Paradigms Lost, Paradigms Found : Lessons Learned in the Fight Against the Stigma of Mental Illness

## Abstract This book draws on more than 25 years of experience developing and evaluating anti-stigma programs to reduce negative and unfair treatment experienced by people with a mental or substance use disorder. It builds on a previous edition, Paradigms Lost: Fighting Stigma and the Lessons Learned, that identified new approaches to stigma reduction. This volume examines the newest approaches to stigma reduction with respect to structural stigma, public stigma, and internalized stigma. The goals of anti-stigma work must be to eliminate the social inequities that people with mental and substance use disorders and their families face to promote their full and effective social participation. Awareness raising and mental health literacy are important, but they do little to change the accumulated practices of social groups and social structures that systematically disadvantage those with mental and substance use problems. The book is written with one eye to the past (what we have done well) and one to the future (what we must still do). It goes into depth in targeted areas such as healthcare, workplaces, schools, and the media. We expect that this edition will be a useful sequel to Paradigms Lost, chronicling what we have learned as a global community regarding stigma related to mental illness and substance use and stigma-reduction approaches. In 2012, Paradigms Lost critically examined the key paradigms used in programs aiming to prevent or reduce the stigma attached to mental illness. Today, many programs addressing stigma have been successfully developed or improved using the notions and recommendations presented in that volume. Paradigms Lost, Paradigms Found builds on the lessons of the first edition and adds new approaches to reducing the stigma related to mental illness. It brings together the latest theory and experience in the field to provide effective recommendations for addressing stigma in its various forms. This second edition also presents targeted programs used by different social groups and explores future directions in stigma prevention, including evolving techniques for the digital age. Integrating experience with modern technology, Paradigms Lost, Paradigms Found provides evidence and inspiration for mental health advocates seeking to prevent or reduce stigma of mental illness and protect the rights of people with mental and substance use disorders. "In the history of medicine, few conditions other than mental illnesses have cast such a pall on an individual, their family, health providers, health systems, and health research. In addition to having serious consequences for one's social identity, having a mental illness or substance use disorder results in structural inequities that impinge on one's health, longevity, quality of life, social welfare, civic participation, and access to resources. Stigma also casts a long shadow, affecting all of the supports and structures that people with mental illnesses need in order to recover and embrace socially meaningful roles and relationships. [2] This chapter provides an overview of the nature and nurture of stigma from the era of the asylum to our current recovery paradigm"-- Provided by publisher Dedication 6 Contents 8 Preface 14 1. Mental Illness–Related Stigma 16 2. Cultures Count: They Stigmatize and Destigmatize Mental Illnesses 34 3. Paradigms Found in Fighting Stigma 50 4. Eleven Steps to Build an Anti-stigma Program 66 5. Fighting the Good Fight 81 6. Media 103 7. Health Systems 122 8. Educational Systems 145 9. Employment Inequity and Workplace Stigma 163 10. Using Technology to Fight Stigma 181 11. Research 197 12. Stigma and Substance Abuse 222 13. Summary and Reflections 242 Appendix: Stigma Section Bibliography 254 References 268 Index 292 Drawing on more than 25 years of experience developing and evaluating anti-stigma programs to reduce negative and unfair treatment experienced by people with a mental or substance use disorder, the authors of the second edition of 'Paradigms Lost, Paradigms Found' identify new to stigma reduction. This volume examines the latest approaches to stigma reduction with respect to structural stigma, public stigma and internalized stigma Building on the lessons of the first edition, Paradigms Lost, Paradigms Found brings together the latest theory and experience in the field to provide effective recommendations for addressing stigma in its various forms.