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The NHS has been collecting data on patients’ experience of care for over 10 years but few providers are systematically using the information to improve services. Angela Coulter and colleagues argue that a national institute of “user” experience should be set up to draw the data together, determine how to interpret the results, and put them into practice

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As discussed in an earlier chapter, self-stigma seems to be represented by a paradox. First impressions about the stigma of mental illness suggest people with psychiatric disability, living in a society that widely endorses stigmatizing ideas, will internalize these ideas and believe that they are less valued because of their psychiatric disorder. Self-esteem suffers, as does confidence in one's future (Corrigan, 1998;Holmes & River, 1998). Given this research, models of self-stigma need to account for the deleterious effects of prejudice on an individual's conception of him or herself. However, research also suggests that instead of being diminished by the stigma, many persons become righteously angry because of the prejudice that they have experienced (Chamberlin, 1978;Deegan, 1990). This kind of reaction empowers people to change their roles in the mental health system, becoming more active participants in their treatment plan and often pushing for improvements in the quality of services (Corrigan, 2002). And yet a third reaction exists that needs to be considered in describing the impact of stigma on the self. The sense of self for many persons with mental illness is neither hurt, nor energized by social stigma; persons instead seem to be indifferent to it altogether.

Euro‐American theories of psychotherapeutic intervention focus on therapist behavior or the therapeutic relationship, conceived in dyadic terms. The cultural prototype is individualistic and rationalistic: a one‐to‐one conversation in which the patient discloses and discusses innermost feelings in regular office visits. This may be appropriate for modern Euro‐Americans. However, anthropological research finds that in many traditional healing systems, intervention is communal, it utilizes dramatic ritual ordeals and altered states of consciousness rather than rational conversations, and the healer–patient relationship may be less central. This article argues that the latter approach is not ignorant of psychotherapeutic principles; it has its own (however opposed to Euro‐American assumptions they may be). Understanding this paradigm clash broadens our understanding of what psychotherapeutic intervention is. It also allows clinicians and policy makers to support traditional peoples in their own efforts at self‐healing. Examples will be drawn from the author's work on the healing ceremonies of the Native American Church among contemporary Navajos. [cultural psychiatry, psychotherapeutic intervention, clinical paradigm clash, healing, Native American Church]

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