Stigma Module

Module Takeaways

• Understand the complex societal, professional and personal ways in which stigma regarding mental health (media, expert knowledge, individual identity) is perpetuated
• Understand systematic discrimination and marginalization as they relate to mental health
• Appreciate the changes to identity that arise from engagement with the mental health system

Module Artefacts

• Two re-enacted plays from the 1940s CBC radio series that set out norms of what was considered “good” mental health. Sociologist Kathleen Kendall provides valuable contextualization for Canada’s first mental health educational campaign
• Frontline stories of marginalization, discrimination, and nascent activism in Toronto’s deinstitutionalization era from writer and activist Pat Capponi’s, author of the 1992 autobiography “Upstairs in the Crazy House”
• A short satirical essay contrasting attitudes toward cancer patients and mental health patients. Written by a HiP community expert Lanny Beckman.
• A reflection on the distance between the patient and the practitioner. Written by a HiP community expert Lanny Beckman

Module Assessment

As a Canadian citizen, have your students write a 250-word letter to describe a stigma or discrimination-free society, using the artefacts which they have examined to develop their ideas.

Their letter should be addressed to one of the following people featured in these modules:

• Kathleen Kendall
• Pat Capponi
• Lanny Beckman

Module Learning Lens

In the 18th century, Londoners used to travel to “Bedlam” – a vast institution for the mad on the outskirts of the city – for the holiday entertainment of watching the patients. Today, the Downtown East Side of Vancouver is regarded by some as a tourist destination, where visitors to the city can view the “street animals”, as one recounted on a recent web-posting that blamed the closure of large psychiatric hospitals for Canada’s poorest postal code. Such public showcasing of people who challenge societal notions of “normal” demonstrates the profound attitudinal barriers to social inclusion faced by people with mental health difficulties. They describe stigma as another whole aspect of their suffering, saying that deeply internalized shame can deter them from seeking help. 

Stigma is defined as a mark of disgrace or inferiority associated with a particular circumstance, quality, or person, and it is widely understood that many people in Canada hold negative attitudes toward mental health difficulties. Discrimination is stigma in action, the unfair treatment of a person or group on the basis of prejudice. Our community experts noted the distinction between these two terms, raising concerns that the concept of stigma is not broad enough to encompass the marginalization that they experience. While a discussion focused on stigma usually acknowledges discrimination due to stereotyping, it remains apolitical and limits the agenda for systemic change. We found that academics agree, arguing that a focus on micro-level interpersonal actions masks social and economic marginalization and obscures unfair treatment and discrimination. In addition, stigma locates root causes in the service user rather than the unjust systems that exclude them. Certainly, the 1940’s radio plays presented in this module – some of Canada’s first efforts in a public mental health education – trace troubling behaviours to dysfunctional families and personal problems rather than the legacies of war or the Great Depression. 

How can we work to remedy this problem? Researchers suggest pulling the concept of discrimination into the center of the picture. Discrimination highlights the role of societal and structural exclusion and accounts for persisting inequities in service provision and opportunities for people with mental health difficulties. It recasts the mental health dialogue as a conversation about civil and human rights and frames stigma and discrimination as a form of social oppression. Placed in a human rights paradigm, the source of the problem shifts from individuals with mental health difficulties to persistent systemic power imbalances. This conception makes space for structural initiatives with a deeper impact such as strategies to enhance work opportunities, political advocacy to address funding inequities, improved legal protection for individuals with mental health difficulties, and new practice models that promote shared decision making and collaborative practice. It also helps people with lived experience of mental health grab hold of a positive sense of self, then contribute to fighting stigma and discrimination. In this module we offer the story of Toronto writer and community worker Pat Capponi as an avenue to help future mental health practitioners understand the scope and impact of discrimination.