Elsevier

Comprehensive Psychiatry

Volume 54, Issue 2, February 2013, Pages 195-200
Comprehensive Psychiatry

Meaning in life, insight and self-stigma among people with severe mental illness

https://doi.org/10.1016/j.comppsych.2012.07.011Get rights and content

Abstract

Recapturing meaning in life has been described as an essential element in the process of recovery from severe mental illness (SMI), but limited quantitative research still restricts our understanding of this phenomenon. The purpose of the current study was to explore the meaning in life among people with SMI and variables that may influence it such as internalized stigma and insight into the mental illness. We expected a significant negative correlation between internalized stigma and meaning in life, and that internalized stigma would moderate the relationship between insight and meaning in life. To explore these assumptions, 60 persons with SMI completed questionnaires that assessed their meaning in life, insight into their mental illness and internalized stigma, after which the data were analyzed using correlation and cluster analysis. Both hypotheses were confirmed. The mechanism behind the relationship between self-stigma and meaning in life and the theoretical and clinical implications of the moderation model are discussed.

Introduction

Recapturing the sense that one's life has meaning has been described as an essential element in the process of recovery from severe mental illness (SMI) [1], [2], [3]. For instance, recovery is defined as a process that “involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of psychiatric disability” [2]. A study that explored the meaning of the recovery process from the perspective of mental health consumers found that people with SMI perceive meaning in life as a core aspect of recovery. From their point of view meaning can be achieved through work, social relationships, spirituality, pursuing goals, and through the process of recovery [1]. Although the concept of meaning in life is a core issue in the process of recovery, there is a lack of quantitative research regarding this phenomenon. In particular, it is unknown which variables contribute to the ongoing process of recapturing one's meaning in life. Accordingly, in the current study, we sought to explore the relationship between meaning in life, insight into their mental illness and internalized stigma among people with SMI.

Insight into their mental illness is defined as the ability of people with SMI to demonstrate awareness of being sick, of having symptoms and of the illness's implications [4], [5], [6]. It reflects a narratized account of psychiatric challenges which can vary in terms of its coherence, plausibility and adaptiveness. Research has shown that approximately 50%–80% of persons with schizophrenia exhibit varying degrees of lack of insight into their illness [7]. There is a disagreement in the literature regarding the ways in which insight into mental illness influences functioning and quality of life. On the one hand, there is evidence indicating that high levels of insight are related to treatment adherence and functioning [5], [8], [9], [10], [11], [12]. On the other hand, there are also findings showing that high levels of insight into one's mental illness can impair functioning, hope and quality of life of people with SMI [13], [14], [15], [16]. It has recently been suggested that these associations occur via self-stigma [17], [18].

Self-stigma or internalized stigma refers to the phenomenon of accepting the negative stereotypes that society relates to mental illness and applying it to oneself [19], [20], [21]. Studies show that about a third of people with SMI have high levels of internalized stigma [21], [22], which may have significant negative implications on those coping with SMI including less self-esteem, less sense of self-efficiency, less empowerment, less social support, lower hope, lower compliance to treatment and lower quality of life [17], [23], [24], [25].

Several studies have suggested that self-stigma moderates the influence of insight into the mental illness on functioning and quality of life among people with SMI. For example, Lysaker and colleagues [17] found that self-stigma among people with SMI moderates the relationship between insight and hope, self-esteem and social functioning. They found that people with high levels of insight who had high levels of self-stigma showed lower levels of hope and self-esteem and fewer social interactions compared to people with high insight and low levels of self-stigma. Similarly, Staring and colleagues [18] found that stigma moderates the relationship between insight and depression, low quality of life and negative self-esteem.

Corrigan and colleagues [26] suggested the “why try?” model as a framework for understanding self-stigma implications. This three-step model describes the evolution and consequences of self-stigma. According to the model, self-stigma is comprised of three components: awareness of the stereotype, agreement with it and applying it to oneself. As a result of these processes, people suffer reduced self-esteem and self-efficacy which lead to an avoidance of the pursuit of life goals [26]. This avoidance of pursuing life goals may then lead to less involvement in activities that help create meaning in life such as work, social relationships, spirituality and the process of recovery [1].

Based on this literature, we obtained assessments of internalized stigma, insight and meaning in life in adults with SMI and developed two hypotheses. First, we expected a significant negative correlation between internalized stigma and meaning in life. Second, we expected that internalized stigma would moderate the relationship between insight and meaning in life. Our expectation was that the combination of high levels of internalized stigma with high levels of insight would evoke the worst consequences in relation to meaning in life.

Section snippets

Research participants

Participants consisted of 60 people with SMI who were receiving inpatient and outpatient psychiatric services at Sheba Medical Center in Israel. Diagnoses (DSM-IV) were determined based on standard clinical interviews carried out by a psychiatrist. Table 1 presents the demographic and diagnostic characteristics of the study sample. As can be seen in Table 1, the majority of the participants was inpatient (61.7%), unemployed (73.3%), had a diagnosis of schizophrenia (66.6%) and was single or

Inter-correlations between the study variables

Correlations between insight, self-stigma, and meaning in life are presented in Table 2, in which, according to the first hypothesis, significant negative correlation between internalized stigma and meaning in life was found. In addition, the research identifies negative correlation between insight and meaning in life and a positive relationship between insight and self-stigma.

Testing the moderation model

In order to test the moderation model, we used the cluster analysis method based on Lysaker and colleagues' work [17].

Discussion

The current study examined whether self-report meaning in life was related to levels of insight into mental illness and of internalized stigma among people with SMI. It was hypothesized that internalized stigma and meaning in life would be negatively correlated and that internalized stigma would moderate the relationship between insight and meaning in life. Specifically, it was expected that the combination of high levels of internalized stigma with high levels of insight would evoke the lowest

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