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Schizophrenia is a mental illness with symptoms like delusions, hallucinations, disorganized speech and behaviour, and inappropriate emotions (Barlow & Durand, 2009). These symptoms would distort an individual’s living to a certain extent. For example, the irrational thoughts may result in communication problems. In fact, not only do the symptoms of schizophrenia affect an individual, stigmatization of people with schizophrenia also has profound effects on those people with schizophrenia.
Stigma is the general negative attitudes towards a certain group of people (Schneider, 2004). Many scholars suggested that people with schizophrenia are highly stigmatized (Chang & Johnson, 2008; Gingerich & Mueser, 2006; Prior, 2004). They are generally described as depressed, unpredictable, violent, dangerous and aggressive (Chang & Johnson, 2008; Schneider, 2004). Although these may be true for some cases, it is believed that there is overgeneralization of the situation. The situation would also be worsened by the media (Chang & Johnson, 2006), which sometimes connect schizophrenia to violent acts. For example, a person with schizophrenia would be more likely to be a murder. These negative views would trigger discrimination on people with schizophrenia.
Schneider (2004) suggested the labeling theory to explain why people with mental illness behave in the way that the general public describes as dangerous and violent. He explained that they act as dangerous and violent just because they are stigmatized and play out their assigned roles. Therefore, it can be seen that they may actually be socialized to behave in those ways instead of behaving naturally.
It should be noted that people are not only stigmatized while they are suffering from schizophrenia. A research was done by Cheung and Wong (2004) with 193 people in Hong Kong on the perception of stigmatization on people with mental illness. The result shows that the majority agrees with the fact that “most people believe that someone with a previous mental illness is untrustworthy and dangerous”. Schizophrenia, being one of the mental illnesses, is of no exception. The implication of this research is that stigmatization on people with schizophrenia is a life-long issue, from the onset of the disorder until the end of one’s life.
Gingerich and Mueser (2006) suggested that stigma on people with schizophrenia may make others feel fear of and avoid interacting with those people. This fear and avoidance would in turn reduce the interaction between people with schizophrenia and the public and there would be less opportunity to change the stigmatizing beliefs (Gingerich and Mueser, 2006).
Holmes and River (1998) introduced the concept of social stigma and self-stigma. The aforementioned are social stigma as the general public stigmatizes those with schizophrenia. Chang and Johnson (2008) suggested that there are social messages delivered in the stigma which may lead to self-stigmatization of an individual. This further stigmatization would cause even more negative effects on oneself.
Effect of stigmatization on people with schizophrenia
As suggested by Tsang, Tam, Chan and Cheung (2009), stigmatization prohibits mentally ill people from recovery. Regarding situations in Hong Kong, Tsang et al. (2009) found from a survey that 80% of respondents thought social stigma has negative consequences towards mentally ill people. Compared with the high percentage, much less respondents considered social stigmatization unacceptable. Which means quite a number of people tolerate or accept stigmatization even though they know the impact brought. Other figures found by Tsang et al. (2009) also revealed the severeness of stigmatization in Hong Kong. For example, one fourth of respondents are hesitate to accept people with mental illness and about 30% of respondents oppose mentally ill elderly into elderly home. These thoughts and stigmatizations contribute to the effects brought by schizophrenia and make it more serious in Hong Kong.
There is no doubt that stigmatization poses negative consequences on people with schizophrenia throughout their life. Chan, Mak and Law (2009) confirmed the point above after reviewing a lot of literatures. Firstly, it imposes constraints in daily living on those with schizophrenia. Moreover, it may lead to lower self-esteem, reduced life satisfaction and social adaptation. It also hinders help-seeking behavior. Apart from the above impacts, Corrigan (1998) also suggested that stigmatization would lead to discrimination, followed by loss of social opportunities as members of society withhold the chances related to work or income. Thus lead to poor quality of life.
It should be noted that the psychological, social and biological aspects cause the negative consequences and they are interrelated. Socially, negative attitudes towards people with schizophrenia inhibit the employment opportunities (Corrigan, 1998). The claim is also supported by the finding by the Equal Opportunities Commission (1997) in Hong Kong. It stated that the mentally ill people’s employment rate is low (around 30%). The unemployment problems may trigger a lot of other problems. It is obvious that unemployment causes financial problems. It also places burden on clients’ relatives. Moreover, as stated by Mowbray, Bybee, Harris and McCrohan (1995), “employment offers opportunities for social interaction, builds self-esteem and identity, and is the best predictor of recovery and social integration”. However, without a job, there may be disappointment and self-blame of being a burden to the family or being incapable to earn a living. The psychological aspect of the people is thus affected and may reduce life satisfaction.
Tsang et al. (2003) also suggested that stigmatization not only affect the individual but also his family or social network. An example illustrated is that a large number of people would change seats in public transport when sitting next to people who appear to have mental illness. When going out with the mentally ill people, their relatives or families would feel embarrassed. Thus their emotions are also affected. And because of the stigmatization of experiences that irritate the mentally ill people, they may isolate themselves. The family is also likely to conceal their illness because they feel ashamed of the schizophrenic people. This is particularly true in Hong Kong as Chinese stresses the importance of collective representation of families (Tsang et al., 2003). This further prohibits the individual from interacting with other people. Because of the isolation, the individual is not quite possible to seek help from other. Without social support and social resources, the schizophrenic people are hard to adapt to the environment. This forms a vicious circle and the situation may become worse.
Biological aspects may also increase the seriousness of stigmatization. Age of onset of mental illness may be an important factor. If a person is mentally ill since he/she was young, his/ her social network would narrow down as there may be discrimination and isolation. Thus the support is limited. Moreover, if the person suffers from schizophrenia during college or secondary school, his/her education is not competitive enough in Hong Kong as there are more and more students receiving tertiary education (Census Department, 2005). With the mental illness and lower than average academic achievement, they face a lot more difficulties in employment.
It can be seen that stigmatization causes many negative effects on people with schizophrenia. Therefore, it is necessary to reduce the stigma on them. However, there should be some consideration when intervening in the situation. Chiu, Chui, Kelinman, Lee and Tsang (2006) pointed out that those interventions which focus on changing public’ attitude towards schizophrenia are actually isolating those stigmatized to be a group that deserves special treatments. This in turn reinforces the stigmatization. Chiu et al. (2006) also stressed that there may be the possibility of making those stigmatized more aware of the fact that they are being stigmatized. They may become hopeless about changing the current situation and just conform to the stigmatization.
Hong Kong has actually taken some actions to intervene in the stigmatization on people with schizophrenia. However, it seems that the actions taken are not quite effective in reducing the stigma. For example, “psychiatrists changed the Chinese term for schizophrenia from “splitting of the mind to “perceptual disorder”” (Chiu et al., 2006, p. 1694). However, Chiu et al. argued that the new term was re-stigmatized quickly after a short period of time.
Besides changing the name, there have been anti-stigma programmes which promote a sense that “schizophrenia is an illness like any other” (Davies, Haslam, Read & Sayce, 2006). Davies et al. (2006) pointed out that these programmes failed to reduce the stigma as they deliver the message that individuals cannot control themselves when they are suffering from schizophrenia. This makes the public feel that those with schizophrenia become even more unpredictable and thus increasing the stigma.
As it has been mentioned, stigma on people with schizophrenia can be divided as social stigma and self-stigma. Therefore, interventions at both community and individual level are needed to reduce the stigma on people with schizophrenia.
For the community level, Gingerich and Mueser (2006) suggested letting people understand more about the situation instead of changing how they think about the situation directly. One common but effective way is education (Gingerich & Mueser, 2006). Education allows people to develop a better understanding on schizophrenia, for example, the cause, effects and treatments. They may be able to view psychiatric symptoms as understandable psychological or emotional reactions to life events, thus reducing the fear on people with schizophrenia (Davies et al., 2006). A research done by Chan et al. (2009) discovered that it is more effective in reducing stigma on schizophrenia if there is a lecture about schizophrenia followed by a video show which includes real cases of schizophrenia. They explained the effectiveness of the education-video model as allowing participants to get enough information and background before having deeper processing of the video.
It is suggested that there was little or no organized advocacy by psychiatric patients to strive for their own interest (Chiu et al., 2006), like legislation and resource allocation on people with schizophrenia. Besides, it is suggested that poor treatment of schizophrenia may intensify the stigmatization of schizophrenia (Prior, 2004) because people may over-generalize those small group who are poorly treated and have adverse symptoms as the majority of people with schizophrenia. Advocating for the improvement of services for people with schizophrenia can thus help to reduce stigma by allowing better recovery. Besides, services like employment assistance can help integrate them in society and allow them to develop a social network (Prior, 2004).
For individual level, treatments like medication, psychosocial education (Chang & Johnson, 2008). In addition, family cares and supports are important to reduce stigma on an individual with schizophrenia (Chang & Johnson, 2008; Gingerich & Mueser, 2006) as it is the first system that the individual would situate. If the family is a supportive one, it is more likely that the individual would be less self-stigmatized.
In conclusion, stigmatization poses great impacts on individuals with schizophrenia and their families. These impacts included reduced life satisfaction and social adaptation. Unemployment is also an important factor that affects social and psychological functioning of people with schizophrenia. On the other hand, interventions should not focus on changing public’s attitude towards people with schizophrenia. Instead, it should focus on letting people understand more about schizophrenia and providing supports to people with schizophrenia. In the community level, there can be education and advocacy. In the individual level, there can be medication, psychosocial education and family support.
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