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In International Relations (IR) scholarship, there is a growing body of research on the connections between emotions, stigma, and norm violations. It is often presumed that for stigma imposition to be successful, norm violators should feel shame. We argue instead that the emotional dynamics that inform the management of stigma are more complex and involve overlooked emotions such as anxiety, sadness, and hopelessness. We substantiate this by analysing the successful stigmatisation of anti-war voices in Azerbaijan during the 2020 Karabakh war. While the vast majority of the Azerbaijani population supported the war, a small minority contested its legitimacy and the related emotional obligation to express hatred against Armenians. However, these anti-war voices became stigmatised as ‘traitors to the homeland’, and were ultimately pushed to self-silence. We contribute to the growing IR scholarship on emotions and stigma in two ways. First, we show how successful stigmatisation of norm violators may involve emotional dynamics that go beyond shame. Second, we discuss the power of emotion norms of hatred, which, especially in times of war, can push ‘ordinary people’ to pro-actively and vehemently stigmatise norm-violators. In conclusion, we elaborate on the potential future implications of stigma on peacebuilding activities between Armenia and Azerbaijan.
Examines the concept of hoarding, what it is and how some animals and most people have a tendency to collect items beyond their immediate requirements. The distinction is made between a hoard and a collection. The types of items which are hoarded are discussed along with a description of animal hoarding.
Social aspects of hoarding. We address the stigma of hoarding and how this can be treated by society, along with discussion of the shame and humiliation which prevents many people with hoarding problems from seeking help. This stigma can be reinforced by “helping” agencies who may view it as a “lifestyle choice” rather than a condition which requires help. Then looking at the role the media has played in perpetuating the myth that hoarders should be able to deal with it themselves.
Hoarding is a symptom rather than a distinct diagnosis and may be found in many conditions but there is a specific condition with characteristic features known as Hoarding Disorder. Some possible causes of hoarding are then described followed by a more detailed examination of the diagnosis of Hoarding Disorder
Finally, the chapter examines t what age hoarding arises and introduces the idea of hoarding in childhood.
In this chapter we will examine the psychological treatments that have been found to be helpful for people with Hoarding Disorder. The main approach used is Cognitive Behaviour Therapy (CBT). This may be with an individual or in a group setting. Although, as with much of the research into Hoarding Disorder, the number of studies of high quality are limited, we have good evidence that CBT does work and can have life-changing impacts both on the hoarding and also the depressive symptoms which often accompany Hoarding Disorder. One of the major issues, however, can be the reluctance of people with Hoarding disorder to enter into treatment programmes and then to stick with the programme. There may be many reasons for this reluctance. One recent development which may be hopeful for the future has been using an approach known as Compassion Focussed Therapy in addition to the standard CBT.
Addiction is a highly prevalent brain disease. It is a major cause of many secondary forms of medical illness and accidents, and it is a leading root cause of death. The disease attacks the circuits of the brain that govern motivational learning and control. It is defined by increasingly compulsive drug seeking and use, despite the accumulation of negative medical, social, and psychiatric consequences. Because the disease also impacts brain systems governing the exercise of free-will, decision-making, and insight, it is often judged, criminalized, and stigmatized, which are countertherapeutic social responses to the disease. Addiction psychiatry is a field of psychiatry that is uniquely trained to treat the entire spectrum of addictions and mental illness, especially for mainstream dual-diagnosis patients who suffer with combinations of these disorders. The epidemiology of addiction shows that the disease is not evenly distributed in the population. Rather, it tends to concentrate in people with genetic, developmental, and environmental risk factors, many of which overlap with those that also produce mental illness. Advances and growth in addiction psychiatry training, research, and clinical care hold tremendous potential for ending mass incarceration and rendering the healthcare system more efficacious and cost-effective.
In this chapter we examine the difficult problem of trying to offer help and support to a friend or loved one who has Hoarding Disorder. Many people with Hoarding Disorder are reluctant to admit that they have a problem. This may be due to shame and the stigma surrounding the condition, or may be due to a lack of insight as the individual has become so accustomed to this way of living and denies there is a problem. Family members and friends need to be empathetic, patient, and tolerant. Constant nagging is likely to increase resistance and so it is a difficult path between urging them to get help but not causing them to feel persecuted and to cut ties with those trying to help them. If their own health and safety, or that of others is at risk, then we suggest ways in which you can ensure they receive the help they need. At the end of this chapter, we list some of the agencies that can offer help and advice for family, friends, and people living with hoarding problems. While helping a person with hoarding it is imperative you also consider your own health and safety as well as that of the person with hoarding.
It is widely known that people with a severe and persistent mental illness (SPMI) are more at risk of poor physical health outcomes because of disparities in healthcare access and provision. Less is known about the quality of end-of-life (EoL) care in people with SPMI who have a life-limiting disease.
Methods
A comprehensive and systematic literature search in PubMed, Embase, Web of Science, Scopus, and CINAHL electronic databases (from inception to November 2023) was conducted, without language restriction, for reviews on EoL care and/or palliative sedation for people with SPMI and a life-limiting disease. A critical appraisal of the selected reviews was performed. Data were analyzed according to the four principles of biomedical ethics.
Results
Ten reviews were included. These show that people with SPMI are at risk of suboptimal EoL care. Stigma among healthcare professionals, lack of integrated care policies, absence of advanced care planning, and insufficient expertise and training in palliative care of psychiatrists have been identified as key challenges to the provision of adequate EoL care for people with SPMI. No data were found about palliative sedation.
Conclusions
To optimize palliative and EoL care for SPMI patients with a life-limiting disease, a policy of coordinated and integrated mental and physical healthcare is needed. Moreover, education and training initiatives to reduce stigma and discrimination among all healthcare workers and to enhance palliative care skills in psychiatrists should be offered. Finally, more research is needed on EoL particularly on palliative sedation for people with SPMI and a life-limiting disease.
In academia, as in any profession, one of the toughest decisions facing an autistic person is whether and when to disclose their diagnosis. On the one hand, disclosure can bring awareness, understanding, and support. On the other, it can bring misunderstanding, stigma, and discrimination. In this chapter participants reflect on their decisions to disclose (or not to disclose) to employers, colleagues, staff, and students – and the impacts of these decisions. This chapter also addresses the issue of masking (hiding their autistic characteristics), including when and why participants feel the need to mask and the impact this has on them.
Borderline personality disorder (BPD) is a highly stigmatised mental disorder. A variety of research exists highlighting the stigma experienced by individuals with BPD and the impacts of such prejudices on their lives. Similarly, much research exists on the benefits of engaging in compassionate acts, including improved mental health recovery. However, there is a notable gap in understanding how stigma experienced by people with BPD acts as a barrier to compassion and by extension recovery. This paper synthesises these perspectives, examining common barriers to compassionate acts, the impact of stigma on people with BPD, and how these barriers are exacerbated for individuals with BPD due to the stigma they face. The synthesis of perspectives in the article highlights the critical role of compassion in supporting the recovery of individuals with BPD, while also revealing the significant barriers posed by stigma. Addressing these challenges requires a comprehensive understanding of the intersection between compassion and stigma, informing the development of targeted interventions to promote well-being and recovery for individuals with BPD.
Historical research on efforts to reduce the stigma associated with venereal disease (VD) generally dates these campaigns back to the 1930s. Within the United States, one of the earliest attempts to detach VD from its traditional association with sexual immorality occurred during the late nineteenth- and early twentieth-century, when the New York City dermatologist Lucius Bulkley coined the term syphilis insontium (‘syphilis of the innocent’) in the hopes of demonstrating that many of those who contracted this disease did so through non-sexual contact. Gaining widespread acceptance within the medical community, Bulkley’s ideas served as the intellectual foundation for a discursive assault on the prevailing belief that syphilis constituted the ‘wages of sin’—one designed to destigmatise the disease and to promote more scientific responses to it. However, the effects of this anti-stigma rhetoric were often counterproductive. Encouraging doctors to discern ‘innocence’ or ‘guilt’ through assessments of a patient’s character, syphilis insontium often amplified the disease’s association with immorality. With the passage of time, physicians became increasingly aware of these problems, and in the 1910s, a backlash against Bulkley’s ideas emerged within the American medical community. Yet even with the resultant demise of his destigmatisation campaign, discourses of ‘innocent syphilis’ continued to circulate, casting a long shadow over subsequent stigma reduction efforts.
While early intervention in psychosis (EIP) programs have been increasingly implemented across the globe, many initiatives from Africa, Asia and Latin America are not widely known. The aims of the current review are (a) to describe population-based and small-scale, single-site EIP programs in Africa, Asia and Latin America, (b) to examine the variability between programs located in low-and-middle income (LMIC) and high-income countries in similar regions and (c) to outline some of the challenges and provide recommendations to overcome existing obstacles.
Methods
EIP programs in Africa, Asia and Latin America were identified through experts from the different target regions. We performed a systematic search in Medline, Embase, APA PsycInfo, Web of Science and Scopus up to February 6, 2024.
Results
Most EIP programs in these continents are small-scale, single-site programs that serve a limited section of the population. Population-based programs with widespread coverage and programs integrated into primary health care are rare. In Africa, EIP programs are virtually absent. Mainland China is one of the only LMICs that has begun to take steps toward developing a population-based EIP program. High-income Asian countries (e.g. Hong Kong and Singapore) have well-developed, comprehensive programs for individuals with early psychosis, while others with similar economies (e.g. South Korea and Japan) do not. In Latin America, Chile is the only country in the process of providing population-based EIP care.
Conclusions
Financial resources and integration in mental health care, as well as the availability of epidemiological data on psychosis, impact the implementation of EIP programs. Given the major treatment gap of early psychosis in Africa, Latin America and large parts of Asia, publicly funded, locally-led and accessible community-based EIP care provision is urgently needed.
Stigma of mental health conditions hinders recovery and well-being. The Honest, Open, Proud (HOP) program shows promise in reducing stigma but there is uncertainty about the feasibility of a randomized trial to evaluate a peer-delivered, individual adaptation of HOP for psychosis (Let's Talk).
Methods
A multi-site, Prospective Randomized Open Blinded Evaluation (PROBE) design, feasibility randomised controlled trial (RCT) comparing the peer-delivered intervention (Let's Talk) to treatment as usual (TAU). Follow-up was 2.5 and 6 months. Randomization was via a web-based system, with permuted blocks of random size. Up to 10 sessions of the intervention over 10 weeks were offered. The primary outcome was feasibility data (recruitment, retention, intervention attendance). Primary outcomes were analyzed by intention to treat. Safety outcomes were reported by as treated status. The study was prospectively registered: https://doi.org/10.1186/ISRCTN17197043.
Results
149 patients were referred to the study and 70 were recruited. 35 were randomly assigned to intervention + TAU and 35 to TAU. Recruitment was 93% of the target sample size. Retention rate was high (81% at 2.5 months primary endpoint), and intervention attendance rate was high (83%). 21% of 33 patients in Let's talk + TAU had an adverse event and 16% of 37 patients in TAU. One serious adverse event (pre-randomization) was partially related and expected.
Conclusions
This is the first trial to show that it is feasible and safe to conduct a RCT of HOP adapted for people with psychosis and individual delivery. An adequately powered trial is required to provide robust evidence.
Current social assistance programmes in Canada and beyond have been criticised for normalising the dehumanisation of recipients through policy design and implementation. In this article we look at how exposure to a form of basic income through the Ontario Basic Income Pilot (OBIP) allowed recipients to imagine a different kind of support. We report on the findings from a study in OBIP from Hamilton, Canada, thematically analysing a subset of interviews with forty OBIP participants. We find that the higher levels of support, fewer behavioural conditions compared to social assistance, and reduced surveillance under OBIP-nurtured feelings of trust and confidence. Participants felt rehumanised as full members of society in reciprocal relationships with community and government that had been strained under previous forms of social assistance. We consider how the OBIP model provided a transformative framework for participants’ expectations for income support programmes and discuss implications for future research.
Lists have come to define terrorism. In the absence of an agreed-upon definition of what constitutes terrorism, proscription, or the inclusion of non-state armed groups on terrorist lists, has created a new category, a new reality. The material and symbolic consequences of these lists have been explored in human rights law and critical terrorism studies literature. But as the world seems to shift away from the terrorist framing, what happens to the ‘terrorists’ stuck on these lists?
Grounded in empirical research with listed non-state armed groups the article explores how listed actors themselves react to the listings. They should not be seen as mere passive recipients of these labels and lists – they are active agents and able to cope strategically with this stigma. Building on Rebecca Adler-Nissen’s work on stigma in world politics, the article shifts the focus from state to non-state actors and assesses how different listed groups cope using Adler-Nissen’s typology of stigma recognition, stigma rejection, and counter-stigmatisation. This diversity in reaction is unpacked through three case studies (ETA, Hezbollah, and FARC). While some armed groups have tried to explicitly reject the label imposed on them, others have embraced it.
The article traces what happens to the ‘terrorists’, how they are reacting, and whether they can ever escape their condition. Listing regimes have enabled the continuation of the war on terror through their embeddedness in the multilateral system, creating a permanence that can endlessly be reactivated.
In contemporary Europe, far-right parties threaten liberal democratic principles such as pluralism, media freedom and minority rights. Despite the stigma they normally face, far-right parties have experienced electoral breakthroughs even in countries where they remained electorally marginal such as Germany, Portugal, Spain and Sweden. We advance the idea that this happened because the level of stigmatization faced by these parties decreased before their electoral breakthrough. Therefore, we form a theoretical framework based on a threefold mechanism: far-right parties manage to reduce the stigma they face because of a reputational shield or by moderating their message; the media help the far right gain visibility and legitimacy by accommodating its views; established parties accommodate far-right parties without ostracizing them. Then, we test the framework by looking at the electoral breakthroughs of four parties: the results confirm the expectations except for the role of established parties, which is inconclusive.
The aim of this study was to explore the perspectives of older medicinal cannabis consumers and those advising them on older Canadians’ experiences accessing cannabis and information about it, as well as how stigma may influence their experiences. A concurrent triangulation mixed methods design was used. The design was qualitatively driven and involved conducting semi-structured interviews with older adults and advisors and developing a survey for older adults. We used a Qualitative Descriptive approach for the analysis of qualitative data and descriptive statistics for quantitative survey data. Findings demonstrate that many older adults are accessing information about cannabis for medical purposes from retailers, either because they are reticent to talk to their healthcare professionals or were rebuffed when bringing up the subject. We recommend cannabis education be required for healthcare professionals working with older persons and that future research examines their perspectives on medicinal cannabis and older adults.
The World Health Organization (WHO) proclaimed September 21 as World Alzheimer’s Disease Awareness Day and extended the observance to the entire month. Various awareness campaigns are being conducted around the world, with special emphasis on the importance of education to improve the quality of life for patients, families, and the community at large, and to eliminate stigma and ageism.
It is estimated that there are approximately 44 million people worldwide with some form of dementia, while in the United States it reaches 5.4 million. In Puerto Rico, it is estimated that there are approximately 60,000 people with Alzheimer’s disease. An AARP study (2021) showed that there are over 500,000 caregivers of older adults, making Puerto Rico one of the top three countries with the largest aging population and the 6th country in the world. While in Latin America and the Caribbean there is a prevalence between 6.2 and 6.5 per 100 adults aged 60 years or older (WHO).
This health and social situation require an educated and empowered society to meet the challenges. Muñoz et. al (2023) conducted a qualitative study with caregivers and found that 91% of the participants stated that training would help them provide better care to the elderly. Social work is one of the main disciplines dealing with this social phenomenon and should therefore play a leading role in education and therapeutic intervention.
For the past five years, the Department of Social Work at Inter-American University, Metro Campus, has joined and supported the cause through the celebration of the Alzheimer’s Symposium: A Perspective from the Academy. This event involves the entire university community, as well as the community at large, which includes caregivers, government and non- profit agencies, and professionals from various disciplines. There will be concurrent lectures, Discussions among local and international professionals, a film forum, poster presentations, artistic expressions, and educational tables. The 6th Symposium will be held on September 20, 2024. The Symposium is promoted through various media. This activity has generated alliances, recommendations and new educational projects that contribute to the well-being of older adults.
Back to work as a senior house officer in geriatrics. No formal support, but the kindness of some helped. I worked for my MRCGP exam, then decided I might after all become a psychiatrist, against most peoples’ advice. I applied for different posts, clear that there was prejudice in some.
I went back to work in the hospital in Edinburgh, as my previous employers could not give me part-time work. Experience as a psychiatric trainee in this hospital was hard. Passed MRCPsych Part 2.
Reflection on diagnoses, treatments and comorbidities – anxiety, obsessive-compulsive disorder and substance misuse or addiction. Stigma, and self-stigmatisation are common, and hard to address. The treatments for bipolar disorder can be difficult to tolerate, including weight gain and sedation. Life as a patient informs work as a psychiatrist as a psychiatrist, hopefully for the good. I do have long periods of being on the high side of normal, which is enjoyable, but can end in disaster. The future with bipolar disorder is ultimately unpredictable.