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Stigma surrounding schizophrenia is a circumstance of mental illness that the newly diagnosed schizophrenic may not initially perceive or anticipate. To my knowledge, many schizophrenics initially speak of their mental illnesses publicly to strangers, not really expecting that this will cause others to view them as extremely peculiar or exactly what they are: mentally ill.
Newly diagnosed schizophrenics may seek reflection of their internal states, attempting to understand themselves as mentally ill. It is then that they encounter stigmatization.
As a matter of course, stigma tends to exacerbate the condition of schizophrenia because it leads to interpersonal alienation and a withdrawal into the mental realm. This culminates in greater involvement in psychotic ideation and perhaps greater interaction with one’s hallucinations, as this is understood by the schizophrenic. Stigmatization is damaging to the schizophrenic. It leads to engulfment in mental illness, given that stigma, in a cyclic way, culminates in deeper psychopathology, and deeper psychopathology leads to increased stigmatization by others.
There was a person of my acquaintance, diagnosed with schizophrenia and early in the process of her mental illness, but newly aware of stigmatization. She asked her clinician how she would be able to combat stigma. The clinician replied: “Get a job.” This was good advice.
Vocational activity in the form of employment or scholastic endeavor can help to ameliorate stigma. Such activity may normalize the self-concept of the schizophrenic individual, and it will lead to a greater sense of self-worth. If a schizophrenic can obtain vocational activity prior to the emergence of damage to her sense of self as a result of stigma, she may have more success in vocational spheres. She may gain self-confidence in spite of her mental illness.
The fact that the newly diagnosed schizophrenic may be particularly responsive to intervention at the initial stage of dealing with her illness stems from the reality she has not really accepted stigma as an aspect of her self-definition. Healthy and normative activity can be enacted by this individual at this stage specifically prior to assumption of the damaging effects of stigma in terms of her self-concept. Stretching the newly diagnosed person’s belief in terms of what she is capable of in the vocational and educational realms will benefit that schizophrenic individual.
One clinician, a psychotherapist, engaged in treatment with a schizophrenic individual of my acquaintance. The schizophrenic individual expressed her desire to attend graduate school. The clinician stated: “You will never go to graduate school. Look at the statistics on people like you.” This therapist’s statement was contraindicated by the facts regarding appropriate treatment for mental illness. The psychotherapist stigmatized the client. The client, however, did not accept the stigmatization that the clinician projected onto her. The client went on to achieve a doctorate in psychology.
This client was an anomaly. Most schizophrenics may have believed the therapist’s statement, whether it did or did not accurately reflect their level of ability. There is no way of estimating how many schizophrenics’ life goals have been destroyed by the way others have stigmatized them. Perhaps the mental illness, schizophrenia, is only partially the culprit in the failure of people with schizophrenia to achieve vocational and educational success.
Clearly, another culprit may be the damaging and stigmatizing ways that others view schizophrenics. These views, communicated to the schizophrenic, become prophetic specifically because the schizophrenic believes them, incorporates them into his self-definition, and lives by them.
Early in the course of the illness of an individual diagnosed with schizophrenia represents the ideal time to intervene and even halt the progress and the process of emerging psychopathology. The fact that the newly diagnosed schizophrenic does not readily perceive the stigma associated with mental illness can actually benefit her. If the newly diagnosed schizophrenic is assisted in engaging in activities that will strengthen her self-concept, she may be better equipped to cope with stigma and its implications.
Encouraging vocational and educational activity is an important aspect of treatment for schizophrenia. However, stigmatization may be a substantial reason for failure in these areas. As a result, the schizophrenic individual may reside in secrecy regarding her mental illness, as a way of deflecting the effects of stigmatization. Note, as well, that alienation is one effect of stigma, and alienation bolsters mental illness. Failure, alienation and a sense of personal diminishment and defeat accompany stigma. It is essential that schizophrenics are reached early in their illnesses, before the effects of stigma have virtually predetermined failure.
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