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Prejudice, stigma and 'schizophrenia': The role of bio-genetic ideology

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... Beyond the important issues of accuracy and bias, biogenetic causal explanations for mental health problems have been repeatedly demonstrated to be positively related to fear, prejudice, and discrimination (30,(32)(33)(34). Despite the fact that many destigmatization programmes, often funded by drug companies, explicitly promulgate the 'medical model' (using the 'mental illness is an illness like any other' approach), a recent review (32) confirmed that 'biogenetic causal models are an inappropriate means of reducing rejection of people with mental illness' because 'generally, biogenetic causal attributions were not associated with more tolerant attitudes; they were related to stronger rejection in most studies' (p. ...
... 367). Besides increasing prejudice by exaggerating differences between 'us' and 'them', unwarranted focus on genetics, brain abnormalities, and chemical imbalances reduces the perceived chances of recovery, on the part of the public and users of mental health services (30,34). Seventy percent of depression websites described depression as an 'illness' or disease' (19). ...
... Conversely, belief in psychosocial causes is associated with more positive attitudes and reduced prejudice (30,34). Furthermore, minimizing psychosocial causal factors may reduce the probability that service users will raise, and that staff will ask about, important issues such as current social and financial stressors or past neglect and abuse (35,36), thereby inhibiting comprehensive formulations and impeding appropriate treatment planning (37). ...
Article
Objective The pharmaceutical industry exercises pervasive influence in the mental health field. The internet has become a primary source of mental health information for the public and practitioners. This study therefore compared mental health websites funded and not funded by drug companies. MethodA systematic literature review of studies examining the role of drug companies in the funding of mental health websites was conducted, followed by a meta-analysis of studies comparing drug company-funded (DCF) sites with sites not funded by the industry. ResultsMental health websites, in general, overemphasize biogenetic causal explanations and medication. Many mental health websites (42%) are either drug company owned (6%) or receive funding from drug companies (36%). A meta-analysis found that DCF sites are significantly more biased toward biogenetic causes (P<0.01) and toward medication (P<0.0001) than sites that are financially independent of the industry. Conclusion Practitioners are encouraged to inform patients about the bias inherent in industry-sponsored websites and to recommend, instead, more balanced websites that present a range of evidence-based information about causes and treatments.
... Presenting mental illness as being ''like any other medical illness'' [9,10], or the adoption of a causal model focusing on biogenetic factors has not reduced stigma [10,11]. People with mental disorders continue to be perceived as dangerous and unpredictable and to be discriminated against by the public, in some circumstances even more so than in the past [12,13]. ...
... Presenting mental illness as being ''like any other medical illness'' [9,10], or the adoption of a causal model focusing on biogenetic factors has not reduced stigma [10,11]. People with mental disorders continue to be perceived as dangerous and unpredictable and to be discriminated against by the public, in some circumstances even more so than in the past [12,13]. ...
... However, differences in public views of mental disorders, including depression and schizophrenia, exist [12,14,15]. Most lay people view depression mainly as a consequence of exposure to depressing psycho-social factors and as a temporary condition, but tend to view schizophrenia as a genetic brain disorder with an unfavorable prognosis and as an illness associated with high risk of aggressive behaviors [5,10,13]. Studies also report public preference for psychological treatments and the involvement of psychologist in the care of depression, and of long-term pharmacotherapies and the involvement of psychiatrists in schizophrenia [11,16]. Data from studies comparing public beliefs about causes of mental disorders in different periods of time, suggest that there is now an increment in the endorsement of neurobiological factors as causes in both depression and schizophrenia. ...
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This study explored the opinions about depression and schizophrenia among Italian psychology students, and whether students’ opinions changed during education. Of the 705 students who read a description of depression (N = 275) or schizophrenia (N = 430) and then completed a questionnaire on their opinions about the disorder, 490 made a correct diagnosis (depression = 243/275; schizophrenia: 247/430) and were included in the study. Compared to schizophrenia-group students, depression-group students: more frequently mentioned psychosocial factors and less frequently heredity among the causes; were more convinced about the usefulness of psychological therapies and less about pharmacotherapies; had more prognostic optimism; had lower perception of unpredictability and dangerousness. Compared to first-year students, fifth-year students (depression = 105; schizophrenia = 162): in both diagnostic groups more frequently cited heredity among the causes; in depression group, had lower perception of unpredictability; in schizophrenia group, had higher perception of dangerousness and more prognostic pessimism. More education about stigma should be provided to psychology students. Download from Journal of Psychosocial Rehabilitation and Mental Health at: https://link.springer.com/article/10.1007/s40737-017-0087-8
... Despite this, the ''one size fits all'' approach remains. Biological psychiatry is currently seeking to impose, primarily via the ''Global Mental Health'' movement (Mills, 2014;Read, Haslam, & Magliano, 2013), Western ''medical model'' concepts and treatments on numerous countries and places including India, Pakistan, Bali, Nigeria and Malawi, and, within the United States, on African Americans and Latinos. Within this movement, whole cultures are being labelled as having poor ''mental health literacy'' (the degree to which one agrees with psychiatry's belief that one's distress is a manifestation of a biologically-based illness) and the ongoing use of culturally embedded explanations and recovery pathways is pathologised (Mills, 2014;Read et al., 2013;Tribe, 2014). ...
... Biological psychiatry is currently seeking to impose, primarily via the ''Global Mental Health'' movement (Mills, 2014;Read, Haslam, & Magliano, 2013), Western ''medical model'' concepts and treatments on numerous countries and places including India, Pakistan, Bali, Nigeria and Malawi, and, within the United States, on African Americans and Latinos. Within this movement, whole cultures are being labelled as having poor ''mental health literacy'' (the degree to which one agrees with psychiatry's belief that one's distress is a manifestation of a biologically-based illness) and the ongoing use of culturally embedded explanations and recovery pathways is pathologised (Mills, 2014;Read et al., 2013;Tribe, 2014). Essentially, local spiritual or social causal beliefs are characterised as misinformation or ignorance, and a typical conclusion of psychiatry's studies in this field (see Read et al., 2013) is the call for ''interventions aimed at increasing the mental health literacy of traditional healers'' (Sorsdahl, Fisher, Wilson, & Stein, 2010 ). ...
... Within this movement, whole cultures are being labelled as having poor ''mental health literacy'' (the degree to which one agrees with psychiatry's belief that one's distress is a manifestation of a biologically-based illness) and the ongoing use of culturally embedded explanations and recovery pathways is pathologised (Mills, 2014;Read et al., 2013;Tribe, 2014). Essentially, local spiritual or social causal beliefs are characterised as misinformation or ignorance, and a typical conclusion of psychiatry's studies in this field (see Read et al., 2013) is the call for ''interventions aimed at increasing the mental health literacy of traditional healers'' (Sorsdahl, Fisher, Wilson, & Stein, 2010 ). ...
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This project explored how Māori understand experiences commonly labelled “schizophrenic” or “psychotic”. Semi-structured interviews were conducted with 57 Māori participants who had either personal experiences labelled as “psychosis” or “schizophrenia”, or who work with people with such experiences; including tangata whaiora (users of mental health services), tohunga (traditional healers), kaumatua/kuia (elders), Māori clinicians, cultural support workers and students. Kaupapa Māori Theory and Personal Construct Theory guided the research within a qualitative methodology. The research found that participants held multiple explanatory models for experiences commonly labelled “psychotic” or “schizophrenic”. The predominant explanations were spiritual and cultural. It seems that cultural beliefs and practices related to mental health within Māori communities remain resilient, despite over a century of contact with mainstream education and health services. Other explanations included psychosocial constructions (interpersonal trauma and drug abuse), historical trauma (colonisation) and biomedical constructions (chemical brain imbalance). Participants (both tangata whaiora and health professionals) reported they were apprehensive about sharing their spiritual/cultural constructions within mainstream mental health settings due to fear of being ignored or pathologised. This study highlights the importance of asking users of mental health services about the meaning they place on their experiences and recognising that individuals can hold multiple explanatory models. Māori may hold both Māori and Pākehā (European) ways of understanding their experiences and meaningful recognition should be afforded to both throughout assessment and treatment planning in mental health services. Clinicians need to be aware that important personal and cultural meanings of experiences labelled psychotic may be withheld due to fear of judgement or stigmatisation.
... Bio-genetic beliefs (genetic, biochemical imbalance and brain disorder) have repeatedly been demonstrated to be related to increased stigma (e.g. belief in dangerousness and unpredictability or desire for social distance) or decreased expectation of recovery (Angermeyer et al., 2011;Kvaale et al., 2013;Read et al., 2006Read et al., , 2013a. ...
... In the Schomerus et al. (2014), study the relationship between belief in Childhood Adversities and desire for distance was mediated by increased perceptions of the affected person's differentness, dangerousness, responsibility for the onset of their difficulties and untreatability. They point out that this is contrary to the assumption that seeing mental health problems as understandable reactions to adverse life events should lead to increased acceptance (Read et al., 2006(Read et al., , 2013a, and suggest that unlike adult stress, childhood adversity may be understood in an essentialist way. People may believe that early trauma and stress produce irreversible effects and make people who experience them deeply, biographically different from others, just as biogenetic causes are seen as unchangeable and as making people fundamentally, biologically different (Bastian and Haslam, 2006;Haslam et al., 2004). ...
Article
Background Public beliefs about the causes of mental health problems are related to desire for distance and pessimism about recovery, and are therefore frequently studied. The beliefs of people receiving treatment are researched less often. Method An online survey on causal beliefs about depression and experiences with antidepressants was completed by 1829 New Zealand adults prescribed anti-depressants in the preceding five years, 97.4% of whom proceeded to take antidepressants. Results The most frequently endorsed of 17 causal beliefs were family stress, relationship problems, loss of loved one, financial problems, isolation, and abuse or neglect in childhood. Factor analysis produced three factors: ‘bio-genetic’, ‘adulthood stress’ and ‘childhood adversity’. The most strongly endorsed explanations for increases in antidepressant prescribing invoked improved identification, reduced stigma and drug company marketing. The least strongly endorsed was ‘Anti-depressants are the best treatment’. Regression analyses revealed that self-reported efficacy of the antidepressants was positively associated with bio-genetic causal beliefs, negatively associated with childhood adversity beliefs and unrelated to adulthood stress beliefs. The belief that ‘People cannot׳ get better by themselves even if they try’ was positively associated with bio-genetic beliefs. Limitations The convenience sample may have been biased towards a favourable view of bio-genetic explanations, since 83% reported that the medication reduced their depression. Conclusions Clinicians׳ should consider exploring patients׳ causal beliefs. The public, even when taking antidepressants, continues to hold a multi-factorial causal model of depression with a primary emphasis on psycho-social causes. A three factor model of those beliefs may lead to more sophisticated understandings of relationships with stigma variables.
... A biological approach to understanding people diagnosed with 'schizophrenia' has, for decades, dominated not only clinical services but also the way people with this diagnosis are viewed by medical professionals (Deacon, 2013;Larkings & Brown, 2018;Lebowitz & Ahn, 2014;Read, Haslam, & Magliano, 2013) and portrayed by the media (Magliano & Marassi, 2018;Robinson, Turk, Jilka, & Cella, 2019). Nevertheless, surveys in more than 20 countries, including Italy (Magliano, Fiorillo, De Rosa, Malangone, & Maj, 2004;Read, Magliano, & Beavan, 2013), find that the public (including people with a diagnosis of 'schizophrenia' and their families) endorse psychosocial causes far more than biogenetic ones (Read, Haslam, Sayce, & Davies, 2006;Schomerus et al., 2012). ...
... Presenting schizophrenia as 'a disease like any other', that is, equating the experience of psychosis with that of having a physical disease, was intended to improve social acceptance of 'schizophrenics' by reducing blame for this condition. In fact, explaining schizophrenia as caused by genetic factors, chemical imbalances, and brain anomalies causes prognostic pessimism, perceptions of dangerousness and unpredictability, and desire for social distance from these people (Angermeyer & Matschinger, 2005;Haslam, 2011;Kvaale, Haslam, & Gottdiener, 2013;Read, Haslam et al., 2013). ...
Article
Objectives: To examine the causal beliefs about schizophrenia of non-psychiatric doctors and whether differential belief in biogenetic vs. psychosocial causes influences doctors' views about treatments and prognosis. Design and methods: Three hundred and five non-psychiatric doctors working in outpatient community centres completed the 'Opinions on mental disorders Questionnaire' after reading a clinical description of people with schizophrenia. Results: The factors most frequently reported as causes of schizophrenia were heredity (65.2%) and use of street drugs (54.1%). Seventy-five per cent of participants endorsed both one or more biological causal factors and one or more psychosocial causal factors. Of the 264 participants who expressed their opinion about the most important cause of schizophrenia, 53.8% indicated a biogenetic cause. Fifty-two per cent of respondents thought it 'completely true' that drugs are useful in schizophrenia, and 33.9% thought it 'completely true' that people with schizophrenia must take drugs all their life. Participants stating that the most important cause was biogenetic more frequently recommended a psychiatrist and less frequently a psychologist. Compared to doctors who indicated a psychosocial cause as the most important one, those who indicated a biogenetic cause were more sceptical about recovery, more confident in the usefulness of drugs, and more convinced of the need of lifelong pharmacological treatments in schizophrenia. Conclusions: These findings suggest the need to provide some doctors with training on the multiple, interacting causes of schizophrenia and the efficacy of the broad range of available treatments. The education of health professionals regarding stigma and its effects on clinical practice is also needed. Practitioner points: Viewing schizophrenia as mainly due to a biological cause is associated with greater confidence in the usefulness of drugs, higher belief in the need for lifelong pharmacological treatments, and greater prognostic pessimism. Belief in a biologically oriented model of schizophrenia may lead doctors to underestimate the value of psychologists. Prognostic pessimism among doctors may negatively influence clinical decisions, the information doctors provide to their clients, and clients' own beliefs about their chances of recovery. Belief in the need for lifelong pharmacological treatments in schizophrenia may lead doctors to resist drug withdrawal in case of severe side effects.
... This is not just academic. Labels like 'schizophrenia' can, like the biogenetic causal beliefs that tend to accompany them, destroy lives, through prejudice, fear and prognostic pessimism [17][18][19]. ...
... Despite all this, biological psychiatry is trying to expand the reach of what others consider to be an unscientific, reductionist, simplistic and pessimistic 'medical model'. Some psychiatrists have bemoaned what they call the poor 'mental health literacy' (i.e., one's willingness to agree with biological psychiatrists about the causes of human distress), not only of people in their own countries and cultures, but of people in numerous 'developing' countries, including India, Pakistan, Bali, Nigeria and Malawi [18]. Terms like 'misinformation' and 'lack of knowledge' are used to describe spiritual and social causal beliefs. ...
... Historically, the convergence of neuroscience and genomics to tackle psychosis has been situated in an overly-polarised cultural milieu, which is very different from the one found in physical health. The fight between biological and psychosocial approaches to mental illness has been raging for decades and it is far from being resolved [20,21]. Within this fight, biological psychiatrists often see the implementation of neuroimaging and genomics as a mandatory step towards the development of effective treatments and public health agendas, whilst psychosocial scholars tend to reject such framings on ethical and political grounds [9,22]. ...
... Several scholars argue that translating neuroimaging and genomics into psychiatry is imperative, given the burden of mental illness on population health [9,65]. Conversely, psychosocial researchers often criticise the expansion of neurobiological approaches to psychosis on ethical and even political grounds [21]. As an exercise of aetiological neutrality, this study suggests that the ethical implications of biomedical innovation in psychiatry may go beyond this, even though extremely important, normative issue. ...
Article
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Background The convergence of neuroscience, genomics, and data science holds promise to unveil the neurobiology of psychosis and to produce new ways of preventing, diagnosing, and treating psychotic illness. Yet, moral challenges arise in neurobiological research and in the clinical translation of research findings. This article investigates the views of relevant actors in mental health on the moral challenges of accessing neurobiological information in the context of psychosis. Methods Semi-structured individual interviews with two groups: researchers employed in the National Health Service (NHS) or a university in England ( n = 14), and mental health professionals employed in NHS mental health services ( n = 14). This article compares results in the two groups (total n = 28 ). Results This article presents findings around three conceptual areas: (1) research ethics as mostly unproblematic, (2) psychosis, neurobiological information, and mental health care, and (3) identity, relationships, and the future. These areas are drawn from the themes and topics that emerged in the interviews across the two groups of participants. Researchers and health professionals provided similar accounts of the moral challenges of accessing—which includes acquisition, communication, and use of—neurobiological information in the context of psychosis. Acquiring neurobiological information was perceived as mostly unproblematic, provided ethical safeguards are put in place. Conversely, participants argued that substantive moral challenges arise from how neurobiological information is delivered—that is, communicated and used—in research and in clinical care. Neurobiological information was seen as a powerful tool in the process through which individuals define their identity and establish personal and clinical goals. The pervasiveness of this narrative tool may influence researchers and health professionals’ perception of ethical principles and moral obligations. Conclusions This study suggests that the moral challenges that arise from accessing neurobiological information in the context of psychosis go beyond traditional research and clinical ethics concerns. Reflecting on how accessing neurobiological information can influence individual self-narratives will be vital to ensure the ethical translation of neuroscience and genomics into mental health. Trial registration The study did not involve a health care intervention on human participants. It was retrospectively registered on 11 July 2018, registration number: researchregistry4255.
... Cet article analyse les liens entre la participation aux groupes d'entendeurs et d'Entendeuses de voix (EV) et la manière dont les EV parlent de leurs voix. L'entente des voix est un phénomène fortement stigmatisé socialement qui s'accompagne de préjugés selon lesquelles les voix sont «irréelles», des productions d'un cerveau dérangé et d'un esprit délirant de la part de personnes perçues comme imprévisibles, voire dangereuses (Read et al., 2013). Dans le milieu médical, l'approche qui a longtemps prédominé est de faire taire les voix par la médication et de ne pas aborder l'expérience des voix de peur de rendre cette expérience plus réelle et d'accentuer la détresse des personnes (Longden, 2017). ...
Article
Dans le milieu médical, l'approche qui a longtemps prédominé à l'égard des voix est de les faire taire par la médication et de ne pas aborder le sens qu'elles ont pour les personnes de peur d'alimenter l'entente des voix et la détresse des personnes. Une des conséquences de cette situation est que les personnes disposent essentiellement des termes proposés par la psychiatrie - délires, hallucinations, symptômes, maladie, diagnostic - pour parler de leurs voix, ce qui peut avoir pour effet d'enfermer la parole des personnes dans le discours médi-cal. Dans les groupes d'entendeurs de voix, les personnes reprennent la parole dans un es-pace sécuritaire entre pairs et développent leurs propres explications à propos de leurs voix. L'article décrit les retombées positives de ce processus qui permet l'ouverture à un plura-lisme explicatif psychologique et parapsychologique des voix. Nous soulignons néanmoins la persistance des explications médicales des voix au sein de ces groupes en raison de leur so-cialisation de long terme au langage psychiatrique et de l'autorité des discours médicaux. Mots clés: groupes d'entendeurs de voix; pluralisme explicatif; récit; santé mentale; multisi-gnification; injustices épistémiques.
... Previous research has consistently shown that social stigmatization is stronger toward people diagnosed with schizophrenia compared to other mental health problems (Crisp et al., 2000). This is not surprising given that negative stereotypes of dangerousness and fears of potential violence associated with schizophrenia are highly prevalent in public perceptions (Link et al., 1999;Read et al., 2013). There is recent meta-analytic evidence for a negative relationship between stigma and subjective quality of life among people diagnosed with psychosis (Degnan et al., 2021) whilst previous research has documented social stigma as a barrier to service users' recovery (Link, Struening, et al., 2001) and social inclusion (Corrigan & Watson, 2002). ...
Article
Stigma is detrimental to persons experiencing mental distress, as it impacts on their social inclusion, quality of life, and recovery. In this article, we present the self‐presentation strategies employed by persons with psychosis to manage internalized stigma. A study of the life trajectories of persons with psychosis analyzed 27 biographical interviews and identified five types of biographical trajectories. This article focuses on one biographical type, represented by six narratives. Participants placed in this biographical type struggle to portray a socially acceptable self through concealing experiences of distress and distancing the self from the psychiatric label they entail. This was achieved through several strategies, including the normalization of prior life, unwillingness to disclose psychotic experiences, unquestioning compliance with psychiatric medication, and presenting oneself as an ordinary person. Fostering more adaptive coping strategies to reduce internalized stigma may be a potential goal for psychosocial interventions.
... Such campaigns adopt a "mental illness is an illness like any other" message (Read, Haslam, Sayce, & Davies, 2006). However, Psychosis 11 literature reviews conclude that this approach increases perceptions of service-users as dangerous and unpredictable and increases fear and social distance (Read et al., 2006;Read, Haslam, & Magliano, 2013). Psychosocial approaches to understanding mental health engender a more favourable view towards service-users among the public. ...
Article
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Aims: This study aimed to conduct a systematic review of the qualitative literature to understand stigma from a service-user perspective.Method: A thematic synthesis of nine studies examining service-users’ experiences of stigma was conducted. Studies were included if they used a qualitative methodology to examine experiences of stigma as a primary research question with participants who have personal experience of psychosis.Results: Two overarching themes were identified; the stigma system and stigma processes. The stigma system highlighted the multi-layered social system which can cause and maintain stigma. Five sub-circles of the stigma system were detailed including the individual, family, friends, community and society. Stigma processes are the mechanisms which contribute to the development of stigma and to how it can be overcome. Eight sub-themes of stigma processes were included broadly pertaining to acceptance, kindness, communication, education and understanding within all areas of the individuals’ social system.Conclusion: Stigma is embedded in the individual’s social system and involves a number of distinct processes. While individualised interventions may be effective in preventing or alleviating the internalisation of stigma, it is clear that wider systemic or societal interventions are also required.
... One set of beliefs that has been studied extensively, is beliefs about the causes of depression, largely because causal beliefs are considered central to stigma. Contrary to the hopes of the designers of destigmatisation programmes based on the 'mental illness is an illness like any other' notion, which promote biogenetic causal explanations, such illness-type beliefs have been consistently shown to increase fear and prejudice and decrease expectation of recovery (Angermeyer et al., 2011;Kvaale et al., 2013;Read et al., 2006Read et al., , 2013Schomerus et al., 2014). ...
Article
The beliefs of people receiving treatment about the causes of their own mental health problems are researched less often than the causal beliefs of the public, but have important implications for relationships with prescribers, treatment choices and recovery. An online survey on a range of beliefs about depression, and experiences with antidepressants, was completed by 1829 New Zealand adults prescribed anti-depressants in the preceding five years, 97.4% of whom proceeded to take antidepressants. Six of 17 beliefs about the causes of their own depression were endorsed by more than half the sample: chemical imbalance, family stress, work stress, heredity, relationship problems and distressing events in childhood. There were some marked differences in content, structure and level of conviction of beliefs about one׳s own depression and the sample׳s previously published beliefs about depression in general. There were also significant differences between the beliefs of demographic groupings. Regression analyses revealed that self-reported effectiveness of the antidepressants was positively associated with bio-genetic causal beliefs. The quality of the relationship with the prescribing doctor was positively related to a belief in chemical imbalance as a cause and negatively related to a belief in unemployment as a cause. The convenience sample may have been biased towards a favourable view of bio-genetic explanations, since 83% reported that the medication reduced their depression. People experiencing depression hold complex, multifactorial and idiosyncratic sets of beliefs about the causes of their own depression, apparently based at least in part on their own life experiences and circumstances. Exploring those beliefs may enhance the doctor-patient relationship and selection of appropriate treatment modality. Copyright © 2014 Elsevier B.V. All rights reserved.
... Over-emphasising diagnosis also increases mental healthrelated stigma 66 . Presenting an understanding as 'how it really is' reinforces the idea of a meaningful gap between two groups (the 'mad' and the 'sane'). ...
... Over-emphasising diagnosis also increases mental health-related stigma [67]. Presenting an understanding as 'how it really is' reinforces the idea of a meaningful gap between two groups (the 'mad' and the 'sane'). ...
Article
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Background: Two discourses exist in mental health research and practice. The first focuses on the limitations associated with disability arising from mental disorder. The second focuses on the possibilities for living well with mental health problems. Discussion: This article was prompted by a review to inform disability policy. We identify seven findings from this review: recovery is best judged by experts or using standardised assessment; few people with mental health problems recover; if a person no longer meets criteria for a mental illness, they are in remission; diagnosis is a robust basis for characterising groups and predicting need; treatment and other supports are important factors for improving outcome; the barriers to receiving effective treatment are availability, financing and client awareness; and the impact of mental illness, in particular schizophrenia, is entirely negative. We selectively review a wider range of evidence which challenge these findings, including the changing understanding of recovery, national mental health policies, systematic review methodology and undertainty, epidemiological evidence about recovery rates, reasoning biased due to assumptions about mental illness being an illness like any other, the contested nature of schizophrenia, the social construction of diagnoses, alternative explanations for psychosis experiences including the role of trauma, diagnostic over-shadowing, stigma, the technological paradigm, the treatment gap, social determinants of mental ill-health, the prevalence of voice-hearing in the general population, and the sometimes positive impact of psychosis experience in relation to perspective and purpose. Conclusion: We propose an alternative seven messages which are both empirically defensible and more helpful to mental health stakeholders: Recovery is best judged by the person living with the experience; Many people with mental health problems recover; If a person no longer meets criteria for a mental illness, they are not ill; Diagnosis is not a robust foundation; Treatment is one route among many to recovery; Some people choose not to use mental health services; and the impact of mental health problems is mixed.
... Imprevedibili, pericolose, affette da malattie inguaribili. Sono questi i luoghi comuni che rendono più difficile per le persone con problemi di salute mentale riprendersi ed essere accettate nei contesti lavorativi, affettivi e sociali (1). ...
Article
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Riassunto. Obiettivi. Le persone con disturbi mentali gravi hanno un ridotto accesso ai servizi sanitari e ai programmi di prevenzione e ricevono spesso cure più scadenti degli altri cittadini. Queste disuguaglianze, spesso legate allo stigma che accompagna la malattia mentale, sovrapponendosi ai possibili fattori di rischio derivanti da stili di vita non sani sono causa di maggiore morbilità e mortalità. Il presente contributo descrive le principali discriminazioni sanitarie nei confronti delle persone con disturbi mentali e riporta buone pratiche e strategie organizzative raccomandate per ridurre i gap di accesso, trattamento e mortalità. Metodi. Revisione narrativa su stigma e strategie per contrastare le discriminazioni in ambito sanitario nei confronti delle persone con disturbi mentali gravi. Risultati. Il personale sanitario, non immune da pregiudizi, appare poco consapevole delle misure organizzative da adottare in risposta ai bisogni di salute di cittadini con disturbi mentali gravi. La formazione universitaria ha effetti solo limitati nel ridurre atteggiamenti negativi e discriminatori. Appaiono necessarie strategie formative e informative da realizzare in compartecipazione con utenti e familiari e in sinergia tra servizi di salute mentale, cure primarie e altri dipartimenti territoriali e ospedalieri. Buone pratiche raccomandate per contrastare le discriminazioni e incrementare la responsiveness sono il coordinamento, la comunicazione e la continuità assistenziale tra servizi sociali e sanitari, e l’inclusione della salute mentale in una cornice multidisciplinare di cura alla persona, in stretto collegamento con le cure primarie. Conclusioni. Le evidenze sull’efficacia di specifiche strategie per migliorare la salute delle persone con disturbi mentali gravi sono ancora carenti. Tuttavia, nel predisporre modelli organizzativi basati sulla medicina di iniziativa, potenzialmente in grado di rispondere ai bisogni delle persone più vulnerabili e discriminate, sembrano emergere alcune raccomandazioni: prevedere una funzione di raccordo e orientamento attraverso i percorsi preventivi e curativi della rete sanitaria; rafforzare la condivisione dei processi tra medici di medicina generale, centri di salute mentale, altri servizi specialistici; potenziare il partenariato con l’associazionismo. Approcci così orientati si stanno sperimentando in alcune realtà, come ad esempio nelle Case della salute dell’Emilia-Romagna. Parole chiave. Disturbi mentali, stigma, tutela della salute. Abstract. Objectives. People with severe mental disorders are at high risk of stigma in many life domains. Within the healthcare system, discriminatory behaviors lead to lower access to services and preventive programs, as well as to poorer quality of care. This entails higher prevalence of physical comorbidities and premature death due to other risk factors, such as unhealthy lifestyles. The present paper aims at describing the most critical healthcare discriminations towards people with mental disorders, as well as some examples of best practices and strategic decisions recommended to reduce inequalities in access to services and mortality. Methods. Narrative review on stigma and management strategies recommended to hinder healthcare discriminations towards people with severe mental health disorders. Results. Health professionals are not immune to stigma nor are they fully aware of organizational measures required to meet the complex health needs of people with mental disorders. Given the limited impact of the university curricula on professionals’ negative attitudes, further ad-hoc educational programs are needed in healthcare systems, including the participation of users representatives, to involve mental health and primary care services, besides other community and hospital departments. Best practices aimed at reducing healthcare discriminations and increasing the responsiveness of the health system should include key-ingredients, such as coordination and continuity of care among social and health services and multidisciplinary health care, based on the integration of specialized mental and physical health services with primary health services. Conclusions. Evidence on the efficacy of measures aimed at improving the health of people with severe mental disorders is scanty. However, in order to move towards proactive medicine and to meet the healthcare needs of the most vulnerable and discriminated ones, it seems crucial to coordinate different levels of preventive and therapeutic activities across the whole network of health services. Furthermore, it would be necessary to strengthen and share the mental health pathways of care with the other stakeholders, also including active involvement of citizens and partnership with users’ organizations. The Houses of health in the Emilia-Romagna Region might represent an organizational example of such a model. Key words. Mental disorders, physical healthcare, stigma.
... We need much more information on long-term consequences before we deem it safe to continue prescribing these techniques Furthermore, believing you have a brain disease requiring medical intervention can be profoundly disempowering. It encourages people to view themselves as the victims of their biology, to adopt pessimistic views about recovery, increases self-stigma and discourages people from taking active steps to improve their situation (Deacon & Baird, 2009;Kemp, Lickell, & Deacon, 2014;Read, Haslam, & Magliano, 2013). Amongst the general population and mental health professionals biological causal beliefs (genetic, biochemical imbalance etc.) about 'mental health problems' have been consistently linked to negative attitudes (Kvaale, Haslam, & Gottdiener, 2013;Lebowitz & Ahn, 2014;. ...
Article
The dominant view within mental health services and research suggests that feeling depressed is a kind of medical illness, partially caused by various biological deficits which are somehow corrected by physical interventions. This article critically appraises evidence for the effectiveness and value of antidepressant drugs and electroconvulsive therapy (ECT), the two principle physical treatments recommended for depression. It also describes the negative effects of these interventions and raises concerns about how they impact the brain. We propose an alternative understanding that recognises depression as an emotional and meaningful response to unwanted life events and circumstances. This perspective demands that we address the social conditions that make depression likely and suggests that a combination of politics and common sense needs to guide us in providing help for one another when we are suffering in this way. This alternative view is increasingly endorsed around the world, including by the United Nations, the World Health Organization and service users who have suffered negative consequences of physical treatments that modify brain functions in ways that are not well-understood.
... The Neo-Kraepelin model has based its research on a biological and genetic idea of mental disorders. At present this paradigm has not been supported (Moskowitz 2011, Ross 2016, Read et al. 2013. Despite the fact that numerous research data has demonstrated the long-term deleterious effects of psychotropic drugs (Gøtzsche 2015, Longden and Read 2016) and there is no evidence of the theoretical model based on chemical imbalances (Council for Evidence-based Psychiatry 2014), the central paradigm of psychiatry has not undergone major changes. ...
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Since the early twentieth century dissociative disorder has undergone a decline and since the seventies the field of psychiatry has begun its path of medicalization. Dissociative disorders are complex disorders that activate within the therapeutic setting specific dynamics related to traumatic family relationships. Recognizing and dealing with it becomes necessary before defining any pharmacological treatment. This paper aims to review some crucial issues on the history of dissociative disorders and medical model of mental disorders. The article wants also to highlight the importance of the therapeutic alliance specifically in the first contacts with dissociative patients, the main role of the psychotherapist in treating Dissociative Identity Disorders (DID) and it wants to suggest some strategies to cope with these patients in the integrated settings of therapy.
... The outsiders' interpretation was that psychosis was partly portrayed as comparable to physical illness. This seems to communicate that psychosis is something that one should not be ashamed of, and in the same way as with physical illnesses-the victim is not to blame [54]. The effects on reducing stigma by stressing that psychosis is an illness like other illnesses have later been questioned [55,56]. ...
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Background Intervening at an early stage of psychosis improves the chances of recovery from first-episode psychosis. However, people who are experiencing distress and early psychotic symptoms generally seem to delay seeking help. Therefore, multifaced information campaigns targeting help-seeking behavior of potential patients and their network are considered important tools within early detection and intervention strategies. In this study, we aimed to explore which discursive meaning content, including roles and actors, such information campaigns build on and construct. Our intention was not to provide objective answers, but to contribute to a discursive debate about potential conflicts in messages conveyed in such campaigns. Methods A broad sample of information material utilized by TIPS Stavanger University Hospital (Norway) was examined. The material consisted of posters, booklets and brochures, newspaper ads, Facebook ads, and TIPS Info’s website, representing various campaigns from 1996 to April 2018. A narrative discursive approach was applied at an epistemological level. At a practical level, a team-based thematic analysis was utilized to identify patterns across data. Results Diversity and several changes in strategy were recognized throughout the information material. Furthermore, three main themes and four subthemes were found to constitute the meaning content built in the information campaigns: knowledge is key; (almost) an illness among illnesses; and we all have a responsibility (comprising of the subthemes; to respond quickly; to step in; to provide an answer; and to tag along). Conclusion Our findings pointed to common dilemmas in mental health services: How to combine professional expert knowledge with collaborative practices that emphasize shared decision-making and active roles on behalf of patients? How to combine a focus on symptoms and illness and simultaneously express the importance of addressing patients’ recourses? And how can we ask for societal responsibility in help-seeking when professionals are placed in expert positions which may not be optimal for dialogue with potential patients or their network? We discuss whether highlighting practices with more weight on resources and active roles for patients and their surroundings in information campaigns could promote earlier help-seeking. Electronic supplementary material The online version of this article (10.1186/s13033-019-0289-4) contains supplementary material, which is available to authorized users.
... However, findings reveal that the biogenetic approach has consistently been shown to result in a number of negative outcomes, such as increased prejudice and stigmatization, fear, and desire for social distance (e.g., Angermeyer et al., 2011Angermeyer et al., , 2013Angermeyer & Dietrich, 2006;Angermeyer & Matschinger, 2005;Kvaale et al., 2013;Longden & Read, 2017;Read, 2020;Read et al., 2006Read et al., , 2013Read & Harper, 2020;Read & Harre, 2001;. For instance, Yao and colleagues found that increased biogenetic beliefs were related to an increase in close others' desire for social distance through increased perceptions of affiliate stigma, the fear of being associated with those with schizophrenia, among a sample of Chinese community residents. ...
Article
Background: The biogenetic approach in mental health stigmatization reduction has received increased attention. Taking the perspective of Weiner’s attribution theory, the biogenetic explanations can be helpful in reducing the perceptions of controllability of mental illnesses (e.g., schizophrenia). However, recent studies reveal that biogenetic explanations may increase social stigma and discrimination against people with schizophrenia. Aims: The current research, using Weiner’s attribution theory, empirically examined the effects of biogenetic beliefs on the desire for social distance via perceptions of controllability and stability of schizophrenia using a Chinese sample. Methods: A cross-sectional study (n=156) and an experiment (n=124) were carried out. Participants were recruited from an urban city in China. In the experiment, participants were randomly assigned to receive a biogenetic/control lecture and filled out a survey. Results: Biogenetic beliefs had indirect effects on the desire for social distance via decreased perceived controllability and increased perceived stability, which resulted in little to no change on the desire for social distance. Conclusion: The biogenetic approach could decrease the perceptions of controllability of schizophrenia which may reduce the desire for social distance; however, it could also increase the perceptions of stability which may increase the desire for social distance, especially among close others. Cautions are warranted when using and disseminating the biogenetic causes of schizophrenia amongin the general public.
... Our findings showed that biological etiological beliefs about schizophrenia lead to more negative attitudes in MHP. The role of the bio-genetic ideology is well known as a main predictor of mental illness stigma in general population and persons with mental illness (for a review, see Larkings and Brown, 2018;Read et al., 2013;Rüsch et al., 2010;Schomerus et al., 2014). Despite this, many anti-stigma programs use bio-genetic arguments, as "mental illness is an illness like any other" approach, increasing perceptions of dangerousness and unpredictability, fear and desire for social distance (for a review, see Read et al., 2006): "When the disease model is applied to the brain, the assumption is that the person is incapable of judgments, reason, autonomythat their personhood is negated" (p 311, Read et al., 2006). ...
Article
Background : The consequences of schizophrenia stigma are numerous and highly damaging to individuals, their families, the health care system and society. Mental health professionals (MHP) are considered to be one of the main sources of stigmatization. Objectives : To identify the characteristics of MHP stigma in schizophrenia in comparison with other psychiatric disorders, the specificities of MHP compared with other social groups, and associated factors. Methods : Following PRISMA guidelines, we systematically searched multiple electronic databases for articles: (i) reporting original data published in English in peer-reviewed journals, (ii) reporting quantitative data with statistical analysis, (iii) assessing stigma in a broad sense, and (iv) including samples composed only of MHP. Results : A total of 38 articles published from 1999 to 2019 and involving 10926 MHP fulfilled our inclusion criteria. Studies showed that schizophrenia is the most stigmatized mental illnesses in MHP, despite recent results suggesting that borderline personality disorder and substance abuse may be more stigmatized. In comparison with other social groups, MHP reported less dangerousness beliefs and more positive beliefs regarding pharmacological treatment. Nevertheless, results were less consistent regarding prognosis and desire for social distance. Age, education level, type of mental health profession, or length of practice were associated factors that showed inconsistent relations with stigma. Work setting and biological causal beliefs were more clearly associated with MHP stigma. Conclusion : These findings provide strong support for the need to conduct specific research on schizophrenia stigma in MHP and the importance of controlling for several variables to identify predictors of stigma.
... Those with superficial experiential knowledge can be quite ineffectual mediators or 'brokers' in the politics of experience as a result (Boyce, 2016), failing to retain nuance regarding recovery journeys throughout their negotiations with publics and funding bodies. For instance, celebrities who advocate that mental illness is 'an illness like any other' often end up increasing rather than decreasing stigma by reflecting back the very same discourses of individualism and biogenetic causality that underlie prejudice against those diagnosed with mental illnesses (Read et al, 2013). ...
Article
This article argues that words like “psychosis” and “schizophrenia” create the illusion of an explanation for certain behaviors and thoughts but actually explain nothing. Hearing distressing voices and feeling very paranoid do not occur because someone has something called “schizophrenia” that causes them to act in certain ways, although many psychiatrists still cling to this delusion. The behaviors and thoughts that experts in some cultures label psychotic or schizophrenic are usually understandable reactions to our life events and circumstances. So rather than ask, “What is wrong with you?” and “What shall we call it?” It is more sensible, and useful, to ask, “What happened to you?” and “What do you need?”
Article
This study examines whether medical students' views of treatments for 'schizophrenia' and of patients' rights to be informed about their condition and their medication were influenced by diagnostic labeling and causal explanations and whether they differed over medical training. Three hundred and eighty one Italian students attending their first or fifth/sixth year of medical studies read a vignette portraying someone who met diagnostic criteria for 'schizophrenia' and completed a self-report questionnaire. The study found that labeling the case as 'schizophrenia' and naming heredity among its causes were associated with confidence in psychiatrists and psychiatric drugs. Naming psychological traumas among the causes was associated with confidence in psychologists and greater acknowledgment of users' right to be informed about drugs. Compared to first year students, those at their fifth/sixth-year of studies more strongly endorsed drugs, had less confidence in psychologists and family support, and were less keen to share information on drugs with patients. These findings highlight that students' beliefs vary during training and are significantly related to diagnostic labeling and belief in a biogenetic causal model. Psychiatric curricula for medical students should include greater integration of psychological and medical aspects in clinical management of 'schizophrenia'; more information on the psychosocial causes of mental health problems.
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This study explored the influence of an educational intervention addressing common prejudices and scientific evidence about schizophrenia on medical and psychology students' views of this disorder. The intervention - consisting in two three-hour lessons with an interval of a week between - was run at first for medical students and then for psychology students. Participants' views of schizophrenia were assessed at baseline vs. at post intervention by matched questionnaires. At medical school, participation was voluntary and also included a six-month online re-assessment, while at psychology school, participation was mandatory. A total of 211 students attended the educational initiative. At post intervention assessment, students more frequently mentioned psychosocial causes of schizophrenia, and more firmly believed that recovery in schizophrenia is possible and that persons with this disorder are not unpredictable and dangerous vs. their baseline assessment. The online six-month assessment confirmed favourable changes in medical students' views found at post intervention. These results confirm that an educational intervention including personal experiences and scientific evidence can be successful in reducing students' prejudices toward persons with schizophrenia.
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In almost all countries the public prefers psycho-social explanations of 'schizophrenia' to bio-genetic ones. The causal explanations of people who experience psychosis have been under-researched, and, if they diverge from the dominant bio-genetic paradigm, can be dismissed as 'lack of insight'. 701 people, from 30 countries, who completed an online survey about their experiences on antipsychotics, answered an open question about what had caused the problems for which they had been prescribed the drugs. On a 'Bio-Social' likert scale, from 1 = 'Purely Biological' to 5 = 'Purely Social', the mean score was 4.24. Thematic analysis of 1,063 causal statements produced seven themes: Social (49.9%), Psychological (12.1%), Bio-genetic (11.6%), Iatrogenic (11.3%), Drug and Alcohol (6.7%), Medical Condition (4.5%) and Insomnia (4.0%). Respondents were 13 times more likely to report predominantly or exclusively Social causes as to report predominantly or exclusively Bio-genetic causes. Those with a psychosis diagnosis were even more likely than others to report a Social cause. The causal beliefs of this sample are consistent with previous studies of people diagnosed with 'schizophrenia' and the beliefs of the public. They are also aligned with recent research into the social causes of psychosis. It is argued that rather than dismiss the beliefs as 'lack of insight' it is more respectful and productive to listen carefully and adjust our understandings and services accordingly.
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This study explored views of 566 Italian psychology students about schizophrenia. The most frequently cited causes were psychological traumas (68 %) and heredity (54 %). Thirty-three percent of students firmly believed that people with the condition could recover. Reporting heredity among the causes, and identifying schizophrenia were both associated with prognostic pessimism, greater confidence in pharmacological treatments and lower confidence in psychological treatments. Schizophrenia labeling was also associated with higher perception of unpredictability and dangerousness. Compared to first year students, fourth/fifth year students more frequently reported heredity among the causes, and were more pessimistic about schizophrenia recovery. Stigma topics should be included in future psychologists' education.
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The review paper focuses on mental health and illness as one of public health challenges in the 21 st century. Main epidemiological data and strategies discussed on both national and European level are shortly presented. The main emphasis is than given to overview of recent findings from disciplines such as critical psychiatry, developmental psychology, neuroscience, trauma and social studies. The current knowledge from those disciplines is still rarely included in general medicine and psychiatry, particularly in those European countries, in which a narrow biological model dominates medicine, and in which the transformation of mental health care system has not been accomplished. However, the reviewed findings seem to provide both critical reflection of biological model in psychiatry and better understanding of the complexity of mental health/illness issues. It is argued throughout the text, that such findings inevitably call for a bio-psycho-social approach in both prevention and treatment of mental disorders. On top of that, integrating the reviewed findings into a new framework of mental health/illness may lead to a development of more effective prevention strategies and well-functioning, multileveled mental health services.
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Suicide is a significant issue worldwide and despite comprehensive prevention activities, suicide stigma remains. To explore this issue, we used critical discourse analysis to examine how Australian suicide prevention documents (n = 8) constructed people living with thoughts of suicide. We found that risk and biomedical discourses dominated, with people experiencing suicide ideation constructed as dangerous, different, lacking coping skills, and burdensome. We propose that future suicide prevention activities address potentially stigmatizing language, broaden support and advocacy options, and meaningfully include people with lived experience of suicidal ideation or behavior in the development of policy and interventions.
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Background General practitioners (GPs) play a key role in the care of somatic and psychiatric problems in people diagnosed with schizophrenia (PWS). It is probable that, like other health professionals, GPs are not all free of prejudices toward PWS. In clinical practice, GPs sometimes interact with clients diagnosed with schizophrenia by specialists, passively accepting this diagnosis. Other times, GPs interact with clients having symptoms of schizophrenia but who have not been diagnosed. In this case, GPs are expected to actively make a diagnosis. Giving the key role of GPs in the process of care, it is worthwhile examining whether passive acceptance and active usage of the diagnosis schizophrenia have differential effects on GPs’ attitudes toward people with this disorder. Aims To investigate GPs’ views of schizophrenia and whether they were influenced by a ‘schizophrenia’ label, passively accepted or actively used. Methods A total of 430 randomly selected GPs were invited to complete a questionnaire about their views of schizophrenia, either after reading a description of this disorder and making a diagnosis, or without being provided with a description but passively accepting the label ‘schizophrenia’ given in the questionnaire. Results The GPs who passively accepted the label schizophrenia ( n = 195) and those who actively identified schizophrenia from the description ( n = 127) had similar views. Compared to the GPs who did not identify schizophrenia in the description ( n = 65), those who used the diagnosis, actively or passively: more frequently reported heredity and less frequently psychosocial factors as causes of the disorder; were more skeptical about recovery; were more convinced of the need for long-term pharmacotherapies; believed more strongly that PWS should be discriminated against when in medical hospital; and perceived PWS as more dangerous and as kept at greater social distance. Conclusion The diagnosis ‘schizophrenia’, however used, is associated with pessimistic views. Stigma education should be provided to GPs.
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Sinossi: sono qui riportati i risultati preliminari di uno studio sull'effetto di un intervento educativo sulle opinioni dei futuri psicologi in merito alle persone con schizofrenia (PCS), erogato in DAD durante la pandemia di COVID-19. L'intervento, sviluppato in collaborazione con persone con disturbo mentale grave, è stato utilizzato con studenti del secondo anno della Laurea Magistrale in Psicologia Applicata dell'Università della Campania. Prima dell'intervento e a un mese dal suo completamento, ai partecipanti è stato chiesto di compilare il Questionario online sulle Opinioni sui disturbi mentali. Rispetto alle valutazioni iniziali (N=65), al follow-up (N=62) gli studenti sono risultati: più convinti dell'utilità degli interventi psicologici, della possibilità di guarigione nella schizofrenia e della capacità delle PCS di riferire i propri disturbi mentali allo psicologo; più scettici sulla pericolosità, imprevedibilità e necessità di trattare le PCS diversamente dagli altri clienti. Abstract: here are reported preliminary results of a study on the effect of an intervention to improve psychology students' views of persons with schizophrenia (PCS), provided by using a digital platform during the COVID-19 pandemic. The intervention, developed with the collaboration of persons with severe mental disorder, was administered to second-year students of the Master Degree of Applied Psychology at the University of Campania. Before the intervention and one month from its completion, participants were asked to complete online the Questionnaire on the Opinions about mental disorders. Compared to the initial assessments (N=65), at follow-up (N=62) students were: more convinced of the usefulness of psychological interventions and the possibility of recovery in schizophrenia and the ability of PCS to refer their mental disorders to the psychologist; more skeptical about the dangerousness and unpredictability of PCS and the need to treat them differently from other clients.
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Resumen: El artículo parte de la preocupación por los efectos negativos, constatados en múltiples publicaciones internacionales, que el estigma tiene sobre la calidad de la atención que reciben las personas con esquizofrenia en el ámbito de los servicios sanitarios y en relación con su salud física, frecuentemente deteriorada. Como consecuencia del desconocimiento sobre las causas y características de esta enfermedad y las ideas erróneas que muchos profesionales comparten con la población general sobre la peligrosidad e incurabilidad de las personas afectadas por este trastorno, son habitualmente objeto de falta de respeto y mala atención en los servicios sanitarios generales. Un momento importante para mejorar la información y corregir las ideas erróneas es el periodo de formación de los profesionales y a ese respecto se presentan los primeros resultados de una experiencia piloto, desarrollada entre estudiantes de Medicina de una Universidad italiana, consistente en la inclusión de un curso breve sobre el estigma y la esquizofrenia. Aunque los resultados deben ser confirmados por otros estudios, permiten constatar los evidentes cambios positivos que se producen en el conocimiento y las actitudes de los estudiantes con una breve intervención educativa, asociada a la participación de usuarios, confirmando también otros estudios internacionales. To counteract stigma towards people with schizophrenia in the health sector: a pilot experience in a sample of Italian students of medicine Abstract: The article is based of the concern about the negative effects, found in many international publications, that stigma has on the quality of care that people with schizophrenia receive in the field of health services, in connection with their physical health, often deteriorated. As a result of the lack of knowledge about the causes and characteristics of this disease and the misconceptions that many professionals share with the general population about the dangerousness and lack of recovery of the people affected by this disorder, they are usually subject of lack of respect and poor care into general health services.Very important to improve the information and correct erroneous attitudes is the period of training of professionals and in this regard are presented the first results of a pilot project, developed between students of Medicine of an Italian University, consisting in a brief course on stigma and schizophrenia. Although the results must be confirmed by other studies, they noted the evident positive changes occurring in the knowledge and attitudes of students with a brief educational intervention, associated with the participation of users, also confirming other international studies.
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Psychiatric diagnosis is accepted and pervasive in mental health care and adjoining social systems throughout the world. The recognition of the inadequacy of diagnosis in advancing positive outcomes and healing is prompting the search for alternatives to diagnosis. While there is progress in seeking alternatives, we must be clear on the nature and depth of challenges associated with psychiatric labeling to achieve meaningful movement forward. To these ends, this article explores the intention, use, function, and impact of select naming practices from developmental, social, cultural, religious, and historical reference points. In studying the role of naming in our human development and making evident the parallel workings of naming systems from sociocultural history and that of diagnosis, the often obscured ways in which psychiatric labels are harmful becomes clearer. The authors offer a perspective drawn from a synthesis of their education, clinical work, lived experience of extreme mental states, and the challenges of growth and development while carrying psychiatric labels.
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