CLINICAL HANDBOOK OF SCHIZOPHRENIA

536 VII. POLICY, LEGAL, AND SOCIAL ISSUESsubordinate positions. There is not a specific prejudicial group in power maintainingstructural stigma; rather, it is the product of discriminatory historical trends relative tomental illness. For example, current structural stigma maintains a political and economicenvironment that promotes the inability to achieve parity between mental and physicalhealth insurance coverage. For several decades, insurance benefits for physical illnesshave continued to surpass benefits for mental illness; this leads to the assumption thatgreater benefits for mental health decrease the benefits available for physical health. Inanother example of structural stigma, mental illness research receives minimal Federaldollars compared to other health care research. Because agencies fund physical health researchat a much higher rate, knowledge that reduces mental illness stigma and enlightensmental health policies cannot be gained at the same rate as knowledge in physical healthfields. Overall, structural stigma manifests itself as either institutional policies or socialstructures that negatively impact the lives of individuals with mental illness.Social JusticeFrom a clinical perspective, symptoms may appear to be the main cause of stigma. Individualswith manifest psychotic and bizarre behavior experience greater stigma than individualswith symptoms under control. This type of assertion exemplifies the “kernel oftruth” perspective. Stigmatization and prejudice relative to any group is based on a kernelof truth, or separate evidence about that group. For example, the public views Irishmenas drunken sots, because the Irish, as a culture, imbibe more than most other culturalgroups. The public discriminates and fears people with mental illness because of the kernelof truth in the belief that they may be more violent than the rest of the population.This “kernel of truth” perspective suggests that one way to decrease stigma is to diminishthe social belief. Widespread programs that foster recovery provide one mechanismto decrease the kernel of truth and erase the stigma of mental illness. Note, however,that dealing with stigma is not a clinical agenda. New generations of medication andpsychosocial treatment will not bring about its demise, because stigma is a problem of socialjustice. Stigma is not the natural result of symptoms; rather, stereotypes exist as socialconstructs that lead to stigmatization of the targeted group. Erasing intrinsically stigmatizingsocial injustices increases opportunities for individuals with mental illness to pursuecrucial hopes, dreams, and life goals.STIGMA CHANGE STRATEGIESEffective stigma change strategies match the type of stigma they address. Antistigma approachesthat counter stereotypes, prejudice, and discrimination address public stigma,and personal strategies address components of self-stigma.Changing Public StigmaResearch identifies three approaches that diminish the impact of public stigma experiencedby people with mental illness: protest, education, and contact. Groups protest inaccurateand hostile representations of mental illness to challenge the stigmas they represent.These efforts send two messages. First, to the media to stop reporting inaccuraterepresentations of mental illness, and second, to the public to stop believing negative reportsabout mental illness. Largely anecdotal evidence suggests that protest campaignshave been effective in getting stigmatizing images of mental illness withdrawn from themedia. Consider, for example, what happened to the ABC show Wonderland, in which