THE EFFECT OF STIGMA ON PSYCHIATRIC PATIENTS AND THEIR RELATIVES AT REHABILITATION MKAR, BENUE STATE

CHAPTER ONE

INTRODUCTION

1. BACKGROUND OF THE STUDY

Mental illness stigma refers to the view that persons with mental illness are marked, have undesirable characteristics, or deserve reproach because of their mental illness (Goffman 2010; Corrigan and Penn 2009). Stigma leads to negative stereotyping and to discriminatory behavior toward persons with mental illness (Link et al. 2011; Davidson et al. 2009). Stigma may cause affected persons to experience rejection and to feel shame about their condition. Stigma and discrimination exert a detrimental effect on persons with mental illness by limiting their opportunities and reducing their self-esteem (Link et al. 2013; Corrigan 2009). Concern about mental illness stigma has increased over the past several decades. During this period, the process of deinstitutionalization has moved the vast majority of persons with serious mental illness from hospitals to community settings (Torrey 2011). In community settings, they are likely to have interactions with a variety of persons from the public at large. These interactions may be affected by negative stereotyping and discriminatory behavior. To reduce the stigma toward persons with mental illness, several psychiatric organizations and advocacy groups have mounted "antistigma campaigns" (Fink and Tasman 2011; Kommana et al. 2011; Sartorius 2009; Bryne 2009). However, it is uncertain what impact these campaigns have had on public attitudes or on the experience of persons with mental illness (Mayville and Penn 2009; Corrigan and Penn 2009). Unfavorable views of persons with mental illness have been found in surveys of public attitudes (Nunnally 2009; Rabkin 2009; Link et al. 2009). Negative attitudes toward persons with mental illness have also been demonstrated in behavioral analog studies (Farina 2009). In these experiments, research confederates are falsely identified as having mental illness to research participants, whose reactions are assessed. Less is known about the actual stigma experiences of persons with mental illness and their family members. In one survey of family members performed in the late 2011s, a vast majority of respondents reported that mental illness stigma was present and had a negative impact on their ill relatives. The most commonly cited negative effects were loss of self-esteem, difficulty in making and keeping friends, and difficulty in finding a job (Wahl and Harman 2013). The attitudes and experiences of consumers themselves have been the focus of limited investigation. In a series of studies with psychiatric patients, Link found that a majority of respondents perceived devaluation and discrimination because of mental illness (Link 2011; Link et al. 2013, 2009, 2011). Attitudes were measured by subjects' degree of agreement with statements such as "Most people would willingly accept a former mental patient as a close friend" and "Most people believe that a former mental patient is just as trustworthy as the average citizen." In a more recent study, Wahl surveyed mental health consumers regarding the frequency of specific stigma and discrimination experiences (Wahl 2009). The sample in this study consisted of a total of 1,301 consumers who had various psychiatric diagnoses; 19 percent reported a diagnosis of schizophrenia. These consumers were solicited through the publications of the National Alliance for the Mentally 111 (NAMI), a large advocacy organization. The most frequent experiences reported by respondents concerned indirect stigma: having witnessed stigmatized comments about mental illness, being aware of hurtful media portrayals, and feeling shunned or avoided by others because of the respondents' consumer status. There were fewer reports by respondents of actual discrimination experiences such as being turned down for a job. In the second phase of the Wahl study, a representative subgroup of respondents was more extensively interviewed. Nearly half of these respondents indicated having experienced stigma in their interactions with persons in the general community. Other sources of stigma that were frequently cited included family members, coworkers, and mental health caregivers. The Wahl survey suggests that experiences of mental illness stigma are widespread among consumers who are affiliated with an advocacy organization and who choose to respond to a questionnaire on stigma. As noted by Wahl, it is uncertain if the responses to the survey were representative of typical mental health consumers. One might assume that the NAMI sample was skewed toward persons who had had stigma experiences and wished to share them. On the other hand, persons with schizophrenia, the most serious and the most stigmatized mental illness, were underrepresented in the NAMI sample. It might be expected that a group of more severely ill consumers, all people with schizophrenia, would experience more stigma and discrimination than did the respondents in the Wahl study. Another important question concerns which patient characteristics contribute to the strength or frequency of stigma experiences. Patients with more severe illness symptoms may be more likely to experience mental illness stigma. Studies indicate that persons with mental illness who have more conspicuous illness symptoms and poorer social skills engender more negative responses from others, as one would intuitively expect (Farina 2009). Other studies suggest, as well, that persons with mental illness who have lower incomes and more unemployment are more likely to endorse beliefs that mental patients will experience devaluation and discrimination than are persons with better social outcomes (Link 2011; Link et al. 2009). Socioeconomic status may also affect stigma attitudes; higher socioeconomic status has been associated with both more and less stigma in different types of investigations. On the other hand, studies of persons with mental illness indicate that a higher educational level and socioeconomic status may be associated with more perceived stigma (Angermeyer et al. 2011). In one survey, persons from families with higher socioeconomic status were more likely to conceal the hospitalization of their relatives with mental illness from their friends and associates as compared to persons from families with a lower socioeconomic status (Phelan et al. 2009). The gender of the person with mental illness may affect the extent of stigma that is experienced. There is some indication from behavioral analog studies that women with mental illness are regarded more favorably than are mentally ill men (Farina 2009). The latter may be perceived as more likely to become aggressive or dangerous than their female counterparts. Therefore, the study examines the effect of stigma on psychiatric patients and their relatives at rehabilitation Mkar, Benue State.

1.2 STATEMENT OF PROBLEM

According to data from the World Health Organization we can aspect that every fourth person will have a mental disorder during his life course. Psychiatric services have the goal to equally take care of the biological, psychological and social dimension of treatment. The most serious obstacle for treatment initiation is stigma (Ivezić 2006). A person is stigmatized when some characteristics or differences are linked to other characteristics which then are valued as his primary discredit feature. Stigma is a concrete collective idea of people with psychiatric disorders, a negative stereotype about psychiatric disorders which then additionally complicates and firms the stigma. Stereotypes (collective beliefs that psychiatric patients are dangerous) related to stigma contribute to additional discrimination. Stigmatized psychiatric patients not only suffer from the disorder, they suffer because of the stigma as well (Kecmanović 2010). Hence the study examines the effect of stigma on psychiatric patients and their relatives at rehabilitation Mkar, Benue State.

1.3 AIMS OF THE STUDY

The major aim of the study is to examine the effect of stigma on psychiatric patients and their relatives at rehabilitation Mkar, Benue State. Other specific objectives of the study include;

1. To examine the main goal of psychiatry as a medicine branch.
2. To examine the social psychological approaches to stigma on psychiatric patients and their relatives.
3. To examine the effect of stigma on psychiatric patients and their relatives.
4. To examine the core features of stigma on psychiatric patients and their relatives.
5. To examine the negative stereotypes about psychiatric patients and their relatives.
6. To examine the strategies for overcoming stigma on psychiatric patients and their relatives.
   1. RESEARCH QUESTIONS

1. What is the main goal of psychiatry as a medicine branch?
2. What are the social psychological approaches to stigma on psychiatric patients and their relatives?
3. What is the effect of stigma on psychiatric patients and their relatives?
4. What are the core features of stigma on psychiatric patients and their relatives?
5. What are the negative stereotypes about psychiatric patients and their relatives?
6. What are the strategies for overcoming stigma on psychiatric patients and their relatives?

1.5 RESEARCH HYPOTHESIS

Hypothesis 1

1. : There are is no significant effect of stigma on psychiatric patients and their relatives.
2. : There is a significant effect of stigma on psychiatric patients and their relatives.

1.6 SIGNIFICANCE OF THE STUDY

The study will be of profound benefits to educate the public on the negative effect of stigma on psychiatric patients. This study would also be of immense benefit to students and scholars who are interested in developing further studies on the subject matter.

1.7 SCOPE AND LIMITATION OF THE STUDY

The study is restricted to the effect of stigma on psychiatric patients and their relatives at rehabilitation Mkar, Benue State.

LIMITATION OF THE STUDY

Financial constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview)

Time constraint: The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.

1.8 OPERATIONAL DEFINITION OF TERMS

Stigma: results from a process whereby certain individuals and groups are unjustifiably rendered shameful, excluded and discriminated against.

Discrimination: means any distinction, exclusion or preference that has the effect of nullifying or impairing equal enjoyment of rights. Special measures solely to protect the rights, or secure the advancement, of persons with mental illness shall not be deemed to be discriminatory. Discrimination does not include any distinction, exclusion or preference necessary to protect the human rights of a person with a mental illness, or of other individuals.

Mental disorder: refers to those health problems currently classified by the WHO ICD-10 classification in its chapter on ‘mental and behavioral disorders’