Stigmatization – Brain Blogger Health and Science Blog Covering Brain Topics Wed, 30 May 2018 15:00:03 +0000 en-US hourly 1 Is It Possible to End the Stigma of ID/DD? Tue, 27 Oct 2015 15:00:35 +0000 Lazy, burdensome, violent. Dangerous. These are all words used to describe those with intellectual and/or developmental disabilities (ID/DD), especially adults.

Are they accurate? Perhaps among a small population of those with ID/DD, but if you Google “rate of violence perpetrated by adults with ID/DD,” the majority of results will detail abuse rate perpetrated against adults with ID/DD.

These results are telling in the context of the perceptions of adults and teenagers with ID/DD. Instead, it might be better to label these misconceptions. They are in fact, part of a larger epidemic which has been raging for decades, if not centuries: stigmatization of adults with ID/DD.

Stigma are defined as “marks of disgrace or infamy; a stain or reproach, as on one’s reputation.” In other words, stigma are a set of prejudices about one group help by another. The stigma of ID/DD can be felt by the person with the disability as well as her family, friends, and caregivers.

This still happens?

It’s 2015 and yet people with ID/DD are still saddled with labels which cause them pain. For Sam, a young man in California who worked with an educational program that empowered him to run his own Individualized Educational Plan meetings, the stigma started in school when he was labeled “mentally retarded.”

“I felt I was really being treated the wrong way when that word is used. It’s like, whenever it was used, it felt like I was not independent, learning bad, struggling with homework. I felt like my life was uncomfortable.” Sam’s words echo through the world of ID/DD, as the term “mental retardation” was only removed from the Federal Register in 2013.

In 2012, there were more than 115,000 people with ID/DD living in large-scale community facilities. More than 120,000 were waiting for receive funding for home- and community-based services such as those provided by Laura, a state social work contractor in Idaho.3

Laura’s own son, who is on the autism spectrum, is stigmatized by neighbors as being “dangerous,” though he is a sweet, gentle young man who loves swimming and his family. Laura has participants through her agency who live independently. Many also hold jobs and are ambassadors for the Special Olympics.

“They have the same desires and interests as anyone else,” stated Laura.

A lack of education

One of the main reasons these stigma still exist is the fact that people without ID/DD remain uneducated about those with the disabilities. Even those who are tasked with taking care of teens and adults with ID/DD are often not given the tools necessary to assist those with ID/DD.

This lack of education results in people being restrained by their caregivers, students being locked in rooms during classes, and adults stuck living in group homes when they are perfectly capable of living on their own.

Laura has asked many in her circle what would change the perceptions of those with ID/DD, and for her it does come down to education. “Unfortunately,” she says, “people take the education they are given and either use it or ignore it. Just because someone is provided the information regarding a population doesn’t mean their perception will change.”

Each fall, Laura teaches for an hour at her son’s school, educating his teachers and peers about ASD and the other conditions he has. Once she has shared her information with this group, “they treat my son with respect and patience,” says Laura. “It’s amazing what a little education can do.”

Does stigmatization lead to budget cuts?

A lack of education at the personal level leads to effects for individuals, which is harmful enough. However, a lack of education at a governmental or organizational level can affect the entire population of those with ID/DD.

Many of the services which allow Laura’s participants to hold jobs, live independently, and seek education are paid for through Medicaid. Medicaid is budgeted through the state, regardless of the state. These budgets are prepared by members of the legislature. Based on the law of averages, not every member of the legislature is going to be fully educated as to how the Medicaid budget will be used.

Even members of the state agency which advocates with the legislature might not be educated regarding all participants in their programs, especially adults with ID/DD. Laura surmises that because many of the participants are nameless and faceless, the stigmas persist and are reflected in budget cuts.

Laura’s agency once had 12 hours per participant budgeted for plan development. This has been whittled down to just 6 hours, yet the plans typically take 10 hours to complete. The state of Idaho has a Medicaid budget of $492 million. As Tom Mortell of the Idaho Business Review pointed out, many people don’t realize that much of this budget is used to fund healthcare for those who don’t have insurance, like many (if not all) adults with ID/DD.

Change on the horizon?

One can only speculate if education and inclusion, such as what Laura does with her own son, can help end the stigmatizing of those with ID/DD. Ignorance remains even in the 21st century. A woman in a wheelchair reported to Laura that people have used her wheelchair to lean on without asking. “My assistive devices are an extension of me and should not be violated,” she said. “Would you sit on someone’s lap at a store?  Then don’t sit on parts of my wheelchair.”

Until education is thorough enough to force out such ignorance and stereotypes, it’s unlikely that the stigmatization of persons with disabilities will ever be eradicated.


Hurst, D. (2014, March 19). Medicaid in Idaho: More costly now than nearly the entire state budget from 10 years ago. Retrieved 13 July 2015.

James, H. E. (2015, July 9). Life as a State Social Work Contractor. Retrieved 13 July 2015.

Mortell, T. (2015, July 14). Medicaid redesign is important for Idaho’s businesses. Idaho Business Review.  Retrieved 14 July 2015.

Intellectual Disability and a Path to Overcoming Stigma: My Conversation with Sam | ACAT: Ala Costa Adult Transition Program on (2014, May 5). Retrieved 9 July 2015.

Change in Terminology: ‘Mental Retardation’ to ‘Intellectual Disability’. (2013). Retrieved 10 July 2015.

From Awareness to Respect | Disability.Blog. (2012, March 26). Retrieved 9 July 2015.

Social Work and the Ideals of Social Justice | UNE Online. (n.d.). Retrieved 14 July 2015.

Image via PathDoc / Shutterstock.

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Join the World Mental Health Day 2015 Movement #IAmStigmaFree Tue, 06 Oct 2015 11:50:34 +0000 Did you know that approximately 1 in 4 people live with a mental illness worldwide? And that simply by learning and talking more about mental health you could help millions of people around the world? This is the message behind this year’s Mental Health Awareness Week (MHAW, October 5th-11th), which also encompasses this Saturday’s World Mental Health Day (WMHD, October 10th).

Each year, MHAW presents the World Federation for Mental Health’s theme of the year, this year its ‘Dignity in Mental Health.’ To help make dignity in mental health a reality, together we can ensure that mental health problems are better understood, and importantly, are absolutely nothing to be ashamed of!

So how can you get involved in Mental Health Awareness Week and World Mental Health Day?

Social Media

The hashtags described below, #MHAW15 and #IAmStigmaFree, can be used to help share fundamental facts and your experiences with mental health on social media so that together we can take the world one step closer to being mental health stigma free!

Use #MHAW15 to not only spread the word, but to enter a competition to win great daily prizes if you:

1. Share a random act of kindness
2. Nominate a friend of family member as a giver
3. Let everyone know how you are celebrating World Mental Health Week, or what mental health awareness means to you.

#IAmStigmaFree has been popular since May, following the release of a video of more than 40 celebs, from Pamela Anderson to Mekhi Phifer, in partnership with Each Mind Matters: California’s Mental Health Movement to start a conversation around being open and honest about mental health. Now, it is cooking up one heck of a twitterstorm representing the ‘Dignity in Mental Health’ theme of the year.


The Mental Health Awareness Week and World Mental Health Day is recognized in over 150 countries! You can find out about local events simply by searching with the above hashtags on social media, or even start your own event!

There is a fantastic list of events on official pages for New Zealand and Australia. In the UK, the British Psychological Society is hosting free events. Time to Change also has a searchable map to find events near you. In the US there is no central database of events, however searching in your state will let you know what is on. Can’t find anything? Start your own event using the report below for ideas.

The Dignity in Mental Health Report

The World Federation for Mental Health has put together a fantastic campaign report filled with great ideas and actionable advice. This includes how to help support someone experiencing a crisis of mental health, fun mental health education interventions for schools and further advice on many of the fantastic movements that are really making a difference – even planting sunflowers as a symbol of mental health hope solidarity!


By donating to organizations advocating mental health awareness you can help them help others live a mental health stigma free life.

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Opening the Classroom Door for Children with Autism Thu, 16 Apr 2015 12:16:35 +0000 We can all probably remember how we were taught to swim. Some of us had parents who took us to swimming lessons in a safely constructed pool at the local YMCA, with numerous, trained adults right next to us in the pool and floaties on our arms, while we paddled on a kickboard for as long as necessary until we were ready to swim independently. Others had the parents who just surprised them one day on summer vacation by sneaking up on them on the dock, hoisting them into the air, and jettisoning them into the dark and unknown depths of a lake, figuring they would jump in and help if they started to sink. Whichever way we experienced it, we are likely to have strong feelings about whether or not it was the best way to do it.

Sometimes we tend to think of educational experiences in a similar light and view options for students with disabilities in the same way. We tend to think that they need to either be pulled into a safe and protected environment for intensive instruction, or plunged into the unpredictable landscape of the general education classroom to sink or swim.

But it is possible that an educational concept called “Universal Design for Learning” can remove barriers for children with autism while also improving outcomes for all students.

With the ever-growing prevalence of autism in American children (1 in 68 according to recent CDC estimates), a growing topic for debate among educators, advocates and families of children with autism revolves around the best educational option for children who, by definition, are faced with significant social-communication and behavioral challenges. There is no “one size fits all” answer as to whether or not it is best to educate children with autism in specialized, intensive “pull out” programs, or by providing the needed services within the general education classroom, often termed the “inclusion” or “push in” model.

Advocates of the “push in” model espouse that the more naturalistic setting of the general education classroom provides access to higher expectations, richer academic instruction, improved transfer and generalization of skills, and broader social acceptance of students with autism.

Others, however, caution that the highly structured, intensive and systematic teaching strategies are more appropriately implemented in “pull out” programs which focus intensive attention to the social communication and behavioral differences that are the hallmarks of autism spectrum disorders.

While there has been a great deal of inquiry and research in recent years outlining the pros and cons of both options, a frequent conclusion is that no single educational model is right for every child with autism. The adage attributed to autism advocate Stephen Shore bears repeating:

“If you’ve seen one child with autism… you’ve seen ONE child with autism.”

One possibility for bridging the gap between these philosophies, however, lies in the application of an approach called “Universal Design for Learning” wherein evidence based practices for students with special needs can be more broadly applied to benefit all learners.

The National Professional Development Center on Autism Spectrum Disorders (NPDC) has conducted extensive reviews of the research into some of the most commonly recommended instructional strategies for educating students with autism. This multi-university project has identified 27 practices to date that are deemed to be “evidence based” for educating students with autism. Many of these strategies can very effectively be incorporated into general education settings where, not only can the intervention open doors to communcation and academic skills for students with autism, but can also benefit other students. The concept of designing instruction in this manner, is known as “Universal Design for Learning,” or “UDL”.

The term “Universal Design” was coined in the 1980’s by architect Ronald Mace to describe the process of designing environments, products and services in a manner that would make them of the greatest benefit possible to all people, regardless of age, health or ability. A prime example is the curb cut in sidewalks, which were designed to allow wheelchair access but also benefit non-disabled people with strollers, carts, bicycles, and skateboards.

This concept was expanded in interpretation as “Universal Design for Learning” or “UDL”, when the Center for Applied Special Technology (CAST) was formed by a group of educational researchers on a mission to explore how these same principles could impact educational outcomes for all learners. The idea behind UDL is the flexible and purposeful design of instructional methods, materials and technology to improve instructional outcomes for all learners.

UDL bases its concept of instructional design on three distinct brain networks that impact learning: the Recognition network (“what” is learned), the Strategic network (“how” it is learned) and the Affective network (the “why” behind learning). This multi-dimensional approach places emphasis on presenting information in different formats, offering options for interaction, and creating activities which maximize learner engagement and motivation.

There are five “evidence based practices” identified by the NPDC for teaching students with autism, which are also recommended by CAST for incorporation into the “UDL” classroom in order to maximize outcomes for ALL learners.

Evidence Based Autism Practice 1: Visual Supports
Related UDL Principle: Multiple Means of Presenting Information

Many individuals with autism process information most efficiently through their visual system, and therefore benefit from information being presented in visual formats rather than largely through the auditory channel.

According to the National Research Council, visual supports are defined as any tool that is presented visually to support an individual in developing such diverse skills as communication, task engagement, independence and self-management. Common visual supports used to support learners with autism include: pictures, videos, written words, objects, labels, schedules, checklists, outlines, graphic organizers, and even the physical arrangement of the environment.

Similarly, according to CAST, one of the principles of UDL is that learning material must be “perceptible” in order to be learned efficiently, and thus, one of the best ways to remove barriers to learning is to providing information through different learning channels, or “modalities” so that all students have the opportunity to learn through their strongest modality. While research bears out that visual supports are an evidence based practice for students with autism, visual representation also makes information easier to process for many other students to comprehend and retain, including those with hearing impairments, English language learners, or those who simply have a preference for visual learning.

Evidence Based Autism Practice 2: Naturalistic Intervention
Related UDL Principle: Recruiting Student Interest

According to the NPDC’s evidence based practice brief, naturalistic intervention is a method of designing the learning environment, interactions, and instructional strategies, to include self selected activities which promote motivation and engagement. Oftentimes, a child with autism may more willingly and actively engage in social communications, vocabulary, turn taking and sharing attention within a highly preferred, or “special interest” activity.

Similarly, CAST recommends that instruction in the universally designed classroom should be planned specifically to “recruit the interest” of the learner by regularly offering opportunities for individual choice. Information that is closely attended to is more likely to be retained for reference in future skill development. It is for that reason that CAST recommends that teachers incorporate regular opportunities for student choice in topics of study, formats for expressing learning, and activities to gain information, thus paving the way for naturalistic intervention opportunities for students on the autism spectrum in the classroom as well.

Evidence Based Autism Practice 3: Peer Mediated Instruction and Intervention
Related UDL Principle: Fostering collaboration and community

Peer-mediated instruction and intervention is described in the NPDC’s evidence based practice briefs as the training of typically developing peers to help and encourage learners with autism to interact within a variety of activities in natural environments, such as the classroom, lunchroom or playground.

From the UDL perspective, this is not only another avenue for recruiting interest and engagement through preferred activities, but is also another method to “foster collaboration and community”, another principle of UDL. CAST emphasizes that peer mentoring and collaborative groups can be an extremely useful option for providing support to students for whom social participation is challenging or less intrinsically motivating.

Evidence Based Autism Practice 4: Computer/Technology Aided Instruction
Related UDL Principles: Mulitple Means of Representation, Multiple Means of Expression, Options for Recruiting Student Interest

Computer/technology aided instruction is described by the NPDC as the use of computers or other technology to teach academic or communication skills. CAST describes the use of computers and other technology as an important aspect of UDL, as it allows many options for information to be presented and expressed through multiple learning modalities, and is an area that is highly motivating to many students, with and without autism.

It comes as no surprise that, as technology is more and more prevalent in all learning environments, the incorporation of computer and technology aided instruction is a natural fit for implementation of this evidence based practice within the context of the general education classroom. Technology is used in many ways in today’s classrooms, and for many purposes. Some examples include: interactive white boards, tablets, personal communication devices, and computers with a variety of accessibility features such as speech to text, text to speech, word prediction, screen readers and grammar checkers. The variety and relative availability of technology in most classrooms allows many options for all students to communicate and interact with information, both to gain and express knowledge.

Evidence Based Autism Practice 5: Social Skills Groups
Related UDL Principle: Fostering Community and Collaboration

Social skills groups are an evidence-based practice identified by the NPDC as a method for teaching individuals with autism how to interact appropriately with neuro-typical peers. This intervention usually involves the teacher and small group of students practicing social skills through direction instruction, structured activities or role-play.

While one of the hallmarks of autism is difficulty engaging in social relationships, children with autism are far from the only children who benefit from opportunities to engage in direct instruction and practice of appropriate and effective social skills. Children from different cultures, children from disadvantaged backgrounds and children with limited social exposure can all benefit from structured opportunities to learn how to navigate the challenges of various social scenarios.

In closing….

While it is likely that no single educational situation is the “right” solution for every child, it may be beneficial for parents, teachers, and other service providers to understand that many of the recommended practices for children with autism may not only be easily integrated into the general education classroom with excellent results, but may benefit many typically developing students in the process.


Baker, J. (2003). Social skills training for children and adolescents with Asperger syndrome and social communication problems. Shawnee Mission, KS: AAPC Publishing.

CAST Through the Years: One Mission, Many Innovations. (2014). Retrieved May 30, 2014.

CDC estimates 1 in 68 children has been identified with autism spectrum disorder. (2014). Retrieved May 30, 2014.

Collet-Klingenberg, L. (2009). Overview of computer-aided instruction. Madison, WI: The
National Professional Development Center on Autism Spectrum Disorders, Waisman
Center, The University of Wisconsin.

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Professional Development Center on Autism Spectrum Disorders, Waisman Center,
University of Wisconsin.

Combs, L. (2014). Push to open: A teacher’s guickguide to universal design for teaching students on the autism spectrum in the general education classroom. Shawnee Mission, KS: AAPC Publishing.

Coucouvanis, J. (2005). Super skills. Shawnee Mission, KS: Autism Asperger Publishing Company.

Evidence Based Practice Briefs. (2014). The National Professional Development Center on Autism Spectrum Disorder. Retrieved March 21.

Franzone, E. (2009). Overview of Naturalistic Intervention. Madison, WI: National Professional Development Center on Autism Spectrum Disorders, Waisman Center, University of Wisconsin.

Hall, T.E., Meyer, A., Rose, D. H. (2012). Universal design for learning in the classroom. New York, NY: The Guilford Press.

Hume, K. (2013). Visual supports (VS) fact sheet. Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development Institute, The National Professional Development Center on Autism Spectrum Disorders.

Jenson, E. (2005). Teaching with the brain in mind. Association for Supervision and Curriculum Development.

Kwakye, L., Foss-Feig, J., Cascio, C., Stone, W., & Wallace, M. (2011). Altered Auditory and Multisensory Temporal Processing in Autism Spectrum Disorders Frontiers in Integrative Neuroscience, 4 DOI: 10.3389/fnint.2010.00129

Leekam SR, Nieto C, Libby SJ, Wing L, & Gould J (2007). Describing the sensory abnormalities of children and adults with autism. Journal of autism and developmental disorders, 37 (5), 894-910 PMID: 17016677

Lewis, R., Doorlag, D. (2003). Teaching special students in general education classrooms. Upper Saddle River, NJ: Merrill Prentice Hall.

Myles, B., Adreon, D., Gitlitz, D. (2006) Simple strategies that work! Helpful hints for all educators of students with Asperger syndrome, high functioning autism, and related disabilities. Shawnee Mission, KS: Autism Asperger Publishing Company.

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Neitzel, J. (2008). Overview of peer-mediated instruction and intervention for children and youth with autism spectrum disorders. Chapel Hill, NC: National Professional Development Center on Autism Spectrum Disorders, Frank Porter Graham Child Development Institute, The University of North Carolina.

Salend, S. (2011). Creating Inclusive Classrooms: Effective and Reflective Practices. Upper Saddle River, NJ: Pearson Education, Inc.

Schwartz, P. Kluth, P. (2007). You’re welcome: 30 innovative ideas for the inclusive classroom. Portsmouth, NH: Heinemann

Sousa, D., Tomlinson, C.A. (2011). Differentiation and the Brain. Bloomington, IN: Solution Tree Press.

Stewart, R. Motivating students who have autism spectrum disorders. Indiana Resource Center for Autism. Retrieved on May 30, 2014.

Stoke, S. (n.d.) Developing Expressive Communication Skills for Non-Verbal Children with Autism. Retrieved, May 30, 2014.

Tomlinson, C. (2001). How to Differentiate Instruction in Mixed Ability Classrooms. Alexandria, VA: Association for Supervision and Curriculum Development.

Tomlinson, C. (1999). The Differentiated Classroom: Responding to the Needs of all Learners. Alexandria, VA: Association for Supervision and Curriculum Development.

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Wilczynski, S.M., and Pollack, E.G. (Eds.). (2009). Evidence-based practice and autism in the schools: A guide to providing appropriate interventions to students with autism spectrum disorders. Randolph, MA: National Autism Center

Image via nito / Shutterstock.

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Eric McCormack Moderates Real-Life Discussion of Mental Illness on Campus Thu, 22 Jan 2015 17:10:03 +0000 Eric McCormack is an articulate actor who played the fictional Dr. Daniel Pierce, a crime-solving schizophrenic neuropsychiatrist in the dramatic television series Perception.

As McCormack is careful to clarify, “I’m not a professor, nor am I a person living with paranoid schizophrenia… I just play one on TV.”  McCormack largely modeled his character after the real-life Elyn Saks, a highly successful academic who battles schizophrenia. Late last year, McCormack joined Professor Saks to moderate a panel discussion at USC’s Gould School of Law: “In Real Life and as Seen on TV: Stories of Mental Health on Campus,” sponsored by the Saks Institute for Mental Health Law, Policy, and Ethics.

The event also featured Jessie Close (sister of actress Glenn Close) and law student Sam Brown. They told their personal stories in an effort to spur the discussion about the problems of stigma and shame (i.e., “self-stigma”) among sufferers of mental illness, particularly college students, and how the media and university community have the power to harm or help. McCormack remarked:

“The stigma of mental illness…is the result of fear and ignorance.  People fear and despise what they don’t understand. And when the media only discuss schizophrenia after there has been a mass shooting, it only increases that fear and that ignorance.”

McCormack further noted the media’s contribution to the stigma around mental illness; a TV show like Criminal Minds or The Blacklist, in which the focus each week is someone with “something wrong upstairs,” risks sensationalizing and trivializing mental illness. He asked the panelists whether the media had contributed to their own sense of shame about their mental illnesses.

Brown admitted to being affected by media reports about mass shootings and drama shows, but he could not suggest a satisfactory solution for the media.

 “I don’t think it makes good news, when mentally ill people take their medication and go on with their day,” Brown reasoned.

Elyn Saks thought the media had improved in the area of mental illness over the years compared to the 1960s and ‘70s.

“When I look back, there weren’t that many shows that portrayed mental illness. We have that now…It’s really good to portray the illnesses accurately and sensitively, and I think we’re doing that more than we used to.

Saks thought that one way the media can reduce the stigma associated with mental illness is that if there were violence committed by a mentally ill person, it should be put in context.  She noted that only a small percentage of violence is committed by mentally ill people, and people with mental illness are much likelier to be victimized, e.g., 20 times likelier to be murdered.  She also proposed telling success stories that humanize the mentally ill, for example, McCormack’s character Daniel Pierce:  He’s got schizophrenia.  He struggles with it.  He doesn’t completely accept it.  He functions with it.

McCormack asked how the shame of mental illness could be mitigated, especially in a campus setting.  All the panelists agreed that early detection could save students from much of that shame.

When Close was first diagnosed with bipolar disorder, she called her sister Glenn Close, who was much relieved:

“Oh, thank God it’s actually something, and you’re not just crazy!’”

Professor Saks suggested mental health education in high schools, so that people know what some of the signs and symptoms are.

Being diagnosed with a mood disorder forced Brown to accept that, “this was a part of me; my mood was myself…my personality…I was going to have to deal with it.”  His condition did not prevent Brown’s graduation from UCLA in 2007.  He first encountered stigmatization, when he was no longer wanted at a camp where he had previously enjoyed a summer job for several years. Due to his experience with the camp, he had decided to be tight-lipped about his condition at law school, first “coming out” at this public panel discussion event.

Recently married, law student Brown revealed that he would tend to tell his dates early on about his mental illness. “It’s important to tell; you need someone to know who you are quickly.  It’s not something you are going to hide.”  Brown cautioned that the person with mental illness can become the monopolizer of “complicated” in the relationship, potentially a source of tension for a new couple.

Saks further illustrated the problem of self-stigma from her own life.  She shared how she had once received a message T-shirt about schizophrenia as a gift.  Saks thought, “Do I really want to wear a T-shirt that identifies me as having schizophrenia?”  Then she thought:

“I’ve also had cancer.  People wear armbands and pins and T-shirts in pride, with solidarity and without shame…and that’s the way it should be with schizophrenia also, but it’s not.  And I myself am guilty of those negative shameful feelings.”

However, Brown was most concerned about stigma placed on the mentally ill by others:

“When I first got out of the hospital, my family and friends were so on-the-ball, as if nothing had happened to me, nothing’s changed.  So I came out with this open attitude about it.  I probably told too many people…I probably told girls too quickly when I was courting them…The people around you, your friends, your family, because they love you, are going to be most willing to accept [mental illness].”

Brown, who plans to practice employment law when he graduates and wrote a soon-to-be published article on “moral fitness” in bar applications, continued about stigma:

“The things that terrify me are employers, law school admissions, the California state bar; to be a lawyer in the state of California you need to tell them that you had a mental illness.  You need to waive your medical privacy.”

Even physicians with lives in their hands are not legally required to do this.

Brown challenged those of us who have been in a hiring situation:

“Are you going to be able to hear about the mental illness of someone applying for a job and say that it just doesn’t matter…It’s the people in real positions of power and the way they treat you that can really knock you down a peg, or lift you up.”

Brown would not want universities to aggressively pursue proposals, such as requiring students to take a mental health test in order to return to school after a break of a semester or quarter, or to condition a student’s return on his continuing to go to therapy.  Although such proposals may be well-intentioned, Brown suggested, “We don’t want a campus where someone feels afraid to “come out’” as a person suffering mental illness.

Brown recognized that some people with mental illness prefer to compartmentalize their illness, to take their medications and see their doctors regularly, but prefer not to identify with their illness. However, he believes that a community is important. Brown advocates developing a strong group identity for people with mental illness.  He compared it to cancer survivors having a strong group identity.  Brown thought it would be positive for the university to foster a sense of community pride in overcoming adversity, not just mental health awareness week when students make sure they’re not sick.

Saks spoke from deep personal experience:

“The worst thing about stigma is that it deters people from getting care, and they shouldn’t have to suffer, but they will unless they get care.”

Close urged students living with mental illness to take care of themselves, find a therapist or counselor they can talk to, and, above all: “Stay in school!”  Despite the obstacles and interruptions that may occur in a one’s studies, “Try, try, try again,” she concluded.

Finally, McCormack commended the panelists for being open about their mental illness in order to further vital public education:

“We educate people about what to do if someone has a heart attack, but we don’t tell them what to do if they suddenly [encounter] a psychotic…and of, course, what are they going to do but back away and fear for their life, as opposed to thinking, ‘How can I help this person?’…It’s hard to teach empathy.”

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The Concept of Race in Science Part II – Human Evolution Sun, 04 Jan 2015 12:00:50 +0000 While some scholars try to disentangle the nuances in the distinctions between race and culture, and debate the validity of the use of race in scientific discourse, some others seem to have assumed that race is an unavoidable term and simply consider it as a factor needing to be taken into account when carrying out scientific research or referring to human evolution.

Scholars who seem to operate with such an assumption include Philippe Rushton, a former professor of psychology at the University of Western Ontario who argues that there are actual racial differences which shape human intelligence, brain size, genital size and sex drive.

Others such as Richard Lynn, a British professor emeritus at the University of Ulster, have claimed that the highest IQs are found amongst Northeast Asians, followed by Europeans who score on average ten points higher than Southeast Asians and Amerindians. His arguments have sparked controversy and debate over the relation of intelligence and race.

Bold claims

The claims mentioned above have been widely criticised. They are regarded by many as racist and the works have been accused of lacking scientific rigour as well as promoting racist political agendas. They also have been critiqued for their methodology and data interpretation.

One thing is for sure, they prove that racism is still an active issue within the scientific community. While the concept of race is itself debatable, racism still occurs in varying degrees.

The first academic reference to race can be found in the 18th century, when the German scientist Johann Friedrich Blumenbach suggested that his classification of five different races had varying degrees of beauty depending on their degree of degeneration from the perfect form of Adam and Eve who were created by God, and were regarded as having been Caucasian.

Evolution of one species

The theory of evolution demolished such views. Some of the first theories of human evolution suggested that we developed in different places and forms and were affected by a number of environmental and social conditions which made us into different “racial groups”.

However current scientific theories discard most of these ideas and modern biological research has questioned the concept of race per se. If we are considering evolution in genetic terms, race may seem to be an irrelevant and clumsy means of classification.

It is widely accepted that modern humans (Homo sapiens) spread from Africa into other parts of the world. However some theories have suggested that there might have been some interbreeding between Neanderthals and modern humans, mainly in Europe. According to the Smithsonian Museum of Natural History, approximately 1-4% of non-African modern human DNA is shared with Neanderthals – some of our closest ancestors but still a far less developed human species.

Humans share a similarity of genetic information with chimpanzees of 98-99%. Indeed we human beings share 99.9% of the same genetic information. The possible definition of race based on genetic differences relies on a minuscule percentage of 0.1 and for this reason it is widely acknowledged that race is not a relevant classification of humans in genetic terms or in terms of hard science, but rather a product of cultural history.


Cavalli-Sforza, L.L., Menozzi, P., Piazza, A., 1994. The History and Geography of Human Genes. Princeton University Press, Princeton, NJ.

Heinz A, Müller DJ, Krach S, Cabanis M, & Kluge UP (2014). The uncanny return of the race concept. Frontiers in human neuroscience, 8 PMID: 25408642

Smithsonian Natural Museum of Natural History (2014). What does it mean to be human?

Image via Procy / Shutterstock.

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Antifeminism – An Online Trend Wed, 15 Oct 2014 11:00:05 +0000 Feminism isn’t necessary anymore. At least that’s the claim made by many proponents of a growing antifeminism movement. No longer is this movement the prerogative, as it has been historically, of backwards-looking males who have no wish to see the status quo reconstructed. In fact a recent trend rocking the Internet has seen many women voicing antifeminist views.

There’s a plethora of websites discussing the topic and a large debate on Tumblr and Twitter, using the hashtag of the now famous social media campaign Women Against Feminism. Their Facebook group has more than 16,000 likes. On YouTube, numerous female users explain in their own videos why they are against feminism.

Women post selfies holding messages: ‘I don’t need feminism because…’ Their arguments range from the most complex to naive and apparently trivial. Some read: ‘I don’t need feminism because I love my boyfriend and we both respect each other’; ‘I don’t need feminism because I want to promise my man to love him, honour him and obey him’; ‘I don’t need feminism because I have the same equal rights as men’.

While some of the antifeminist arguments are against specific aspects of feminist theory, some others are simply opposed to the dominant and perceived ideas of a modern movement which sustains the need for a critical movement acting on behalf of women. According to some experts, the antifeminist movement has been historically largely based on religious and moral views, and frequently supported in argument by Biblical references.

Proponents have often put an enthusiastic emphasis on the need for the submission of women to men as well as a critique of the aggressive attitude held by some feminists. According to Occhipinti, the movement is centred on the idea of women returning to the domestic sphere to maintain the house and raising children as fundamental for the betterment of society.

For decades, there have been movements labelled as antifeminist such as masculinism which criticises the effects of the feminization of society and supports the interests of fathers and male partners. Other antifeminist views are based on an argument which misconstrues feminism as supporting women as superior to men and therefore as promoting inequality. 

In addition, a debate promoting the need to give a voice to men who suffer oppression is also ongoing online and many also label this as antifeminist. Many see the current antifeminist movement taking place online (and centered around this campaign from Women Against Feminism) as the direct result of misconceptions of what feminism actually is.

The origins of the movement seem to trace back to a social media project run by Professor Rachel Seidman of Duke University, called Who needs feminism? This project aimed to bring about awareness of feminist issues and incite dialogue, through asking students to share their reasons for needing feminism over social media. It certainly did release some strange inhabitants of Pandora’s Box, as thousands of women started to respond to this project with antifeminist views of their own!

Journalists, researchers and feminists have since weighed in, raising concerns about the amount of ignorance and incoherence displayed in many of these critiques of feminism seen online. Many have also made reference to the privileged backgrounds of the women sending such messages, perhaps free from the worst forms of sexist abuse which threaten those women living less comfortable and secure lives.

These relatively privileged women doubtless still face a degree of inequality, which we must assume they ignore, embrace or simply accept. Yet the majority of the world’s victims of domestic violence, poverty, illiteracy, abuse and modern slavery are women. They also have lower salaries and perform the bulk of the unpaid domestic work which goes on in the world.

The debate is still ongoing but one thing is for sure: feminism is not dead and this is not demonstrated only by the ongoing inequality between men and women but also by strength of its counter-movement.


Blais, M., & Dupuis-Déri, F. (2012). Masculinism and the Antifeminist Countermovement Social Movement Studies, 11 (1), 21-39 DOI: 10.1080/14742837.2012.640532

Occhipinti , Laurie (1996). Two Steps Back? Anti-feminism in Eastern Europe. Anthropology Today, 12(6), 13-18.

Image via Dasha Petrenko / Shutterstock.

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Personal Experience in Labeling Borderline Personality Disorder Tue, 23 Jul 2013 11:00:38 +0000 The diagnosis of Borderline Personality Disorder is inherently associated with stigma. Many clinicians refuse to work with clients who have this condition, and the term “borderline” may manifest negative emotions in people, clients and clinicians associated with the mental health field. There’s little argument that working with individuals with Borderline Personality Disorder is extremely difficult.

Some clinicians may react to such clients with eye-rolling dismay, but too many people treat Borderline Personality Disorder as the cause rather than the result of problems underlying this diagnosis. The term itself represents a superficial description of deep-seated problems emerging as relational difficulties that precede the diagnosis of Borderline Personality Disorder.

The condition of Borderline Personality Disorder can be described as a “thick concept”. This phrase conveys a label or a stereotype that symbolizes an amalgamation of characteristics, etiology and causes a term such as “Borderline Personality Disorder” can connote. It is important to recognize the diagnosis signified as Borderline Personality Disorder to be a thick concept, not as a label that conveys the associated prejudices.

I have worked with these types of clients, and I have been regularly appalled at the lack of respect that some clients with BPD have displayed toward me. One individual was particularly angry. His name was Tom, and he was a client of mine while I was working as a counselor in a group home in my late twenties. Tom had a superior IQ and used words that were not in my vocabulary. He was also extremely vulnerable.

I had read in the staff log one evening that he had reported to another staff member that he was planning to hoard his medication in order to make a suicide attempt. Also reported was the fact that he had said: “The staff person doling out the medication does not pay attention (to whether he swallowed his dose of medication) anyway”.

The next time I was distributing medication, I asked Tom to take his medication in my presence. He turned toward me, and he stated harshly: “Are you ethical or what? You just told everyone (the other clients) that I am suicidal!” I told him I was sorry. When I went home that day, I spoke to my husband about the incident. He said: “He told everyone he was suicidal — not you.”

Tom, nevertheless, wrote a letter to the director of the group home, complaining about my behavior in particular. My superiors did not reprimand me but supported me. Still, I remained daunted by the anger exhibited toward me by Tom.

He was an excellent artist, and, when he left that group home, he went to college in the Seattle area on a scholarship. I only saw him once after he left the group home. I was walking down a Seattle street with my sister, and I saw Tom walking toward me. I greeted him, without saying his name for reasons of confidentiality, although I did introduce to him my sister. I treated him in a friendly and polite manner.

He was stunned. He looked at me as though he could not understand, and I knew he did not understand why I would treat him well after the way that he had treated me as his counselor at the group home. My kindness toward him on a street in Seattle was one of my most successful moments during my career as a clinician. My behavior penetrated Tom’s perspective. In spite of his negativity, he realized that I had no ill will toward him. It proved to be an authentic, but deliberate therapeutic moment on a street corner in Seattle.

Terms relating to Borderline Personality Disorder include the following: dependent, histrionic, sociopathic, superficial, defiant, sullen, masochistic and ingratiating. We all know that these descriptive terms are negative, perhaps insulting. Even the words I’ve used here: angry, vulnerable and harsh, may be construed as negative. Diagnoses can amount to name-calling. The persons who are labeled with these terms clearly may feel negatively toward themselves and the people who label them, and this results in negative behavior in people like my ex-client, Tom.

The fundamental attribution error pertains to the presentation of negative behavior in those individuals who are labeled as “borderline”. Often we view other people’s behavior as emanating from their personalities, and we view our own behavior as resulting from situational factors. This has bearing on how individuals with Borderline Personality Disorder may view their own behavior and that of their clinicians.

It is easy to see that the terms mentioned here are accurately descriptive of BPD. However, the authority of clinicians who wield them may influence the creation of these negative qualities in their clients.

I have observed the reality that most diagnoses reinforce themselves in a cyclic way. This may be understood in terms of the process of labeling. The cyclic processes of labeling are complicated. They are not always understood, but they can be understood. It can be angering and frustrating to have insulting terms applied to oneself, and labeling can be enacted with impunity with regard to BPD clients who may feel powerless in terms of her negative treatment, even by well-meaning clinicians.

Essentially, the negative behavior of individuals with BPD is perhaps a reaction that is clearly exacerbated by the somewhat complicated processes of labeling. For this reason, it’s vital for clinicians to scrutinize the environment of their clients in an effort to determine exogenous reasons for the behavior of their clients with BPD, or any other client demonstrating a condition indicating psychopathology.

Image via Rob Byron / Shutterstock.

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The Company you Keep – Social and Associative Stigmas Wed, 11 Apr 2012 12:00:36 +0000 You can’t choose your family, say the metaphorical “they,” but you can choose your friends. Choose wisely, but bear in mind that regardless of whether or not the decision is yours, you are going to be judged on it.

The credit for some of the most seminal work on social stigma goes to Erving Goffman who worked on defining what is meant by social stigma and delineating its variants. According to Goffman, social stigmas may be physical “abominations” such as deformities or handicaps, “tribal stigmas” such as race or religion, and character flaws, such as a criminal record or drug abuse. Goffman believed that such stigmas applied not just to the person with the perceived defect, but also extended to those individuals who onlookers associated with the stigmatized person. This sort of secondary stigma came to be called associative stigma.

Associative stigmas are more insidious than they initially appear. They are not only formed through the identification of “meaningful relationships” between two people, such as familial relationships or friendship, but they may also be the outcome of unintended or incidental associations. The latter are called “simple associations” and may be the result of such coincidental circumstances as simply being in the same room as a stigmatized individual.

There may be one of two processes at work when a stigma is formed. Spontaneous or reflexive processes are responsible for the rapid, often emotionally motivated reactions to any of the perceived stigmas mentioned above. That they are based on instinctive reactions makes them all the more difficult to control and moderate. In contrast, deliberative reactions to stigma, as the name suggests, involve more voluntarism on the part of the individual and are consequently more difficult to bring on. Deliberative processes require the individual to actively think about the situation prior to arriving at a judgment. In the case of deliberation, the perception of control plays a great part. Individuals are less likely to react negatively to an individual they perceive to have no control over his or her situation (such as one who is visually impaired) than one they believe is under a controllable stigma (such as a drug user).

Reflexive and deliberative reactions are two separate processes, but they may operate on the same situation. Reflexive reactions are likely to be behind one’s immediate reaction to a stigma. Deliberative processes come into play after a bit of a delay. They are more effortful and time-consuming, consciously applying certain rules to the situation in addition to taking into account the initial reaction to it. Changes in one’s reaction to the same stigma after a period can thus be traced to this mental process.

How do these primary judgments carry over to individuals who do not appear to possess the stigmatized trait themselves? There are some theories that attempt to explain stigma by association. The idea of evaluative conditioning puts it down to a simple case of evaluative conditioning where a neutral target becomes the recipient of an onlooker’s negativity simply because they are in the physical presence of a negatively judged target. Another more conscious theory puts it down to the simple application of the adage “birds of a feather flock together.” This is especially true when a relationship appears to be voluntary as in the case of friends and partners. An individual in the company of a stigmatized person is judged on his or her decision to be in the company of that person. Heider reasons that this tendency may be due to a need to eliminate cognitive dissonance. The assumption two people in the company of one another share similar characteristics is easier on the mind than having to reconcile the ideas that they might be markedly different yet opt for each other’s company.

Social and associative stigmas often appear irrational. We do our best to believe we are unbiased and non-judgmental, and many societies work to eliminate (or at least decrease) the prevalence of such stigmas within their populations. Nonetheless, the generation of stigma seems to be wired into the human brain and there are few who are immune. After all, even the most pious among us might be prone to stigmatizing those who stigmatize others.


Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.

Heider, E. (1958). The psychology of interpersonal relations. New York, NY: Wiley.

Mehta, S., & Farina, A. (1988). Associative Stigma: Perceptions of the Difficulties of College-Aged Children of Stigmatized Fathers Journal of Social and Clinical Psychology, 7 (2-3), 192-202 DOI: 10.1521/jscp.1988.7.2-3.192

Pryor JB, Reeder GD, & Monroe AE (2012). The infection of bad company: stigma by association. Journal of personality and social psychology, 102 (2), 224-41 PMID: 22082057

Pryor, J., Reeder, G., Yeadon, C., & Hesson-Mclnnis, M. (2004). A Dual-Process Model of Reactions to Perceived Stigma. Journal of Personality and Social Psychology, 87 (4), 436-452 DOI: 10.1037/0022-3514.87.4.436

Walther, E. (2002). Guilty by mere association: Evaluative conditioning and the spreading attitude effect. Journal of Personality and Social Psychology, 82 (6), 919-934 DOI: 10.1037/0022-3514.82.6.919

Image via corepics / Shutterstock.

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Stigma Influences Seeking Mental Health Care Wed, 20 Jul 2011 12:00:17 +0000 Stigmatization of mental health disorders leads to a decreased quality of life, missed opportunities, and lost independence for the affected individual. A new study reports that stigmatization also determines if and when people will seek mental health care for themselves.

A large population-based survey in Finland evaluated the stigmatizing attitudes about mental illness and the use of mental health services. The study used a questionnaire to explore participant’s beliefs about mental illness. They were asked to respond “yes” or “no” to a variety of statements, including “Depression is a sign of failure,” “Mental health problems are a sign of weakness and sensitivity,” and “Depression is not a real disorder.” Other questions reflected participant’s desire for social distance from others affected by mental illness, as well as attitudes toward antidepressant medication. Respondents also reported their own experiences with depression. In total, nearly 5200 people aged 15 to 80 years old completed the survey.

Stigma is a complex concept that can be divided into three main categories: perceived public stigma (the general belief that people with mental illness are stigmatized by society), personal stigma (an individual belief about mental illness), and self-stigma (an individual’s view of his own mental illness). These attitudes and beliefs are closely related to people’s knowledge and education about mental health and treatments and services for mental illnesses.

Overall, people with depression reported more social tolerance of mental illness and held more positive beliefs about antidepressant medications compared to people without depression. People with more severe depression were more likely to seek healthcare compared to those with mild to moderate cases of depression. The study showed that stigmatizing attitudes do not prevent care-seeking behavior among people with depression, but the depression must be severe enough to overcome the social and self-stigmatization.

Throughout industrialized nations, only one-third of people with major depression seek help, and many who do seek help discontinue treatment prematurely. Factors such as age, gender, education, income, insurance, and availability of services influence the decision to seek treatment, but these qualities do not fully explain care-seeking attitudes. The costs and benefits of treatment impact this decision, and stigma is a substantial cost to many people.

Stigma is not isolated to depression, but has been studied across many populations and many diagnoses: young and old, military and civilian, urban and rural, and even among healthcare professionals themselves. Like mental illness, stigma does not discriminate. Multidimensional efforts may be needed to overcome mental illness stigma, including changes in legislation, alterations in media depictions of mental illness, inclusion of family-based treatment programs, and improved public education.

The good news to come out of the current study is that stigma does not prevent people from seeking help for their own mental illness. The disheartening news, though, is that the illness must be severe before most will seek treatment.  No one would wait until his cancer or cardiovascular disease was “severe” before seeking care or initiating treatment. When will mental illness be viewed the same way?


Aromaa E, Tolvanen A, Tuulari J, & Wahlbeck K (2011). Personal stigma and use of mental health services among people with depression in a general population in Finland. BMC psychiatry, 11 PMID: 21453504

Hinshaw SP, & Stier A (2008). Stigma as related to mental disorders. Annual review of clinical psychology, 4, 367-93 PMID: 17716044

Horsfall J, Cleary M, & Hunt GE (2010). Stigma in mental health: clients and professionals. Issues in mental health nursing, 31 (7), 450-5 PMID: 20521914

Jones AR, Cook TM, & Wang J (2011). Rural-urban differences in stigma against depression and agreement with health professionals about treatment. Journal of affective disorders PMID: 21665289

Kim PY, Thomas JL, Wilk JE, Castro CA, & Hoge CW (2010). Stigma, barriers to care, and use of mental health services among active duty and National Guard soldiers after combat. Psychiatric services (Washington, D.C.), 61 (6), 582-8 PMID: 20513681

Yap MB, & Jorm AF (2011). The influence of stigma on first aid actions taken by young people for mental health problems in a close friend or family member: Findings from an Australian national survey of youth. Journal of affective disorders PMID: 21658776

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Domestic Violence – Understanding is Getting More Nuanced Sun, 05 Jun 2011 12:00:30 +0000 A few years ago I brain blogged about domestic violence (DV), focusing on how ideology, politics, and stereotypes were interfering with an effective social response. It got a big response, almost entirely supportive. At that time, the tide was turning because of lawsuits and a preponderance of research that were beginning to overwhelm the dominance of old-school DV responses.

For example, it was becoming clear that roughly half of DV comes from women, there is a wide range of perpetrators, the majority of DV is mutual fighting, and current “treatment” (the Duluth model) is not effective, unless more modern intervention is sneaked into the mix. (Or maybe patriarchal conspirators are sneaking into lesbian households, starting a fight, and then sneaking back out before the police arrive.) Various dynamics were beginning to humanize violent people, including a huge spike in arrests of women for domestic violence. It was easier to demonize perps when the archetype was all hetero male.

Let’s look at the latest insights that have been building beyond the key points that men’s advocates have been pressing. This post is about antisocial personality and genetics in intimate partner violence.

Antisocial personalities (sociopaths) are the people that best match the stereotype of the DV perpetrator: violent and controlling. They have become the perp poster child because they elicit the most sympathy (and funding) for women, they create the strongest need for abused women to seek shelter, and they constitute the most dangerous and invasive profile. However, there are some inconvenient differences between the antisocial men and the patriarchal stereotype. They are not an expression of the patriarchy that feminists have blamed DV on, even though they may blurt out some patriarchal ideas as they grasp for some way to justify their behavior. Sociopaths have a limitless capacity to rationalize and blame; and they don’t suffer from the burden of being consistent or rational.

Other than the convenience of taking Marxist theory and substituting patriarchy for capitalism, there isn’t a lot of support for the idea of pervasive patriarchy in western societies. These antisocial types are not only violent with their partners; they tend to have a history of violence and criminal behavior outside of their domicile. Alcohol and other drugs often contribute to the violence, crime, and other chaos. But then, boozy households are more likely to have violence, including mutual violence, regardless of whether there’s a sociopath in the house.

Much has been made of research connecting childhood exposure to violence with later violent behavior in adulthood. The connection is there, but not as strong as people think. Old school feminist ideologues are highly motivated to ignore genetics and stress learning, childhood abuse, and patriarchy (while stressing that childhood abuse is no excuse), but genetics researchers point to a very strong genetic basis for antisocial personality. A meta-analysis published last year concluded that 56% of variance in antisocial personality was accounted for by genetic influences. We also know that childhood events trigger genetic change in individuals (epigenetic change) that can dramatically alter the course of their mental health over the lifespan.

So when we say that violence in childhood causes violent adults, we should also point out that violence in childhood (from biological parents) is an indication that the child may have violent genetics. At this point, it appears that the genetics takes the lion’s share of the credit. However, genetics as triggered by childhood stressors (epigenetics) may turn out to be the more powerful blend, because we are realizing that we have to think in terms of vulnerability profiles, rather than think species wide in assessing the effects of stress.

Perhaps we will be able to get a genetic test one day that will tell us what stresses are most important for each of us to avoid. We also know that it’s getting more complicated, in that genetic vulnerabilities appear to come in combinations. In other words, there are numerous illnesses (including psychiatric problems) that appear in heightened quantities in vulnerable families. Only certain problems are the result of passing on a single genetic vulnerability. Science is tasked with nailing down the difference (or spectrum) between these two types of problems: The specific disorder that is passed down (such as sickle cell anemia), versus the vulnerability to a variety of problems.

According to Ferguson, geneticists’ desire not to be contaminated by controversial and hard-to-substantiate theories of evolutionary psychology has slowed the integration of genetic and evolutionary theory regarding human behavior. At the same time, evolutionary psychologists have not used genetics to its potential because of a desire to focus on natural selection rather than more proximal effects on behavior, as well as to focus on more general (species-wide) traits at the expense of looking at genetic differences. And then, there is a general allergy to anything that might be conflated with racism or eugenics. Be as objective as you want, but touch certain topics and suddenly your a woman-hating KKK Nazi. After all, people tend to think in stereotypes, and stereotypes are easily triggered.


Ferguson, C. (2010). Genetic Contributions to Antisocial Personality and Behavior: A Meta-Analytic Review From an Evolutionary Perspective The Journal of Social Psychology, 150 (2), 160-180 DOI: 10.1080/00224540903366503

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Is Trauma Victim Becoming the New N-Word? Sat, 09 Apr 2011 15:58:58 +0000 A prevalant stereotype of trauma victims is the person transformed into a serial killer or other threat to society. The Oakland Tribune has gone over the top in reinforcing this stereotype with some truly awful journalism. They dramatically misinterpreted a highly-regarded researcher, Bessel van der Kolk, MD, in their article Scientists Seek to Treat Chronically Traumatized Brains.

The article makes rash statements that could help make “trauma victim” into the new N-word, and attributes them to the good doctor. It’s too bad, because Dr. van der Kolk has maintained important roles in trauma research as well as awareness of EMDR, the trauma treatment. I helped bring him to Denver for a conference (a long time ago).

Perhaps the most bizarre fear-mongering tactic in the article was posting a list of local murder victims in the middle of the article, strongly implying that they were all killed by people who were, like a new version of the zombie flick, transformed into murders by trauma.

You’ve seen that the press has been conditioned to point out that mentally ill people are not normally killers. They point this out when a mentally ill person kills. Why couldn’t the paper afford trauma victims the same courtesy?

The article makes it sound as though Dr. van der Kolk is talking about trauma victims. Actually, he is referring to children with serious symptoms that are difficult to save from lives of crime and violence. The newspaper author quotes him as saying, “I think the 50 kids we have are no longer the future rapists and killers of America,” (as a result of treatment).

Excuse me!… are NO LONGER? They WERE? It’s destiny? Although my main beef is with the Oakland Tribune, I have to take issue with Dr. van der Kolk in his phrasing either the pathological behavior or the cure as faits accomplis. I really hope that Dr. van der Kolk is correct about his ability to save these children (and, by extention, their victims), but it will be a long time before there is enough verification of his treatment approach to produce a scientific consensus.

We know that trauma is not destiny, and we know that not all people who experience potentially traumatizing events actually evince trauma symptoms. We need to distinguish between trauma as injury and “traumatic event” as something that, in some percentage of people, causes trauma. These events have been referred to as traumatogenic, to get across the idea that the events do not induce trauma in everyone, much less destin them to rape and kill.

Now tell me, what percentage of elevation of rape and murder is actually caused by PTSD? And if you think you have a percentage, how controversial and defensible would it really be in a scientific debate?

And add to this the matter of acculturation. The kids he is referring to are in areas where there is a strong gang influence; where there are powerful economic and cultural incentives to join a gang. How much of the elevation in crime in that population is the result of acculturation and under-privilege, and how much is trauma? Are the middle and upper class kids that are insulated from such influences also destined to become rapists and murderers when traumatized?

Of course not. Neither group is destined. But the question brings up the matter of race. The areas (Compton and Richmond, California) have high minority populations. You already know how the media and society in the USA and elsewhere paint with a broad brush. This kind of superficial talk reinforces racial and victim stereotypes.

Don’t hire an African-American, they were probably traumatized and will rape and kill.

Don’t hire that person that posted to their Facebook page that they experienced a trauma, they will rape and kill.

Here’s more from the article:

Trauma also muddies the connections between the left and right sides of the brain, affecting speech and cognitive abilities. ‘These things change the brain to become chronically fearful, or to not fear at all, or think the best thing to do before someone hurts you is to hurt them,’ van der Kolk said. ‘It’s bad news.’

‘Trauma is the residue of what those experiences leave in your body,’ van der Kolk said. ‘People’s brains change because of trauma.’ The effects of this are well-known: anti-social behavior, emotional numbness, aggression, violence and physical and mental dissociation — the hallmarks, in other words, of the emotional states of many traumatized youth in cities like Oakland and Richmond.

(At least the author bothered to throw in the word “many.” But to the average reader, what does “many” mean?)

And how dare the author say that it is “well-known” that trauma equates to “anti-social behavior” and so forth. It doesn’t. And it’s well-known that it doesn’t. It may, but in what percentage? Not a high percentage.

And there are bits about smaller brains, lower IQs, and not knowing where you are in physical space.

“Scientists and therapists now believe the long-term effects of childhood trauma are more far-reaching and worrisome than previously thought.” We weren’t worried enough a few years ago? It’s worse than we thought? Really? I haven’t seen any shortage of such concern among clinicians.

I think the new brain science will yield important clinical tools in coming years, but at this point, much of it is telling us what we already know. (As in, “You know that phenomenon we’ve been observing and commenting on and treating for so many years? Now we can point to a place in the brain where there’s less oxygen consumption!”) By over-hyping the science and making poorly-considered statements, we could easily do more harm than good.

I wrote Dr. van der Kolk about my concerns. He said he didn’t have time to post a response, but said I could quote him. Here is the bulk of his response:

I am talking (about) the 500,000 children and adolescents in residential treatment and juvenile detention settings in the US, who are there because of their violence and extreme impulsive behavior. Furthermore I am talking about the urgent need to help these kids to achieve a state of mindful self-possession and executive functioning so that they can grow up to become relatively healthy contributing members of society. Right now most of these kids are medicated to such a degree that it severely impairs their capacity to learn and to develop into well-functioning adults.  This issue goes well-beyond ‘trauma processing’ — it requires our finding out how we can help their brains develop in a way that they can play, understand other people’s intentions, anticipate the future, and experience the joy of work and love.

These children now are at extreme risk to grow up to have both miserable lives and to also inflict enormous damage on those around them. I am warning people that, unless effective  treatments are developed and implemented, these children will not only pay with very unhappy lives, but society will pay with staggering costs of incarceration, medial illnesses and other socially expensive consequences.

Feel free to argue about the political correctness of these statements, but I would prefer it if the energy went into the development and implementation of effective treatments.

I think he is underestimating the power of the media to exact harm through stereotyping. I think the social class and racial implications of some of his comments deserve more consideration. But the way the Oakland Tribune ran with the idea that trauma equals destiny was really over the top, and not his responsibility.

But this is just an extreme example of a trend of depicting traumatized individuals as becoming killers because of PTSD without providing the message that such conversion is rare and generally involves other aspects of mental illness and social dynamics. I hope that trauma victims can receive the same consideration that persons with other mental illnesses do when it comes to media representations of violent behavior, fictional or actual.

For an example of the complexity of PTSD and how numerous other factors determine the outcomes, have a look at a very touching and sad documentary on the fates of Iraq veterans by Frontline, called A Company of Soldiers. Here is a related program and ample additional materials called The Soldier’s Heart.

We know trauma is a matter of degree, and that Iraq veterans have experienced higher rates of PTSD becuase of matters such as multiple deployments and being coerced to commit (or to witness) war crimes. I point this out to remind readers that there is no poster child for PTSD; there are many manifestations and combinations.


Johnson, S. (2011). Scientists seek to treat chronically traumatized brains. Oakland Tribune, 3/30/2011..

Resources for Persons with PTSD

There are numerous resources that could be found at PTSD Forum.

Resources for Professionals

The PsychIN Directory has numerous professional PTSD resources. There is also an anxiety disorders section.

A Company of Soldiers, Frontline.

The Soldier’s Heart, Frontline.

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Clinical Psychologists’ Perceptions of Persons with Mental Illness Thu, 20 May 2010 12:00:17 +0000 Many people have fabulous relationships with their psychologists. They feel supported, understood, well-liked. But there are also those who feel a little uneasy. Research by Lynn Servais and Stephen Saunders of Marquette University in Milwaukee, Wisconsin may have unearthed one of the reasons why.

Some psychologists have a hard time connecting with people with mental illness, especially when they have diagnoses of borderline personality disorder or schizophrenia.

Most psychologists start off by evaluating people — that’s what a diagnosis is. Diagnoses, by their very nature, look at what’s not working. Most would agree that’s a good thing — if you don’t know where the problem is, it’s hard to fix it.

On the other hand, psychologists are people. Like you and me, they have personal likes and dislikes; perhaps they are even not so different from the employer who, research has shown, often decides who to hire within the first few minutes of meeting a prospective employee.

What Servais and Saunders looked at specifically was the concept of “disidentification” which

involves the process of characterizing persons with mental illness as easily recognizable and different from “normal” individuals while characterizing oneself as normal and not susceptible to mental illness (Cumming & Cumming, 1957; Mahatane & Johnston, 1989).

This is similar to the concept of othering you may have heard of and which often comes up when people talk about ethnocentrism (e.g. “I don’t know that I want to live in Surrey; there are so many East Indians there. They are just… different.”)

Disidentification can help boost a person’s self esteem; from my research in chronic pain, I have also formed the hypothesis that it goes even further — there may be a very primitive sense that by distancing oneself from someone who is “afflicted”, one could avoid “catching” an illness. (Of course this goes on at an unconscious level; very few psychologists would consciously hold such an irrational thought.)

The researchers analyzed surveys returned by 306 psychologists. It’s interesting to note that 95% of them were Caucasian; 83% saw mostly mildly or moderately “disturbed” clients.

Psychologists tended to see themselves as quite dissimilar to persons with borderline features and persons with schizophrenia. Borderlines tended to be experienced as quite dangerous and as least desirable of the five classes of people psychologists were asked to rate (themselves, a member of the public, a person with moderate depression, a person with borderline features, and a person with schizophrenia.

What is the effect of such disidentification? The researchers speculate (and find some basis for it in already existing research) that such perceptions detract from the therapist-patient relationship; could dissuade people in need of psychological services from seeking help; make it difficult for the therapist to feel and express empathy and genuine concern; could decrease the therapist’s belief in their clients’ recovery; and may model inappropriate behaviour.

Where does all of this come from? The need to keep up one’s self esteem and a fear of “infection” were already mentioned. Other sources are professional training, especially when it overemphasizes the psychologist as an expert. Personally, I also think that a focus on diagnosis which, as I mentioned earlier on, focuses on what’s wrong, is unhelpful. Additionally, I wonder whether the fact that 95% of those surveyed were Caucasian had something to do with it; conceivably, non-Caucasians may be more sensitive to the detrimental effects of disidentification.

Lastly, and most importantly, how can psychologists be helped to see clients with mental illness as more like themselves, less “other”?

  • Psychologists could take a more holistic view of their patients and focus not only on their problems but also on their strengths. Solution focused approaches such as advocated by Scott Miller de-emphasize diagnosis and concentrate on concrete, future-oriented solutions, with great success.
  • Universities and other training bodies need to a) specifically address stigmatization and stereotyping; and b) help psychologists form the belief that individuals who have a mental illness can indeed recover.
  • Persons with mental illness could be used as trainers for psychologists.


Servais, L., & Saunders, S. (2007). Clinical psychologists’ perceptions of persons with mental illness. Professional Psychology: Research and Practice, 38 (2), 214-219 DOI: 10.1037/0735-7028.38.2.214

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The Silent Epidemic of Health Illiteracy Mon, 06 Oct 2008 16:08:13 +0000 Nobody questions the fact that healthcare is a confusing profession. Doctors and nurses seem to speak in foreign tongues; medicines have names and ingredients that are not even pronounceable; more and more news comes out every day about diseases and conditions that seem to contradict each other. If doctors must devote 12 years of higher education just to get a basic understanding of how the body works, how does a patient hope to know what’s wrong with them?

In the federal government report, Healthy People 2010, which was written in 2000 and speculated on the upcoming problems facing the population, one of the objectives identified as a barrier to effective healthcare was the problem of health literacy. Health literacy goes well beyond the specific problem of an inability to read. The report defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” Making appropriate health decisions is a huge task made up of thousands of tiny ones. Scheduling and keeping appointments, knowing medications and dosages, understanding complications, consenting to procedures, and reading health information are all critical components.

Healthy People 2010 reports that as much as 30% of the United States population is either health illiterate or only has a “basic” literacy, meaning that they can only comprehend the most remedial tasks. Most people who are health illiterate either have a job or are retired workers, meaning they are otherwise functional within society. The problem is especially worrisome within the elderly population, where two thirds of adults over age 60 have inadequate or marginal literacy skills, and 81% of patients age 60 and older at a public hospital could not read or understand basic materials such as prescription labels. Other groups with high levels of health illiteracy include immigrant populations, minorities, and patients with lower incomes. About half of Medicare/Medicaid patients read below the 5th-grade level.

According to the AMA, having poor health literacy is “a stronger predictor of a person’s health than age, income, employment status, education level, and race.” Patients with inadequate literacy tend to suffer from more complications from medications due to errors in dose and timing. Medical complications are also more common because patients are less likely to follow-up with conditions that require it, and in general are less compliant with physician instructions. Without clear and accurate language to describe their symptoms, patients with less health literacy are also more difficult to evaluate and diagnose, leading to longer times until appropriate treatment is initiated. The cumulative effect is that poor health literacy costs the United States over 100 billion dollars every year in extra healthcare and lost productivity.

Ultimately the issue of health literacy needs to be addressed on a national level with a well-funded initiative for patient education and awareness. However, anything professionals can do to facilitate better communication is of the utmost importance for the well-being of our patients. Everybody in the healthcare profession needs to recognize the possibility that patients may not be understanding what is expected of them. Simple changes like providing a plainly written care plan for the patient to take home after every visit can help to avoid potential errors. After an encounter, rather than asking patients if they have any questions, consider instead to ask if there is anything you can explain more clearly. We may not be able to change our patients’ behavior overnight, but we can start by changing our own.

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Woman Comparable to Men in Domestic Violence: Stereotypes and their Consequences Sun, 08 Jun 2008 14:07:39 +0000 Anti-Stigmatization CategoryIt’s very common to hear about violence against women and about male batterers rather than about violence against men and about female batterers. Like it or not, experts that do not cherry pick their data find a fairly even split when the general public is polled in various ways.

Domestic Violence expert John Hamel, LCSW recently addressed this, with abundant research citations, for a book chapter. I will provide, with his permission, his annotations. But why? First, derogatory stereotypes are bad in principle. Second, the stereotypes cause people to downplay or ignore domestic violence and related behaviors by women. Third, funding for shelters and other services for men who are victims of domestic violence is affected. Fourth, men may end up as victims of the justice system when it turns against them because of the stereotypes.

PoliceConsider these two examples:

A volunteer who presents about male victims was presenting to a police department. She had 200 law enforcement personnel present. At the end, she got a police officer to volunteer a call to a shelter, posing as a male victim. He called a hotline for a battered womens program and asked about services for men, explaining that he was experiencing violence at the hands of a female. The hotline worker said, “You should be in jail.” The officer restated that he needed help because his wife was violent. The hotline worker hung up on him.

In a recent article in the San Diego Metro Weekly domestic violence was mentioned in the context of the California Supreme Court ruling in favor of gay marriage, regarding gay divorce. It says,

And, if any violence has preceded the divorce discussions and say… the local gendarmerie is called in, our boys are subject to domestic violence laws, which are stickier by far than if they were single and decided to box each other on the ears.

This not only assumes there is no violence in lesbian relationships, and there certainly is, I’ve seen it, but it also diminishes the seriousness of it by referring to it as boxing the ears.

Hamel’s Review of Research

Now here is a taste of Hamel’s review of the data. Thank you, John!

Straus et al. (1980); Straus & Gelles (1990). Both National Family Violence Surveys, with a combined sample of more than 8,000 respondents, reported comparable gender rates for not only physical assaults, but verbal abuse as well.

Rouse, Breen and Howell (1988). This survey of 130 dating and 130 married students found that women are more likely than men to engage in isolation behaviors, such as “monitors time,” “discourages same-sex friends” and “discourages opposite sex friends.”

Stets (1991). The male and female respondents in this study of dating students reported equivalent rates of controlling behaviors (e.g., “I keep my partner in line,” “I am successful in imposing my will onto my partner”), as well as psychological abuse (e.g., “Said mean things,” “Degraded him/her”).

Kasian & Painter (1992). The authors surveyed a large sample (1,625) university students. Male respondents reported higher rates of received abuse, as measured by a modified version of the Psychological Maltreatment of Women Inventory, for control, jealousy/isolation, verbal abuse and withdrawal of affection. There were no gender differences in rates of received emotional abuse (“diminishment of self-esteem”).

Feder and Henning (2005). In this study of 317 couples dually arrested for IPV (interpersonal violence), most of them African-American, criminal justice data revealed no differences between the partners in injuries inflicted or weapons use. Interview data revealed no differences in physical assault; women were more likely to use a weapon, but to suffer slightly higher rates of injuries (19.6% vs. 15.0%). There were no gender differences in overall psychological abuse or coercive control tactics.

Stacey, Hazelwood & Shupe (1994). Higher rates of victimization than perpetration were reported by the male subjects in this Texas study of men in batterer treatment on four of the thirteen items from the CSR Abuse Index: “deny rights to privacy,” “deny access to family,” “withdraw emotions to punish,” and “withhold sex to punish.” Although the men reported lower rates of victimization than females on the other items, the differences were usually not large (e.g., “deny freedom of activities” was cited by 71% of men and 72% of women; “deny access to friends” was cited by 57% of men and 63% of women, and “censor phone calls” was reported by 53% of men and 60% of women.) One would have expected much larger differences from this population, considering that the men had been arrested and deemed “batterers,” while their female partners were deemed the “victims.”

Tjaden & Thoennes (2000). The National Violence Against Women Survey (NVAWS), drawing on a sample of 16,000 men and women, reported that 0.2% of men are stalked each year by a current or former intimate, and 0.5% of women, a ratio of 2.5 women for each man victimized. In addition, .038% of the men reported to having been raped the previous year. Five times as many women (0.2%) said that this had happened to them.

Spitzberg & Rhea (1999). The authors examined a variety of stalking subtypes, collectively known as obsessive relational intrusion (ORI). Results from their sample of college students in Texas revealed a 54% rate of male-perpetrated ORI’s, versus 46% for females.

Langhinrichsen-Rohling, Palarea, Cohen & Rohling (2000). In this college survey, respondents were asked to report on their own ORI behavior, as well as incidents of victimization. There were no overall gender differences in stalking rates. However, men made more unwanted visits to homes and apartments, whereas women left the greater share of unwanted phone messages. Women were also four times as likely to report having been physically threatened.

Meloy & Boyd (2003). The authors reported on 82 female cases from mental health clinics and some who came to the attention of law enforcement. The women were similar to male stalkers in having a history of failed intimate relationships and having cluster “B” DSM IV personality disorders (not antisocial). They were also similar in that 50% — 75% threatened and 50% — 55% assaulted their victim. But they were different in that they more often carried out threats and caused property damage.

Busby & Compton (1997). A large survey of 3,034 engaged couples reported that 6.1% men and 13.0% women had been sexually pressured by their partner.

O’Sullivan et al. (1998). In this survey of 433 dating university students, 18.5% of the men and 42.5% of women reported to having been sexually coerced by their partner.

Muehlenhard & Cook (1988). This college study revealed that men more often than women engaged in unwanted sexual intercourse, at rates of 63% versus 46%. Being taken advantage of when intoxicated was reported by 30.8% of the men, and 21.0% of the women. Among the men, 13.4% had been verbally coerced, and 11.5% of the women said that this had happened to them. The rates were 5.7% for men subjected to nonviolent coercion (e.g., blocking the door, holding the person down), compared with 5.4% for the women. Coercion involving physical assaults was experienced by 1.4% of the men and 2.7% of the women.

Waldner-Haugrud & Magruder (1995). The authors asked a dating population about a range of coercive sexual behaviors. In the previous year, the men had an average of 2.26 incidents perpetrated upon them, and the women 2.86. Persistent touching was reported by 51% of males and 70% of females. Men were twice as likely to report blackmail (8.5% versus 4.2%); women reported a higher incidence of manipulative guilt (30.1% versus 22.5%). The women were twice as likely as men to be restrained or detained, and more threatened with physical force (6.9% to 6.0%); but three times more men had weapons used against th em (4.5% versus 1.4%).

Coker, Davis, Arias, Desai, Sanderson, Brandt & Smith (2002). A re-examination of data of 16,000 respondents from the National Violence Against Women Survey found lifetime male victimization rates of 10.5% for experienced verbal abuse and jealousy/possessiveness, and 6.8% for power/control, compared to rates of 5.2% and 6.9% for women.

Riggs, O’Leary & Breslin (1990). Found a strong correlation between having a dominant and aggressive personality and IPV for both men and women.

Cano, Avery-Leaf, Cascardi & O’Leary (1998). Found a significant correlation in high school dating study for boys and girls between the use of jealousy and dominance tactics and physical assaults.

Hines & Saudino (2003). Using the Revised Conflict Tactics Scale, this survey of 481 university students found comparable levels of physical aggression between the genders. Women were found to have engaged in higher levels of psychological aggression, and the two types of abuse tended to co-exist.

Graham-Kevan & Archer (2005). Drawing upon a community sample of university students and faculty in Lancashire, England, the authors found rates of 13% for female intimate terrorists and 9% for male intimate terrorists, based upon the same criteria as used by Michael Johnson (a combination of physical violence, control, and psychological abuse).

Laroche (2005), and Graham-Kevan (2007). Laroche analyzed a massive Canadian study, the 1999 GSS, involving 25,876 respondents. Respondents were asked about their victimization by a current or previous spouse in the past 5 years. In addition to questions on physical assaults, the survey also asked respondents about victimization from the following psychologically abusive and controlling behaviors by their partner, similar to those in the Duluth Power and Control Wheel: “Limits your contact with family or friends,” “puts you down or calls you names to make you feel bad,” “is jealous and doesn’t want you to talk to other men/women,” “harms or threatens to harm someone close to you,” demands to know who you are with and where you are at all times,” “damages or destroys your possessions or property,” and “prevents you from knowing about or having access to the family income, even if you ask.” For the five year period prior to the study, approximately 3% of the surveyed women, and 2% of the men, were counted as victims of severe intimate terrorism (IT) – defined as having experienced severe and frequent physical violence and high levels of psychological abuse and control, and who would fit Ehrensaft et al.’s “clinical abuse cases” from injuries sustained, fear expressed, and use of police and other services. Graham-Kevan analyzed the results of the same survey, except that she focused on abuse reported for the past year only, and found very comparable rates of intimate terrorism between the genders. This is a remarkable finding, considering the study’s methodology (akin to the NVAWS in t hat its questionnaire framed IPV in terms of personal safety rather than conflict, thus suppressing male victimization rates) and “the inadequate assessment of controlling behaviors suffered by men” (Laroche, 2005, p. 11).

Felson & Outlaw (2007). An analysis of data originally obtained through the NVAWS with a sample of over 15,000 currently married or formerly married adults found that: (1) women are just as controlling and jealous towards their male partners as other way around; (2) the relationship between use of control/jealousy and physical violence exists equally for both male and female respondents; (3) “Intimate terrorists” can be either male or female. (Controlling/ jealous behaviors defined as: “Prevents you from knowing about or having access to family income even when you ask”; “Prevents you from working outside the home”; “Insists on knowing who you are with at all times”; Insists on changing residences even when you don’t want or need to”; “Tries to limit your contact with family and friends.”) Regarding the extent to which men and women engage in “intimate terrorism,” the authors write: “Both husbands and wives who are controlling are more likely to produce injury and engage in repeated violence. Similar effects are observed for jealousy, although not all are statistically significant. The seriousness of the violence is apparently associated with motive, although the relationship does not depend on gender” (p. 404). It should be pointed out that the National Violence Against Women Survey was designed, conducted and analyzed by feminist researchers, who sought to prove that violence against female intimate partners is much more serious than violence against male intimate partners.

Straus (2006). 7.6% of the male respondents and 10.6% of the female respondents interviewed in the International Dating Violence Survey (sample of 13,601 university students in 32 countries) reported having perpetrated severe assaults, and both partners were found to be violent in 68.6% of the cases. Based on 9 items related to dominance on the PRP (e.g., “my partner needs to remember that I am in charge”), the survey found overall dominance scores to be equal across gender, although higher dominance scores were found for women in 24 of 32 countries. It was also found that dominance by either partner increases the probability of severe violence, and that dominance by females increases risk of severe female-only or mutual IPV more than does male dominance.

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In Deed, Indeed – Compassion and Empathy Thu, 10 Apr 2008 16:42:55 +0000 Anti_Stigmatization.jpgI find the subject of compassion compelling. I believe this aspect of human-kind is a pivotal component in successful negotiation of the human experience where family and community is concerned. Pivotal, because in the absence of compassion there is stagnant disconnect. I suppose if one were to live solitary in the woods and could sustain the needs that promote healthy survival without interactions with fellow man, compassion and empathy would be unnecessary provisions in the condition of living. A rare few would decide to do that. Even if it were plausible to do so, we don’t willingly choose to. We desire the interaction of others. It promotes a sense of inclusion and well-being. There can be no perception of that belonging without some amount of compassion and empathy echoing within the dynamic of human interaction. To that end, it’s fundamental.

PicI’ve spent a great deal of time thinking about this subject. Increasingly so in the past several years because I have particular need in my personal life to understand this trait so that I might better manage my own feelings of disappointment related to this subject where my son’s constant battle with chronic major depressive disorder is concerned. I aspire for a kind of closure that would facilitate my utilizing that gained energy toward increased focus in supporting my son’s health, as well as to the assistance of other’s goals of enhanced wellness where addiction and mental health related issues are concerned. As a direct result of my experiences related to my unavoidable involvement and through investments in this edification, I accept that some people, for varying reasons, have a lesser capacity to act in service in even the simplest forms of support and encouragement in relation to the compassion they experience. I would go one step further and communicate that this kind of diminished capacity is especially prevalent with regard to the subject of compassion as it concerns addiction and depressive mental illnesses.

There are slightly varying definitions for the word compassion; differentiating from empathy, sympathy, and pity can be a bit tedious as they are often used in description of one another. However, it is defined in the GoodWiki pages from the Greater Good Science Center, University of California, Berkeley, as:

… a feeling of sorrow, or concern for another person’s suffering or need accompanied by a subsequent desire to alleviate the suffering.

Note that it doesn’t read:

… a feeling of sorrow or concern for another person’s suffering or need that results in a desire, followed by an action, to alleviate suffering.

There is documented research explaining why the latter, enhanced definition would be inaccurate. I think the explanation of this holds inherent truths, specifically as it relates to societal stigmas.

It appears, based on researched evidence, that benevolence is directly impacted by the way individuals process their own response to feeling compassion. The resulting self-regulation of that emotion determines whether the individual will act in an altruistic, benevolent manner in connection to another’s recognized need, or that a person may instead process their initial feeling of emotional response in a manner that produces subsequent personal distress. A personal distress response will not necessarily result in an action-oriented behavior aimed at easing the pain of someone else. The research supports that sympathy motivates people to act benevolently, while personal distress can cause an “egoistic” response. There are even polar opposite physiological responses to the individualized processing of sympathy and personal distress. Studies show that sympathy can produce a decrease in heart rate, while personal distress, on the other hand, can initiate, you guessed it, an increase in heart rate.

Okay, so there it is. The terms “personal distress” and “egoistic” explain a great deal, at least to my understanding. Basically, what I gleaned from my reading is that some people act as a result of their feelings of compassion in a way that they believe will serve the need of someone else. Others act in a way that would serve to assist in the avoidance of further investment outside of their initial emotional response. The study supported that this is due to a self-perceived anticipation of encountering “stress,” thus “personal distress,” associated with that investment.

When the tears are not enoughI have a personal need to better understand the emotion of empathy. This subject of compassionate response as it relates to addiction and depressive illness helps serve my goal in assembling a reasonable, thoughtfully-woven perspective as to why I witness a rampant lack of action-oriented compassion in relation to those suffering the isolation they often experience in coping with the effects of the disease. Frankly, the perspective I have been forming over the years is affected, too, by my inexpressible disdain for the many uninformed commentaries and downright hateful, critical judgments that occur frequently in our society with regard to the clinical and social realities of addiction and depressive mental illness. There exists a huge amount of conscious and unconscious perpetuation of stigmatic energy associated with the disease. We ALL witness the demoralizing result, and collectively we are all allowing it to continue. The presence of this stigma assists to impede advancements in treatments and cures. I’m unaware of another disease whose proliferation as well as successful treatment is dependent upon pro-socially motivated emotional response, or is as innately rooted in how we act or don’t act in terms of compassion.

One result of this stigma is that it causes a diminished capacity in recognizing the disease as one of physiological origin. It’s a complex issue, as we tend to be wired to judge the symptomatology of the disease as character-related. Subsequently, we often distance ourselves when we perceive that another’s challenges are a result of willful “bad behavior,” rather than understanding that the behavior is one resulting from the presence of a physiological, or psychological impairment. In contrast, when we witness someone struggling with what we perceive as a physical ailment, we are much more likely to respond with an encouraging, compassion-related action. As well, this compassion-related action is also more likely to occur in response to the perceived emotional suffering of another when we see it as result of physical injury and disease. Because we are not as apt to recognize the behavioral impairment and subsequent choices relating to that behavior as stemming from physiological components occurring from disruptions in normal brain functions, we don’t respond properly in terms of need, treatment and cure. Even when the behavioral symptomatology is recognized as having physiological origin, apathy still occurs. The possibility of self-perceived personal distress is a contributing factor in this apathetic response. The bottom line is that we fall unwitting victim and perpetrator, of sorts, in the amplification of a rebounding, vicious cycle of disease, which impacts the patient, the family, and ultimately the community. It is a disease of phenomenal scale as it relates to family dynamic and its reverberations in societal context.

This leads me to what I perceive is a logical conclusion. In order to restrain and thus improve the far-reaching, devastating effects of addiction and depressive mental illness, there is requirement, first and foremost, in reversing the stigma associated. It needs to happen now. The cure is dependent on this focus. Every single person is impacted by the presence of the symptomatology of this disease. Do that math. It should not require calculative tools to ascertain that we are witnessing an ever-increasing need for counter actions that will reduce the unparalleled, prolific resonance associated with addiction and depressive mental illness stigma.

I have invested in supporting my child in his battle with the life-threatening symptomatology associated with chronic Major Depressive Disorder. We had to get a grip, or we were going to lose him. Admittedly, we have not done everything right. It’s impossible. It’s exceedingly difficult to always know exactly what to do in regard to the symptomatology. But disconnect?… NOT AN OPTION. So, we persevere, everyday, inspired through responsible, dedicated love. It’s hard to hang there, at times. The symptomatology sucks up all manner of resources. I’ve referred to the investment in my son’s illness as like being, at times, “tied to a tornado,” with respect to the illness’s unpredictability. Its power to devastate everything in its path is increased if it is not responsibly, compassionately treated. I wouldn’t dream of presuming to understand anyone else’s parameters of engagement. Every case is unique. I’m just trying to be clear that I would rather be tied to a tornado than freed of that connection through his departure from this earth as a result of his illness.

A great deal of the challenge I personally experience in connection with the disease is a direct result of the associated stigma. I have developed an inexpressible disdain for the many uninformed comments and downright hateful, counterproductive, critical judgments that I am exposed to in our society in regard to it. You witness them, too. But, I have acquired an improved understanding as to why some of us don’t take our feelings of compassion to the next step of responsible action — action of encouragement and service to another person in need. I get it, alright. But still, I experience disappointments related to the fact that I, and many others, shouldn’t have a need to work so hard to understand this counter-productive response to the disease in the first place. That energy would better serve to support those struggling to cope with the disease.

GapSomething else I am forced to recognize? All that logical assertion serves little good. All the cognitive conclusions in the world will never be adequate in facilitating a filling-in of the shameful gap created by rampant, societal disregard. No… That gap isn’t going to fill itself, making itself a pretty, little blossoming cherry tree-lined, cobblestone path to the land of, “Nobody Has Drug Addiction Tendencies or Mental Health Issues, USA.” Nice place, I suppose, if you can get there. Since I’ve been trained to expect the unexpected due to my experiences with my son’s illness and have also learned to be responsible for creating my own sense of hope from what is, at times, seemingly, hopeless, I’ll keep a suitcase packed, just in case. I’d be thankful to relocate. But in absence of that reality, I believe the bridging of disease, to treatment and cure, specifically related to this human condition, begins with an action-related, compassion-born foundation. We are all in this quest together, because together, we have created much of the need.

We are not solitary creatures. We exist in a family, community, society, and global scope.We need each other. We all intensely desire a sense of acceptance and inclusion on some level. Existence in this spirit promotes wellness, so it makes perfect sense that addiction and mental health related stigmas would serve in opposition of health.

We need to do better in honoring the state of humanity as it relates to addiction and depressive illness. It’s not enough just to feel compassion or empathy. Dedicated, heart-driven, solicitous, actions serve prevention, serve treatment, and serve cure.


Batson, C.D., Fultz, J., Schoenrade, P.A. (1987). Distress and Empathy: Two Qualitatively Distinct Vicarious Emotions with Different Motivational Consequences. Journal of Personality, 55(1), 19-39. DOI: 10.1111/j.1467-6494.1987.tb00426.x

Eisenberg, N. (2002). Empathy-related emotional responses, altruism, and their socialization. In R. J. Davidson & A. Harrington (Eds.), Visions of compassion: Western scientists and Tibetan Buddhists examine human nature (pp. 131-164). London: Oxford University Press.

Zhou, Q., Valiente, C., Eisenberg, N. (2003). Empathy and its measurement. In S. J. Lopez and C. R. Snyder (Eds.), Positive psychological assessment: A handbook of models and measures (pp. 269-284). Washington, DC, US: American Psychological Association.

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