Marianne Kastrup

WPA guidance on how to combat stigmatization of psychiatry and psychiatrists

In 2009 the WPA President established a Task Force that was to examine available evidence about the stigmatization of psychiatry and psychiatrists and to make recommendations about action that national psychiatric societies and psychiatrists as professionals could do to reduce or prevent the stigmatization of their discipline as well as to prevent its nefarious consequences. This paper presents a summary of the Task Forces findings and recommendations. The Task Force reviewed the literature concerning the image of psychiatry and psychiatrists in the media and the opinions about psychiatry and psychiatrists of the general public, of students of medicine, of health professionals other than psychiatrists and of persons with mental illness and their families. It also reviewed the evidence about the interventions that have been undertaken to combat stigma and consequent discrimination and made a series of recommendations to the national psychiatric societies and to individual psychiatrists. The Task Force laid emphasis on the formulation of best practices of psychiatry and their application in health services and on the revision of curricula for the training of health personnel. It also recommended that national psychiatric societies establish links with other professional associations, with organizations of patients and their relatives and with the media in order to approach the problems of stigma on a broad front. The Task Force also underlined the role that psychiatrists can play in the prevention of stigmatization of psychiatry, stressing the need to develop a respectful relationship with patients, to strictly observe ethical rules in the practice of psychiatry and to maintain professional competence.

Mental health of Turkish women in Germany: resilience and risk factors

BACKGROUND The purpose of the present study was to examine the protective and risk factors of mental distress among Turkish women living in Germany. METHOD 105 Turkish immigrant women living in Berlin were investigated with measures of extraversion/neuroticism (NEO-FFI), general self-efficacy (GSE), social support (BSSS), social strain (F-SOZU) and mental distress (GHQ-28). Interrelations between psychosocial variables were assessed using simple Pearson correlations. RESULTS In all subjects, social strain (Pearsons r=.26(**), p=.008) and neuroticism (r=.34(**), p<.001) were positively associated with mental distress. In contrast, perceived self-efficacy (r=-.38(**), p<.001) and extraversion (r=-.36(**), p<.001) were negatively associated with mental distress. CONCLUSION Protective factors such as extraversion and self-efficacy seem to have a buffering effect on the process of migration. However, in addition to neuroticism, social strain seems to be positively associated with mental distress.

Measuring the stigma of psychiatry and psychiatrists: development of a questionnaire

The stigma of mental illness is a severe burden for people suffering from mental illness both in private and public life, also affecting their relatives, their close social network, and the mental health care system in terms of disciplines, providers, and institutions. Interventions against the stigma of mental illness employ complementary strategies (e.g., protest, education, and contact) and address different target groups (e.g., school children and teachers, journalists, stakeholders). Within this framework, the World Psychiatric Association has adopted an Action Plan with the goal to improve the image of psychiatry and to reduce potential stigmatizing attitudes toward psychiatry and psychiatrists. To evaluate such interventions, a questionnaire has been developed that assesses opinions and attitudes toward psychiatrists and psychiatry in different samples of medical specialists (psychiatrists and general practitioners). The questionnaire comprises scales about perceived stigma in terms of the perception of societal stereotypes, self-stigma in terms of stereotype agreement, perceived stigma in terms of structural discriminations, discrimination experiences, stigma outcomes, and attitudes toward a second medical discipline. It is available in several languages (Arab, English, German, Japanese, Polish, and Spanish) and can easily be adapted for utilization in other medical specialties.

Toward a new definition of mental health

According to the World Health Organization (WHO), mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (1). This definition, while representing a substantial progress with respect to moving away from the conceptualization of mental health as a state of absence of mental illness, raises several concerns and lends itself to potential misunderstandings when it identifies positive feelings and positive functioning as key factors for mental health. In fact, regarding well-being as a key aspect of mental health is difficult to reconcile with the many challenging life situations in which well-being may even be unhealthy: most people would consider as mentally unhealthy an individual experiencing a state of well-being while killing several persons during a war action, and would regard as healthy a person feeling desperate after being fired from his/her job in a situation in which occupational opportunities are scarce. People in good mental health are often sad, unwell, angry or unhappy, and this is part of a fully lived life for a human being. In spite of this, mental health has been often conceptualized as a purely positive affect, marked by feelings of happiness and sense of mastery over the environment (2–4). Concepts used in several papers on mental health include both key aspects of the WHO definition, i.e. positive emotions and positive functioning. Keyes (5,6) identifies three components of mental health: emotional well-being, psychological well-being and social well-being. Emotional well-being includes happiness, interest in life, and satisfaction; psychological well-being includes liking most parts of ones own personality, being good at managing the responsibilities of daily life, having good relationships with others, and being satisfied with ones own life; social well-being refers to positive functioning and involves having something to contribute to society (social contribution), feeling part of a community (social integration), believing that society is becoming a better place for all people (social actualization), and that the way society works makes sense to them (social coherence). However, such a perspective of mental health, influenced by hedonic and eudaimonic traditions, which champion positive emotions and excellence in functioning, respectively (7), risks excluding most adolescents, many of whom are somewhat shy, those who fight against perceived injustice and inequalities or are discouraged from doing so after years of useless efforts, as well as migrants and minorities experiencing rejection and discrimination. The concept of positive functioning is also translated by several definitions and theories about mental health into the ability to work productively (1,8), and may lead to the wrong conclusion that an individual at an age or in a physical condition preventing her/him from working productively is not by definition in good mental health. Working productively and fruitfully is often not possible for contextual reasons (e.g., for migrants or for discriminated people), which may prevent people from contributing to their community. Jahoda (9) subdivided mental health into three domains: self-realization, in that individuals are able to fully exploit their potential; sense of mastery over the environment; and sense of autonomy, i.e. ability to identify, confront, and solve problems. Murphy (10) argued that these ideas were laden with cultural values considered important by North Americans. However, even for a North American person, it is hard to imagine, for example, that a mentally healthy human being in the hands of terrorists, under the threat of beheading, can experience a sense of happiness and mastery over the environment. The definition of mental health is clearly influenced by the culture that defines it. However, as also advocated by Vaillant (11), common sense should prevail and certain elements that have a universal importance for mental health might be identified. For example, in spite of cultural differences in eating habits, the acknowledgement of the importance of vitamins and the four basic food groups is universal.

Quality of life: a dimension in multiaxial classification

The study provides an overview of the historical aspects of multiaxial classification. Particular reference is paid to the multiaxial formats of ICD-10, DSM-IV and the WPA International Guidelines for Diagnostic Assessment (IGDA). The IGDA proposes a tetraaxial format with quality of life as one axis as well as an axis on symptomatology, an axis on adaptive functioning and an axis on environmental/psychosocial conditions. The axis on quality of life is added in recognition of the increasing importance placed upon the patient’s perception of his/her capacity of self fulfillment and the attention paid to quality of life as a major descriptor of health status as well as an outcome measure of clinical care.

A proposed new definition of mental health

The authors propose a new approach to the definition of mental health, different than the definition proposed by the World Health Organization, which is established around issues of persons well-being and productivity. It is supposed to reflect the complexity of human life experience.

Exemplary Contribution of Professional Scientific Organizations: The European Psychiatric Association

Stigma affects psychiatry and psychiatrists in two ways: firstly, through its negative effects on the patients’ illness course, help-seeking behavior, treatment adherence, and social inclusion; secondly, negative views about psychiatry and psychiatrists are also common in the medical profession itself (Gaebel et al. 2015). The negative image of psychiatry and psychiatrists may keep medical graduates from choosing psychiatry as their professional career.