Dr Haghighat's response to my invited editorial comments (Reference CrispCrisp, 2001) upon his paper (Reference HaghighatHaghighat, 2001) adds to his overall discourse and may illuminate this matter for readers of these articles. I respect his proposition that self-interest is a basis of the stigmatisation process and all that flows from it. It advances thinking on the matter. Self-interest could be proposed as an explanatory hypothesis for much of human nature. Within the arena of stigmatisation of people with mental illness probably it can range across human experiential and ingrained biological needs, from its protective value for preservation of self-esteem through to selective mating subserving evolutionary purposes. He has emphasised cultural, political and socio-economic factors. I have suggested that greater emphasis is needed on our existential concerns and fears and the biological substrates to our personal survival strategies in the face of such perceived threats. All require our attention if we are to maximise our capacity to change.

He appears to despair of us changing our biologically driven nature and behaviours which, in this context, translate into crude defensive categorisations and labelling of those with mental illness, often leading to distancing rather than exploitation. I believe that the best chance of achieving such change is first to acknowledge the power of human biology. In civilised society we have usually striven then to shape and curb it by influencing attitudes and behaviour via moral, educative and legislative channels. We have sometimes succeeded. Importantly, we also need to address individual vulnerabilities and related triggers to such innate mechanisms. I reiterate that they probably importantly include the degrees of personal psychological fragility and related defensiveness, along with their social extensions and projections such as Haghighat emphasises. It may also benefit from clarification of the social handicaps and sometimes the advantages that can accompany some mental illness diatheses.

The College's anti-stigma campaign is about to go public after 3 years of development and planning. Thoughtful input within contributions such as Haghighat's paper, along with this welcome support from the Journal, are at its heart.