reviewed by Jean Arnold

Social scientists say that the American public's understanding of mental illnesses has improved in the past 50 years. Why then are mentally ill people in jails instead of safe shelter with community supports, social networks, and opportunities to work and pursue meaningful interests? Why are mental health resources shrinking nationwide? Does anyone really know how to reduce prejudice and discrimination?

Graham Thornicroft, Professor of Community Psychiatry, Kings College London, is a reformer and his book, SHUNNED: Discrimination Against People with Mental Illness, appraises anti-prejudice work over the past several decades. He is determined to conquer the ignorance, prejudice and discrimination that plague people diagnosed with psychiatric labels.

Early chapters of Shunned describe a largely hostile world where dwell millions of people who experience mood swings, fears, voices and visions. In this spirit-breaking environment, many people with psychiatric vulnerabilities live at the margins of society. In first-hand accounts, they speak of conflict within families, paternalism in treatment settings, lack of empathy at work, and bias in all manner of civil and social life.

The situation calls for urgent action. Although anti-stigma advocates have worked for decades to reverse negative stereotypes, there is far too little to show for their efforts. "For pain to go away, it must be shared by the culture," said a wise man whose name is now lost.

Shunned testifies to how little pain the public shares with people who have psychiatric vulnerabilities, and suggests reasons and remedies.

Thornicroft exposes the routine misrepresentation of mental illnesses by the news, entertainment, and advertising industries. He examines in detail the public's misperceptions about violence, which he calls "by far the strongest defining feature of mental illnesses according to its popular portrayals in the mass media." He believes that "popular knowledge about mental illnesses is a potent cocktail of profound ignorance and pernicious misinformation." This pernicious misinformation is assimilated by people who experience symptoms as well as those who do not. Thus misled, people may hide tormenting features of psychiatric conditions and put their well-being at risk while protecting self-esteem.

Thornicroft's thorough analysis is aided by charts and wrenching photos. As this scholarly but engaging book explains, many surveys report public attitudes, but attitudinal changes that occur over time are rarely studied. Still rarer are scientific analyses of the results of prejudice-intervention projects. Without strong evidence about what works, attempts to provide effective public educational materials are hampered, writes Thornicroft.

He then lists seven wrong assumptions about how to erase prejudice and discrimination, all of which will surprise most mental health advocates. For example, according to British activist Liz Sayce, it is not useful to stress how common mental illnesses are or to ask the public to show greater tolerance of diversity. Nor is it useful to particularly target anti-prejudice education to people who are most rejecting of people with mental illnesses. Instead, Thornicroft recommends testing the effectiveness of a series of techniques that include personal testimonies by people with mental illness, the inclusion of mental illness themes in popular drama such as soap operas, and deliberately associating mental illness with positive attributes.

A decade ago Otto F. Wahl exposed the disgraceful -- some would say defamatory -- misrepresentation of the millions of people who cope with psychotic illnesses. Wahl's Media Madness and Telling Is Risky Business were unique in the mental health literature until joined in 2001 by Don't Call Me Nuts by Patrick Corrigan and Robert Lundin.

Graham Thornicroft now advances the search for better answers to the question "what works."

*Jean Arnold, Co-founder and Chair, National Stigma Clearinghouse