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Shunned: Discrimination Against People with Mental Illness
Reviewed by LARRY J. SIEVER
Am J Psychiatry 2007;164:1272-1273. doi:10.1176/appi.ajp.2007.07061020
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by Graham Thornicroft. New York. Oxford University Press, 2006, 328 pp., $47.50.

While there is great concern regarding issues of stigma and discrimination against people with mental illness, there are few accessible sources that summarize the state-of-the-art of our understanding of issues concerning discrimination against individuals with mental illness and even fewer that provide a window into these individuals’ subjective experience of such discrimination. Graham Thornicroft provides a readable exposition, replete with graphs, photographs, and documents, that explicates the many faces of discrimination experienced by those with mental disorders. More importantly, he provides rich quotes and even vignettes that make the experience that many individuals with mental illness encounter come alive for the reader. Thus, he straddles both an objective and subjective approach to this issue.

Professor Thornicroft understands the tendency of the human mind to stereotype and the mistrust often engendered by mental illness, making the origins of this kind of discrimination understandable if not defensible. He addresses distinctions between stigma and discrimination by defining stigma as an indelible ”mark” metaphorically that sets apart the stigmatized individuals who become “in some way morally diminished.” He shows how stigma can work against people with mental illness receiving the medical care, economic support, and community support they are entitled to. He addresses the shortcomings of models of stigma, including an unnecessarily restrictive focus on schizophrenia and a neglect of the strong ties of stigma with a broader understanding of civil liberal and human rights. He illustrates how stigma serves as a way of “blaming the victim” and examines a number of common myths associated with it.

Perhaps the most powerful parts of this book are the descriptions of how individuals struggle with both the pain of their mental illness and the shunning they receive from society. A persistent sadness purveys many of the accounts set forth in this book, as these individuals live with a profound loneliness and repeated experiences of rejection.

There are some discussions of the recovery movement, which some hope will be an antidote in part to the stigma and discrimination associated with mental illness. While this section might be better developed, Professor Thornicroft recognizes the power of self-management in recovery.

One of the strengths of this book is that it addresses, in individual chapters, the specific domains of discrimination people with mental illness encounter. Thornicroft provides accounts of shame and avoidance by family members of those with mental illness and their distancing of these individuals to avoid stigmatization themselves. He documents results of a recent study of over almost 500 relatives of mentally ill persons in New York in which the relatives agreed with statements that members of their community would rather not be friends with families with a member who is mentally ill living with them and members of the community look down on such families. He shows how people with mental illness have smaller social networks, and he supports these statistics with individual accounts of people who have lost their friends as a result of mental illness. Similarly, sexual relationships are problematic, and women with mental illness may often become victims of coercion and abuse, while having mental illness increases the likelihood of separation or divorce. The work area is problematic as well because of prejudice from managers and supervisors, who are often reluctant to rehire individuals who have recently experienced a mental illness. These are just a few of the areas that Professor Thornicroft systematically examines before outlining plans of action at both the local and national level, including discussions of coordinated antistigma activities, public education, and enabling work through use of job coaches and supportive work schemes. In summary, this book provides a complete compendium of state-of-the-art research but goes further in providing individual perspectives and action plans to deal with the extraordinary burdens and problem of stigma in major mental illness.

+This review (doi: 10.1176/appi.ajp.2007.07061020) was accepted for publication in May 2007.




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