Fighting stigma: theory and practice

Corrigan and Watson's paper is easy to read and presents valuable information. It is based on the author's experience and publications by psychologists, sociologists and psychiatrists. This is a point that is worth a mention, because papers published by the representatives of the three professions usually cite only papers written by other members of their own profession, neglecting the others. The literature cited is all anglophone, a sign of times. There are also publications relevant to the issue of stigma and its elimination in other major languages (1): perhaps World Psychiatry will follow this review by another, later on, covering that literature.

Corrigan and Watson draw attention to the fact that more research on stigma is needed: indeed, most of the work that has been cited in this article was carried out in the USA and in a small number of other countries. This is a recommendation that remains relevant even if one does examine literature in other languages as well as publications dealing with transcultural psychiatry and psychology. Another recommendation that could have been made is that information about the experience of people who have a mental illness should be more systematically recorded and used in anti-stigma activities. Most of that type of data is anecdotal and there is, to my knowledge, no systematic assembly of accounts by patients and families about their lives since a mental illness struck them. To an extent that has to do with the attitudes of researchers: it might be that they also see people with mental illness as being unreliable sources of information.

Corrigan and Watson also list some of the broad scale interventions that were found to be useful. These interventions are probably among those that cost most and achieve least. Action on a less grandiose scale seems to be more effective. An example are interventions directed at medical personnel (including psychiatrists), who are often important sources of stigmatization. Work with them to make them aware of their (stigmatizing) behaviour - in small groups or on a one to one basis - is among strategies that can be sued in many settings and at relatively low price. Changes in the curricula of medical schools and of schools of other helping professions might also be important: to combat stigma it is necessary to think and develop long-term programmes, since campaigns that last a short while leave little trace in people's behaviour.

Another important area of work is also touched upon in the review: the self-stigmatization and the loss of self-respect of people affected by a mental illness. The search for ways to prevent these feelings is of high priority. The experience of the Canadian site of the WPA Program against Stigma and Discrimination because of Schizophrenia showed that the establishment of a speakers' bureau, in which people with schizophrenia were taught how to best present their views and then invited to present their history and ideas about ways to handle people with mental illness in schools, was outstandingly useful. It did change the attitudes and ideas of the teenagers in those schools; just as importantly it gave the speakers reassurance of their own value and made them regain some of the self-respect that they have lost in their illness.

The reader of the review might have been interested to see a list of currently ongoing programs against stigma, possibly join them. The WPA has recently started a Program against Stigma and Discrimination because of Schizophrenia, which is underway in some twenty countries, in Europe, the Americas, Asia and Africa. The program is characterized by the selection of its targets according to patient and family accounts of their experience, by the involvement of various social sectors and by the collaboration among centres in different parts of the world (more information can be found on the program's web site openthedoors.com). There are also other programs in the United Kingdom (carried out by the Royal College of Psychiatrists), in Australia, in Sweden, in the USA and elsewhere.

Finally, we should be grateful to Corrigan and Watson for this fine article and hope that the subject of stigma will find a regular presence in the World Psychiatry journal. There is no doubt in mind about the fact that stigma is the most important obstacle to the provision of mental health care to those who need it and to the advancement of psychiatry and related disciplines.