Paradigms Lost: Fighting Stigma and the Lessons Learned.

Paradigms Lost challenges key paradigms currently held about the prevention or reduction of stigma attached to mental illness using evidence and the experience the authors gathered during the many years of their work in this field. Each chapter examines one currently held paradigm and presents reasons why it should be replaced with a new perspective. The book argues for enlightened opportunism (using every opportunity to fight stigma), rather than more time consuming planning, and emphasizes that the best way to approach anti-stigma work is to select targets jointly with those who are most concerned. The most radical change of paradigms concerns the evaluation of outcome for anti-stigma activities. Previously, changes in stigmatizing attitudes were used as the best indicator of success. Paradigms Lost and its authors argue that it is now necessary to measure changes in behaviors (both from the perspective of those stigmatized and those who stigmatize) to obtain a more valid measure of a program's success. Other myths to be challenged: providing knowledge about mental illness will reduce stigma; community care will de-stigmatize mental illness and psychiatry; people with a mental illness are less discriminated against in developing countries.

Paradigms Lost concludes by describing key elements in successful anti stigma work including the recommended duration of anti-stigma programmes, the involvement of those with mental illness in designing programmes, and the definition of programmes in accordance with local circumstances. A summary of weaknesses of currently held paradigms and corresponding lists of best practice principles to guide future anti-stigma action and research bring this insightful volume to an apt conclusion.

Heather Stuart, PhD, has been working in the field of stigma research for almost 15 years and is the co-founder and current Chair of the Scientific Section on Stigma and Mental Disorders for the World Psychiatric Association. Dr Stuart is Director, Masters of Public Health Program, Department of Community Health & Epidemiology and Associate Director, Queen's/Pan American Health/World Health Organization Collaborating Centre for Training in Psychiatric and Behavioural Epidemiology, both at Queen's University, Ontario, Canada. Dr Stuart is also the Senior Consultant for Canada's Opening Minds national anti-stigma/anti-discrimination initiative.

Julio Arboleda-Flórez, MD, ECFMG, LMCC, D. PSYCH., DLF, FRCPC, DABFP, PhD, DLFAPA, FCPA, FACFP, FABFE, FRSM, is Emeritus Professor, Departments of Psychiatry and of Community Health and Epidemiology and the Inmediate Past Head and Chief-of-Psychiatry at Queen's University in Ontario, Canada. Dr Arboleda-Flórez is a leading authority on legal psychiatry and human rights of the mentally ill. He is the Honorary Chair of the Forensic Section and a longstanding member of the Ethics Committee of the World Psychiatric Association, an Honorary member of several national psychiatric associations. He has extensive experience in anti-stigma work and has contributed numerous publications to this area.

Norman Sartorius, MD, MA, DPM, PhD, FRCPsychg, was Director of the World Health Organization's mental health programme from 1977 - 1993, President of the World Psychiatric Association from 1993 - 1999 and has been President of the European Psychiatric Association since 1999. Dr Sartorius holds professorial appointments at the Universities of London, Prague and Zagreb and is Senior Associate of Faculty at Johns Hopkins University in Baltimore, MD. Dr Sartorius is among the world's leading authorities on fighting stigma, co-morbidity of mental and physical illness, public health aspects of psychiatry and psychiatric education.