Recovery From Schizophrenia: Psychiatry And Political Economy

THE PERSON WITH SCHIZOPHRENIA IN WESTERN SOCIETY 185may have a significant effect on shaping the features of mental illness onceestablished. John Strauss and William Carpenter, American psychiatrists who areauthorities on the outcome of schizophrenic illness, conclude that:Labeling is an important variable affecting the course, and perhaps the onsetof schizophrenia…. Who can doubt the devastating impact on a fragileperson of perceiving that the entire social milieu regards him (wittingly ornot) as subhuman, incurable, unmotivated, or incompetent to pursueordinary expectations…? Can we doubt that a deteriorating course ofdisorder is fostered when fundamental roles are changed by social stigmaand employment opportunities become limited? 112HOW STIGMA INFLUENCES THE COURSE OFILLNESSExactly how could the stigma and degradation of mental illness affect thesymptoms of schizophrenia and shape the course of the illness? Cognitivedissonance theory helps explain this process. In outline this social psychologicaltheory states that:(a) pieces of knowledge or ideas (cognitions) are dissonant if one contradicts theother;(b) dissonance is psychologically uncomfortable and motivates a person to resolvethe contradiction; and(c) the person will actively avoid situations that increase the dissonance.For example, if a woman smokes two packs of cigarettes a day, believes herself tobe reasonably strong-willed and sensible but knows that cigarettes cause lungcancer, she may reduce the level of dissonance between these ideas by eitherquitting cigarettes, coming to see herself as weak-willed and foolish, or minimizingthe evidence that links smoking with cancer.Experiments have shown the following consequences of cognitive dissonancetheory to hold true:(a) After a change in opinion has been made with the aim of reducingdissonance, the person will select from available information evidence toconfirm his or her decision, and will tend to overvalue this evidence.(b) In the face of contradictory evidence that increases dissonance the individualwill become more active in defense of his or her belief.(c) If a person is obliged to state a public opinion that is contrary to his or herprivately held opinion (thus creating dissonance), there is a tendency for theopinion to change to conform more closely with the public statement; thesmaller the external pressure to make the public statement, the greater is theopinion change. 113