Chapter 10 questions whether law should widen its lens to address general appearance discrimination too. Would a protected characteristic of appearance offer viable legal rights to the many millions of us who do not have a disfigurement but are less-than-beautiful in some way? For example, is appearance objective enough to be adjudicated in law? Is a clear distinction between mutable and immutable aspects of appearance important – or even possible given increasing medico-cosmetic opportunities to change the way our bodies look? Do we have an unobjectionable nomenclature to describe appearance and attractiveness in legal terms? And could we swallow well-meaning employers’ attempts to measure the attractiveness of their staff for the purposes of diversity monitoring? The discussion draws on examples of comparative laws in France and America. Both countries have adopted wider conceptions of appearance equality, and America’s laws have seen a recent period of growth, with Binghampton, New York, the latest to vote such a law onto its statute books in 2023. However, both sets of laws remain little used so far, despite evidence showing that appearance discrimination remains prevalent. How could we ensure that a protected characteristic of appearance in the UK avoided a similar fate?

Chapter 2 explores an important premise which underlies this critique of the law: it examines the idea that disfigurement inequality is a problem which merits a legal response – namely the granting of protective rights under the Act. It concludes that, despite some uncomfortable distinctions, there is a compelling case for a legal response in this area. The nature of law’s current response is then laid out. Relevant parts of the international legal framework – including EU law, the UN Convention on the Rights of Persons with Disabilities (‘CRPD’) and decisions of the European Court of Human Rights (‘ECtHR’) applying the European Convention on Human Rights – are explained by reference to the models of disability which implicitly inform them.

Chapter 6 concludes the three-partite discussion about what hampers meaningful assurances of ‘Never Again’ in Bosnia and Herzegovina (BiH) and what transitional justice has to do with conflict recurrence anxieties. The chapter first identifies the widespread glorification of war criminals and denial of atrocity crimes as key sources of anxiety about potential renewed conflict in BiH. Next, the chapter analytically links these practices to the global project and discusses how past practices of legal and institutional reform such as vetting led to a legal structure that did not regulate convicted war criminals’ access to power. The chapter then explains these behaviours as responses to the perceived threats to different political communities’ ontological securities. The chapter shows how the resulting widespread practices of glorification and the culture of denialism are framed by the international community as a ‘civilisational issue’ which serves to prolong the relevance and presence of the external actors in Bosnia and Herzegovina and stigmatise actors in international society.

For all intents and purposes, life was good for Karen: happily married and settled with three children and a nice life. A series of events -- including bereavement; a large, organised fraud involving threats, police involvement and a court case; and the sudden severe ill health of her husband -- sent her down a deep hole. Major depression and anxiety opened boxes that were closed many years ago containing trauma that was never disclosed and everything collapsed. PTSD added to the deep despair and there were numerous episodes of self-harm and suicide attempts. Six years of repeated admissions (mostly involuntary) followed, being treated with medications and four courses of ECT. ECT was instrumental in Karen being well enough to be able to engage with the therapy she needed for long-term recovery. The story is narrated with original diary extracts and poems written at the time of her suffering. Karen now works with the ECT Accreditation scheme, reviewing ECT clinics around the country, and has spoken extensively about her experiences to journalists and at conferences, trying to reduce the stigma that surrounds the treatment. She is also employed in the clinic where she received treatment as a peer support worker

CJ experienced mental health problems and trauma during childhood and adolescence. This was treated effectively with psychotherapy. He remembers being exuberant and outgoing. Then, at the age of twenty-one, he developed a severe depressive episode, feeling numb and emotionless, unable to taste anything. Due to the previous history, a diagnosis of personality disorder was suggested, resulting in a delay in starting ECT whilst an inpatient. Relapses followed, the first one in Brazil, where he was quickly offered ECT. Back in the UK, CJ found pervasive barriers to getting treated with ECT, especially maintenance ECT, which he asked for several times, having seen the effect of the acute courses. He had to first try various drug treatments. There was also hesitancy in receiving psychotherapy because it was felt that ECT may affect his ability to engage in therapy. CJ feels that the community team had been inadequately resourced, equipped and educated about ECT to properly support him as an outpatient. CJ finishes the story with a description of his ‘life on maintenance’, which did not stop him from starting studies on a degree and working part-time as a research assistant.

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.

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.