Schizophrenia and Stigma - Coursework Example

Schizophrenia and Stigma Introduction Mental health illnesses have traditionally been viewed in a negative light. In ancient times, these illnesseshave been viewed as demon possession, often prompting various ancient rituals to be carried out on those afflicted with mental illness. The mentally ill are also not viewed in a positive light and they are often considered as a danger to society, of as individuals who must be feared or who must be segregated from the rest of normal society. In the years since mental health advancements in diagnosis and treatment have been seen, the connotations and perceptions of the mentally ill have somehow changed. People’s understanding of mental illness has improved and some of the mentally ill have been acknowledged as normally functioning individuals. However, the stigma against them has always been strong. The label of mental illness seems to have dictated how people should treat them. The perception and treatment of these people has been less than acceptable and the labels have prevented these people from functioning in normal society, in their work, their family, and in their community and social life. More often than not, people acting strangely or differently from the norm have been labelled as mentally ill or simply, “crazy.” After such label is bestowed upon certain behaviours, individuals are often treated differently, based on their labels. However, most of the time, these ‘abnormal’ thoughts and feelings are often simply part of an individual’s personality. Nevertheless, society labels these thoughts and feelings as signs of mental illnesses. For which reason, misdiagnoses of mental illnesses are common occurrences. These are dangerous patterns of behaviour because subjecting individuals to these labels can also subject them to inappropriate treatments. In the end, their human potential can be lost. Under these considerations, some argue that it is not helpful to view the thoughts and feelings of others as manifestations of illness. This essay shall evaluate this thesis, specifically discussing the impact of labelling thoughts and feelings in mental health. The first part of this essay shall be a general discussion of schizophrenia, including its essential qualities and the other labels associated with it. The second part shall consider the various arguments and issues in relation to labelling in mental health care. The third part shall seek to support the argument that it is not helpful to label thoughts and feelings in mental health. Finally, concluding remarks and a summary of the arguments shall be present and end this essay. Body According to the Royal College of Psychiatrists (2012), schizophrenia is a mental disorder which impacts on one’s thoughts, feelings, and behaviour. It often initially manifests from age 15 to 35 years and in some cases take a long while to diagnose. Schizophrenia is attributed to various causes, including one’s genes, possible brain damage during birth, viral infections during pregnancy, and in some instances, child abuse (Royal College of Psychiatrists, 2012). The use of drugs has been known to trigger it, most especially among teenagers; however, stressful events and family issues have also been considered triggers for this mental health issue (Royal College of Psychiatrists, 2012). Schizophrenia has been detected based on positive and negative symptoms. Positive symptoms include: hallucinations, delusions, difficulty in thinking, and feeling controlled. Negative symptoms include: loss of interest, loss of energy, as well as loss of emotions (Royal College of Psychiatrists, 2012). Under these conditions, a patient may cease to carry out his or her normal activities, including activities of daily living like cleaning the house, grooming self, dressing self, and working. Some schizophrenics often hear voices without experiencing negative symptoms, however others experience no other symptoms except delusions; in some patients, they may only experience negative symptoms and muddled, confused thoughts (Royal College of Psychiatrists, 2012). As a result, with fewer symptoms to signal mental affectation, they may go for years without being diagnosed for their mental illness (Royal College of Psychiatrists, 2012). It is not helpful to view thoughts and feelings as manifestation of disease because of the stigma it can bring to mental health patients. Studies on schizophrenic patients reveal that many of them suffer stigmatization because of their disease (Hayward and Bright, 1997). Studies indicate that for some individuals, the stigma can sometimes be persistent and can compromise their daily functions. Such stigma against mental illness has been considered one of the bigger issues in mental health today (Sartorius, 2001). Public stigma often refers to the reaction that the community has on the mental disorder; on the other hand, self-stigma is the patient’s own reaction to the mental health issue and the public stigma they are subjected to. In evaluating self-stigma, Link (2001) discusses that most people have expectations and beliefs which often have major effects on individuals with serious mental health issues. The impact of these expectations is that people may then consider whether or not other individuals would discriminate against them. In effect, in relation to stereotypes, the labels often affect an individual’s self esteem. Moreover, lower self-confidence coming from self-stigma may affect rehabilitation and treatment, including motivations in work and living conditions (Wahl, 1999). The major issue in using thoughts and feelings as manifestation of illness is the shame often associated with these thoughts and feelings. Stigma is defined as a distinctive mark of shame (Goffman, 1963). It is also the negatively viewed defining quality setting individuals apart from the rest of normal society. Stigma is usually associated with discrimination. Individual thoughts and feelings often signal qualities which are labelled or stigmatized as not part of normal society or normal behaviour. These thoughts and behaviour often eventually lead to discrimination and stigma. Such stigma has often been seen in schizophrenia patients, especially because it is a mental illness which often manifests with the most severe deviation from reality and or normally accepted societal behaviour (Wing and Agrawal, 2003). Schizophrenia is a disease said to impact on about 1% of the global population (Jablensky, et.al., 1992). Researchers confirm the stigma and the labelling issue often associated with this disease (Cannon, et.a., 2002). Such stigma is seen as the main barrier in the management of the disease, including the treatment of other mental illnesses. Researchers have also established that the stigma against schizophrenia have often caused delays in treatment, often leading to more risks in the patient’s health and more risks for abnormal behaviour and violence (Appelbaum, et.al., 2000). The labelling experience is described by family members and caregivers in a way which is different from the patients themselves (Schulze and Angermeyer, 2002). A study by Shrivastava, et.al., (2011) indicates that the labelling issue was considered most significant in the family and social setting; many respondents also experienced labelling issues in their personal lives as well. Lesser stigma was seen in the work setting and it was even to a lesser degree in marital life. Their study also revealed that about 12% of them experienced labelling issues and stigma outside the previously mentioned groups and individuals (Shrivastava, et.al., 2011). In relation to the perceived causes of stigma and labelling, most of the respondents indicate that such stigma is due to the lack of awareness about the disease. Stigma has also been caused by the illness itself where the symptoms of the disease have shunned people away, alienating them from normal society (Read, et.al., 2006). Adverse effects in relation to drug treatments for schizophrenia have also been one of the sources for stigma or labelling issues. Drooling, confusion, and hyperactivity, are just some of these adverse effects which are often perceived negatively by general society (Read, et.al., 2006). Many sufferers of this disease also declare that they are often avoided or ignored; and these situations often cause much depression and sadness. Their families are also often subjected to issues with labelling or stigma where their families are taunted with offensive comments from other people due to their disease (Angermeyer and Matschinger, 2003). Many respondents experience issues in their marriage due to their illness; and some admit that they find it difficult to build romantic relationships due to their disease and due to the negative perception which often colours other people’s perception of their disease (Angermeyer and Matschinger, 2003). Schizophrenics also declare that even hearing things in the media can further exacerbate their feelings of sadness about their disease; in some instances it often impairs their sexual performance, thereby further diminishing their self confidence (Angermeyer and Matschinger, 2003). The most common cause of stigma and labelling issues is the general community, co-workers, and family. In general, these indicators are major issues in the overall management of schizophrenia, as they ultimately impact negatively on patient recovery. Labelling is however not an entirely disadvantageous aspect of mental health. Labelling and mental health diagnosis is needed in order to arm clinicians with an effective method of defining patients, including their presenting symptoms, expected prognosis, patterns of behaviour, and family psychiatric history (Ben-Zeev, et.al., 2010). For various individuals with clear mental health issues, knowing that the symptoms they are experiencing are not normal often provides relief for them. They find relief in the fact that there can be a treatment and that they can live lives free of these unfavourable symptoms (APA, 2000). Labels and diagnostic determinations also guide mental health professionals in their management of patient’s symptoms (APA, 2000). For schizophrenia patients, their management of the patient’s symptoms and their subsequent expectations on the patient’s behaviour and outcomes would be based on the diagnosis or the label. Labelling a patient as one suffering from depression or schizophrenia would assist the professionals in planning treatment and medications (First, et.al., 1997). Treating a patient with schizophrenia is very much different from managing a patient with depression. Delineating a mental health issue very much apart from other health issues and from the normal population provides essential guidance for health professionals. Without these points of reference, wrong medications and management remedies may be carried out. In the end, unfavourable patient outcomes may manifest and persist. Nevertheless, although there are perceived benefits in using thoughts and feelings as manifestations of illness, this practice also have various pitfalls. Using the manifested thoughts and feelings of a person in order to detect illness can be problematic because it can place an unfair label on these thoughts and feelings, making them seem abnormal or unacceptable (Corrigan, 2000). Using thoughts and feelings like sadness or hyperactivity as manifestations of illness makes these feelings seem abnormal to most people, even those who are perfectly healthy. In effect, manifesting said feelings would risk a person being labelled as mentally ill. Moreover, those labelled with mental illness would now be conscious of their thoughts and feelings which have been labelled as symptoms of mental illness (Corrigan, 2000). Every time they would manifest these feelings, health experts would likely express that their mental illness is not being treated or managed. In effect, when a recovering depressed individual manifests feelings of sadness, she risks being labelled as relapsing from her mental illness (Corrigan, 2007). Moreover, she would already be viewed and grouped in a category of individuals sharing the same label. Groupness refers to a “collection of people...perceived as a unified of meaningful entity” (Ben-Zeev, et.al., 2010, p. 321). When a person is labelled as part of a group, this group acquires a sense of differentiation from the general population based on specific and socially defined qualities. Within the group, these individuals may feel comfortable and may feel a sense of belongingness. However, the rest of society who may not understand their illness and the fact that they pose no grave danger to the rest of society (Corrigan, 2007). The label burdened on these individuals also lumps them together as one group in the public’s eyes, even where these groups and individuals have specific qualities which distinguish them from each other. For the majority of society, the labels and stereotypes they are familiar with are understandable in relation to a meaningful group of people; they do not recall labels of amorphous classes. “Hence diagnoses that increase the sense of groupness will strengthen the stereotypes associated with mental illness. Conversely, stereotypes are the negative attributes that provide description to the group” (Ben-Zeev, et.al., 2010, p. 321). As a result, these negative qualities often define the group, and it is often difficult to establish an identity beyond such label. Conclusion It is not helpful to view the thoughts and feelings of others as manifestations of illness. Viewing thoughts and feelings of others to detect illness unfairly labels individuals based on these thoughts and feelings. In the end, these thoughts and feelings cease to be simple emotions, instead, they become means of detecting illness. In effect, individuals who manifest thoughts and feelings which are deemed as symptoms of diseases are defined by these symptoms. Their emotions and feelings are no longer simple thoughts and feelings, but they are symptoms of disease. To the rest of society, these labels serve as stereotypes and they create a stigma against individuals labelled with mental illness. As these feelings and thoughts are used to define the absence or presence of illness, these same thoughts and feelings can no longer be used in order to indicate normal thoughts and feelings. Thoughts and feelings cease to be such, and now become defining qualities for mental illness. Among schizophrenia patients, the feelings and thoughts defining their illness may serve to define their totality as individuals. They cannot gain an identity beyond these symptoms. It may also be dangerous to manifest these same symptoms as normal individuals, lest be burdened with the same biased labels. For which reason, for those who are and those who are not mentally ill, it is not helpful to view the thoughts and feelings of others as manifestations of illness. References American Psychiatric Association, 2000. Diagnostic and statistical manual of mental disorders (4th edn, text rev.). Washington, DC: American Psychiatric Association. Angermeyer, M. and Matschinger, H., 2003. Public beliefs about schizophrenia and depression: similarities and differences. Soc Psychiatr Psychiatr Epidemiol, 38, 526–534. Appelbaum, P. S., Robbins, P. C., and Monahan, J., 2000. Violence and delusions: Data from the MacArthur violence risk assessment study. American Journal of Psychiatry, 157, 566–572. Ben-Zeev, D., Young, M., and Corrigan, P., 2010. DSM-V and the stigma of mental illness. Journal of Mental Health, 19(4), 318–327 Cannon, M., Caspi, A., Moffitt, T. E., Harrington, H., et.al., 2002. Evidence for early-childhood, pan-developmental impairment specific to schizophreniform disorder: Results from a longitudinal birth cohort. Archives of General Psychiatry, 59, 449–456. Corrigan, P., 2000. Mental health stigma as social attribution: Implications for research methods and attitude change. Clinical Psychology: Science and Practice, 7, 48–67. Corrigan, P., 2007. How clinical diagnosis might exacerbate the stigma of mental illness. Social Work, 52, 31–39. First, M., Frances, A., and Pincus, H., 1997. DSM-IVTR handbook of differential diagnosis. Washington, DC: American Psychiatric Association. Goffman, E., 1963. Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall. Hayward, P. and Bright, J., 1997. Stigma and mental illness: A review and critique. Journal of Mental Health, 6(4), 345 – 354. Jablensky, A., Sartorius, N., Ernberg, G., Anker, M., et.al., 1992. Schizophrenia: manifestations, incidence and course in different cultures: A World Health Organization ten-country study. Psychological Medicine – Monograph Supplement, 20, 1–97. Link, B., 2001. Evidence concerning the consequences of stigma for the self-esteem of people with severe mental illnesses. Paper presented at the First International Conference on Reducing Stigma and Discrimination because of Schizophrenia, Leipzig. Shrivastava, A., Johnston, M., Thakar, M., Sarkhal, G., et.al., 2011. Origin and impact of stigma and discrimination in schizophrenia - patients’ perception: Mumbai study. Stigma Research and Action, 1(1), 67–72. Read, J., Haslam, N., Sayce, L., and Davies, E., et.al., 2006. Prejudice and schizophrenia: a review of the mental illness is an illness like any other approach. Acta Psychiatr Scand, 114, 303–318 Royal College of Psychiatrists, 2012. Schizophrenia : key facts [online] Available at: http://www.rcpsych.ac.uk/mentalhealthinfoforall/problems/schizophrenia/schizophreniakeyfacts.aspx [Accessed 22 June 2012]. Sartorius, N., 2001. Opening session. Paper presented at the First International Conference on Reducing Stigma and Discrimination because of Schizophrenia, Leipzig. Schulze, B., and Angermeyer, M., 2002. Subjective experiences of stigma: A focus group study of schizophrenic patients, their relatives and mental health professionals. Social Science and Medicine, 56, 299–312. Wahl, O., 1999. Mental health consumers’ experience of stigma. Schizophrenia Bulletin, 25, 467 – 478. Wing, J. and Agrawal, N., 2003. Concepts and classification of schizophrenia. In S. R. Hirsch & D. R. Weinberger (Eds.), Schizophrenia. Oxford: Wiley-Blackwell. Read More