Examining psychological recovery in persons with serious mental illness : the role of experienced stigma and the insight paradox

Abstract

The purpose of this study was to investigate how insight (awareness of mental illness and its associated consequences) into having serious mental illness (SMI) and the experienced stigma associated with SMI may affect psychological recovery among people in this population. Examining the role of insight in the recovery process is important because low insight is a highly prevalent and complex phenomenon that carries paradoxical effects for persons with SMI. Additionally, the stigma associated with having SMI has been recognized as the single greatest concern facing SMI populations and can have a detrimental impact in all life domains. The current study differs from previous research as it examines both the direct and moderating effects of insight and stigma on the recovery process rather than correlates of recovery. Additionally, previous studies have only examined the role of internalized stigma in the relationship between insight and correlates of recovery. This study examined the role of experienced stigma, an important precursor to internalized stigma. Fifty-three participants with SMI completed a recovery scale and an experienced stigma scale. Insight was assessed via information collected from semi-structured clinical interviews. Results indicated that neither insight nor experienced stigma predicted changes in psychological growth, the highest stage of psychological recovery. Experienced stigma had a marginally significant moderation effect on the insight/recovery relationship. Specifically, higher insight predicted greater psychological growth when experienced stigma is also higher. This was not observed when experienced stigma was lower. Subsequently, neither insight, stigma, nor their interaction predicted changes between people's stages of recovery. Findings further suggest that insight has paradoxical effects on persons with SMI that can be exacerbated by stigma. However, the moderating effects of experienced stigma on the insight/recovery relationship are the opposite of those supported with internalized stigma. Areas for future research and the implications for SMI populations are discussed.