect 3. Label Avoidance - blocks service use for people in need of psychiatric care - one way people are publicly labeled is by associating with a mental health program, to avoid labeling some people refrain form seeking services 4. Structural Stigma - the absence of appropriate services for people with mental illness, manifests itself in 2 ways: (1) policies of private and governmental institutions that intentionally restrict opportunities, and (2) polices of institutions that yield unintended consequences which hinder the options of people with mental illness - intentional institutional discrimination manifests itself as rules, policies and procedures of private and public entities in positions of power that consciously and purposefully restrict the rights and opportunities of minority groups What Is There To Do About Recovery Evidence-Based Practices - assumes that consumers will be involved only in services that have been shown to be effective - help all stakeholders choose which practice will be more effective - disadvantages: (1) the criteria for classifying a service as effective (empirical evidence base) reflect the priorities of the
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