Chapter 7 examines interventions that can be implemented to address mental illness stigma. These include individual actions that the person who is stigmatized can engage in to help them cope with or resist stigma and actions that other people are obligated to perform in order to decrease stigma they may endorse or perpetuate unwittingly. These also include structural changes that social institutions and systems must undergo to make social structures less stigmatizing and more supportive of people with mental illness, and social and cultural interventions that increase the belongingness and acceptance of people with mental illness into the community as well as transform social norms to be more supportive of people with mental illness. In addition to using philosophical argumentation, this chapter draws on empirical literature in social psychology that examines what works to reduce and resist stigma.

Chapter 3 analyzes some of the ways that stereotypes harm people’s sense of self and identity. One way is through expressive harm, which is the harm that results from the unwitting and inevitable perpetuation of stereotypes. Stereotypes have a pervasive cultural power that enables them to control people’s thoughts, feelings, behavior, and social interactions even when people actively disavow the stereotype. Other ways that stereotypes harm people’s sense of self and identity are through the internalization of oppressive social scripts, which ascribe motivations and expectations for behavior, and through stereotype threat, in which people inadvertently and paradoxically act in ways that correspond to stereotypes even as they are trying hard to avoid fitting stereotypes. When people with mental illness internalize oppressive social scripts and experience stereotype threat, they incorporate negative stereotypes into aspects of their experience and identity, which damages their identity and sense of self and also diminishes their autonomy.

Chapter 5 assesses harms that people with mental illness experience that are related to how their self is constituted. These include harms of de-individuation and mis-identification, but also, as this chapter focuses on, harms of social exclusion and dehumanization that result from status loss and moral distancing. Dehumanization occurs through both being reduced to a stereotyped trait and being viewed as lesser compared to others. Having a sense of belonging and being accepted as an equal member of a moral/epistemic/social community are important parts of being viewed as and viewing oneself as a full human being; these are also critical for developing and exercising autonomous agency as well as for well-being and flourishing. People with mental illness are often excluded from these communities as a result of public stigma, diminishing their autonomy and well-being. This chapter shows how dehumanization, social exclusion, and belonging uncertainty threaten belongingness and autonomy.

Chapter 1 examines what mental illness stigma is and analyzes the components of mental illness stigma to show how people with mental illness experience stigma in their daily lives. These components include labeling, stereotyping, prejudice, moral distancing, social exclusion, status loss, dehumanization, microaggressions, discrimination, and epistemic injustice. In each case, I use empirical evidence from the social psychology literature on stigma to show ways in which people with mental illness experience these forms of stigma. Next, I look at factors that affect the kind, degree, and scope of stigma associated with mental illness, including beliefs, political values, cultural values, socioeconomic status, education, and gender. Finally, I examine how many people experience compounding stigmas that come from multiple sources.

Chapter 6 examines what makes discrimination and microaggressions (as a form of discrimination) wrongful. Discrimination involves differential treatment where some people are treated in different, unequal, and worse ways compared to others, and where that differential treatment is based on possessing a socially undesirable trait that marks a person as bad and inferior. Discrimination is wrongful because it harms people in a variety of ways, impacting their circumstances, resources and opportunities, options, agency, autonomy, and well-being. It causes material disadvantage and distributive injustice that denies people access to resources and opportunities and prevents them from having the basic goods necessary to participation in society. It also demeans people and leads to unfair subordination, loss of deliberative freedom, and decreased autonomy. This chapter reviews the philosophical literature on discrimination to provide a pluralistic account of the many harms discrimination and microaggressions cause to people with mental illness, which altogether make discrimination wrongful.

Chapter 2 assesses what stereotypes are and explains what makes them both wrongful and harmful. The chapter begins by defining stereotypes, explaining their relationship to prejudice and implicit bias, and showing how they are maintained due to cognitive biases. I examine factors that go into making the judgments involved with stereotyping. Then I analyze what makes stereotypes wrongful, including their rigidity, their falsity, and the way they overgeneralize about a person’s experience so as to erase its nuance and complexity. I look at descriptive and normative components of stereotypes and show that negative stereotypes always make a normative judgment about the badness and inferiority of a person who fits the stereotype.

Chapter 4 shows how internalized stigma often results in adaptive preferences that harm a person. When people incorporate aspects of negative stereotypes into their identity, they sometimes develop adaptive preferences by internalizing harmful social norms and beliefs embedded within these stereotypes. I show how people with mental illness often develop goals and desires that are shaped by these beliefs and social norms, which limits what they believe they are capable of, thus reducing their options for action and truncating their agency and autonomy. While adapting desires to one’s circumstances can be positive, as in positive adaptation, it is negative when it is harmful to a person. The adaptive preferences that result from this can be seen as rationality deficits that are oppressive and nonautonomous and that damage well-being and flourishing.

The introduction motivates the book’s arguments by showing how mental illness stigma remains pervasive despite greater awareness of mental health issues and more resources directed at mental health treatment and destigmatization. The forms of mental illness stigma most commonly expressed are stigma against people with severe mental illness who are perceived as homeless, and internalized stigma that people with mental illness project onto themselves. Mental illness stigma arises as a reaction to the violation of social norms of what a human being should be in the Western world in the twenty-first century. I give an account of stigma as the devaluing and discrediting of a person based on possessing a social trait that is seen as violating social norms, constituting a relationship of power. Components of stigma include labeling, stereotyping, prejudice, moral distancing, social exclusion, status loss, dehumanization, microaggressions, discrimination, and epistemic injustice. The chapter ends with a description of the book’s scope, methodology, and chapter outline.

The research for this chapter was undertaken on the lands of the Wurundjeri people of the Kulin Nations. As is customary in the country in which I live and work, or so-called ‘Australia’ (see Watego, 2021), I acknowledge them as the traditional owners of country, as well as elders past and present. I acknowledge that sovereignty over these lands was never ceded, and that Aboriginal and Torres Strait Islander peoples remain strong in their enduring connections to land, sky, water and culture.

Fundamentally, a psychiatric patient’s relationship with the health professionals treating her depends on developing trust and that trust relies on understanding on both sides: that is why it is so critical for a clinician to have as deep an understanding as possible of his or her patient’s perspective. It’s unusual for a patient with a physical ailment to feel a need to deliberately conceal things from her clinician but this is a common occurrence for women in a perinatal mental health setting. The main reason for this is fear; fear of having her children taken away, fear of being ‘judged’ for wanting to have a child while coping with a chronic mental illness. This chapter will provide an overview of the research I have conducted since 2010 to identify and record the experiences of women in receipt of perinatal mental health services or, in some cases, of women not in receipt of the services they needed.

Personality disorder (PD) is a complex condition, which has been the subject of both debate and research. However, maternal PD has only been the focus of research in the last two decades. In this chapter I discuss that research in the context of what is known generally about PD, as a disorder with a predictable presentation of signs and symptoms; an aetiology, and indications for effective treatment. There has been more research on maternal PD in the last 15 years, which shows that mothers with PD may struggle to care for their children, especially in the postnatal period, and their mental health may also deteriorate during pregnancy. In this chapter I describe the issues described above and discuss how clinicians approach the management of mothers with PD. I place special emphasis on the impact of maternal PD on mother-child relationships and attachment, and the implications for child health.

This chapter investigates the continuum which exists between vernacular speech and standard language and examines various issues which arise in this area. Key to the continuum of speech in any Western-style society is the notion of a supraregional variety which, on the one hand, embodies sufficient vernacular features to fulfil the identity function of language but, on the other hand, does not contain features which are stigmatised in a speech community. Supraregional varieties are dynamic entities and are thus subject to language variation and change. Such varieties are only occasionally explicitly codified. However, speakers in any speech community will be aware of stigmatised and non-stigmatised features (with regard to accepted usage in more formal situations) and can move along the continuum of relative vernacularity in given contexts.

A brief conclusion ties together central themes of the book - deception, blame, and stigma - and reflects on how this history of a long-forgotten epidemic can shed light on everyday life hundreds of years ago in ways that resonate with modern disease experiences.

In this chapter, multiple anti-oppressive and liberative lenses are reviewed and discussed as application to anti-oppressive decolonial clinical social work supervision and leadership practice. This chapter both review of the theory or practice lens and an emphasis on application to practice. By design subsequent chapters will overlap, deep dive, and offer multiple practice views of several concepts offered in this chapter.