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Healing the Stigma of Depression Healing the Stigma of Depression A Guide for Helping Professionals A resource for helping professionals of all disciplines serving people who may be affected by depression—and by its stigma. Written by Pamela Woll, MA, CADP for the Midwest AIDS Training and Education Center and the Great Lakes Addiction Technology Transfer Center Healing the Stigma of Depression: A Guide for Helping Professionals Published by: Midwest AIDS Training and Education Center Nathan Linsk, PhD, Principal Investigator Barbara Schechtman, MPH, Executive Director Great Lakes Addiction Technology Transfer Center Larry Bennett, PhD, Principal Investigator Nathan Linsk, PhD, Co-Principal Investigator Lonnetta Albright, Director Project Leader: Barbara Schechtman, MPH Co-Leader: Lonnetta Albright Author: Pamela Woll, MA, CADP Research Assistant: Charles M. Bright, LCSW, ACSW Midwest AIDS Training and Education Center Great Lakes Addiction Technology Transfer Center Jane Addams College of Social Work University of Illinois at Chicago 1640 W. Roosevelt Road, Suite 511 (M/C 779) Chicago, Illinois 60608 November, 2007 This publication was produced by the Midwest AIDS Training and Education Center (partially supported by a grant from the Health Resources and Services Administration and through funds raised independently), and the Great Lakes Addiction Technology Transfer Center (under a cooperative agreement from the Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. This was produced by the Midwest AIDS Training and Education Center, funded in part by HRSA Grant # H4A HA00062. For more information on obtaining copies of this publication, please call (312) 996-1373. Developed in part under a grant funded by the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services Center for Substance Abuse Treatment, 5600 Fishers Lane Rockwall II, Suite 618, Rockville, Maryland 20857, 301.443.5052 Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the agency. Grant No. 6 UDI TI13593-02-3 Healing the Stigma of Depression A Guide for Helping Professionals A resource for helping professionals of all disciplines serving people who may be affected by depression—and by its stigma. Written by Pamela Woll, MA, CADP for the Midwest AIDS Training and Education Center and the Great Lakes Addiction Technology Transfer Center Midwest AIDS Training and Education Center www.matec.info Great Lakes Addiction Technology Transfer Center www.glattc.org The University of Illinois at Chicago Jane Addams College of Social Work 1640 W. Roosevelt Road, Suite 511, M/C 779 (312) 996-1373 Chicago, IL 60608-1316 (312) 413-4184 November, 2007 In loving memory of Reggi Marder, whose great love and brave heart will inspire us the rest of our days. Table of Contents Preface ............................................................................................................ v Foreword ....................................................................................................... vii Acknowledgments ......................................................................................... ix Chapter One: Purpose .................................................................................... 1 The Purpose of This Manual.................................................................................................... 3 Defining Stigma........................................................................................................................ 6 The Lure of Stigma .................................................................................................................. 8 Finding Hope.......................................................................................................................... 10 Healing the Stigma: This Manual's Approach ....................................................................... 11 Chapter Two: Depression ............................................................................ 15 Depressive Disorders............................................................................................................. 16 Who Contracts Depressive Disorders?.................................................................................. 19 The Onset of Depression ....................................................................................................... 24 The Timing and Termination of Depressive Episodes ........................................................... 27 When Depression Proves Fatal ............................................................................................. 28 Jennifer’s Story.................................................................................................................... 30 Chapter Three: The Brain ............................................................................ 33 Chemical Messengers ........................................................................................................... 35 Brain Structures ..................................................................................................................... 37 Implications for Stigma Reduction ......................................................................................... 45 Chapter Four: Treatment for Depression .................................................... 47 Stigma and the History of Treatment ..................................................................................... 48 Diagnosis ............................................................................................................................... 50 Treatment............................................................................................................................... 54 One Vision for Treatment and Stigma Reduction .................................................................. 60 Chapter Five: When Depression is Not Alone.............................................. 63 General Medical and Developmental Disorders and Depression .......................................... 63 HIV and Depression............................................................................................................... 66 Substance Use Disorders and Depression ............................................................................ 70 Trauma and Depression ........................................................................................................ 76 Louise’s Story ...................................................................................................................... 80 Healing the Stigma of Depression: A Guide for Helping Professionals Page i Table of Contents Chapter Six: Stigma and Depression........................................................... 83 Why People Stigmatize.......................................................................................................... 85 Attitudes ................................................................................................................................ 89 Stigma Toward Treatment ..................................................................................................... 90 Stigma and Culture ................................................................................................................ 91 Stigma and Helping Professionals ......................................................................................... 93 Chapter Seven: The Effects of Stigma ........................................................ 97 Discrimination ........................................................................................................................ 98 Effects on Help Seeking....................................................................................................... 100 Self-Stigma .......................................................................................................................... 101 Effects on Depression.......................................................................................................... 103 Chapter Eight: Healing The Stigma in Society.......................................... 107 Starting With Ourselves ....................................................................................................... 107 Choosing a Stigma-Reduction Role..................................................................................... 110 Choosing Strategies Based on Their Effectiveness............................................................. 113 Becoming an Advocate ........................................................................................................ 118 Examples: Anti-Stigma Campaigns .................................................................................... 121 Fred’s Story ........................................................................................................................ 125 Chapter Nine: Healing Self-Stigma ........................................................... 129 Countering Self-Stigma........................................................................................................ 129 Resiliency............................................................................................................................. 132 Empowerment...................................................................................................................... 134 The Story 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