Stigma Rules and Stories 污名化规则和故事

Objectives 目标

1. Identify unspoken internalized thoughts, rules, or stories that may perpetuate internalized and social stigma
   识别出可能会持续自我污名和社会污名的一些被内化了的默认想法、规则或故事

2. Examine the relationship between stigma and behaviours
   了解污名与行为之间的关系

3. Explore the potential for personal and social change to decrease suffering caused by stigma
   探索个人和社会变革的潜力，以减少污名化造成的痛苦

Suggested Time 建议时间

• 45 – 60 minutes 45-60 分钟

Number of Facilitators 带领者人数

• 1

Brief Description 简述

This exercise helps participants to reflect on and identify the impact of personal and societal stigma around mental illness in the form of implicit rules or narratives. The participants are first guided to individually fill out a worksheet that explores their personal and societal perceptions about mental illness and their impact on their behaviours and on the society. The facilitator summarizes the participants’ responses on the flipchart, highlighting the apparent link between stigmatizing perceptions and negative consequences at the individual and societal level. In debriefing the exercise, stigma and its sequelae are examined at a content level, including the issues raised and neglected, and at a process level, including the process of fusion to rules and narratives.

这项练习可以帮助参与者反思和识别个人和社会以隐性的规则或叙事的形式对精神障碍的污名化所产生的影响。首先会引导组员单独填写一份工作表，探讨他们对精神障碍的个人及社会观点，以及这些观点对他们的行为和对社会的影响。小组带领者将在夹纸白板上总结参与者的回答，强调在个人和社会层面，污名化的观点与负面后果之间的明显联系。在简要介绍这项练习时，我们会在内容层面查验污名化及其遗毒，包括浮现出的和被忽视的问题，以及在流程层面，查验包括对规则和叙述的认知融合过程。

ACE Processes ACE 流程

• Defusion 解离
• Values 价值
• Social justice & Equity 社会公义

Key Learning Points 学习要点

• Biases and assumptions may take the form of automatic thoughts, implicit rules, or narratives in our minds and may influence us.
  偏见和预设可能在我们的脑海中以自动的想法、隐含的规则或叙述的形式出现，并可能影响我们。
• These perceptions may lead to internalized stigma, i.e., perceiving ourselves negatively based on certain attributes or social stigma, i.e., perceiving others negatively based on certain attributes.
  这些观念可能导致个人内化的污名化，即基于某些属性负面地看待自己，还会导致社会化的污名化，即基于某些属性负面地看待他人。
• Stigma may influence our behaviors in both actions and avoidance.
  污名化可能在行动和回避两方面影响到我们的行为
• Societal biases and assumptions, which may take the form of implicit rules or narratives, may influence the whole society including us.
  社会偏见和预设对整个社会可以有很大的影响，包括我们在内，而有时候是通过隐含规则或叙述的形式 。
• Personal and social changes against stigma and its sequalae can be facilitated by defusion and a focus on our values.
  认知解离和关注我们自身的价值，可以促进针对污名化及其余毒的个人及社会的变革。

Materials 教學用具

• Mental Illness Stigma Reflection Worksheet 精神障碍污名化反思工作表
• Flipchart 夹纸白板
• Markers 马克笔

Instructions & Sample Script 说明和示范文稿

1. Introduction – “Let us look at the impact of negative biases and judgement we may make about mental illness, and how this affect ourselves and the society.”
   简介 – “让我们来看看我们对精神障碍抱持的负面偏见和评价所产生的影响，及其对我们自己和社会的影响。”
2. Distribute and give directions for the worksheet. 分發工作表

• “On the worksheet, you will find a list of issues related to mental illness followed by 5 reflective questions. The first couple of questions will be about your own personal perceptions around two issues you would like to focus on from the list. In reflecting on your perceptions, include any first impressions or thoughts related to these issues, or relevant rules that you may have learned over the years, or stories that you have been told or even personally experienced. For the second question, think about the impact of your perceptions on your own behaviours, including things that you would actively do because of these perceptions or things you don’t do or even avoid because of them. For example, if you believe that people with mental illness are dangerous, you may avoid talking to them. For question 3, reflect on society’s perceptions on two issues from the list; you may pick the same or different issues as question 1. Since societal perceptions may influence everyone, on question 4, see if you can notice any impact societal perceptions have on your own behaviours. For question 5, think about the impact of societal perceptions on people with and without mental illness, as well as on social structures, programs, polices, etc. See if you can complete this sheet over the next 10 minutes.”
  “在工作表上，您将找到与精神障碍相关的议题列表，然后是5个反思问题。前两个问题将围绕着您从列表中选择出来的两个议题而发表的个人看法。在反思您的观点时，请包括与这些议题相关的任何第一印象或想法，或过去多年来您可能学到的相关规则，或您曾被告诉的，甚至是亲身经历过的故事。对于第二个问题，请考虑您的观念对您自己的行为的影响，包括因为一些观点，你想积极去做的一些事情，或者，因为另一些观念，您不去做甚至，避免去做的事情。例如，如果您认为患有精神障碍的人是危险的，您可能避免与他们交谈。对于问题3，请反思社会对列表中的两个议题的观点; 你可以选择与问题1相同或不同的议题。由于社会观念可能影响每个人，在问题4上，看看你是否能注意到社会观念对你自己的行为有任何影响。对于问题5，考虑社会观念对有和没有精神障碍的人以及社会结构，项目，政策等的影响。看看你是否可以在接下来的10分钟内完成这个表格。

3. Summarize participants’ work. On the flipchart, make a 2×2 table. Label the first column – “Perceptions” and the second column “Consequences” and the first row “Individual” and the second row “Societal”. Invite participants to share their work and capture this on the flipchart.
   总结参与者的答案。 在夹纸白板上，制作一张2×2的表格。 标记第一列 – “观念”和第二列 – “后果”和第一行 – “个人的”和第二行 – “社会的”。 邀请组员分享他们的答案并在白纸上写出来。

• “Would you please share your reflections on your personal or societal perceptions and how they have impacted on you at a personal level or on the society?”
  “请您分享您对个人或社会观念的反思，以及他们如何对您在个人层面上或对整个社会产生影响？”

4. Debrief the exercise, highlighting: 小结练习，强调：

• The content: the impact of stigma on topic areas that have been brought up by participants, as well as on topic areas not discussed
  内容：污名化对参与者提出的话题范围，以及未提及的范围的影响
• The process: the tendency of following socialized rules and stories enacted in individual behaviours and systems, and the alternative of defusion and guidance by values of compassion and equity
  过程：个人的行为和体系的运作往往都倾向于跟随着社会化的规则和故事，而另一种处事方式就是运用解离，以及以恻隐心和平等为价值观为指导。

Debriefing & Sample Scripts 小结和示范文稿

The impact of Stigma  污名化的影响

• “In reflecting on our collective work, what strikes you most about the stigma of mental illness and its impact – at a personal level and at a societal level? Are there any particular common pervasive themes? Or important issues that need to be urgently addressed?”
  “反思我们的小组活动，在个人层面和社会层面，对于精神障碍的污名化及其影响最引起你的注意是什么？是否有些较为普遍的概念？ 或者亟待解决的重要问题？“
• “While we have covered many important areas on the flipchart, there are also issues from the list that are not captured or mentioned. Why do you think that’s the case? Could there be a hidden bias about not highlighting these issues? For example, did anyone reflect on our perceptions about whether people with mental illness should have their own family or children?”
  “虽然我们已经在夹纸白板上涵盖了许多重要领域，但列表中也存在未提取或提及的问题。 你认为为什么会是这样的？ 没有强调这些问题是因为隐藏的偏见吗？ 例如，对于精神病患者是否应该建立自己的家庭和生儿育女的看法，有没有人反思过啊？“

The fusion of stigmatizing rules and stories 与污名化的规则和故事的认知融合

• “How does stigma cause discrimination and inequity?”
  “污名化如何导致歧视和不公平？”
• “Notice that a lot of these biased assumptions, rules, or stories is based on ignorance, misinformation, or fear. Psychoeducation so that people have more accurate understanding and perceptions is an important response, and all of us have a role to play in this.”
  请注意，许多这些有偏见的假设，规则或故事都是基于无知，错误信息或恐惧。进行心理教育使人们有更准确的理解和看法是一个重要的回应，我们所有人都可以在这方面发挥其作用。“
• “Another complementary strategy that we have been learning about is the capacity for defusion, i.e., to be not so wedded to our thoughts in a rigid way. This is why it is so important to become aware of how stigma can insidiously and naturally live in our minds and our society as invisible rules and stories. As we practice defusion, we are practicing letting go of the need to stick to these rules or to literally believe in scary narratives. We can practice not taking judgmental thoughts about ourselves and about others seriously, even if these thoughts naturally come up. Our actions can be guided by our values instead of stigma, even though stigma may still be present. Can you give me an example of what you could do personally or collectively to make a personal or social change – even though there is still stigma around? What would it be like if our actions are instead guided by compassion and equity?”
  “我们一直在学习一个能够配合心理教育的策略，这就是提升认知解离的能力，即不要过于拘泥于我们的想法，这也是为什么我们必须要意识到污名化是如何隐蔽而自然地存在于我们的思想里和社会中作为无形的规则和故事。当我们练习解离时，我们正在练习放下遵从这些规则的意念，或者不再盲目相信这些可怕的叙述。即使这些想法自然而然地出现，我们也可以练习不把对自己和他人有批判性的想法当回事儿。我们的行为可以以我们的价值观而不是污名化为指导，即使污名化可能仍然存在。 你能举个例子说明你个人或我们作为集体可以做些什么来取得个人或社会的变革 – 尽管污名化依然存在？ 如果我们的行动是以恻隐心和公平为指导，会是什么样的呢？“

Reference 参考

1. Fung, K. P., & Wong, J. P. (2014). ACT to Reduce Stigma of Mental Illness: A Group Intervention Training Manual on Acceptance and Commitment Therapy. Toronto, ON: Strength in Unity.
2. Fung, K. P., & Zurowski, M. (2011). ACT protocols for CHAMP Study. Toronto, ON: Committee for Accessible AIDS Treatment.