Customer Reviews

The Mark of Shame: Stigma of Mental Illness and an Agenda for Change

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My remarks on this book, the second in Dr. Hinshaw's remarkable trilogy that examines our culture's attitudes towards mental illness, are late in coming.

I've waited for another reviewer to offer a counter-point to the first reviewer's comments about this reading like a textbook. I've suffered through many a dry textbook, and cannot imagine making such a comparison. I find Dr. Hinshaw's writing style extremely clear, concise, and, what's more, very empathic to the reader. Repeatedly, as I found myself responding to a point with "but what about," the next sentence directly addressed that thought. If you're looking for a Time-Life History of Mental Illness, though, complete with voyeuristic depictions of tortuous conditions in institutions, you might find this book less of a page-turner. But if you're looking for a highly intelligent and comprehensive book on this subject, you won't be disappointed.

Mostly, I've delayed writing a review because I feel under-qualified to do the book justice. It seems that highly placed experts in the mental health field should be commenting, not foot soldiers volunteering in their communities, such as me. But it seems such experts do not review books on Amazon.

I know that this book is on the professional radar, because it received an excellent review by Dr. Claire Kelly in The New England Journal of Medicine. It begins with this (and continues at[...]):

"Stephen Hinshaw's book will be of interest to readers well beyond the fields of psychology and psychiatry. He begins with a critical analysis of concepts and deftly summarizes the major schools of thought regarding what mental illness is, removing the comfort zone created by the hegemony of our academic departments, disciplines, and personal beliefs. He shows clearly that although many models of mental illness can help us understand various aspects of psychopathology and treatment, no extant model -- nor, perhaps, any conceivable model -- can fully explain what mental illness is or what it means."

The fact is, this topic affects every single one of us, not just academics and clinicians. Do you know of someone, perhaps a family member or even yourself, who has suffered stigmatization due to mental illness? I think most of us do. Individuals, families, and mental-health advocates bemoan society's attitudes, but they typically lack a clue as to how we should go about correcting such attitudes.

Education, some insist. If people understand mental conditions (especially what causes them, including genetics), that surely will ease harsh judgments, fears, and ostracism, their reasoning goes. But, as Dr. Hinshaw writes, the irony of today's better detection and diagnosis, even with the less severe forms of psychiatric conditions, is that education often intensifies stigma. That is, as public perception shifts from viewing problematic behavior as volitional or even intentional to viewing it as having an organic basis ("brain based"), they are more apt to see the person as permanently flawed and unsalvageable.

Dr. Hinshaw's agenda for change explains why this is so--and describes the components of a more complete strategy for creating more enlightened attitudes. But first he lays the historical foundation. For example, we might assume that the centuries have seen a steady forward progression in its treatment of men and women suffering from severe mental illness. But that's not the case. At various points over the centuries, we've risen to heights of enlightened compassion only to fall embarrassingly backwards.

As Dr. Kelly points out in her NEJM review, the reader learns that, throughout the ages, "when mental institutions have looked like prisons, and when patients are treated as though they are prisoners. the sense that people with mental illness are dangerous is reinforced." With our modern-day prisons our de facto mental institutions, one hopes that our country's mental-health decision makers do take the time to read this extremely well-written, cogent, and compassionate book. Because it seems that, here in the 21st century--with the bounty of effective treatment strategies at our disposal-- we should be at an apex and not a nadir.

Gina Pera

Madness attracts and repels human society. On one hand, humans seem drawn to accounts of mental illness. On the other, human society frequently forces those suffering from mental illness towards its margin. Hinshaw's study captures these competitive interests with skill. His narrative form is concise, clear, and easily accessible to the lay person. His account of stigmas and their impact on the treatment of mental illness is nuanced and avoids the pedantry that plagues other authors' work.

While I applaud his work, it is not an unalloyed good. His citation format leaves much to be desired and is cumbersome. A better font should be chosen and the text begs for careful copy-editing. Finally, his reliance on the work of Erving Goffman in Chapter 3 is misplaced, he should have focused on more contemporary stigma-theorists like Link and Phelan.

In short, any student of mental illness's affects on both suffers and society will do well to read this text.

I found this book difficult to read from cover to cover. In fact, I never succeeded in reading the whole book although I tried several times. Yet, when I opened the book at random, or went to the Index, I found absorbing information, well-written and informative. The problem is there is so much of it. Every subject - and the author finds many, many aspects of his topic to write about - is covered in weighty detail, all given in what appears to be 9-point type. My experience was that within the 200+ pages of this book lays a loving offering of sentence after sentence, paragraph after paragraph, page after page of dense, laborious reading.

Take Chapter 2 (Perspectives from Social Psychology, Sociology, and Evolutionary Psychology) for example. Within the first three of two dozen pages of that chapter, the reader is reminded of what social psychologists and sociologists do and how they do it. A little historical perspective is provided concerning how these two groups similarly and differently have approached and now approach the topic of stigmatization, particularly in shifting the focus of research and theorizing from looking at deep-seated personal tendencies to "emphasizing the universality of social comparisons, the ubiquity of stigmatization processes, and the clear association between social power and stigma" (p. 29). Stigmatization "is embedded in everyday psychological functions (e.g., tendencies to categorize), social processes (e.g., ingroup versus outgroup identification), and structural variables (e.g., unequal social power and justice)" (p. 29). Ingroups and outgroups are defined. Then, faithful to his outline, the author goes on to cover these areas in the following 21 pages, in detail. Keep in mind that this is not the outline of the whole book; this is the outline for Chapter 2 alone!

Do I feel guilty for reviewing a book I didn't complete? Yes, I do. But maybe I've become somewhat hurried and lazy. Maybe I just no longer want to plow through a book that I sense could be very informative and valuable, but which (darn it!) reads like a textbook.

*This is a condensed version of my review of the book in PsycCRITIQUES--Contemporary Psychology: APA Review of Books, 52(31), 2007.