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“When stigma is present, any individual belonging to a particular category, such as schizophrenia, is assumed to possess all of th enegative stereotypes associated with that category and is therfore feared, disliked, or avoided. (Mueser, K. and Gingerich, S. 2006, p. 431)

Stigma can be caused by people’s exposure to biased information. For example, though the number of people with schizophrenia who are violent is quite low, only slightly higher than the general population, there is an idea among the general public that most people with schizophrenia are extremely violent. This is in large part due to the disproportionate amount of news coverage and media (movies, etc.) stories of people with schizophrenia who are violent. There seems to be a tendency for people to try to distance themselves from frightening experiences, like “He was a heavy smoker, that’s why he got lung cancer. I’m different, I don’t smoke, so that won’t happen to me.” In relation to schizophrenia, they might think, “She has schizophrenia, no wonder she freaked out and attacked four cops. I don’t have schizophrenia, so that would never happen to me.” People cling to this difference, despite the real fact that many more people without schizophrenia are violent against police than people with the disorder.

The effects of stigma are profound, ranging from people refusing to hire someone or rent an apartment to a person with mental illness to people just plain avoiding them out of misplaced fear. Neighbors fight against a proposal to open a group home or halfway house in their area, people call the police on peaceful, well-behaving strangers, and news reports frequently equate mental illness with crime. Schizophrenia has some of the worst stigma of all the mental illnesses. An additional issue is self-stigma, in which a person incorporates stigmatized beliefs that they then apply to themselves. Self-stigma can result in a person’s refusal “to acknowledge having schizophrenia because he feels that to accept the label would be tantamount to admitting he is crazy, worthless, or has nothing to contribute to society” (Mueser, K. and Gingerich, S. 2006, p. 432) or in feelings of hopelessness and grief and giving up on goals and resigning themselves to a lesser life than they could achieve.

The tragedies of stigma include the decrease in the quality of life of people with schizphrenia and the loss of some of the wonderful things people with schizophrenia can bring to the world. I personally have had clients who came in intially dejected, self-hating, and passive, thinking they were the lowest of the low and couldn’t’ do anything. Many of them have since started working, building friendships and hobbies, and bringing joy to their families with their kindness. As I mentioned in the previous blog post, the news and movies discard this type of story as one that won’t sell, one that’s not worth mentioning. However, I feel it’s the most important type of story worth mentioning regarding people with schizophrenia, as it gives them hope and gives the rest of us the knowledge that these people matter and bring a lot of good to the world.

In the next part of this series of blog posts, we’ll take a look at what you and your family and friends can do in the battle to fight stigma.

Citations:

Mueser, K. and Gingerich, S. (2006). The Complete Family Guide to Schizophrenia

As the people who have been in my therapy groups will know, I am a video game player. So I was interested when one of my group members told me about a video game called Hellblade: Senua’s Sacrifice, a game in which the main character is portrayed as having psychosis, including hearing voices, seeing visions, having paranoia, and flashbacks. Intrigued, I read several reviews about how the game’s portrayal of psychosis was handled. (e.g. Distance, Critical, “Perspectives Differ on How ‘Hellblade’ Handles Mental Illness”, waypoint.vice.com; Lacina, Dia, “What Hellblade: Senua’s Sacrifice Gets Wrong About Mental Illness”, polygon.com; Lloyd, James, “How Hellblade: Senua’s Sacrifice Deals with Psychosis”, sciencefocus.com). Not surprisingly, the reactions were mixed, with some people praising the game’s sensitivity and insightfulness and others finding the portrayal invalidating and hollow. However, the fact is, it’s rare to see a character with psychosis being a nuanced character who isn’t evil or pathetic. It’s even more rare to find a positive main character with psychosis, be it a movie, book, or video game. I can come up with a handful—the movie “The Soloist,” the movie “A Beautiful Mind,” and now, this video game. (An argument could also be made for “Benny and Joon,” and I’m sure there are some newer ones I’m missing, but you get the idea.) I’m not saying that these are realistic characters, or that they’re handled perfectly, I’m noting that the idea of treating a main character with psychosis as a real person, who is neither a villain nor a pathetic object of pity, is a relatively rare one. I’m encouraged by this development, while at the same time still disappointed by the flaws in portrayals of characters with psychosis and by the slow progress of awareness/understanding of these symptoms. The primary reason for this appears to be stigma against mental illness, especially against people with psychotic symptoms.Stigma. “People with schizophrenia and their families have to live with an extraordinary amount of stigma. Schizophrenia is the modern-day equivalent of leprosy, and in the general population the level of ignorance about schizophrenia is appalling.” (Torrey, 2013, p. 356) Serious mental illness is often seen as worse than physical or intellectual disabilities, and, more dishearteningly, the fault of the person with the illness. (Corrigan and Lundin, 2001, p. 15) Stigmas are stereotypes, and with mental illness, they almost always affect the people with the illness in a negative way. Researchers have found three broad categories of stigma against people with mental illness: that they are dangerous and should be kept out of our communities; that they are irresponsible and others should make decisions for them; and that they are incompetent and need to be cared for as if they were children. (Corrigan and Lundin, 2001, p. 20) I would add, that in the media, both news and entertainment, there is an erasure of positive, realistic portrayals of people with psychosis. The vast majority of people with psychosis that are covered in the news or portrayed in movie/book/video game stories are negative. I joke with my clients sometimes about how the news would never air a story like, “Local woman takes her meds, symptoms are stable, enjoys her job, going to her grandchildren’s sports events, and playing the piano.” These are many of the people with a psychotic disorder, but for the layperson, people with psychosis are all scary or incompetent. Fortunately, as the video game discussed above shows, the public is slowly starting to be aware of people with psychosis in a more realistic way. Flawed, sure, like any person, but not a one-dimensional caricature.
This series of blog posts aims to 1. take a close look at stigma and how it affects those with schizophrenia, their families, and the public at large, 2. Study how stigma hurts society, and 3. Examine how all of us can fight stigma and move forward in the progression of understanding and helping people with psychosis have enjoyable lives and bring as much positivity to the world as they can. We are early on in the journey, but when it occurs to large video game companies to try to present a hero with psychosis as the main character in the game, this gives me heart. We are moving forward.

Citations:
https://waypoint.vice.com/en_us/article/433kjj/perspectives-differ-on-how-hellblade-handles-mental-illness

https://www.polygon.com/2017/9/15/16316014/hellblade-senuas-sacrifice-mental-illness

https://www.sciencefocus.com/the-human-body/how-hellblade-senuas-sacrifice-deals-with-psychosis/

Corrigan, Patrick, and Lundin, Robert. (2001). Don’t Call Me Nuts! Coping with the Stigma of Mental Illness. Champaign, Illinois. Abana Press.

Torrey, E. Fuller. (2013). Surviving Schizophrenia: a Family Manual. New York. HarperCollins Publishers.

https://www.smm.org/mindmatters

The Science Museum in St. Paul, Minnesota, in having this traveling exhibit show through January 2019, is aiming to #MakeItOk to talk about mental health. Mental health is often seen as an unimportant or “taboo” topic, something that should be avoided entirely. This has led to understandable but significant ignorance among people about what mental health and mental illness is, the effectiveness of treatment, and most importantly for people with schizophrenia-spectrum disorders, how “normal” people with these illnesses often are.

I attended the exhibit recently, and was very impressed by it. The most common mental health disorders all have displays, including schizophrenia. The information presented was clear, comprehensive, and understandable to people with any level of education or experience with mental illness. The exhibit does not shy away from the history of many of our horrific ways of treating mental illness, and highlights current treatments and how consumers experience them. There are also interactive exhibits, like the one where you can try to do some math puzzles while speakers play taunting voices from several different directions, mimicking the experience of hearing voices. Other exhibits involve a warped mirror to help one experience Body Dysmorphic Disorder (having an unrealistically negative view of one’s body) and writing down one’s worries and shredding them. I especially liked the booths running videos of interviews with people with various mental health disorders. The people in the videos talked about their experiences with their symptoms before they got treatment, how those symptoms changed after getting treatment, and about their lives since treatment, in general and about how they’re coping. These videos presented the interviewees as regular people, not as “mental patients,” and showed the real human side of people struggling with and managing mental illness.

I’ve had some clients attend this exhibit, and heard positive things from them as well. They found it was accurate, easy to comprehend, and most importantly, treated people with mental illness with dignity and respect. In addition, in order to encourage lower-income people to attend, the Science Museum offers a reduced-price ($3.00) admission ticket if one can present evidence of being lower-income (GA/MA/EBT/SSI/SSDI card). I would highly recommend this exhibit to anyone. I hope it continues to travel around the U.S., exhibits like these are so beneficial. Check it out!

January can be a tough month, especially in Minnesota. It’s often brutally cold, the days are short, and holidays are over. As I mentioned in a previous blog, the experience of depression is people with schizophenia can be overlooked. For some people, lack of sunlight during the depths of winter hit especially hard.

If you notice yourself feeling down, sleepy, unmotivated, and sluggish during the months with the shortest days of the year, you may want to look into asking your doctor about what to do. Remember, with seasonal symptoms, help may come in the form of a lightbox or other treatments rather than just more medications. As always, talk to your doctor if you have concerns. See this article for more.