Anti-stigma campaigns have been all the rage in the English-speaking world over the past decade. Led by the psychological professions, backed by patients’ advocacy groups, and supported enthusiastically by governments, a new consensus has emerged that public prejudice constitutes the greatest barrier to a more just and effective mental health care system. Vicky Long's Destigmatising Mental Illness?, part of a new Manchester University Press series, Disability History, examines the history of these campaigns in Britain within the context of the emergence and evolution of mental health care professions. The timeline—from the early decades of the mid-Victorian asylum era to postwar deinstitutionalization—permits a long-term analysis of how stigma and mental health care became entangled.

After a brief historiographical introduction, Long outlines the principal occupational groups under consideration: psychiatrists, of course, as well as asylum attendants and nurses, psychiatric social workers, and those working in the voluntary sector, such as the National Association for Mental Health. She details the historical process of professionalization, both during the era of the asylum, but also in the face of proposals for “community care” articulated in 1960s Britain. Understandably, there was considerable intra- and interprofessional jockeying for position, which revolved around issues of gender (should psychiatric nursing be limited to women?), the relationship between psychiatric and “medical” nursing, and the occupational battles over deinstitutionalization, which threatened the very future and livelihood of institutionally based workers.

As the title suggests, the question of stigma is the leitmotif for the book. As Erving Goffman insightfully observed, stigma has never been static or unidirectional; it has a habit of “radiating” outwards from the stigmatized (in this case the mentally ill) to those around them, including caregivers, family members, and professionals. And although one would expect, then, that paramedical professional groups would work conscientiously to destigmatize the mentally ill (and thus their own vocations), Long demonstrates that, just as often, the opposite occurred. Rather than combat the persistent stigma attached to mental illness, Long contends, mental health care groups often exaggerated the dangers and violence of madness to assist their own occupational demands (such as enhanced contract negotiations and occupational validation) or to exclude certain groups (such as women) from the mental health profession.

Long provides a long-term survey of mental health care workers that moves from the well-documented Victorian era into the less-researched mid-twentieth century. There is also one final chapter on the attempts of the BBC in the 1950s and 1960s to engage in educational programming aimed, in part, at destigmatizing mental illness and psychiatric practice. One of the principal conclusions is that anti-stigma campaigns often do not lead to a reduction of stigma at all. Rather, they indulge in the fabrication of a continuum between mental illness and mental health and then foreground individuals with less severe mental problems who are ultimately, we are told, not that “different” from the rest of us. Long thus suggests that this emphasis in campaigns for less severe and nonthreatening mental illnesses such as anxiety disorders destigmatizes those conditions at the expense of “severe and enduring mental disorders” (222), often chronic psychotics. Moreover, Long suggests, it would seem that the public remains largely unconvinced by such awareness-raising campaigns, particularly the ever-popular claims about how widespread mental illness actually is.

Although Long conveys useful historical detail on the often-neglected topic of mental health care workers, as a historical work the argument seems too one-dimensional. Whenever violence is invoked in newspaper articles, in occupational journals, in voluntary campaigns, it is always evidence of stigma, rather than a reflection of the challenging conditions under which these (often) underpaid workers labored. Moreover, her focus on the labor history of mental health care workers as a way into understanding stigma seems to occlude a larger discussion of the social and cultural factors underpinning negative public attitudes to mental illness more generally. At the end of the book, one is still left pondering why society wants to think the worst of the mentally ill.