Stopping Stigma

by Wayne Munchel, LCSW   0 Comments

The mental health system goes to great lengths to combat stigma. Many consumers describe the effects of stigma as worse than the illness itself. We seek to eradicate it, campaign against it, and educate the public to overcome it. But what if we mental health professionals are a significant source of the stigma? Some recent studies have indicated that MH professionals exhibit less compassion and empathy for people diagnosed with psychotic disorders and schizophrenia. I’ve personally noted the degree of hopelessness and helplessness, the pessimism and fear expressed by many clinicians. What if we’ve met the stigmatizers and they are us?

Another more insidious form of stigma that I believe is common amongst many MH professionals, comes in the form of the “soft bigotry of low expectations”. Once diagnosed with a psychotic disorder or schizophrenia, many well intentioned professionals focus solely on securing benefits, managing symptoms and urging “med compliance”. Important life goals of getting a job, an education, a loving relationship tend to get dismissed as unrealistic and not encouraged. (One consumer recently described his experience of being diagnosed with schizophrenia as feeling that the “book was closed and that (his) life was over)”. The stigma may be evident in both providers when they omit discussing career options and by help seekers who may limit themselves due to self-stigma.

Much of this stigma towards people who hear voices or have unusual beliefs may stem from the dominant medical model. Viewing people in extreme distress as having a brain disease or chemical imbalance may impart distinct disadvantages on help seekers and help-givers. Biomedical conceptualizations of distress can be dehumanizing and disempowering. Help seekers, convinced that that they have a brain disease, can struggle to make meaning of their experiences and become passive in their own treatment and recovery. Furthermore, the biomedical model (it’s all in your brain) overlooks the impact of adverse life events and trauma and minimizes the context of toxic environmental conditions such as poverty and racism.

But what if this pessimistic, “death by diagnosis” outlook is unwarranted? What if the actual recovery rates by people who have been diagnosed with psychosis and schizophrenia is much more frequent than commonly believed? A recent publication by the British Psychological Society, “Understanding Psychosis & Schizophrenia”, provides a helpful, more balanced perspective. This publication makes the case that psychosis is much more common in the population, occurs on a continuum (not just present/absent), and can be seen as an understandable reaction to traumatic events, especially childhood maltreatment and neglect. Substantial research exists that supports the contention that “bad things happen and can drive you crazy. What does this emerging perspective suggest about the myopic fixation on chemical imbalances?

As a mental health system, we can and must do better in our attempts to effectively help people labelled with psychosis and schizophrenia. Here are my Top 10 recommendations – I’d like to hear yours.

  • 1

    Embrace curiosity – Encourage people to talk about their experiences and what has happened to them.

  • 2

    Don’t insist on illness paradigm (“You have a brain disorder requiring life-long medications”) – Explore alternative explanatory models and differing cultural understandings.

  • 3

    Adopt UK Clinical Guidelines (N.I.C.E.), recommending that all people diagnosed with psychosis/schizophrenia be offered talk therapy such as CBT for psychosis.

  • 4

    Vigorously promote access to supported employment & education to counteract “soft bigotry”.

  • 5

    Instill hope by normalizing and decatastrophizing hearing voices and having unusual beliefs and by sharing stories of recovery.

  • 6

    Assess and address trauma

  • 7

    Collaborate with people in extreme distress to create a “psychological formulation” – a shared story of what has happened to them.

  • 8

    Offer shared, informed decision making and medication collaboration and drop medication compliance/adherence terms.

  • 9

    Provide family interventions and care-giver supports.

  • 10

    Ensure access to self-help and peer supports such as Hearing Voices Networks.

Leave a Comment

Previous post:

Next post:

by