'That's Just Crazy Talk': Using theatre to address

mental illness stigma

Dr. Erin Michalak1, Dr. Sagar Parikh2, Dr. Jamie Livingston3, Victoria Maxwell4

1University of British Columbia, 2University of Toronto3BC Mental Health and Addiction Services, 4Crazy for Life Co.

Objectives

1. To discuss mental illness stigma, in particular relating to BD

2. To share findings from a CIHR-funded study exploring the use of theatre to reduce stigma in both people with BD and health care providers

i. Human difference is distinguished and labeled

ii. Dominant cultural beliefs link persons to undesirable characteristics

iii.Persons are placed in distinct categories to separate “us” from “them”

iv. & v. Labeled persons experience status loss and discrimination

“It takes power to

stigmatize”

In Their Own Words

a cloud over you

rejectionthe injustice and

unaccountability of psychiatrists

something that’s directed at you

maliciously

when people bad mouth me about my

mental illnessnegative mark on someone

being haunted by the past

when people think the mentally ill are

weird or dangerous

an anchor that you need to carry around

being called derogatory names by educated

professionals

being royally screwed

a label that destroys your

whole reputation

when people treat you like

a dog

when people look down

on you

being treated unfairly by

people

a deformity

a character defect

look at someone and they say “oh,

he's crazy"

"prejudice" in a more specific

sense

3 Levels of Stigma

Self StigmaCharacterized by negative feelings (about self), maladaptive behaviour, identity transformation, or stereotype endorsement resulting from an individual’s experiences, perceptions, or anticipation of negative social reactions on the basis of a stigmatized social status or health condition.

Livingston & Boyd. (2010). Social Science & Medicine, 71: 2150.

3 Levels of Stigma

Social Stigma

Describes the phenomenon of large social groups endorsing stereotypes about and acting against a stigmatized group.

Corrigan et al. (2005). Applied and Preventive Psychology, 11: 179 .

3 Levels of Stigma

Structural Stigma

Refers to the rules, policies, and procedures of social institutions that restrict the rights and opportunities for members of stigmatized groups.

Corrigan et al. (2011). Challenging the Stigma of Mental Illness: Lessons for Therapists and Advocates. John Wiley & Sons.

Swine Flu Stigma

The spectrum of bipolar disorder

Goodwin FK, Jamison KR. Manic-Depressive Illness; 1990.

Mania

Hypomania

Depression

NormalMood

Variation

Normal

CyclothymicPersonality

CyclothymicDisorder

Bipolar IIDisorder

UnipolarMania

Bipolar IDisorder

SevereDepression

• BD – the orphan child?

• Are some symptoms of BD particularly stigmatizing?

• Hyper-religiosity

• Hyper-sexuality

• Psychosis

• Instability

Stigma and BD

How do we reduce stigma?

Theatrical performance

targeting internalised

stigma

Development of KE tools for findings on

wellness strategies for BD

Development of KE tools for new

BD QoL scale

Knowledge to ActionQuality of Life, Stigma, and BD:

A Collaboration for Change

That’s Just Crazy Talk

Three study components:

1. Stigma2. QoL assessment 3. Wellness strategies

Two target groups:

4. People with BD5. BD healthcare providers Two main research sites:

6. Vancouver 7. Toronto

QoL.BD scale

Wellness study team

Knowledge Exchange

Theatrical – based

performance

To exchange knowledge with people with BD and healthcare providers about how to recognize internalized stigma, how to

deal with it, and how to recognize and respond to public stigma.

To provide a compelling theatrical presentation that will engage people with BD and healthcare providers simultaneously to

reinforce mutual understanding.

Specific Objectives

Methods – (I)• People will watch and evaluate a new play by established

playwright and actress Victoria Maxwell, as well as participate (optional) in post-screening discussions

• Deliberately, people with BD, healthcare providers, and the general public will watch at the same time – building a shared experience and also allowing for sharing of question and answer period following play

• Play creation, performance, and evaluation all product of CIHR grant

Methods (II) Evaluation Strategies

Satisfaction scales and standardized Stigma scales (MICA-4, Day Scale, ISMI)

Assessment scales administered at 3 time points: (T1) prior to the theatrical intervention (T2) immediately after the intervention

(T3) 3 months post intervention.

Telephone interviews at 3 months post-play to elicit narratives regarding reflections and impact of the

performance

Day’s Mental Illness Stigma

Scale

Day Scale

Internalized Stigma of Mental Illness

Scale (ISMI)

Internalized Stigma of Mental Illness (ISMI) Scale

Mental Illness: Clinician’s Attitudes

Scale (MICA)

Mental Illness: Clinician’s Attitudes (MICA) Scale

Performances • 3 research events (Vancouver & Toronto)• 2 public events (Toronto and

Victoria )

Participants• 89 health care providers • 81 people with BD• 3 individuals indentifying as both • Over 270 general public

• TJCT is valid, receiving positive feedback across people with BD, healthcare providers and general audience members

• 98% of participants described the event as ‘good’ or ‘excellent’

• TJCT observed to have the potential to affect stigma

• 85% of healthcare providers and 67% people with BD thought the play could ‘change public acceptance of BD

Results: feedback

Healthcare ProvidersPRE POST

Effect Size

N M SD N M SD t df P d

.123 0.17

83 .000 0.585.5584 2.07 0.61

8130.61 6.52 82 29.77 6.65 1.56

0.27Professional Efficacy 84 2.74 1.35 84 2.53 1.32 1.78 83

84 2.20 1.38 2.44 83 .017

Stigma among Clinicians (MICA) (a=0.66)

.079 0.20

84

3.42 83 .001 0.37

Anxiety* 84 1.72 0.89 84 1.60

3.40 0.83 0.01 83 .990 0.00

0.82 2.14 83 .035 0.24

84 2.06 0.94 4.35 83 .000 0.48

Hygiene**84 1.93 0.99 84 1.67 0.87

Treatability 84 1.74 0.76 84 1.52 0.54 2.94 83 .004 0.32

Stigma (DMISS) (a=0.87)

Recovery* 84 2.55 1.31

Relationship disturbance* 84 2.38 0.99

Visibility* 84 3.40 0.84

Total*** 84 2.26 0.63

Total 82

*p<.05, 2-tailed; **p<.01, 2-tailed; ***p<.001, 2-tailed

• Significant improvement on DMISS domains:

• ‘relationship disturbance’ (concerns about BD-related disruptions to normal, meaningful relationships)

• ‘hygiene’ (negative beliefs about the appearance and physical self-care of people with BD)

• ‘recovery’ (negative beliefs about the potential for recovery from BD)

• ‘anxiety’ (affective feelings of anxiousness, nervousness, uneasiness, and fear of physical harm when around someone with BD)

• ‘treatability (negative beliefs about the treatability of a person with BD)

Healthcare provider results: headline

People with BDPRE POST

Effect Size

N M SD N M SD t df P dStigma (DMISS) (a=0.88)

Social withdrawal 79 2.04 0.68

Self-Stigma (ISMI) (a=0.94)

Discrimination experience 75 2.20 0.63

Relationship disturbance* 80 3.22 1.23 80 3.00 1.22 2.42 79 .018 0.27

Alienation*78 2.35 0.70 78 2.23 0.77

75

2.61 77 .011 0.31Stereotype endorsement 77 1.55 0.45 77 1.56

2.24 0.72 -0.61 74 .542 0.08

0.45 -0.48 76 .635 0.04

0.02Stigma resistance 77 2.02 0.61 77 1.93 0.58 1.14 76

79 2.05 0.75 -0.32 78 .751

74 .319 0.13

.259 0.14

Total 75 2.01 0.49 75 1.98 0.55 1.00

*p<.05, 2-tailed; **p<.01, 2-tailed; ***p<.001, 2-tailed

• In people with BD, significant improvement on ISMI ‘alienation’ domain

• Floor effect at play

People with BD results: headline

Next Steps• Performances scheduled: • Toronto, ON- CME Congress, June 2012• Boston, Mass – Nat’l Society of Genetic Counsellors Conference, October 2012

• Distribution of DVD • March 2012

• 1000 in production

erin.michalak@ubc.cawww.crestbd.cawww.facebook.com/#!/CRESTBDBipolarResearch