Sing Lee, M.D.
E-mail: singlee@cuhk.edu.hk
Schizophrenia has been the most stigmatized of all mental
disorders. Although the stigma
of
schizophrenia may have a kernel of truth, it is over-generalized to
connote a host of unjustified negative stereotypes, such as lunacy, aggression,
contagion, unpredictability, untreatability, and inevitable heritability. The impact of stigma is fundamentally social, can
be devastating, and is costly. It
leads to devaluation, ostracism, discrimination, impaired health status, and
even murder of the stigmatized subjects. Recent research findings attest to
the ubiquity and complexity of the sources, consequences, functions, and
management of psychiatric stigma. Via
the interactive mechanisms of lowering self-esteem, social isolation, cognitive
intrusion, impaired access to health care, and under-employment, stigma
has multiple adverse effects on psychological and physical health. Nonetheless, the psychiatric impact
of stigma on subjects with schizophrenia varies with the types
of symptoms, individuals, and social contexts. More specifically, it depends on such
factors as its perceived controllability, alterability, contagiousness,
concealability, and violent propensity. That
stigma exists in every society attests to certain functions that it may serve
for individuals, institutions, and even the state. It is more marked in societies where anti-discrimination laws,
human rights, press freedom, and advocacy efforts are absent or
under-developed. It may also arise from health care
professionals and psychiatric treatment itself.
There is not much evidence that stigma can be effectively reduced by public
education and increase in health knowledge alone. It is also unclear if anti-stigma strategies such as advocacy
that succeed in one country can be transplanted into another. An inter-sectoral approach that
integrates legal, human right, media, advocacy, school, and other institutional
efforts is more likely to reduce stigma. Key
recommendations for enhancing future research include building a coherent theoretical framework
that takes account of the complex interactions among the perceivers and
the stigmatized, the integration of quantitative and qualitative methodologies,
inter-disciplinary research collaboration, use of the action research approach, examination
of treatment-induced stigma, harnessing the framework of discrimination, and
transcultural research.