Can We Learn? Do We Learn?

This is the 2^nd in a series of blogs discussing Recovery.

It does seem to me the popular media capitalizes and exploits the fear of mental illness that many people in our society experience.  Just a quick look at many of the popular television shows including CSI, Criminal Minds and the Law and Order franchise, the person who commits what is often a frightening and despicable crime is usually someone with mental illness.   And I am sure the way in which those with mental illness are portrayed in the popular media results in stigma. 

What is stigma exactly and how is it experienced by those we serve?  The classic work on stigma was written by Erving Goffman (http://en.wikipedia.org/wiki/Goffman), a Canadian born sociologist and writer, in 1963. In Stigma: Notes on the Management of Spoiled Identity   stigma is defined “…as a visible or invisible ‘mark’ that disqualifies its bearer from full social acceptance.”   According to this idea mental illness marks affected individuals as having “blemishes of individual character,” the acquisition of which “spoils their identities and removes them from their place within the social hierarchy.”  Reflecting on this definition gives some insight to what many of those we serve must face on a daily basis and energizes us as professionals to help reduce the stigma of mental illness!

In order to address the stigmatizing attitudes in our own community toward those with mental illness,   First Step applied for and was awarded a grant in 2003 to hire a Community Educator whose job it would be to inform the community at large about mental illness.  The idea at the time was that the stigma, fear and anger associated with mental illness could be successfully combated with education.  As the theory went, the more you knew about mental illness the less likely you would be to be afraid of those with mental illness and the less likely you would be to discriminate.  First Step hired a talented and committed individual to fill this important role.  Jennifer Gross, the now Deputy Director of the Eastern Region Mental Health Board held the position of “community educator” for almost four years.  Jennifer was a skilled writer and presenter who spent much of her time writing and working with community groups to foster greater awareness and understanding about mental illness.    Jennifer penned many op-ed pieces, letters to the editor and topical articles that appeared in the local newspapers all of which were aimed at reducing the stigma associated with mental illness. 

First Step and subsequently Sound Community Services expended much time and resources on this educational approach to reducing stigma.  Jennifer worked for our agency for almost 4 years-   and each of those four years she wrote many articles and op-ed pieces, organized community presentations and activities and did whatever she could to reduce stigma.  And I was always dismayed that much of what we did seemed to have very little long lasting impact on the attitudes of the New London community. The City of New London Planning and Zoning Commission still refused to give us a zoning permit for our Social Rehab program and as recently as 18 months ago when we tried to  move our agency to 21 Montauk, the vehemence of the  public  “hate speech” at the hearing held by Planning and Zoning was appalling.  I vividly remember the individual who at the public hearing complained about how dangerous our clients were and how we interfered with business in the downtown area!

I never understood why we were so decidedly unsuccessful in changing attitudes in any meaningful way given our considerable educational efforts until I ran across some recent research that statisticians call meta-analysis.   In a January 2010 article, A Review of Interventions for Reducing Mental Health Stigma, David Godot points out that while educational interventions are the most frequently used and studied interventions for reducing stigma, the empirical research does not support the effectiveness of such approaches.  According to Godot, although many studies have found significant reductions on stigmatizing attitudes through exposure to college courses or informational sessions, the magnitude and duration of the effects tends to be limited. He further notes that the effects of educational interventions correlate to participants’ knowledge of mental illness prior to participation in the educational programs, indicating that the effects of education-based interventions may primarily reflect the attitudes of participants who had already agreed with the programs’ messages- a “preaching to the choir effect!” 

So all the work that our community educator did probably had a very limited and at best only a short term effect!  And for me personally, my belief that the solution to any problem is “more or better training or education” has been challenged.

So if education does not work to reduce stigma what does?

See next week’s blog for more on this topic!

Be well!

Gail