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Question:
People with schizophrenia recover and thrive as self-determining citizens in their communities. How can we stop coverage that sensationalizes, emphasizes outlier violence, stereotypes people with schizophrenia as needing substituted judgment?

Sylvia Caras
Santa Cruz, California


Answered by Robert Whitaker:
The stereotyping of people with schizophrenia runs deep in our society, and that stereotyping has far-reaching consequences. Here are three things that I believe would help fight this problem.

a) Expand the public dialogue so that it includes the voice of "consumers."

Stereotypes tend to flourish when people in the stereotyped group are not heard. And that is one of the problems we have today. Public discussion of schizophrenia (in the media, etc.) is driven largely by three groups: psychiatrists and other scientists involved in psychiatric research, the National Alliance for the Mentally Ill, and the pharmaceutical companies that manufacture antipsychotic drugs. What is missing from this dialogue is the voice of "consumers," particularly those who may not share the views of the three groups mentioned above. Consumer groups can be found at both a local and national level. For instance, in the Boston area, there is a group that works on state issues called M-Power. In nearby Lawrence, Massachusetts, several people who have recovered from schizophrenia run the National Empowerment Center. Many of these local groups, in turn, belong to a national organization called Support Coalition International. The leaders of these groups are very articulate and thoughtful, but, unfortunately, their perspectives are rarely heard. Indeed, it is revealing that this voice -- of consumer-run groups -- is missing from this online panel.

b) Rethink the "broken brain" message.

The public message that we hear today about mentally illness, one that is supposed to take away the stigma, is that the mentally ill suffer from "broken brains." The message seems to be, "It's not their fault." Personally, I think that is actually a deeply stigmatizing message. It is also one that, from a scientific standpoint, doesn't accurately reflect the natural spectrum of outcomes in people diagnosed with schizophrenia.

The "broken-brain" metaphor implies that people so diagnosed are "different." In the public's mind, it draws a line separating the "normal" from the "abnormal." If we want to destigmatize mental illness, I think we need a message that emphasizes, so to speak, our "alikeness." In the 19th century, for instance, Quakers emphasized that the severely mentally ill were "brethren," a concept that is wonderfully inclusive. That's what I think we need today, a public message that says, yes, people diagnosed with schizophrenia may grapple with their minds, and yes, there may be biological reasons for why they do so, but that doesn't mean they should be seen as having "broken" brains. That is a term that puts a "defective" stamp on people so diagnosed.

From a scientific standpoint, the "broken brain" metaphor also doesn't reflect the diversity of recovery patterns you see in people with schizophrenia who aren't routinely medicated. In the 1970s, for instance, there were three studies funded by the National Institute of Mental Health that involved treating newly diagnosed patients without neuroleptics. In each one, more than 50% of the patients recovered and didn't relapse in a follow-up period that ranged from one to three years. The World Health Organization, meanwhile, found a similar pattern of recovery in poor countries, like India, Colombia and Nigeria, where only 16% of patients in the study were routinely kept on antipsychotic medications. Two years after diagnosis, 40% of the patients in the poor countries had recovered and were "unimpaired." In other words, they suffered a schizophrenic break and then got better. They didn't become chronically ill and they didn't need constant medication. That is not an outcome consistent with the notion that all people who are diagnosed with schizophrenia have "broken brains," or suffer from a "disease" that will require them to take medication all their lives.

c) Get good data on the violence issue.

Public policy is often driven by fear of the severely mentally ill. But what is the real data on this issue? Do the severely mentally ill commit homicides or violent crime at any greater rate than the general population? Prior to 1955, when neuroleptics were first introduced, four studies found that patients discharged from mental hospitals committed crimes at either the same or a lower rate than the general population. Has this changed? And if so, why? The other part of this story that we never hear about is violence against the mentally ill. They are at dramatically heightened risk of sexual abuse, assault, etc. in other words, they have more reason to fear society than society has to fear them. We need to have some good studies that look at both sides of this question, and then perhaps this violence stereotype can be laid to rest.


Robert Whitaker


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