DSM V Controversy: Asperger's Syndrome

While researching Asperger’s and Autism I found an article from this website (Exploring developmental disabilities) that explained the difference between the two well…
          “One of the main reasons why Asperger’s is separated is the severity of the symptoms as well as not having language delays like children with Autism have. For those who aren’t trained to look for the signs of Asperger’s, many would see a normal child who is a bit odd. Unlike with children who have Autism, children with Asperger’s want to fit in and have interaction with others, but they lack the social skills to do so easily. For some reason, they aren’t able to pick up on social cues that come naturally to others such as how to interpret body language or how to engage in a conversation.”

I found this to be true in a book I was reading for my psychosocial class. It was titled, "Look Me in the Eye" by John Elder Robison. He has Asperger’s and throughout the book he explained how he 1) knew he was different 2) wanted to be like other people and 3) did not understand why other people did not understand him. He struggled throughout his childhood but ended up becoming very successful. He had to learn by trial and error and by really watching other people and getting cues from other people on how he was “supposed” to act/why people act the way they do.

This leads up to my argument against changing Asperger’s disorder into a broad Autism spectrum disorder in the DSM V that is supposed to be coming out in 2013. Although the Huffington Post says that they will not be getting rid of the term Asperger’s, on other websites it says that that is what the DSM V will do. In an article on THE CONVERSATION titled "DSM-V and the changing fortunes of autism and related disorder" it has more of an explanation of how the change will effect Apergians. TheConversation

Great Book!

“Aspergians” are concerned that they will be labeled “autistic” and will lose their identity.  Also a concern is that high functioning individuals with Asperger’s will no longer fall under the criteria for Autism and will not be able to receive help, or as much help as before. They are also concerned that these individuals will not try to get help because they are so high functioning. "

In an article by Lucy Berrington, a member on the board of Asperger’s Association of New England, titled, “Don’t Remove Asperger’s from the DSM” she makes this statement that I think reiterates why the two should remain “together but separate”:
          “Retaining the current diagnosis is not about distancing Asperger’s from other forms of Autism. This is about classifying a particular subgroup in a way that demonstrably adds value. That Asperger’s is a form of Autism does not mean we should know it only as Autism. Spanish and Italian are closely related linguistically, yet it isn’t helpful to call Italian Spanish.”
Don't remove Asperger's from DSM

Autism and Asperger’s are closely related but still need to have their separate definitions.

Like a Moth to Flame

                                    "The moth don't care when he sees the Flame.
                                           He might get burned, but he's in the game.
                                           And once he's in, he can't go back,
                                           He'll beat his wings 'til he burns them black....."
                                                                                   from "The Moth" by Aimee Mann

    A new version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is slated for release in May of 2013. This manual, released by the American Psychiatric Association (APA), is the definitive text that sets criteria for standardizing definitions and coding of Mental Disorders for purposes of research and billing.
     There has been a debate about including Internet Addiction in the new version. It has not been addressed in previous DSM texts, but is slated for inclusion in an appendix of disorders requiring further study for possible inclusion at a later date.
     Dr. Kim Young, from St. Bonaventure University in NY presented the first paper referring to Internet Addiction as an emerging disorder in 1996. Since that time, it has been estimated that 1 in 8 Americans and as many as 30% of  young South Koreans, Chinese and Tawainese citizens suffer from problematic internet use. http://www.huffingtonpost.com/2012/03/28/internet-addiction_n_1385587.html This article, from March 28, also includes a written account and a short video of two different people detailing the challenges they have faced with internet usage that got out of hand.
     On her website for the Center for Internet Addiction, Dr. Kim lists several criteria for having an internet disorder including: Internet preoccupation; need to use the Internet with increasing amounts of time in order to achieve satisfaction; unsuccessful efforts to control, cut back, or stop Internet use; feeling restless, moody, depressed, or irritable when attempting to cut down or stop Internet use; staying online longer than originally intended; jeopardizing or risking the loss of a significant relationship, job, educational or career opportunity because of the Internet; lying to family members, therapist, or others to conceal the extent of involvement with the Internet; and using the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression).

   
  According to a 2008 editorial in the American Journal of Psychiatry by Dr.Jerald Block, there is merit for placing Internet Addiction in the DSM-5. He said by not being recognized as a disorder, those who seek treatment are usually forced to pay expenses out of pocket. That, combined with a high incidence of relapse and comorbid conditions like ADHD and depression that become harder to treat, make it a problem in need of a solution. http://ajp.psychiatryonline.org/article.aspx?articleid=99602
      While I certainly am not an expert on Internet Addiction, from watching a family member's struggles I know this can be a debilitating issue. It caused a National Merit Scholar on a full academic scholarship to drop out of school without informing his parents. His days were consumed with gaming to the extent that nothing else mattered. After returning home, he decided to try school again. The University he was attending agreed to let him back in, however they withdrew all previously awarded scholarships. He lasted one semester before leaving again. Once home a second time, he got a low-paying job but spent all of his free time gaming. The net result was boredom with the job combined with loss of sleep from internet use caused him to walk away from his position. At 26, he is still fighting the lure of gratification he gets when he is in front of the computer monitor fighting others in imaginary duels. Therefore, I would have to support inclusion of Internet Addiction in the DSM-5. If there is not enough data compiled for distinction as a diagnosis, then setting a standard of criteria for validity in testing is the next logical step.
   

 

DSM changes: Mental retardation to intellectual disability

Historically, people who suffer from mental retardation have been described using a variety of terms, including "mentally deficient," "mentally handicapped," "feeble," etc. Some of the terms that have been used have had negative connotations. One advantage of the proposed new term, "intellectual disability," is that it accurately describes the condition without reflecting negatively on people who suffer from it.

An article in the AAIDD (American Association on Intellectual and Developmental Disabilities) discussed the proposed change between the terms "mental retardation" and "intellectual disability."

The article indicated that a term describing a particular condition needs to meet certain criteria in order to be effective. For example, it should be specific, so that people who need to work with the term can understand it. It should be able to be used consistently by various people, such as medical professionals, mental-health professionals, organizations, families, researchers, etc. And it should accurately reflect the current state of knowledge regarding the condition.

According to the article, the term "intellectual disability" meets all of the specified criteria for an appropriate description of a condition. There is no difference between the old term and the new term regarding diagnosis, treatment, etc.

Personally, I feel that "intellectual disability" might sound better than "mental retardation." When I was growing up, I sometimes heard people making unkind remarks about mentally retarded people and calling them names. The term "intellectual disability" might be more likely to help people realize that those who suffer from this condition deserve to be treated with kindness and respect.

The article can be found at:
http://www.aaidd.org/media/PDFs/renamingMRIDDApril2007.pdf

The AAIDD offers answers to frequently asked questions on intellectual disability, including comments about different terminology for it. You can read the FAQs at:
http://www.aaidd.org/content_104.cfm

　

I'm Addicted to Love...(ing) the Internet

The DSM (Diagnostic and Statistical Manual of Mental Health Disorders is about to publish its 5^th version, the DSM-V. With this new revision, those in charge of the manual have made several changes. Some of these changes are due to outdated diagnoses and new information psychologists have gathered on current diagnoses. Some of the changes are as simple as a name change in order to place a diagnosis into a new category, while some changes are due because society has changed itself.

One of these new changes to the DSM involves addictions. Before talking about addictions. One must know what the DSM and psychologist refer to as mental illness. It can be defined as “medical conditions that disrupt a person's thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.” (http://www.nami.org/template.cfm?section=about_mental_illness). With this being said, one would think an addiction would be something that would have an affect, whether positive or negative, on ones self. So, when the updated version of the DSM is published, I wonder how they can say that gambling can be an addiction, but Internet and sex are not. Nothing explains why, or how, the writers decided which addictions would be part of the DSM and which would not. But when one thinks about the definition, anything one does to an extreme disrupts part of their life. It can be drugs, gambling, Internet, working out, church, etc. However, all this being said, after reading a few articles, I have to agree with the new DSM, at least on the part of internet not being part of an addiction, but I think sex should be included.

Once they cross the borders of including Internet as an addiction, then there has to be a type of treatment, and this also opens up a whole new world of possible addictions. John Grohol, Founder & Editor-in-Chief explains it as “If people are using the Internet to socialize — on Facebook, Twitter, etc. — how can we turn around and characterize that as a bad thing? Would we engage in the same negative characterization if we were referring to someone who simply did this over the telephone? Or face-to-face?” (http://psychcentral.com/blog/archives/2011/04/10/virginia-heffernan-on-internet-addiction/). Technology has changed the way we do things and there is no way around that fact. If using the Internet is labeled as an addiction, how do we draw the line? I know I’ve spent countless hours in front of my computer this semester alone studying for school and doing research. I have an I-phone that allows me to check my email anytime, anywhere as well as stay connected with what I need to. Even our class uses this source, the blog, as a resource to share our knowledge as well as using something called “Black Board” that allow professors to post class material. Isn’t that all using the Internet? So if it is considered an addiction, would that make me an addict?

I can see how some people can become caught up within the technological world. There’s Facebook, where people confess to spending hours in front of distracting them from the real reason they got onto the computer in the first place. Other mediums, such as games have developed whole worlds, such as World of Warcraft, where players have this alternate life in another world. People spend days playing this game and even making schedules around events going on in the game. So yes, I do believe there can be extremes, such as there is an extreme to everything. But should we label using the Internet as an addiction that one needs help, what kind of help should they receive. Is there going to be yet another type of medication that will supposedly decrease the amount of time one spends online?

An article in the New York Times by Virginia Heffernan gives an account of one person’s self-proclaimed addiction to using the Internet. This lady explains that she spends a majority of her time on the computer, day through night, but yet she remains successful. Heffernan does not believe that this is so much a problem, as an outlet. Heffernan explains that Dr. Kimberly Young, a professor of business at St. Bonaventure University believes it “allows us to create new personalities and use them to fulfill unmet psychological needs” — which sounds worrying except that art, entertainment and communications systems are designed explicitly to permit self-exploration and satisfy psychological needs.” (http://opinionator.blogs.nytimes.com/2011/04/09/miss-g-a-case-of-internet-addiction/). Heffernan also stated that, just like the Internet, Opera and novels used to be considered addictive and problem causing. But, we won’t ever see those in the DSM.

So yes, some people out there spend too much time in front of their computers. They have chosen technology over sunshine and friendships. Their sedentary lifestyle is, or probably will cause them health problems in the future. But can wanting to stay close to friends, or do research for an article, or even post a blog about your feelings really be considered an addiction. Does it really interrupt ones life, or, since this is the technological age, does it just allow us to fit in and stay caught up with the times.

Not so different

I remember in high school I used to see the kids in the "special classes" being teased, it was usually mocking of how they were walking or talking either directly to them or behind their backs. I think it was because they were different…they were separated…no one really knew what they did or what they could do. Link and Phelan would call this… internalized discrimination. Over time, through socialization we build stigmas against MI. I never thought negatively about these people or made fun of them but I remember being weary the first time I ever talked to someone with a mental illness. A few people were selected from gym class to go help with the Special Olympics team at the bowling alley and I was one of those people. This was in 10^th grade and I remember feeling nervous because I did not know what to expect! I remember questioning: What do I talk to them about?...Can they talk?...Are they violent?...Should I be scared? It turned out to be SO much fun and I really enjoyed it. I wondered afterward why was I so scared? Who put these questions in my head?
If there were more opportunities like this (especially starting at a young age) people wouldn’t have this fear of the unknown. MI shouldn’t be something that is so *hush*hush* and you are not supposed to bring it up or ask questions…how will people learn that they are not so different??They were way better than me at bowling!!!
 The below link is to an article that goes along with my above statements. It says there are 3 approaches to reducing stigma: protest, education, and contact.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489812/

Direct discrimination seems like it should be common sense NOT to do! We learn about the golden rule growing up…treat others how you want to be treated...this rule should be taught by parents, teachers, whoever has contact with young people. Bullying has become a huge issue and it can definitely bring on MI (depression, social anxiety, low self-esteem)  that can impact a person's life forever.

A way to reduce structural discrimination would be through advocacy. People with MI should have the same rights as we do and should be able to get good health care, live where they want to live and feel safe in their environment.

The bullets below are from an article written by Peter Byrne titled, Stigma of mental illness and ways of diminishing it…..
In the past three years, these are the learning experiences that have been encountered at advocates' meetings:

• an architect objecting to her work colleagues' constant references to a psychiatric unit they were designing as a “nut house” or “psycho depot”
• an insurance executive, with a remote history of mental illness, challenging the loading of his insurance policy – by his own firm
• a nurse, following an episode of depression, insisting on returning to the intensive care unit and not, as suggested, to a convalescence ward
• a medical student challenging the Dean to show the same flexibility with mental illness as he had previously shown with physical disability
• a teacher with bipolar disorder encouraging the schools' board to include information on this illness on the curriculum
• a footballer insisting his team play the local psychiatric unit
• a newsagent offering to keep newspaper cuttings to facilitate a local initiative on negative media coverage of mental health issues
• a parent's description of services as “supermarket psychiatry”
• a man who had recovered from an episode of depression, objecting to a public education campaign that would include schizophrenia and depression together: “Why drag depression down to the level of the gutter?”
• a consultant psychiatrist, on hearing an articulate account of schizophrenia from a woman living with the illness, “Then she couldn”t be schizophrenic”

http://apt.rcpsych.org/content/6/1/65.full

I thought these were interesting because they are real life scenarios to show that this is a problem. Through more education, exposure, contact and advocacy  we can fight STIGMAS!

STAMP OUT MI STIGMA'S!

                           

So is there anyone out there that would like to be discriminated against in one way or another?  Please raise your hands now...  If there are no takers to this offer how do we as a society find it ok to discriminate against others?  Be it little or big biases here and there, at the end of the day it is still discrimination. So many of us (myself included) boast the morale of doing onto others as we would have done onto ourselves.  Yet ... (again - my self included) there seem to be these "exceptions" concerning the act of discrimination.  Growing up we were discriminated against pretty much from the time I can remember.  It is because of this I try really hard to educate myself against areas that I might find prejudice.  A big one for me lately are these "mother's" in the news that kill their children.  My ignorance quickly steps in and soon there are expletive's that come bursting out of my mouth concerning the character of these women.  Momentary as it may have been it still happens even when I would like to live a Gandhi 'esque lifestyle.  So instead I try to urge myself away from what the news might report about these people in 2 or 3 short minutes & educate myself on PPD & other MI that may have caused these drastic actions.

So as far as reducing the stigma against those effected with MI I say GET INFORMED!!!  In today's world we would have to be living under a rock not to be able to do a simple Google search.  Facebook is really popular and people check in on that all the time several times a day via a variety of methods.   I typed in MI advocacy to my Google search bar and came up with several very good sources helping to explain MI, what can be done to stop the spread of MI discrimination & what resources are out there for people with a MI.  It took about 15minutes!  Check out some of the sites here:

http://www.naayers.org/programs_stopstigma.html

http://www.mentalhealthadvocacy.org/

http://www.nami.org/template.cfm?section=state_advocacy

                

*Graph courtesy of the New York Board on Mental Health

I have a cousin who was born with FAS (fetal alcohol syndrome), meaning his mother drank alcoholic beverages during pregnancy.  We don't know to what extent she drank if it was just 1 or 2 during a critical developmental point or if she drank on a daily basis.  We don't know this because he had what was called a closed adoption.  Growing up he had some physical trademarks that come from FAS and his behavior was much like that of other young boys i.e. rowdy, loud, hyper.  By the time he was 15 yo he was institutionalized to the grief of my Aunt & Uncle.  His behavior became more erratic, quite violent & he no longer was safe to be around.  It was a struggle for the whole family to try and comprehend what the problem was.  Again, the stigmas arose.  This was in the late 1980's & MI was not spoke of a lot in our community.  Instead he was sent to a state hospital, put in isolation & heavily medicated.  A string of doctors over the years have diagnosed an array of conditions he suffers from schizophernia, manic depressive, the list goes on.  Bottom line is this man who is now 37 yo has been living as if he were a criminal for the last 22 years.  The funding for advancement, continued care, community support, and medication access is ever declining.  This national budget problem effects everyone in big ways.  For more information I have posted a link by NAMI that reports the MI cuts in spending at some alarming rates.  For instance from 2009 - 2011 the Mental Health budget was cut by $1.6 BILLION - dollars!  That is very sad considering that people are released from housing, not getting community support or their medications.  You can check out more here:

 http://www.nami.org/ContentManagement/ContentDisplay.cfm?ContentFileID=126233

   Bruce Link & Jo Phelan identify 3 forms of discrimination; one of which is "direct", this defines persons with a stereotypical belief(s) often directly discriminating against another.  The second is "structural", which as I touched on above is segregating those with MI to isolated tx facilities (out of sight out of mind...?).  The third is called "internalized", this incorporates the ingrained negative beliefs surrounding MI.  Therefore making persons who have signs of MI reluctant to getting help because of the stigmas they would face. 
 
                                        
We can all be advocates everyday in every way.  First by stopping our own misguided thoughts & getting better informed.  Second to SPEAK UP when we witness discrimination occurring.  Third reach out in the community or with loved ones with MI.  We all have a part to play its whether or not we want to join the fight against MI STIGMAS.

Which is worse? What is said or what isn't?

"Despite growing knowledge of how to diagnose and treat mental illness, myths and misperceptions about these disorders persist, leading to stigma and discrimination toward those who suffer from them."
-------Former First Lady Rosalynn Carter

     People with mental illness have been fighting stigma since the Dark Ages, when religious zealots decided it was caused by a flaw in moral character and put the ill in locks and chains in dungeon rooms. Today, the mentally ill may not be locked away and physically tortured, but  they are still kept bound by the judgment of others. Some areas affected by these attitudes include healthcare, employment, entertainment, media, law enforcement, insurance and social relationships.
     According to an initiative by the Australian Department of Health and Aging, people still routinely blame the mentally ill for their disorders. Common misconceptions are the mentally ill are more violent and those with mental illness are more likely to miss excessive amounts of work.
http://www.responseability.org/site/index.cfm?display=134896
     Several years ago, I personally witnessed stigma on the job. A coworker suffering from depression became ill and missed a couple of days of work. Automatically, others in the workplace attributed it to his mental illness rather than the flu (which it was). In the scope of things, it seemed to be a rarely minor discrimination, but compounded it could have prevented him from calling in the next time he was sick or made someone else who was there refrain from seeking help for their problems.
     The same website asserts that "people are more likely to call out discrimination directed toward race, religion, sexuality or physical disability than they are mental illness."
     I don't know how long people need to talk about stigma or how much money needs to be directed toward awareness before others actually listen, but I do believe education is the best first step. After taking part in a class on psychosocial dysfunction I realized I stigmatized by jokingly calling someone "crazy" or "off their rocker" and I consider myself to be accepting of others. So how do other people think?
     The New Jersey State Council on Stigma and Mental Illness has an interesting take on what will happen if people advocate for awareness. They use an analogy for cancer treatment as their example:
 Years ago, people believed cancer was contagious and always fatal. Employers refused to hire someone with cancer, insurance companies wouldn't provide proper coverage, and people refused to let their children play in homes where someone had the illness. Stigma and silence prevented funding from going toward research. Then, cancer advocates fought stigma and money was directed to research. People learned it wasn't contagious, insurance and medications improved, many cancers became treatable, and people were educated about lifestyle choices that could decrease cancer formation.
 They believe the same thing can happen with mental illness if we are willing to stand up and speak out.  http://www.state.nj.us/mhstigmacouncil/about/anatomy/
     To show that others are actively trying to promote awareness as well, I am including an interview Gayle King and Charlie Rose did with Pro-bowl football  player Brandon Marshall just three weeks ago. In it, Marshall, who was diagnosed with Borderline Personality Disorder less than a year ago, discusses his need to come forward, address his illness, and encourage others to do the same.
http://www.cbsnews.com/video/watch/?id=74http://www.cbsnews.com/video/watch/?id=7401377n&tag=mncol;lst

You are NOT your diagnosis

I have not personally seen any discrimination regarding mental illness. I know people have misconceptions of mental illnesses thinking that they can't function "normally" in society which could be their own naive opinion based on what they've seen or read about with mental illnesses such as schizophrenia or autism. I think most people get their information from television, movies, or books and no one is interested in how well people are doing in their lives all people care about is what is entertaining. I think having people with a mental illnesses on shows like Dr. Phil or even the news who aren't held back by their diagnosis would help bring awareness to the world and show everyone that each person is different and just because you have a mental illness doesn't mean you have to be debilitated by it or withdrawn from society.

Based on the three different forms of discrimination identified by Bruse Link and Jo Phelan (direct, structural, and internalized) certain interventions could be appropriate for each to eliminate discrimination from happening. Direct discrimination is described as a stereotypical approach of someone with a mental illness where someone was directly discriminated against. If this happens to someone that person or a person working with them should speak up and say something. They may be able to explain to the person their diagnosis and the strengths that the person has despite their mental illness. Structural discrimination involves someones social environment which can influence their mental illness based on inadequate funding, dangerous environment that could effect their health, sources of care and be harmful to them. I think bringing people with mental illnesses out to the community and having people see that there's a need and sharing with them the inhibiting factors that they have because of what they are surrounded by would help bring awareness and potential help to the facility. Internalized discrimination is caused by socialization of people that learn as children the negative attributes of people with mental illnesses. Therefore, people are more hesitant to seek help if they have a mental illness for fear that they will be ignored or perceived differently. Support from loved ones and the community would help those get treatment and feel accepted by society regardless of their mental illness.

There are resources out there that help reduce the stigma of mental illness and speak out about what's right when it comes to treating those with certain diagnoses. Connecticut Clearinghouse talks about what it's like for someone dealing with a mental illness and some Do's and Don'ts about how to portray someone with a mental illness.

http://www.ctclearinghouse.org/topics/customer-files/Stigma-and-Mental-Illness-061305.pdf

SAMHSA- What a different a friend makes; again talks about some myths associated with mental illnesses and how important it is to have support from loved ones and the community so someone could experience a good quality of life.

http://www.whatadifference.samhsa.gov/learn.asp?nav=nav01_1&content=1_1_mythsfacts

Wisconsin United for Mental Health, shows how the advocate to help stop discrimination of mental illnesses. They also explain some myths about mental illnesses and how they speak out in the community to try to reach out to society.

http://www.wimentalhealth.org/combatingstigma/myths/

Being proactive in reducing discrimination is very important to those with mental illnesses because they can live a happy and functional life, but having support and understanding is key to making that happen.

No different than me and you

A lot of people don't understand mental illness. And, unfortunately, most of them probably never will. While everyone knows February is black history month, I doubt anyone realizes April is National Awareness Month for Autism (http://www.autism-society.org/about-us/national-autism-awareness-month/). I was lucky enough to have been presented with a job that allows me to work directly with the developmentally disabled. Before this job though, I too thought April was only for Easter and rain showers.
I've personally gotten to experience mental illness discrimination within my current work environment. One of the things we do is take our clients into public in order for them to learn how to act in social situations. Just like the public, if they don't go out, they wouldn't be aware of a life outside of their house. The client I work now is a little boy who is just precious. He doesn't have a problem with walking or drooling, or any other features of the face that allows one to immediately know he is dev. disabled. However, he's autistic and can't talk and just does what he wants to do. Sometimes when out in public he'll begin screaming and people look at me like I've just hit him or something. But honestly, most of the time I have no idea why he's screaming. I have had clients that do "look" different too. And it sucks to go out in public at times. One of the places we like to go is the mall, which, so does everyone else. And a lot of people will run out of the way to purposely avoid us like that if they were to get to close they would "catch" the disease. I quickly learned not to care about those that stare at us. My client's don't care, so why should I. However, not everyone who is diagnosed with a mental illness can just ignore those around them, or have no idea what is being said or that they are being judged and stared at differently.
There are three forms, according to Bruce Link and Jo Phelan, about discrimination (http://www.ahrn.net/Lancet-Stigma_and_its_public_health_implications.pdf). Direct discrimination is purposely going out of ones way to not do something because of the other person, such as not allowing someone into a restaurant for an unjustifiable reason. Fortunately, I've never had anyone blatantly discriminate against me or one with me. Structural discrimination is a bit different, because one might not even realize they are being discriminating. Link and Phelan demonstrate this by saying a a white man is given a job opportunity by another white man, then when it is the guys chance to hire someone, he hires a white man. This shows both racism and gender discrimination. One has to be careful to avoid this and really think about what they are doing in order to reduce this type of discrimination. There is also internalized discrimination, which is almost like learned or placed discrimination (a mental institution in the poor areas of a city).
There needs to be a lot of change before discrimination is ever erased and it is something that will most likely never disappear. Some individuals will always feel that they are better than others. But it is up to everyone else to change the way we are. I believe that there needs to be more awareness in the school system. There are some programs now that try to help, such as having dev. disabled students placed into certain classrooms. But there needs to be a much bigger change. I believe a lot of discrimination still exists because people are unaware. I know I didn't know much until my job.

The Equal Educational Opportunities Act of 1974, http://en.wikipedia.org/wiki/Equal_Educational_Opportunities_Act_of_1974, opened up the public school system to everyone. This was a huge step toward opening the doors of understand those that are different. But, once inside the school, these students were placed out of sight. In my hight-school, the mental ill students were locked away in a classroom and we never really saw them. If we did it was just in the hallway and everyone would stare and avoid them. I think the teachers need to provide a better understand and the fact that these are just people, like everyone else. Just like a sex ed class, there needs to be communication about those that are diagnosed. I believe the first step to understanding that we truly are equals is having the knowledge about each other. If we talk about stigmas, the general public could understand that they don't have to be afraid and go to the other side of the store to avoid 'catching' what these individuals are diagnosed with. They deserve a chance to be heard and to have friends and to go shopping just like everyone else. There are programs set up to educate others in the mentally ill. One particular group has a program just to educate teachers so that they may educate their students (http://www.camh.net/education/Resources_teachers_schools/TAMI/index.html). I believe discrimination can be decrease if we educate the young before it gets set into their heads or before they enter the world on their own. If just one person learns that these are people like everyone else, then that's one more than what there is today.

Reducing stigma associated with mental illness

I personally don’t recall observing discrimination toward people with mental illness (M.I.), other than being in public and seeing people staring at others or ignoring them because they seem to be different.  Just as people might stare at someone with a physical disability because he doesn’t look like them, so people might stare at someone with M.I. because he doesn’t act the way they do.

Link and Phelan describe internalized discrimination as something learned at an early age.  I believe that providing education about mental illness at an early age is one of the best ways to help to prevent this type of discrimination.

A conference was held in May 2001 which included the National Institutes of Health as one of the sponsors.  It examined the causes and consequences of stigma regarding various types of physical and emotional illness.  It indicated that this type of stigma would continue to increase.  Individuals with stigmatizing diseases are less likely to seek appropriate professional assistance.  Social stigma, therefore, is a global health concern.  A video of the conference is available online and is a good resource to help educate people who want to avoid being guilty of stigmatizing others.

Through socialization, people learn at a young age about stigma toward those who are different.  Again, education can help to prevent this.

Another Web site offers ways to support people with M.I.  I feel that some of the ideas listed at this Web site represent excellent ways to intervene on behalf of people with M.I.  Advocacy is one example of working to prevent direct discrimination.

Policy makers can provide specific financial support to help people with M.I.  Thus, policy makers can intervene by being advocates on behalf of those who are mentally ill.

Other examples of advocacy include promoting participation in formulating care plans and crisis plans for people with M.I., creating user-led and user-run services, and developing peer-support worker roles in mainstream mental-health care.

One good way to provide structural intervention for people with M.I. is by encouraging employers to make appropriate adjustments for them – for example, by allowing them to use headphones to block out distracting noise, having a quieter workplace with fewer distractions, and offering flexible work schedules so that employees can work at their peak levels and have time off for medical appointments when needed.

My daughter is an SLP and is an excellent advocate for people with various types of physical and mental disabilities.  She has told me about children who are teased or have difficulties in school because of their disabilities.  She strives to provide the best possible care for all of her patients, regardless of their conditions.  Even outside of her job, she works as a volunteer with children experiencing a variety of disadvantages and tries to improve their situations.

Good resources for people who are interested in advocating for people with M.I. include the following Web sites.

www.stigmaconference.nih.gov

www.ijmhs.com/content/2/1/3