Julian Leff

Social inclusion of people with mental illness

Foreword 1. Introduction: Barriers to social and occupational integration 2. The course of psychoses 3. The nature of stigma 4. Poverty and social disadvantage 5. Ameliorating users symptoms 6. Dismantling psychiatric institutions 7. Reducing fear and discrimination among the public 8. Tackling self-stigmatisation 9. Overcoming obstacles to employment 10. Economic obstacles to employment 11. The spectrum of work programmes 12. Social firms 13. Innovative strategies 14. Inclusion and empowerment of consumers.

Social Inclusion of People with Mental Illness: The nature of stigma

What constitutes stigma? Most writers on stigma begin by pointing out its linguistic origin in ancient Greece, when the term referred to a brand or scar burned or cut into the body to signify that the bearer was a slave, criminal or otherwise set apart (Clausen, 1981). There is an interesting parallel with the biblical Cain, who, having killed his brother Abel, is marked by God. However, this sign, visible to all who meet Cain, conveys a double message: on the one hand it pronounces him the first murderer, but on the other it declares that Cain, doomed to be a wanderer on the face of the earth, is under Gods protection and cannot be harmed by any person. There is a link to the supernatural origin of stigmata and their positive connotation in the use of the term during earlier times to refer to marks resembling the wounds on the crucified body of Christ, which were reported to have appeared on the living bodies of saints and other holy people. The contemporary usage of the term is entirely negative, as indicated by the subtitle of Goffmans (1963) groundbreaking work on stigma, Notes on the Management of Spoiled Identity . Goffmans main argument is that stigmatising attitudes and behaviours by others constitute a threat to the targeted individuals identity. He analyses the different aspects of identity that come under attack, and describes the common responses mobilised to defend ones identity in this situation.

Social Inclusion of People with Mental Illness: Introduction: barriers to social and occupational integration

The focus in this book is on people with serious mental illnesses, particularly psychoses, schizophrenia and manic-depressive illness (termed bipolar illness in the USA). Although less serious psychiatric conditions such as depression may also lead to social and occupational exclusion, the barriers are not as formidable or as extensive as with the psychotic illnesses. Perhaps this is because the latter often produce symptoms with which the person in the street cannot empathise. One of us (JL) was sharing the platform at a public meeting with Lewis Wolpert, who has written and spoken extensively about the severe depressive illness he suffered in the past and from which he has fully recovered. He told the audience that it took a great effort for him to overcome his reluctance to expose his experience to the public because of the considerable stigma accorded to depression. JL followed this confession by relating that when patients in his care who suffer from schizophrenia ask him how to explain the gaps in their work record to a potential employer, he advises them to say that they have been depressed. Disabilities produced by the illness The barriers are partly attributable to the effects of the illness and its management by professionals and partly to the reaction of the public. Both schizophrenia and manic-depressive illness commonly lead to delusions – false beliefs about the world – and hallucinations – seeing or hearing things that others do not experience.

Social Inclusion of People with Mental Illness by Julian Leff

Foreword 1. Introduction: Barriers to social and occupational integration 2. The course of psychoses 3. The nature of stigma 4. Poverty and social disadvantage 5. Ameliorating users symptoms 6. Dismantling psychiatric institutions 7. Reducing fear and discrimination among the public 8. Tackling self-stigmatisation 9. Overcoming obstacles to employment 10. Economic obstacles to employment 11. The spectrum of work programmes 12. Social firms 13. Innovative strategies 14. Inclusion and empowerment of consumers.

Social Inclusion of People with Mental Illness: The origins of stigma

Foreword 1. Introduction: Barriers to social and occupational integration 2. The course of psychoses 3. The nature of stigma 4. Poverty and social disadvantage 5. Ameliorating users symptoms 6. Dismantling psychiatric institutions 7. Reducing fear and discrimination among the public 8. Tackling self-stigmatisation 9. Overcoming obstacles to employment 10. Economic obstacles to employment 11. The spectrum of work programmes 12. Social firms 13. Innovative strategies 14. Inclusion and empowerment of consumers.