 The title of Joe's talk is Forensic Psychiatric Experiences, Stigma and Self-Concept. Mental illness, self-stigma, is when people diagnosed with mental illness believe that society's negative beliefs of them are true. Joe's presentation will discuss stigma and self-concept theory, and report on data showing that multiple stigmatized labels can combine and magnify negative outcomes. Audience, please hold your questions and comments to the end so as to not interrupt our presenter who's pretty new to Second Life. Welcome Joe, the floor is yours. Thank you for that introduction, Pego's kid, and congratulations on your 11 years. I'm happy to be here today and speak to you all about Forensic Psychiatric Experiences, Stigma and Self-Concept. You all know why I'm now after that nice introduction, so I'll skip that part. So I just wanted to acknowledge the various contributors on this project. We had six of them. The main researcher and author on the publications and the research that I'll discuss is Dr. Michelle West. This was actually the topic of her dissertation a few years ago, and she's now a licensed psychologist in the United States and also a researcher still in psychology. So I first wanted to give just a quick overview of what I'll be talking about today. So first I'll give some definitions, background, and theory on what I'm talking about. Then I'll talk about the research study that we conducted, and I'll end with some conclusions, discussion, and implications for the research, and I look forward to hearing some questions and feedback as well. I like starting off with a take-home message just to keep a theme in mind of what we'll be talking about today, and that take-home message is that multiple stigmatized identities can impact one's self-concept, their identity, and in turn influence psychiatric treatment outcomes. So just to start off with some definitions. So when I say forensic psychiatric experiences, I'm talking about people living with mental illness who have faced criminal charges, who have had some involvement in the legal system, and these individuals may be currently in a court diversion program. They may be in a long-term inpatient hospital, but these are individuals who have had some contact with the legal system in the United States, or the forensic system we might call them. Pico's kids said a little bit about stigma, I'll just add a little more. So stigma involves stereotyping and devaluing individuals, just based on their membership in a particular social group. So an example of this would be labeling individuals with mental illness as quote-unquote dangerous, or quote-unquote unpredictable, so attaching stereotypes to a label. Stigma can manifest in many ways in society, so it can manifest in what we call structural stigma. So this may include prejudicial policies and laws in society that inhibit opportunities for people with mental illness or discriminate them in some way. It also includes public stigma, so this is the more common type that we know about, and this is a negative attitudes towards people with mental illness, like the ones I mentioned before, believing people with mental illness are dangerous, etc. And then there's also a form of stigma that has really been researched a lot in the past decade or so plus, and that's called self or internalized stigma. I'll refer to it as self stigma today. So one consequence of stigma is that people may internalize stigmatizing beliefs of people in society, and there are two basic prerequisites for this to occur. So there has to be of course some consciousness awareness of the stigma of the stereotype. So being aware that people believe this about mental illness and also being aware of course of group membership. So being aware that you may be someone diagnosed with mental illness and then knowing that there are stereotypes about that. That is necessary to potentially lead to self stigma. An example of an item we use in research, and this is actually an item we used in the current research project along with other items, other statements might be, because I have a mental illness I am dangerous. So that is self stigma right there. That is someone who is living with a mental illness and buying into a stereotype. They're internalizing that stereotype. Another one might be, because I have a mental illness I will not recover or get better. Again, buying into a societal stereotype that people with mental illness cannot get effective treatment, will never get better, etc. All of these stereotypes which are untrue. Self stigma actually affects a relatively high percentage of people with severe mental illness. And if you were here earlier for Dr. Yanos' talk, he's actually my mentor and he talked a bit about self stigma I know as well. And it could be a kind of really negative phenomenon for people. It could predict poorer functional and treatment outcomes, lead to lower self-esteem, lead to kind of less involvement in psychiatric care, and internally to a lot of negative outcomes. So it's really important to be talking about self stigma. Just a bit of a further background. So in addition to mental health, which is definitely stigmatized worldwide, people can be stigmatized based on many different labels. Stereotypes about people with mental illness, like I've mentioned, overlap with stereotypes about criminal offenders and ethnic racial minorities. We know there are stereotypes about those groups too. And we also know that racial minorities are over-represented in the correctional system and kind of disproportionately represented really around the world in criminal justice institutions. And we hypothesized, and we were kind of putting this into a theory as we worked on this research, that this may lead to a triple stigma, to someone who has forensic involvement, someone who is of an ethnic or racial minority group, and someone who's living with a mental illness. We believe that maybe those three different stigmatized identities potentially could magnify the effects of stigma. So just to speak about these other stigmas a little more. So for example, someone who has a legal history background, maybe they've committed a crime or they've been convicted of a crime in the past, they may endorse this statement, because I am an offender, I am a bad person. Right? That would be self-stigma. When it comes to race and ethnicity, someone may believe, I feel bad about the race and ethnicity I belong to. Right? Another idea or rather example of self-stigma, that you are internalizing society's negative attitudes about your group. Not that everyone believes this, but that this stereotype is kind of in the air, that people know it exists. So what is self-concept? It's sort of synonymous with identity. Self-concept is the way we formulate our identity. It's who we are. So everyone in the audience today may want to think about, you know, what makes up them as a person, what's their self-concept? You may be a son or a daughter, mother or a father. You may be someone in a particular profession, a coordinator of something, a boss of something. And self-concept is really a multi-dimensional concept. It relies both on our own labels about ourselves and who we think we are. But self-concept also takes into account what other people think we are, and that's kind of where self-stigma comes into play. Because membership and social groups, including stigmatized ones, are typically integrated into one self-concept. So for example, I am a person, someone might say I am a person with a mental illness, I am a person with a legal history, and then they have to contend with what that means for them. So all of these labels obviously can affect how one views oneself, and the overlap of these labels may uniquely impact racial minorities labeled forensic psychiatric patients, given the stigma and the stereotypes related to individuals of ethnic and racial minority groups. And I think this may be best to visualize this. So I wanted to provide two visual aids, and right now I'm showing a pie chart. And this is a hypothetical person with kind of low self-stigma. Right? So this is someone who doesn't believe their mental illness will hold them back, they are proud of their race and ethnicity, think their mental illness has made them a tough survivor, and they don't think their legal involvement necessarily makes them a bad person. So this is someone who has integrated these social identities in a relatively positive and adaptive way. Now on the flip side, someone with high self-stigma, this is another pie chart I'm showing, may think that they're not proud of their racial or ethnic heritage because they have a mental illness, they believe they won't recover, they might believe they're dangerous. And they may also believe because they have an offense history in the legal system that they're a bad person. Now these two examples are of course extremes, so we have a low self-stigma and a high self-stigma, but there are many variations in between. So someone may stigmatize themselves really for having a mental illness, but still be proud of their racial and ethnic heritage. But these are just two examples to illustrate self-stigma. So why did we do this research? So although mental illness, self-stigma research has received a lot of research attention recently, less research has explored the impact of multiple stigmatized identities. And instead, like I said, most research looks at stigmatized identities in isolation. So they'll look at mental illness, self-stigma, they may look at self-stigma about being of a certain racial or ethnic group, but often they're not looked at together. And on this slide I have a picture of a person, kind of like a stick figure I believe, representing sort of intersectionality. So this is the idea that we have many different characteristics and intersections, again both self-labeled and kind of ascribed to us by society. And I'll refer back to this image, but keep that theme in mind of intersectionality. So for our research study, this was a few years ago, but we've slowly kind of put the data together and recently published another paper a few months ago, we recruited 82 adult participants from two urban sites in the United States. So one was a long-term inpatient psychiatric hospital and the other was a mental health court diversion program. So a mental health court diversion program for those of you who don't know is an outpatient program for people who have been arrested for some type of crime in the community, but they are mandated to treatment by law and they're allowed to live in the community, but they have to kind of attend treatment for a year to two years and then their charges are dropped. Of course we did inform consent, we made sure that we could access participants' charts with their permission, we protected participant data with identification numbers, nothing was attached to people's names in the end, and now participants were compensated for their time. So participants were asked to complete several questionnaires and I'll refer to these throughout. So we asked about participants' experiences of discrimination, we asked about self-stigma related to mental illness, race or ethnicity, being an offender, and then we asked about psychiatric treatment outcomes like self-esteem, depression, medication adherence, so are you taking your medication consistently? Working alliance, how well do you work with your therapists? And the TST, a 20 statements test item, which I'll talk about later. And we also had some clinicians fill out questionnaires too for us, so we had the perspective of both the participant and also their therapist or case manager, excuse me, case manager. And as I'll talk about later on as well, we also did some qualitative interviews, so these are one-on-one interviews where we asked a lot of open-ended questions. We did that with eight participants. So now I'll talk first about some of the demographics of our study. So you will see a chart up here which shows sort of the mean age, age efforts, hospitalization, things like that. I will read off some of these. So our sample was predominantly male, also mostly Latino, Latina or Black, largely middle-aged and single, and varying educational backgrounds. The majority of our participants did have a psychotic spectrum disorder like schizophrenia or a mood disorder like depression or bipolar disorder, and about 50% had a dual diagnosis of a substance use disorder. Most common criminal charges were either drug related, but we also had some charges related to attempted murder. Okay, we want the next one. Okay, so we had a few hypotheses going into this study. The first one unsurprisingly, we believe that discrimination experiences due to mental illness, race, and criminal history would be commonly reported. We also believe that having self-stigma of mental illness would be associated with higher depression, lower self-esteem, and lower treatment adherence, and working alliance, and also that racial self-concept or self-stigma and criminality self-stigma would moderate this relationship between mental illness, self-stigma, and outcomes. Essentially in statistical terms that means that combining these stigmatized identities together, so having a high racial self-stigma, having a high mental illness self-stigma, combining those together would lead to negative outcomes. That's all that means. And right now I'm just showing a picture of two of our publications, one from the International Journal of Forensic Mental Health and the other from a psychiatric rehabilitation journal. Okay, so in regard to our first hypothesis, we did find that most participants reported that they had experienced discrimination at some point, about 65%. Most commonly reported discrimination experiences were in the context of employment, so that it stopped you from getting a job, it stopped you from getting housed, stopped you from getting treatment or education, and we found that most people were affected by stigma related to their race or ethnicity, but they were also affected by stigma related to mental illness and incarceration. To a somewhat lesser degree, but still it's quite a large percentage of people experiencing discrimination. So moving on to our second hypothesis, we did find that people who had more of this mental illness self-stigma, they were significantly more likely to have more depression, lower self-esteem, and lower adherence to taking their medication. So again, these are people who believe that, oh because I have a mental illness I can't recover, because I have a mental illness I'm dangerous. Similarly, we found that people who had high criminality self-stigma, they had a lower working alliance with their therapist. But what that means is they had less of an ability to agree on tasks and goals or create a relationship with the therapist, which we know is an important factor to the therapy process. And again, people high on criminality self-stigma might believe because I am an offender I am bad, right? And then lastly, people who had high racial self-stigma, also had higher depression, lower self-esteem, and lower treatment compliance and working alliance. So again, these are people who may believe that they're not proud of their race or ethnicity, that it makes them bad to be part of certain racial or ethnic groups. So in some kind of having these negative attitudes internalized can lead to a lot of negative outcomes. So what about the relationship between these three stigmas? So we just looked at them in isolation, but what about when we combined them? So we found that higher mental illness self-stigma significantly related to both higher expectations of discrimination due to being an offender and high criminality self-stigma. So again, if you're high on mental illness self-stigma, you were more likely to have high expectations of being discriminated due to being an offender. Similarly, if you had high racial self-stigma, you also had higher criminal self-stigma. So again, that kind of combines the stereotypes of being from a certain racial minority group and then also being involved in the criminal justice system. So basically two stigmas are combining to exacerbate negative outcomes. And again, I show that picture of intersectionality, that people have these multiple dimensions to them, both self labeled and ascribed by society, and these intersections really can impact how we function in the world. And in this case, respond to mental health treatment and our mental health outcomes. Now, I'm sorry if I didn't have the right slide up there. For hypothesis three, we found further interaction effects. So again, just in statistical terms, this means that combining these various identities can lead to more negative outcomes, that having high self-stigma in multiple areas. So we found that people who had higher racial self-stigma scores, they were more likely to experience negative effects in terms of criminal self-stigma on self-esteem scores and criminal self-stigma on medication adherence, as well as mental illness self-stigma on medication adherence. So again, these factors kind of combine to create all of these negative outcomes. Also, the higher the criminality self-stigma scores, so the higher you believe, for example, you were bad that you were an offend, or yeah, a bad person for having committed a crime perhaps, you were also more likely to have negative effects from mental illness self-stigma. I know this is a lot to kind of put together, but again the gist of it is that these multiple identities are combining to create negative outcomes. If you're afflicted by one self-stigma, you're likely to be afflicted by another self-stigma as well, which can create these negative outcomes. So again, consistent with this intersectionality perspective, these interaction effects indicated that criminality self-stigma again magnified the effects of both lower racial concept and higher mental illness self-stigma on negative outcomes. And as we said, provides some evidence that self-stigma combinations can have a real negative impact on self-esteem and medication adherence, greater than that of just one stigmatized identity or looking at it separately. However, some hypotheses were not supported. So for example, criminality self-stigma was not related to self-esteem or higher depression. This could be that our sample was small and more study should look at that, but we did not find that that was directly related. So switching gears a little bit to our qualitative aspect of this study. So what I just reported on was the quantitative data, those are the numbers, the statistical interactions, and looking at how people respond to scales. We also chose eight participants from this sample to do more of an open-ended interview. We picked eight people who we thought were representative of kind of the study and had a story to share. And they all accepted invitation. It was a pretty diverse group four identified as African-American or Black, two identified as Latino, Latina or Hispanic, one as European-American or white, and one as other. Six were men. The age range was pretty wide, but the mean was middle-aged. Most had a high school education. And what did we ask in this interview? We asked a whole bunch of questions. The interview could have could last from 45 minutes to over an hour. We asked about how arrest records impacts participants thoughts and beliefs about themselves. We also asked what type of discrimination or stigma bothers them the most. Is it the mental illness stigma? Is it the racial stigma? Is it being an offender? Is it something else? And we also used this kind of nifty measure called the 20 statements test. And essentially on this measure you're given 20 I am statements with a blank after it and you're asked to kind of just freely input what comes to mind. And that is believed to measure people's identity and self-concept, kind of what they believe about themselves. And I'll talk more about that in a minute. Categories can reign from physical. You might put your hate in age. You may put social groupings, the attributes about yourself. We're just more global or kind of vague responses. I'm human, I'm me. So this is just a picture of our recent publication. The Journal of Forensic Psychiatry and Psychology published this. We put a lot of work into it. So we're very happy to publish it and very happy to share it with you all today. And it was entitled Forensic Psychiatric Experiences Stigma and Self-Concept Mixed Methods because we used the qualitative interview. Okay so what were some of our hypotheses going into this? Well for the 20 statements test we hypothesized that if you had more responses so again not everyone answered all 20 but we hypothesized the more total responses you had. You would have less self-stigma and we thought that might be the case because maybe you have a more multifaceted and well-defined self-concept if you're able to use many different phrases or words to describe yourself. We also believe that having more social responses would be related to less self-stigma. And again a similar hypothesis that maybe this would represent more social connection if you say you're a mother or a father for example. Maybe you're proud of these roles and I can kind of buffer self-stigma. Third we believe that more global responses would be related to more self-stigma. So for example again these are people who say like I am human, I am me, I am alive. Relatively less well-defined words and we thought that may be kind of a risk factor for self-stigma. Lastly we thought that more attributive responses would be again related to less self-stigma. And again with the idea of perhaps this is related to more insight if you're able to attribute things to yourself like I'm friendly, I'm loving, I am nice that could be related to less self-stigma. And what I'm showing now is an example of what the 20 statements test looks like. And we would give something like this in-person to the participants. We interviewed them on-site either at the hospital or at the court diversion program. And we would give them about five minutes or so to complete the task. Very few people did all 20 which you'll see in a second but we encourage them to write as many as they could. Okay so what I'm showing now is a chart of some common 20 statements test responses as well as some of the means. So on average people put 12 responses out of 20. And then you could see some examples of physical responses like good-looking, fat, cute, and some of the other categories that are up there. Just to note the physical example here you will note that people can put both positive and negative items. So for example you may think that good-looking or small or tall may be relatively positive but for some people writing fat or chubby or other items that they may think are negative that may have a kind of detrimental impact. But again sometimes people own these labels so it may not be negative but we couldn't necessarily say what was positive and negative in the study so we didn't go there. So what were the results? So consistent or rather I'm sorry I say inconsistent with our hypotheses we actually found that having more responses on the 20 statements test was related to more racial self-statement. So the more higher number of responses you had on the 20 statements test you were more likely to believe for example oh I'm bad for being an offender. So one theory for this is that maybe role accumulation having many labels about yourself is not always beneficial because like I said some of those labels can be negative so if you have someone who perseverates on negative characteristics about themselves they may have a lot of responses but it doesn't mean it's positive. In terms of global responses that was consistent with our hypotheses so we did find that people who had those vague responses like I am a lie if I'm human they were more likely to have criminal self-stigma. So it could be a combination of the first two findings I'm showing you there that people are maybe writing a lot of global responses which is related to more self-stigma and maybe more susceptible to integrating stigma into their identity. In terms of attributive responses this did confirm our hypotheses as well so people who had attributive responses such as good loving friendly these people had less mental illness self-stigma which is kind of unsurprising that if you're attributing relatively positive characteristics to yourself you would have less self-stigma. It may also indicate just a better self-reflectiveness more insight in some ways and a better ability to integrate aspects of yourself rather than just membership in a social category rather than just being a person living with mental we did not find any relationships on the social 20 statements test items so I'm a mother I'm a father that did not relate to anything that was inconsistent with our hypotheses too but again we need a bigger sample to test this more in the future. So for the interview we didn't have any a priori hypotheses this is very exploratory we wanted to hear about self-stigma from our participants point of view and after we completed the interviews we transcribed what the people said because we did voice record with permission and 10 domains emerged based on our thematic analysis we had three to four people kind of agreeing on what themes to use. Three emerged for mental illness race and criminality that's nine three for each and the subcategories were experience so for example when you were first diagnosed with mental illness was that like community perception reaction so what you perceive the community needs to think about you in terms of your race ethnicity and then individual reaction so for example what is it like for you living with a criminal conviction or having this history being an offender what is it like for you again we're really getting at stigma and specifically self-stigma in a nuanced way getting out from the perspectives of these individuals rather than giving them just a scale to you and then our last theme was up for intersectionality and again our stick figure friend comes back and we still want to keep in mind that we are kind of a combination of many different factors and not just the sum of our parts but how these parts interact and multiply together so I thought the best way to present the results of these interviews was to give some representative examples so one person told us that in my opinion I just think that people see you as damaged goods that's what somebody had once told me when I was sharing with them my struggles with mental illness oh you're just damaged goods so that would be an example of someone's experience in the community with perceptions of mental illness the second one I can go into let's say a university and get discriminated I can feel the discrimination I just can feel it maybe that's because of the way I'm dressed or the way I'm wearing my hair or the mustache on my face or if I'm not shaving oh I know the rest of it there but that one essentially is getting at the idea that how one looks can also be stigmatized as well where they may say I'm an animal is the definition of that role and then the third one is once they see the background check and they see all your charges they don't want to hire because of that it's not like I'm still out there trying to commit crimes I'm just trying to do the right thing just get a nine to five so you can see from these three examples that people identify negative interactions with the community about having a mental illness or being discriminated for race ethnicity or physical in terms of intersectionality and combining these we had some people quite eloquently say how these stigmatized identities multiply in their own lives so for example someone said I think if I wasn't black and if I was white I don't think there would have been such a rush to get me to plead to the felony I really think they would have handled it differently so this person is talking about what it means to be a black person in the criminal justices so that would be an intersection of your race and ethnicity identity and having an offender kind of that part of who you are or a label that is ascribed to you rather I'll let you all read the second one so this brought something really interesting to our study this is a person talking about people perhaps of a lower socioeconomic status not having enough money maybe to see a psychiatrist so that involved intersectionality in terms of social class and how much money and privilege you might have and how that could affect getting effective care most participants overall appear to endorse stigma related to mental illness and being labeled an offender half of the participants indicated that criminal justice involvement exacerbates psychiatric symptoms so for example many people said that being locked up or being in a jail or prison made their symptoms worse or maybe created some symptoms or led them to develop some traumatic symptoms per se again people also talked about multiplying those identities in terms of legal authorities make care less about people with mental illness or they may not get effective legal representation all consistent with our earlier data most people did say that racial stigma was most bothersome they said they were affected by mental illness stigma and stigma related to being in the criminal justice system but they said they were really affected by stigma toward their race and ethnicity so just concluding everything here I bring us back to our take home message that multiple stigmatized identities I should actually say do impact one's self-concept and can influence psychiatric treatment outcomes a triple stigma does appear to exist whereby individuals experience stigma from these three categories that we've been talking about today and probably many more of course there are limitations with our research just like any study for one we had a small sample of just 82 people we conducted the study in a urban part in the northeast of the united states and it really be important for future studies to maybe use more measures do more in-depth interviews use bigger samples more diverse sample and also look at other stigmatized identities so this might be sexuality gender identification class ability status language it goes on and on it'd be really interesting to see how those areas may interact implications are important I mean for mental health professionals especially when working with individuals who have combined stigmatized identities rehabilitation really needs to consider how those identities may overlap and combine to lead to negative outcomes if you were here for Dr. Yanis's talk earlier you may have heard him talk about kind of narrative enhancement cognitive therapy that is one way to target mental illness self-stigma it would really be interesting to adapt that intervention and maybe see if we could target self-stigma related to being an offender or being of a certain racial and ethnic group and based on our 20 statements test findings maybe other targets may include focusing on personal attributes and a balance in nuanced way and moving away a bit for more global identifications of how you identify and last but not least it's very important of course to focus on self-stigma and how people of stigmatized groups think about themselves and internalize these attitudes and how it can lead to negative outcomes but really at the end of the day stigma is not a personal problem it's a societal problem and public stigma programs need to continue to be introduced to break down that stigma in society because that is the root of self-stigma self-stigma exists because public stigma is occurring and i want to thank you all and open the floor for any questions or discussions thank you very much thank you joe i think it's really important to look at these intersections and it's useful for us to be made aware of that we really appreciate your sharing your research with us and i'm thinking we're going to have some very interesting questions here we have a long question for mook so let me read it out loud and you may be able to read it as well mook says you said self-stigma affects relatively high percentage of people with severe mental illness and she wants to know would that have anything to do with the Stanley Milgram effect where subjects in experiments often voluntarily yield in decision making to staff with white coats and obvious authority which had the power to remove the mantle of responsibility from the subject such as i'll take responsibility for that and the the research subjects then agree to do something they might not usually do might self-stigma be higher in people with severe mental illness because these people are the ones most likely to be in close contact with psychiatric professionals and carers who have the power to moderate or influence the subject's sense of responsibility beliefs and labels well that's a good question that's a yeah that's a very good question and then and you know Stanley Milgram showed us a lot about the effects of a power figure and obedience on people and i i've never really thought about it in that way that's really interesting and i have i guess two thoughts related to it so one thought is that um we need to break down stigma among mental health professionals and other doctors too because at the end of the day stigma is a power dynamic and stigma comes from powerful places and is usually put down on stigmatized people who don't have a lot of power so if there are negative messages coming from doctors psychiatrist etc that can certainly contribute to self-stigma so we need to train our doctors and mental health professionals to give as many hopeful messages as possible to improve that similarly i i mean i think the Milgram study can also be relevant to public stigma and what the community believes about mental illness and i think similarly we probably need more people in power such as the president high-powered doctors people who are very visible other politicians to also give out positive messages because the Milgram study showed that people can be very obedient to a power figure and we really need positive messages coming from the top down so i know that was a little tangential but i hope that answers your question i have a follow-up question to that what did you mean when you were talking about public stigma reduction programs are there some good ones out there that we ought to be using that we need to find out about that's another great question so the the gold standard for public stigma reduction is generally contact so having contact with someone with a mental illness so some programs in the united states and worldwide involve having a person with mental illness share their story of recovery share what has helped them share how they're functioning and that tends to have the most powerful effect along with some education too but contact is one of the most important things okay we have another question here Jennifer asked why do we see others as damaged goods in the first place it's our flaws which help make us who we are and help us build personality and character why can't we see others as being perfect as who they are that's also a great question Jennifer i i wish more people thought like you but unfortunately there are people out there who for lack of a better word or ignorant they they believe that certain features are flaws and they believe that they represent weakness or they represent an inability to do something but i totally agree with you though that we can certainly look at any physical feature or label and see the positives that come from it and how it just makes us who we are and that's the goal of public stigma programs we need more people to start thinking like that and Jennifer followed up by saying whoa it's going out of my view here Jennifer said we all have stories to tell by not accepting others for who they are we are not allowing ourselves to see others in their eyes and then she said ignorant to close their own lives i think if i'm if i'm understanding your question Jennifer i think people are ignorant about mental health because they haven't had a lot of contact with it so they may not know someone with a mental illness they may not have ever had a mental health concern themselves they may not know the the research on mental illness and recovery so i think giving more of that to people the contact and the education can reduce the ignorant Jennifer also asked maybe they're ignorant to their own knowledge of what they fear and what scares them i think that's absolutely right in some situations i think people can be so overwhelmed by fear and the other quote on quote that it's hard for them to even get to that place and mook reminds Jennifer of a quote from ericule poirot you attribute always to others the sentiments that you yourself experience yeah that's a good one and you know some theories for why we stigmatize maybe projection of our own insecurities or fears which again i think largely stem from ignorance and kind of lack of contact with with other people so another question we know in the disability community that some types of disabilities are less stigmatized than others hidden disabilities for example like other illnesses are often more stigmatized than visible disabilities like an amputation are there differences between stigmatization of different types of mental illnesses yes there absolutely are so people with schizophrenia tend to be stigmatized the most so these are people with schizophrenia who may have delusions they may be living with hallucinations they tend to be stigmatized the most as violent as unpredictable which is largely largely untrue in a stereotype people for example with depression anxiety other mental health conditions that can often be more concealable are less stigmatized and just to add i see jennifer posted a follow-up there i mean i think sometimes people may feel personal hurt they may feel like they could be attacked by someone with a mental illness but i think like that quote was alluding to before i think sometimes people also feel the reality of how prevalent mental health problems are and and they're worried that that could be them one day or they might be susceptible so i think that process plays out too and pecos asks a question and i think i'm going to ask him to clarify this he said were any members of your study people with disability i think you mean other than the mental illness disability right and missy says she has it she says schizoaffective disorder is acceptable than uh schizophrenia schizophrenia got it so it's a pecos question um we did not measure that so i i don't know for sure and we don't have that in our in our data but uh such an important intersection to study in future research to see if that is potentially internalized negatively by some people um and to missy's question yeah there are a lot of variations in the human condition and um i i think again this comes back to ignorance that i i doubt much of the public even knows the difference between schizophrenia or schizoaffective so a lot of education is required too to let people know what what these mental health conditions are really about and british adding adding the fear is the unknown you can't see mental illnesses they're on the inside you never know what is truly going on in the minds of others yeah i i think that's certainly part of it right that uh it's kind of intangible and i think that's where people's fears can come from too james says i confess that a former friend of mine had that schizophrenia it was not a problem for me until she came unglued with me one time and scared the heck out of me i avoided her after that it was like she became a completely different person and she was simply not safe yeah i'm sorry to hear that james i mean people with mental illness can have relapses and can display certain symptoms that that can seem alarming um but certainly the vast majority are not violent or not dangerous um but people have varying degrees of symptoms and uh that certainly comes up in the research too that friends and family uh can might feel unsafe or or not sure how to respond to crises um but yeah it can be disconcerting uh when you have an experience like that james certainly and jennifer is responding to grit saying but to close ourselves off to the experiences of others to the knowledge that they possess and gloria go ahead answer no i'm sorry i missed that general can you sir this was jennifer responding to grit and jennifer said but to close ourselves off to the experiences of the knowledge that they possess right and and i think some people uh do that i i would certainly advocate for for the opposite that i think the more open we are as a society about mental illness the less stigmatized it will become uh but there are a lot of people out there who don't like talking about their mental health their diagnoses and often for good reason they feel like they'll be stigmatized but i feel like once society gets to a place where we can talk more openly about it we we can start to see some less stigma and gloria joy says it is amazing how just one level up on a med can change a person totally yeah people have all sorts of individualized recoveries for some people a therapy that's all they need for others it's a medication that has the powerful effect so um this is another way to think about mental illness that it's very unique and individualized and it's not one size fits all in terms of symptoms and recovery and jennifer saying we need to not fear and matilda was responding but fear is human perhaps we need to accept that in our fellow humans yeah i i think it's a combination of both i think we need to accept that we are fearful creatures and and that that emotion comes up but i think it's also important to think about and process where is that fear coming from because the emotion tends to happen after you have a thought so i would encourage people have a a visceral emotion to think what is the thought that that led to that i mean relate to that what about journalism's role in stigma to the journalism journalism used to have the um motto if it bleeds it needs you know they're gonna take the worst part yeah that is um i mean some forms of journalism and particular papers have been quite damaging to mental health um there have been many sensational stories about mental health and violence and crimes um and there are actually guidelines in the united states that are out in terms of how to report on mental health but you know we we frequently see stories about people with mental illness being violent in the news but there aren't as many stories about people with mental illness recovering and functioning living well and you know those people represent the majority so and missy is sharing something very personal she says she feels a lot of stigma here in second life when she meets people she doesn't tell them her disability because schizophrenia has so much stigma she can't find the right time to reveal herself she doesn't know if she's ready to let people know so she hides here yeah i appreciate you sharing that and and like i said diagnoses or symptoms can can carry stigma with them and and people may want to be or think they need to be cautious about that um but disclosing mental health symptoms and diagnoses is a very personal decision and it's important to weigh the pros and cons and your reason for doing it and how you feel about it but again it's it's very individualized and it's it's something that you want to link to your goals and what you want to achieve with that but i appreciate you sharing it today and i think we have time for just one last comment mook says fear is also an evolutionary response to unpredictability as in james's scenario when you cannot predict what someone or something is going to do you have no directions for action or decision so it's safer just to stay away and avoid it or them right and and that's absolutely correct so humans need fear if a snake is nearby right you need to know to get away from that snake uh if uh house is on fire right fear is very adaptive you need to know to get out uh in the case of mental illness i i think again people need to think about what the root of the fear is if uh people learn more about mental illness and realize that the base rate of violence is quite low and that many people recover and many people living with mental illness are friends and family members and bosses that can slowly diminish that fear response i i do believe for our audience to thank our presenter um ice guy asked a question she's sneaking it into the last minute there it would help if society certain sentiments of it would stop whipping up that fear and stigma against people with mental illness or blame people with mental illness for things that happen or go wrong we have to reduce that attitude what are the best ways to do that very good points again ice guy i think i would go back to uh one the gold standard of contact so more programs need to be rolled out like that so you can see a people a person living with mental illness i think to the question before journalism needs to improve how they report about mental illness um but society in general like no matter where you live laws and policies that discriminate toward people with mental illness also need to be dismantled but i think it takes kind of a a multi-dimensional approach to to get there for really great information today and also thanks to the audience you shared a lot of information and a lot of very personal stories and that's that's what makes this a very rich environment thank you thank you everyone thank you all it was a it was a pleasure and i really appreciate the the questions and the conversation