Schizophrenia Stigma: Separating Stereotypes From Truth

Schizophrenia is a mental illness that usually involves psychotic symptoms like hallucinations, delusions, and disordered thoughts and behaviors. According to the World Health Organization, about 24 million people in the world have schizophrenia, which equates to about one out of every 222 adults. Schizophrenia and other related disorders, typically referred to as schizophrenia spectrum disorders, tend to be less common than other mental health disorders. As a result, many people in the general population do not understand schizophrenia and the challenges people living with this disorder may face. The lack of understanding and education surrounding schizophrenia can contribute to negative stigmas, which can make life with schizophrenia even more difficult. If you’re having trouble coping with schizophrenia symptoms or stigma, working with a licensed therapist may be helpful.

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What is schizophrenia stigma?

Schizophrenia stigma can be defined as a form of mental health stigma describing the negative stereotypes people often believe about the disorder, as well as the negative biases people may hold against those who have the condition. 

Schizophrenia can cause people to speak or act in unusual ways, which others may misunderstand and make false assumptions about. Sometimes, people fear those with schizophrenia without reason, or they may assume someone with schizophrenia cannot hold down a job or be a good friend or romantic partner. These beliefs are untrue for many people with schizophrenia, but both news reports and mainstream entertainment often reinforce these stereotypes, thereby perpetuating stigma.

Because schizophrenia usually develops in part due to genes and a person's biology, others may wrongly assume that people cannot recover, or that if they experience psychotic symptoms once, they will always have them. That is also untrue in most cases. According to the American Psychiatric Association, people can recover from schizophrenia with treatment. Even those who experience severe or persistent symptoms can find ways to treat and manage them. Many programs and treatments can help people with schizophrenia work, maintain healthy social relationships, and live well in a community.

Schizophrenia stigma of violence

Often, people with schizophrenia are stigmatized and discriminated against because people fear they may commit acts of physical violence. However, this stigma doesn't reflect the research on the topic. While updated evidence may be needed, older studies suggest that between 10% and 15% of people with schizophrenia may engage in violent behavior at some point in their lives, which generally means that 85% to 90% of those with the disorder aren’t violent.

People with schizophrenia may be 14 times more likely to become a target of violence than they are to commit violence. In general, much more research focused on people with mental illness committing violent acts has been conducted than research focused on people with mental illness being targets of violence. This likely impacts the perceptions of not only the general public, but researchers, healthcare providers, and people who work with those who have schizophrenia.

Some experts suggest that when people with schizophrenia become involved in a violent altercation, this could be in part due to a misunderstanding of their symptoms. People with schizophrenia may make false accusations due to their delusions. They may act in emotionally inappropriate ways, such as by displaying unprovoked anger or hostility. Others might not recognize that these are mental illness symptoms and may retaliate or act aggressively in return.

Other research shows that having schizophrenia alone doesn't usually predispose a person to violence. Instead, having schizophrenia and experiencing other stressors, like a financial crisis, violent attack, or divorce, may increase the risk of engaging in violence. This research suggests that the stigma, discrimination, and mistreatment people with schizophrenia may face often play a role when violence does occur.

Negative impacts of schizophrenia stigma

People with schizophrenia usually face a higher risk of negative outcomes compared to other people with mental illness, in part due to the stigma surrounding the disorder. There can be several negative impacts of stigma on people with schizophrenia, such as those below:

Workplace discrimination against people with schizophrenia

Schizophrenia stigma may be part of the reason many people with schizophrenia do not maintain full-time jobs. Employers might not hire people who divulge that they have schizophrenia out of the assumption that they will not be a good worker or will not be able to do the job for long. When a person does not divulge that they have schizophrenia, they may still face bias and discrimination from employers who do not understand their symptoms. People with schizophrenia who land a job may find they face bias or discrimination at work. Superiors or coworkers might not understand their symptoms, or they may jump to false conclusions if they are aware of their diagnosis.

Healthcare discrimination

Compared to the general public, people with schizophrenia are generally two to three times more likely to die early. While there may be many factors contributing to this statistic, stigma is likely one of them. Research suggests that healthcare workers may treat people with schizophrenia differently due to their own fears or biases caused by schizophrenia stigma. Clinicians may assume a person's symptoms are solely due to schizophrenia, and, as a result, they may not investigate when there are other physical illnesses at play that require treatment. People with schizophrenia may also become incarcerated rather than receiving necessary healthcare.

Social exclusion due to mental illness

Social isolation often accompanies schizophrenia, and this may be partly due to stigma, stereotypes, and discrimination. Friends and family may treat a person differently after learning of their schizophrenia diagnosis or witnessing their symptoms. Coworkers or classmates may keep their distance, not understanding what schizophrenia is or how it affects a person. In turn, these instances of exclusion can result in isolation, potentially worsening symptoms.

Human rights violations

People with schizophrenia often face a higher risk of human rights violations, both when they are living in mental health institutions and when they are living in a community. The World Health Organization states that people with schizophrenia might not benefit from living in mental hospitals, since evidence suggests the basic human rights of people with schizophrenia may be violated in those settings.

People with schizophrenia or another mental health disorder are usually more likely to be incarcerated than those without mental illness. According to the National Alliance on Mental Illness, 25% to 40% of U.S. adults with mental illness may be put in jail or prison at some point in their lives, compared to 6.6% of the general public. The general public may assume that if someone with schizophrenia is put in jail or prison, they must have brought it upon themselves. However, there may be social factors to consider that suggest people with mental illness are jailed and imprisoned more often than average, despite not being more violent than average. 

In general, as mental and psychiatric hospitals and wards have closed in recent decades without an increase in community living options, more people with mental illnesses like schizophrenia have become incarcerated. This trend is often referred to as “the criminalization of mental illness.” When people with schizophrenia are arrested, jailed, or imprisoned, they tend to be much more likely to experience human rights violations.

Self-stigma or internalized stigma

The personal stigma a person with schizophrenia faces may involve not only stigma from others, but also their own internalized stigma. Internalized stigma can occur when a person recognizes the stigmas and stereotypes others hold toward or about them and believes them to be true. This self-stigma can reduce a person's self-esteem and lead to feelings of shame, fear, and self-doubt. 

Self-stigmatized: Internalized stigma and quality of life

People with internalized stigma about their mental health typically have a lower quality of life and are more likely to experience anxiety or depression. They may avoid seeking treatment out of embarrassment or shame, or they may avoid communicating their needs to others. As a result, their needs may not be met. When a person with schizophrenia perceives themselves negatively due to self-stigma, they may withdraw socially and alienate themselves, which can worsen their symptoms. 

Reducing internalized stigma

While internalized stigma may have negative impacts, there are ways to reduce these feelings and bolster self-esteem. Reducing the stigma that is prevalent in the general public may be most impactful at reducing self stigma, since that is likely the source from which people with schizophrenia internalize stigma. However, there are other, individual options for those experiencing self stigma. For example, one-on-one talk therapy with an understanding practitioner may also help a person with schizophrenia release some of their internalized stigma.

Therapy for schizophrenia

Mental health care for schizophrenia usually involves multiple aspects, including doctor-prescribed medication, training programs, support groups, and one-on-one talk therapy. Remote therapy in particular may be an attractive option for those with schizophrenia, since the online format allows them to seek help from the comfort of their home or any other comfortable location. BetterHelp offers remote therapy for individuals with various mental illnesses, although in-person therapy may be necessary for crisis situations and when people are experiencing acute psychosis.

Effectiveness of online therapy for mental health

One study looked at people receiving remote cognitive behavioral therapy (CBT) for psychosis and found potential benefits for participants. Engaging in remote CBT usually enabled a person who had experienced psychosis to form a good relationship with their therapist. Many of the people who participated in the study preferred receiving CBT remotely as opposed to attending in-person sessions. The study authors suggested that remote CBT could result in a stronger client-therapist relationship for people with psychotic symptoms who prefer remote therapy.