CLINICAL HANDBOOK OF SCHIZOPHRENIA

51. Stigma 539Disclosing One’s Mental IllnessThe stigma of mental illness is largely hidden. The public may not know whether specificindividuals meet the criteria for mental illness. Hence, individuals need to decide whetherto disclose their illness history. As we suggested earlier, disclosure may result in severaldisadvantages. People may risk the disapproval of peers, bosses, coworkers, neighbors,and community members. Disapproval may include being fired from one’s job, being cutout of opportunities to interact with neighbors, and not being included in communityfunctions. Moreover, people who disclose may become more stressed by worrying aboutwhat others think of them.There are also benefits to disclosure. Avoidance of disclosure may suggest avoidanceof shame, although people who come out typically feel better about themselves. Thissense of shame disappears with the act of disclosing. Because mental illness is largely hidden,people with stigma may not be able to find (on the job or in the community) peerswith mental illness who might provide support as illness issues emerge. Coming out alsodecreases the general prejudice against the community of people with mental illness. Aswe described earlier, contact with other individuals with mental illness can greatly diminishstigma.Stigma is not a categorical experience. Telling some people about mental illness doesnot necessarily mean that one must disclose to everyone in the community. The varioussocial spheres in which to disclose may include work settings, family situations, and communityfunctions. People may opt to tell peers in one sphere but not in another. Moreover,disclosure is not an unequivocal decision. There are different ways in which peoplecan approach this issue. They may selectively let others know about their experience byapproaching individuals who seem open-minded to general issues related to stigma, orthey may let everyone know about their mental illness. This does not mean either blatantlyproclaiming or hiding one’s experience with mental illness. The elements related todisclosure are complex; hence, only the disclosing individuals make these decisions.Addressing Stigma by Fostering EmpowermentResearch suggests that empowerment is at the opposite end of a continuum anchored byself-stigma. Put another way, people who view themselves as having power over theirlives are less likely to be tortured by self-stigma. Several treatment decisions enhance empowermentand decrease stigma. State-of-the-art services are collaborative rather thanbased in adherence frameworks. In collaborative exchanges, individuals and practitionersview each other as peers and work together to understand the illness and develop a treatmentplan; this gives people control over an important part of their lives. Another elementof treatment that diminishes self-stigma is consumer satisfaction; people with mentalillness feel more empowered when program change is the result of their own efforts.Coaching-based psychosocial services also facilitate empowerment. Coaches provideservices and support that help people to be successful in various important areas: work,housing, education, and health settings. This type of success provides an excellent sourceof empowerment. The impact on empowerment increases exponentially when peers withpsychiatric illness provide coaching services. Individuals offering services and overcomingmental illness describe personal success stories that provide significant inspiration. Peoplewith mental illness present special experiences and critical viewpoints that enhance thequality of care. People with mental illness gain empowerment when they develop programsand provide services to assist people with recovery goals. Within these settings,people with mental illness provide peer support and grapple with program elements.