Session Six: Stigma

Partnering With Families Affected by Concurrent Disorders - Facilitators' Guide

Session Goals

• Enhance awareness of the impact of stigma on families affected by concurrent disorders.
• Help participants identify the ways in which their families have suffered the effects of stigma.
• Identify strategies to fight against stigma on a personal, family, community and broader social level.

Content Outline

• Understanding stigma.
• Experiencing stigma.
• Surviving stigma.
• Combating stigma.

Leaders’ Notes

Your piece on stigma reminded me of the fact that everyone handles mental illness differently in terms of disclosure. We need to respect that some families are uncomfortable with disclosure and the added stresses that brings to the family to keep the illness a secret. I myself have no difficulty talking about my own situation, but I know that many find it difficult to expose the addiction on top of the mental illness, and often only after I have said my son has an addiction to alcohol do others reveal the same. Your report alludes to the ignorance of the general population about concurrent disorders and the fear about these illnesses and subsequent stigma. I think families can reduce stigma by being educated about the illness and in turn by educating others.

We have found that discussing stigma with family members is much easier when facilitators begin with practical exercises.

Starting the discussion

Before actually getting into a discussion of personal experiences with stigma, it is generally helpful to ask the group what things come to mind when you say the word “stigma” (e.g., definitions of the term, mental images or words that people associate with stigma, or movies that have dealt with the subject of stigma and mental health and/or substance use problems). Some family members will have experienced feelings of shame and embarrassment, sadness and guilt, and anger and frustration due to stigma, while others will say that they have never been directly affected by stigma at all.

Another way to start a discussion is to ask the group to talk about the difference between the terms stigma, prejudice and discrimination. You can explain that “stigma” refers to a feature that is viewed by others as undesirably different. You can ask the group members for examples or you can provide examples (e.g., medical conditions such as obesity, hair loss, or physical disabilities). Examples relevant to concurrent disorders include someone talking to themselves as a result of a psychotic disorder or hallucinogenic substance use. The idea here is to help the family members differentiate the visible or invisible traits themselves from people’s attitudes toward such stigmatized traits (prejudice), and people’s behaviours toward those who are stigmatized (discrimination).

Stigma and substance use and mental health problems

It is important to discuss reasons for stigmatizing particular conditions, traits, marks and behaviours. For example, ask the group to think about a number of stigmatized health care conditions and then have group members talk about the different reasons for stigmatizing people with these illnesses.

A general discussion about the reasons for stigma usually leads to talking about stigmatization of people who have substance use and mental health problems. This is a good opportunity to talk about common myths about mental health and substance use problems. For example, some people:

• Believe that individuals with personality disorders are seeking attention and are unwilling to take responsibility for their behaviour.
• Fear individuals who hear voices and talk to themselves because they mistakenly associate such behaviours with violence.
• Believe that individuals who have major depression are really just lazy.
• Believe that individuals who have substance use and mental health problems make the problems worse by refusing to take responsibility for their behaviour.

Talking about these, and other, examples is a comfortable way for many family members to begin relating the discussion of stigma to their own personal lives.

Discussing personal experience of stigma

You can ask participants to share their own experiences with the group. It is helpful if the facilitators begin the discussion with a non-threatening example of how they have experienced stigma themselves. I often talk about how I grew to six feet tall before I was 12 years old and was laughed at and discriminated against because everybody else in my class, including (and especially!) all of the boys, were so much shorter than I was. I often add that after suffering a terrible sunburn one summer as a pre-teen, I was known as “The Towering Inferno.”

It can also really put group members at ease if one of the facilitators shares an experience with substance use or mental health problems in their own family. Some clinicians will not be comfortable and willing to do this, but being up front about substance use and mental health issues and the associated experiences of stigma and discrimination is greatly appreciated by family members.

We have found that the module on stigma is often one of the group members’ favourites. Although it can be a painful and uncomfortable topic for family members, once they become engaged in the discussion, they tend to experience a sense of satisfaction and gratitude for such an opportunity.

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Partnering With Families Affected by Concurrent Disorders

• Overview
• Working with families
• Preparation
• Implementation
• Evaluation
• Session Outlines
  • Session 1: Introduction
  • Session 2: Substance use problems
  • Session 3: Mental health problems
  • Session 4: How concurrent disorders affect family life
  • Session 5: Self-care
  • Session 6: Stigma
  • Session 7: Navigating the treatment system
  • Session 8: Medication
  • Session 9: Relapse prevention
  • Session 10: Crisis and emergency
  • Session 11: Recovery
  • Session 12: Saying goodbye
• References
• Resources
• Appendix 1: An Overview of the Research
• Appendix 2: The Partnering With Families Affected by Concurrent Disorders Project

• Print Bookmark