PRINCIPLES OF CONTEMPORARY NURSING

Principles Of Contemporary Nursing

Principles Of Contemporary Nursing

Introduction

Population surveys indicate that, despite increased awareness of the nature of schizophrenia spectrum disorders (Swindle et al., 2000), many among the general public hold stereotyped beliefs about persons with these conditions including expectations of violent and disorderly behavior, and an inability to sustain employment or make informed decisions (Markowitz, 1998, Link et al., 1999, Pescosolido et al., 1999 and Phelan et al., 2000). A matter of great importance, stigma may incline persons in the general public to seek social distance from those with schizophrenia (Angermeyer and Matschinger, 2003 and Martin et al., 2000) and represent a barrier to meeting basic needs (Link et al., 1989 and Wahl and Harman, 1989). Stigma can interfere, for instance, with obtaining work (Bordieri and Drehmner, 1986 and Link, 1987), housing (Page, 1983) and/or negotiating with the legal system (Sosowski, 1980). Stigma may also possibly encourage persons to embrace self-fulfilling prophecies of failure (Ritsher et al., 2003, Ritsher and Phelan, 2004, Thompson, 1988, Warner et al., 1989 and Wright et al., 2000) and has been suspected to be connected to suicide in schizophrenia (Siris, 2001).

While stigma against the mentally ill has been linked to decrements in role function and morale, it remains less clear whether stigma is linked with symptoms and interpersonal relations. Do certain symptoms or patterns of social function increase vulnerability to accepting stigmatizing beliefs? For instance, with heightened levels of positive or affective symptoms, do persons tend to be more accepting of stigma? Considering the converse: as persons increasingly internalize stigma, are they more likely to experience increases in symptoms or decrements in psychosocial function?

We suggest there are several reasons to speculate that stigma may influence and be influenced by symptoms and social relations over time. For one, stigma may drive persons away from society and incline them towards non-adherence to medication (e.g. Katschnig, 2000, Freudenreich et al., 2004 and Lloyd et al., 2005). Such behavior can lead to a number of problems, both for the individual and in terms of others' perceptions. Torrey (2004) proposes that, while there is not a linear relationship between medication noncompliance and violent behavior, treatment non-adherence is related to violent behavior and such behavior perpetuates stigma of those with severe psychiatric disorders. Thus, perhaps as persons internalize stigma, they withdraw and with greater stress and fewer supports experience exacerbations in their symptoms. It is also possible to imagine that, as symptoms and/or social dysfunction reach a certain level, they may identify persons with schizophrenia as mentally ill to others, making them vulnerable to stigma. Perhaps too as persons become more symptomatic they despair and are more likely to accept negative beliefs about themselves. Therefore, as symptoms and dysfunction worsens perhaps, there is also greater internalization of stigma.

Research to date on the association of clinical features of illness and stigma has been limited and equivocal, however. Dickerson et al. (2002) found stigma experiences linked to socioeconomic factors but not with positive or negative ...