In an upcoming book chapter published in The Routledge International Handbook on Discrimination, Prejudice and Stereotypes, David J Harper and Kian Vakili examine the extent of discrimination related to psychiatric diagnoses and the lived experience of those diagnosed with schizophrenia. They recommend moving beyond âstigmaâ models because of their tendency to focus on the victim of discrimination towards an epistemic justice-informed model and focus on those who engage in discriminatory behavior.
To counter the stigma and discrimination associated with psychiatric diagnoses and the predominance of the biomedical model of mental illness, the authors recommend the âPower, Threat and Meaning Frameworkâ (PTMF) and trauma-informed approaches as conceptualizations. possible alternatives to psychological suffering and abnormal disorders. behaviour.
âNew developments such as trauma-informed approaches and PTMF offer alternative ways of understanding mental health, stigma and discrimination. It seems clear that there is a need for a radical shift in focus in the way the issue of mental health bias and discrimination is conceptualized and addressed, âHarper and Vakili write.
âIt will require a collective movement for change, including surviving psychiatric activists and their allies, researchers, policy makers and lawmakers. The international public debate on mental health needs to be rebalanced in order to emphasize the limits of a biomedical approach, the advantages of alternative approaches and to emphasize that ideas of mental health are contested cultural constructs.
Previous research has linked the biomedical model of mental health to stigma and discrimination. While anti-stigma campaigns focusing on biomedical explanations for psychological suffering and abnormal behaviors have been linked to increased stigma, those focusing on psychosocial explanations have been linked to reduced stigma. Anti-stigma campaigns can also hinder withdrawal from psychotropic drugs.
Researchers have explained how psychiatric diagnoses can lead to epistemic injustice, a situation in which people around you take your statements less seriously than they should. Unfortunately, this is a phenomenon that can often occur in clinical settings. One example is the gap between the way clinicians and service users tend to understand the causes of psychological suffering, with clinicians favoring biomedical explanations and service users favoring psychosocial explanations.
Service users explained how epistemic injustice can cause physicians to discriminate against people with psychiatric diagnoses. In addition to discrimination against physicians in clinical settings, research has shown how artificial intelligence could be used in mental health discrimination, including “Trump administration advisers have reportedly encouraged experimentation to determine” so technology, including phones and smartwatches, can be used to detect when people with mental illness are about to turn violent. ‘ Psychiatric diagnoses can also lead to discrimination in professional settings, such as policies that prevent people with mental health diagnoses from being lawyers in Louisiana.
The current work begins by recognizing that Eurocentric ideas of mental health, as represented in this work and the works it cites, are not universal. They explain that concepts of mental health and illness vary greatly from culture to culture, and as such, the applicability of this work may be limited to the cultures in which it was created.
The chapter then explores the extent of the problem of discrimination around mental health. The authors point to previous research indicating that 91% of people with a mental health diagnosis have experienced discrimination in one form or another.
What’s more, research has found that 40% of people with a mental health diagnosis have experienced harassment in their community, compared to just 15% of the general population. The authors explain that people with a psychiatric diagnosis are also much more likely to be victims of crime. Research has shown that they are almost 3 times more likely to be victims of non-violent crime and more than 6 times more likely to be victims of violent assault.
Harper and Vakili point to the increased influence of the biomedical model of mental health at the origin of this discrimination. They present research indicating that while campaigns on psychiatric diagnoses have been successful in promoting the biomedical model of mental health, they have not changed attitudes in terms of stigma and discrimination towards people with mental health diagnoses. The authors also highlight media representations of mental illness and biomedical explanations as determinants of discrimination.
Current work indicates that stigma patterns are also problematic. These models distract from questions of power, justice and systematic failure and turn it towards the victims of discrimination. Rather than focusing on stigma, the authors suggest a shift towards epistemic injustice.
By examining how prejudices cause us to ignore people’s statements, we can better understand how systematic problems lie at the heart of psychological suffering. Ultimately, they argue that we should be dealing with discrimination rather than the stigma of mental illness.
The chapter presents the lived experience of many people diagnosed with schizophrenia, focusing on navigating the discrimination that results from these diagnoses. Participants had two main strategies for dealing with discrimination.
First, many reported having difficulty preventing their diagnoses from becoming public notoriety among their peers. These participants said they had to manage the symptoms and side effects of the drugs to avoid detection.
Second, they tried to establish identities that were distant from their diagnosis. Some participants achieved this sense of identity by emphasizing the commonalities between themselves and those without a psychiatric diagnosis, sometimes avoiding others with similar diagnoses. Others achieved a sense of identity by embracing what made them different from those without a diagnosis.
Harper and Vakili point to conceptualizations of mental illness that emphasize psychosocial rather than biomedical explanations as the first step in addressing prejudice and discrimination in mental health.
PTMF understands psychological distress and abnormal behavior as a response adaptable to environmental circumstances. For example, paranoid tendencies that can be diagnosed as schizophrenia in a biomedical model could be explained as a reaction to the constant threats of poverty and discrimination in PTMF.
Likewise, trauma-informed approaches emphasize the role of trauma rather than that of the brain and chemical imbalances in psychological suffering.
Harper, D., Vakili, K. Mental Health Bias, Discrimination and Epistemic Justice: Going Beyond Biomedical Stigma and Domination. In M. Augoustinos, K. Durrheim & C. Tileaga (eds.), Routledge International Handbook on Discrimination, Bias and Stereotypes. London: Routledge. (Link)