The Power of Reframing a Mental Health Diagnosis
Changing one’s perception can increase self-efficacy and treatment success.
Posted Aug 06, 2020
What is Stigma?
Stigma has been defined as a mark of disgrace, discredit, or belief that an individual and/or group are less than another, more dominant group. Stigma is one of the most prominent reasons why individuals either abstain from seeking treatment for mental health concerns or leave treatment early. Research has shown that a large number of individuals diagnosed with a mental health concern and/or addiction do not engage in therapy. Further, studies have shown that fewer than half of individuals diagnosed with a mental health disorder seek treatment, and these numbers are even lower for those diagnosed with a substance use disorder. Many variables, including access, cost, and lack of insurance, contribute to lack of engagement with therapy; however, the stigma of having a mental illness and/or addiction is often at the forefront.
Social stigma is the negative perception of one group by a more dominating group. The stigmatized group is viewed as inferior or not being able to contribute to society. Social stigma regarding mental health and addiction can be heard in derogatory statements such as ‘they are crazy’ and ‘they can’t be trusted,’ and labels including ‘failures,’ ‘dangerous,’ and ‘losers.’ Self-stigma is when an individual starts to internalize and believe these thoughts expressed by society to be true. Working towards distancing oneself from stigma and the negative labels associated with a diagnosis is a difficult challenge for people who are seeking or trying to stay in treatment.
For many clients, it’s crucial to alter their negative perception about diagnosis and treatment so that they can actually see how strong, resilient, and empowered they are in their recovery. This can be extremely powerful for increasing the likelihood of a successful outcome in treatment. Here are some examples of helping clients see an alternative way of viewing diagnosis, treatment, and recovery.
When working in an inpatient psychiatric facility, I often had a group of about twenty patients. I would ask everyone in the room to state their diagnosis if they felt comfortable doing so. From one person to the next, I heard anxiety, depression, bipolar disorder, alcoholic, drug addict, schizophrenia, etc. Sometimes, a patient stated, “Dr. Mac, I have too many to name,” so I would say, “pick your favorite,” which generated a laugh and a response of one, two, or three diagnoses. I asked the question, if I had a magic wand, how many of you would wish your diagnosis could disappear? Most patients would raise their hand.
Occasionally a patient explained that they would not want their diagnosis to disappear because it is part of who they are, and that they accept it and feel that they are resilient, strong, and empowered. Then the group would share thoughts and feelings about having a diagnosis. From other group members, I would hear that the diagnosis makes them feel like a loser, stupid, failure, F-up, weak and so on. These are two completely opposite perspectives on the same issue. To make this point to the group, I would engage in two different activities: the old and young woman gestalt image and the “Worst Day Ever” poem by Chanie Gorkin. These two activities focus on our perceptions.
The one major focus with my clients is helping them gain a different perspective on, or re-frame, their diagnosis, treatment, and recovery. In a perfect world, we would all join in the fight against social stigma and everyone would support mental health just like physical health. But in reality, stigma exists and it is a barrier to treatment. I focus on self-stigma with my clients. I want them to understand that instead of feeling like a weak, immoral, crazy, dangerous, failure of a person, they are resilient, strong, and empowered.
One activity used to open minds to re-framing perspective is the old and young woman gestalt image. As you look at the image, you may see just the old woman, you may see just the young woman, or you see both. For those who see the image one way, I ask if they believe that you are able to see it both ways. My clients will often state yes. Why do you believe it? They answer: because others can see it; because I believe you; or if I just keep looking, I may be able to see it both ways also. In individual therapy or group therapy, I will ask my clients to help me see the young woman, as if I am struggling to see it. As they begin to show me the different contours that show the young woman, I state to them. “I am so dumb, I can’t see it, you are smarter than me, I will never see it,” and then I give up. I show them that if they start to believe these negative thoughts about themselves, it prevents them from seeing the other ways that recovery and treatment can offer them. When you focus on the negative ways you see your diagnosis, treatment, and/or recovery, you miss being able to see the other beautiful side of acceptance and recovery.
I also read the “Worst Day Ever” poem by Chanie Gorkin. It is an extremely depressing and sad poem, and after my clients read it, they will often ask why they should read such a depressing poem. The poem and our lives are quite similar. I am not going to change the words in the poem, add or take any out, just like we can’t change our past. However, I can have a different perspective on the poem. I read it backwards and this depressing poem turns into an uplifting and positive poem. Perception is crucial to breaking stigma. Helping clients take a different view of their mental illness and addiction can increase self-efficacy and self-esteem. In doing so, the clients become more active in their recovery and serve as role-models to others in breaking stigma.
Sickel, A. E., Seacat, J. D., & Nabors, N. A. (2019). Mental health stigma: Impact on mental health treatment attitudes and physical health. Journal of Health Psychology, 24, 586–599. http://dx.doi.org.holyfamily.idm.oclc.org/10.1177/1359105316681430