The Relationship Between Stigma And Psychosis
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Psychosis: Symptoms, stigma, and compassionate care
Psychosis is not currently categorized as a mental illness in and of itself. Instead, it’s a set of symptoms commonly associated with several serious mental health disorders. It’s defined as a mental state characterized by a disconnection from reality that can significantly affect perceptions, emotions, and behavior. Due to the societal stigma around psychosis in many cultures, some people experiencing its symptoms may be hesitant to reach out for help or treatment, which can lead to additional negative health outcomes. Here, we’ll elaborate on the symptoms of psychosis, discuss the potential repercussions of psychosis-related stigma, and share recommendations for obtaining compassionate treatment.
Key symptoms, avoidance, and warning signs of psychosis
Avoidance behaviors, such as social withdrawal, often occur alongside key symptoms and early warning signs of psychosis. The primary symptoms of psychosis include the following:
- Hallucinations, or sensory perceptions that do not actually exist (e.g., hearing voices no one else can hear)
- Delusions, or belief systems that are not grounded in reality (e.g., believing other people can read one’s thoughts)
- Disorganized thinking, which can result in jumbled speech and an inability to navigate social interactions
Early warning signs of psychosis and mental illness
The National Institute of Mental Health (NIMH) notes that a person is likely to display certain early warning signs before developing clinical symptoms of psychosis. Learning to recognize them can help you know when to seek support if you or a loved one were to experience them. Some of the warning signs the NIMH lists include perceptions of suspicion and paranoia, social withdrawal, a lack of feeling, unusual or intense ideas, a decrease in personal hygiene, sleep disturbances, and general difficulties with daily functioning, managing emotions, and separating fantasy from reality.
The connection between psychosis and mental illness
There are various reasons a person may experience symptoms of psychosis. Genetics are thought to play a role in an individual’s risk of developing a symptom like this, as are differences in brain chemistry or structure. Past experiences of trauma can also increase the risk of psychosis. An individual could experience symptoms once as part of a single episode or more than once as part of a longer-term mental illness of which psychosis is a symptom.
Signs associated with psychosis
A single psychotic episode or longer-term signs of psychosis as a symptom can be associated with a number of different illnesses. Some examples include:
- Schizophrenia, a relatively rare mental illness that commonly presents with psychosis, among other symptoms
- Major depressive disorder, which can present with psychosis in rarer cases
- Postpartum depression, which is thought to present with psychosis in one or two of every 1,000 cases
- Bipolar disorder, which is reported to include symptoms of psychosis in over half of cases
- Various medical conditions such as dementia, traumatic brain injuries, HIV/AIDS, multiple sclerosis, lupus, and Huntington’s disease, though not in every instance
Stress and substance-induced psychosis
Although it’s rare, symptoms of psychosis can also occur in isolation following a severely stressful event, such as the traumatic loss of a close loved one. Some substances can induce psychotic symptoms as well, including certain prescription medications and street drugs like methamphetamine. Note also that a psychotic episode could be triggered in someone who is at increased risk for psychosis or who has a history of psychosis as a result of stress, trauma, and even sleep deprivation. That’s why stress management and healthy lifestyle habits are typically components of long-term treatment for certain mental illnesses like schizophrenia.
Mental health, stigma and psychosis
The American Psychological Association (APA) defines stigma as “the negative social attitude attached to a characteristic of an individual that may be regarded as a mental, physical, or social deficiency” and which “implies social disapproval and can lead unfairly to discrimination against and exclusion of the individual.” Stigma persists around mental health treatment, mental health services, and people with a mental illness—particularly more severe mental illnesses like those that can cause significant behavioral changes and symptoms, as with psychosis. People facing stigma due to negative attitudes about mental health conditions may experience effects such as:
Feeling ashamed or unwilling to talk about the condition
People may feel ashamed or avoid discussing their condition, thinking it isn’t real, it’s their fault, or it’s untreatable, which can prevent them from seeking treatment.
Self-doubt and low self-esteem
Stigma can lead to self-doubt and low self-esteem as a result of bullying, harassment, and/or ostracism.
Increased risk of unemployment for those with mental illnesses
Those facing mental health stigma are at a higher risk of unemployment.
Difficulty finding insurance coverage
People may struggle to find insurance coverage for mental health care and psychiatric medications.
Negative interactions with mental health services due to stigma and psychosis
Experiencing negative interactions with healthcare providers, often due to stigma related to psychosis, may reduce the chances of recovery.
Disconnection from friends and family due to avoidance
Individuals may disconnect from friends and family members who may not understand the situation and/or may make insensitive comments.
Exacerbated symptoms or development of new ones
Stigma can worsen existing mental health symptoms or lead to new conditions, such as anxiety and depression.
Engagement in self-sabotaging behaviors
Some individuals may engage in self-sabotaging behaviors, such as self-harm, as a way to cope or protect themselves.
How common language around psychosis may perpetuate stigma
Negative associations with the word “psychosis” can contribute to the stigma around this symptom. The term “psychosis,” and particularly the adjective form of the word, “psychotic,” can be associated and even confused with the words “psycho” and “psychopath.” The word “psycho” is a derogatory term often used to describe someone who behaves erratically or has difficulty controlling their emotions. Today, it is not considered a valid or appropriate term to use—especially in the context of mental illnesses or mental illness treatment. It can be offensive, harmful, and may further contribute to mental health stigma.
The word “psychopath,” like “psycho,” is colloquially used in a derogatory manner. It is important to note that the term “psychopath” does have a history of clinical use in mental health care, as it was once used to describe people with antisocial personality disorder who can lack empathy or regard for others as a symptom. However, the term’s use in that context is now considered outdated and offensive.
Seeking support for mental illnesses, health services, and stigma
Seeking the support of a mental health professional immediately is recommended if you’re experiencing warning signs or symptoms of psychosis. While both in-person and online therapy are viable options for receiving mental health care in many cases, in-person care should be sought for symptoms like psychosis.
While violent behavior is less common in individuals with serious mental illnesses than media and popular beliefs would indicate (and often more closely tied to their environment rather than their illness), it is possible for someone with psychosis to engage in violent or harmful behaviors toward themselves or others. That’s one reason why seeking in-person care right away for such symptoms is important, in addition to the fact that psychosis can simply be a distressing symptom to experience and that a professional can help.
That said, someone who is in regular contact with an established, in-person care team for a mental illness that has manifested as psychosis in the past may benefit from meeting with a therapist as well. They can allow you a safe space to express your emotions and help you continue working on tools for managing difficult feelings and symptoms. Online therapy may be particularly appealing to someone who is affected by stigma related to psychosis, other symptoms, or mental health care in general. You can engage in this type of treatment from home or anywhere else you have an internet connection, which helps many people feel more comfortable. Research suggests that this format can be associated with “a significant reduction in public stigmatization” of mental health care and can provide similar health outcomes to in-person therapy.
Seeking support for any mental illness, not just psychosis, is crucial. Addressing stigma and obtaining appropriate health services can help individuals get the care they need.
Takeaway
Frequently asked questions
What stigmas are associated with psychosis?
Research on stigma has determined that, while people may understand that mental health disorders are medical health problems, they are still likely to have a negative view of those with mental illness. Stigma exists around various aspects of mental health, including mental health treatment, and people with mental illness, including psychosis.
One study looking specifically at the beliefs about the employment of people with psychotic disorders found that many stigmas and stereotypes impact this population. Study respondents indicated that they associated having psychosis with many negative stereotypes, including being “dangerous, unreliable, unpredictable, less competent, less productive, hard to manage, and lazy.”
How does stigma affect people with mental illness?
According to the American Psychiatric Association, stigma can affect people with mental illness in various ways. It can lead to lower self-esteem and reduced hope, and it may lead to increased symptom severity. The public stigma surrounding mental health may also prevent some people from seeking treatment or sticking with it.
The social stigma around mental health issues can also impact relationships, leading to a lack of understanding from friends, family, and coworkers, which can contribute to social isolation. Because of the negative beliefs, attitudes, and opinions of others and how people with mental health challenges are perceived, they may face increased incidents of bullying and fewer opportunities for school, work, and socialization.
What is self-stigma associated with mental illness?
Self-stigma with mental illness is when someone internalizes negative societal stereotypes. People with mental illness may be aware of the stereotypes that others have about them; when they agree with these stereotypes and apply them to themselves, it can result in emotional distress, fear, shame, guilt, and low self-esteem.
Psychiatric research has found that self-stigma can have various harmful effects, including decreased quality of life and overall well-being and non-adherence to treatment. People with internalized stigma may not seek help for their mental disorders, and they may experience symptoms that are more severe, including increased suicidality.
What is the most stigmatized mental illness?
While mental illness stigma can apply to many conditions, one study attempted to determine a mental illness scale or hierarchy of mental health-related stigma. This research found that schizophrenia had the greatest stigma, followed by antisocial personality disorder, borderline personality disorder, dissociative identity disorder, bipolar disorder, post-traumatic stress disorder, obsessive-compulsive disorder, generalized anxiety disorder, and depression.
How does stigma affect schizophrenia?
Some common aspects of social stigma against schizophrenia are the perception that people with this condition are dangerous and that people not only want to avoid people with schizophrenia but believe that others desire to avoid them, too.
These attitudes can significantly affect the social relationships of people with schizophrenia and other schizophrenia spectrum disorders, like brief psychotic disorder and schizoaffective disorder. According to the World Health Organization, people with this condition are at risk of experiencing human rights violations in community settings and inside mental health institutions, and the stigma against people with a schizophrenia diagnosis can limit access to education, employment, housing, and appropriate health care.
What does stigma mean?
When conceptualizing stigma in relation to mental health, prior research suggests that stigma may include “labelled differences, stereotypes, separation, status loss and discrimination, power, and emotional reaction.” Other researchers believe that “there is stigma if and only if there is labelling, negative stereotyping, linguistic separation, and power asymmetry” and that while stigmas exist against groups of people, it is individuals who experience the negative consequences of them.
What is a stigma example?
Some examples of stigma may include:
- Community members can fear danger or physical violence from those with mental illness, which can lead to people diagnosed with these conditions being isolated.
- Psychiatric patients may feel shamed, rejected, or discriminated against because of the public stigma around mental illness.
- Employers may be reluctant to hire those with mental illness or those who are recovering due to stigmas surrounding their ability to work.
- Media representations of people with mental illness have “often been negative, inaccurate or violent representations” that can lead to a higher level of prejudice against those with mental illness and may lead to greater self-stigma.
In another study, researchers received informed consent from people who experienced this stigma in the Philippines who went on to share personal experiences that included being laughed at, verbally assaulted, hit, tied to a pillar with rope, cheated out of money, neglected, slapped, and locked in a room.
What is stigma in Tagalog?
One study that examined stigma in Tagalog ethnic groups determined that people in this region may face challenges due to unique psychosocial variables. Researchers found that both pessimistic and over-optimistic reactions were important in the context of mental health stigma in the Philippines.
Per this study, “resilience and optimism under difficult situations are among the well-known cultural traits of Filipinos,” and an over-optimistic view of the prognosis and the negative effects of mental health challenges can interfere with people receiving appropriate treatment. Other research has determined that Filipinos may be more likely to believe that mental illness will improve on its own.
What best describes stigma?
There are different types of stigma that can apply to mental health.
Public stigma is the negative attitudes people have toward others and can include discrimination.
Self-stigma is a personal stigma that people may develop toward themselves about their own condition.
Structural stigma is systemic, involving government and public health policies as well as exclusive companies and organizations limiting opportunities for people with mental illness. For example, someone with mental health challenges may not have insurance to adequately cover necessary treatment.
What best defines stigma?
Stigma is a negative social attitude surrounding a certain characteristic, which can lead to discrimination toward people who have that characteristic. In the context of mental health, people with mental illness may be treated differently in social, educational, and professional settings.
Many people with mental health challenges, from intellectual disability to untreated psychosis to schizophrenia, have personal stories about their own experiences with stigma. While there have been recent efforts to reduce stigma around mental health, for many, there is still a significant association with various stereotypes. These beliefs can prevent people who need support, like early intervention services and ongoing treatment throughout the recovery process, to resist getting help.
Efforts have been made to challenge stigma and identify anti-stigma interventions. For example, one randomized controlled trial involving young people in Japan found that 30 minutes of social contact and follow-up educational video interventions had a 12-month sustained effect on reducing stigma. Another systematic review looking at mental health stigma in medical students found that contact with people who have stigmatized conditions can be helpful.
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