In Part One, I shared my thoughts on the first four chapter of Written Off by Philip T. Yanos, In Part Two, I will go over highlights from the rest of the book. If you have not read part one, I highly recommend going back to that and reading it first.  Written Off is available for purchase through Amazon and other booksellers, or your local library may have a copy.

Chapter 5: Responses to Stigma among People Diagnosed with Mental Illnesses

In chapter 5, the reader begins by learning about the development of stigma concern. As early as age five, negative implications in regards to mental health begin to develop.  The impact of stigma, Yanos later argues, includes a fear of potential rejection due to mental illness, which leads to social withdrawal and secrecy.

The rest of chapter five focuses on self-stigma.  The author states: “…there is a strong component of ‘alienation’ in the experience of self-stigma, [which is when] people come to feel that they are fundamentally different from, and worth less than, others.”  He goes on to explain three possible reactions to being identified as having a mental illness; a person will either experience indifference, righteous anger, or self-stigma. Indifference typically occurs in those who do not believe they have a mental illness.  Righteous anger occurs when one identifies as a part of the MI group, but rejects the negative stereotypes (these people are more likely to become involved in advocacy). Self-stigma occurs when someone both accepts their diagnosis as well as the negative stereotypes.

Chapter 6: Discredit The Impact of Self-Stigma on Identity and Community Participation

In chapter 6, Yanos reviews the effect self-stigma has on things such as hope, self-esteem, and suicide risk (hope and self-esteem are low, suicide risk in increased).  Social avoidance is also high in individuals who self-stigmatize.

From there he discusses vocational outcomes. “In the United States, it is estimated that between 39% and 68% of people with severe mental illnesses are unemployed.  These rates are certainly higher than the general population, but are also quite a bit higher than rates of unemployment among people with physical and other disabilities.”  

Chapter 7: Stigma By Association The Impact of Stigma on Family Members and Professionals

Here, Yanos expands his scope to expound on how those who associate with individuals with a mental illness are also stigmatized.  He explains that family members are often stigmatized, and that spouses express the most concern in relation to stigma.  This may be because spouses are seen as having chosen someone with a mental illness as their life partner, whereas a parent or adult child is seen as less of a personal choice.

Mental health practitioners, such as psychiatrists, are also victims of stigmatizing views.  “For example, a study of more than 1,000 medical faculty in 15 countries found that approximately 25% endorsed the view that ‘psychiatry has low prestige’ and they they ‘would not encourage a bright student to enter psychiatry.’”

The author also discusses how shame or compassion fatigue (also known as burnout) can affect associates of those with a severe mental illness. As he confides to the reader, “‘I haven’t gotten too friendly with anyone at the office because I don’t want people to know where my husband is.  I figure if I get too friendly with them, then they would start to ask questions.’”

Chapter 8: The Possibility of Change Peer-Led Options

In the eighth chapter, Yanos reviews peer-led groups and whether or not they are effective of decreasing an individual’s self-stigma.  He notes that there are not enough of the right studies to give definite data, but from the data the currently exists, certain types of peer support programs can be helpful.

Chapter 9:  The Possibility of Change and Interventions Professional Options

In chapter 9 Yanos goes over a few programs that exist in professional settings with the purpose of decreasing self-stigma.  He gave details about four different programs.

• Narrative Enhancement and Cognitive Therapy (NECT) 
• Ending Self-Stigma (ESS) 
• Anti-Stigma Photovoice 
• Coming Out Proud (also called Honest, Open, and Proud)

Chapter 10: Conclusion: Where Do We Go from Here?

In the final chapter, Yano’s summarizes some of the key points made throughout the book.  He concludes “the true alternative to stigmatizing is not just tolerating, but accepting and embracing difference.”

Written Off: Mental Health Stigma and the Loss of Human Potential is a very valuable read that I highly recommend.  If you’ve given it a read, I’d love to hear what you think.

Below is a video from a part of UK anti-stigma campaign Time to Change