Without Stigma: About the Stigma and the Identity of the Mental Illness

By Darko Pozder

The book looks into how developing a new identity can assist an individual that is affected by mental illness to overcome both the self-perceived and public stigma they might be going through owing to mental illness. Individuals that are affected by mental illness often live in denial; the book provides through which these people can come out of denial. Lastly, the factors that can enhance the mental health recovery process are looked into; they include among others employment, relationships, spirituality, resilience and recovery orientated language.

• Language: English
• Publisher: Xlibris AU
• Release date: Dec 6, 2018
• ISBN: 9781984504456

Darko Pozder

Darko Pozder is an Australian mental heath professional who has had medical and psychological education. Darko has completed extensive research and working experience at the Schizophrenia Fellowship of NSW. Darko's main professional and research interest include psychopathology and neuropsychology of mild traumatic brain injury (MTBI) and chronic traumatic encephalopathy. His book: Without Stigma: About the Stigma of the Mental Illness was published in 2018 and its second edition Without Stigma, About the Stigma and the Identity of the Mental Illness appeared in early 2019 and has received nomination for 2020 NSW / ACT Regional Achievement and Community Awards from Local health districts of NSW.

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Copyright © 2019 by Darko Pozder.

Library of Congress Control Number:    2018914329

ISBN:                  Hardcover                       978-1-9845-0447-0

                            Softcover                          978-1-9845-0446-3

                            eBook                               978-1-9845-0445-6

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

Any people depicted in stock imagery provided by Getty Images are models, and such images are being used for illustrative purposes only.

Certain stock imagery © Getty Images.

Rev. date: 12/20/2018

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CONTENTS

Chapter 1     Maslow’s Hierarchy Of Needs Theory And Stigma

Introduction

Physiological Needs and the Mental Illness Stigma

Safety Needs and the Mental Illness Stigma

Social Needs and the Mental Illness Stigma

Esteem Needs and the Mental Illness Stigma

Self-Actualization Needs and the Mental Illness Stigma

Chapter 2     Ways In Which The Big Five Personality Traits Influence Stigma

What Is Personality?

Sensitivity to Stigma Owing to Personal Traits

The Mechanisms for Coping with Status-Based Rejection

The Big Five Personality Traits

The Impact of Personality Traits and the Need for Social Distance on Self-Perceived Stigma

The Impact of Personality Traits and the Desire for Social Distance on Self-Perceived Stigma

Myths about Extroverts and Introverts and Social Stigma

The Impact of Lack of Clear Self-Definition and Unstable Interpersonal Relationships on Self-Perceived Stigma and Isolation

The Impact of Self-Definition on Self-Perceived Stigma and Isolation

The Impact of Interpersonal Relationships on Self-Perceived Stigma and Isolation

The Treatment Implications of Personality Disorders and Stigma

Ways of Reducing Stigma against Personality Disorders

Mentalization-Based Treatment for Personality Disorders

Chapter 3     The Stigma Related To The Inheritance Of Mental Illness

The Explicit Fear of the Inheritance of Mental Illness and Its Impact on Stigma

The Problem of Coincidence, Third Variables, and Single-Case Variables

Implicit Self-Guilt Associated with the Inheritance of Mental Illness

The Problem of Correlation, Causation, and Association and Its Impact on the Mental Illness Stigma

Mental Illness Stigma through Association

The Fear of the Unknown and Self-Perceived Stigma

The Problem of Vividness (Placebo and Decision-Making)

Pseudoscience and Testimony

Chapter 4     Positive Attitude, Resilience, And Help Seeking As Factors In Reducing Stigma That Is Linked To Mental Illness

Self-Confession as a Factor in Reducing the Mental Illness Stigma

Resilience as a Factor in Reducing the Mental Illness Stigma

Help Seeking and Attention Seeking as Tools to Reduce the Mental Illness Stigma

Attention Seeking as a Factor in Reducing the Mental Illness Stigma

Empowerment to Rebuild Confidence as a Way of Reducing the Mental Illness Stigma

Positive Attitude and Thoughts as Factors in Reducing the Mental Illness Stigma

Perception and Pain in Mental Health/Well-Being

Neural Plasticity

Neural Pathways and Resilience

Chapter 5     Self-Awareness And Its Impact On Social And Perceived Stigmas

Anosognosia

Ways in which Objective and Subjective Thoughts Contribute to Self-Perceived and Social Stigmas

Strategic Interpretation of the Social Environment

Prejudice and Discrimination Associated with the Treatment of Mental Illness

The Impact of Lack of Independence on Self-Perceived Stigma

The Lack of Internal and External Locus of Control

Chapter 6     Lack Of Conformity And The Increase In Discrimination And Stigma

Sheriff’s Study of Norms

Asch’s Study of Norms

Milgram’s Obedience Experiments

Factors that Influence the Increase and Decrease of Conformity

Stigma among Non-Conformers Due to Their Psychological Characteristics

The Stigma of Loneliness

Differences between Being Alone and Loneliness

The Impact of Selective Attention and Motivation on Conformity, Discrimination, and Stigma

Ways through Which Selective Attention Can Reduce Discrimination and Stigma Attached to Mental Illness and Increase Conformity

Chapter 7     Stigma And Identity

Personal Identity

Concealable Stigmatized Identity

The Magnitude/Extent of Concealable Stigmatized Identity

Self-Categorization as a Means of Reducing Stigma

Positive Sense of Self as a Means of Reducing Stigma

Redefining Self Due to Mental Illness

Self-Perceived Stigma Due to False Image and a Permanent Sense of Victimization

Building a Positive Sense of Self as a Means of Reducing the Mental Illness Stigma

Chapter 8     Reduction Of The Mental Illness Stigma By Developing A New Identity

Changing Identity by Accepting and Understanding One’s Living Environment

Self-Efficacy and Learned Helplessness

Changing One’s Identity to Eliminate Discrimination

Behavioural Misrepresentation

How to Overcome an Identity Crisis during the Relapse Period

Chapter 9     Absolute Truth And The Social Reality Formed By Stigma

Cognitive Biases

Is There an Absolute Truth?

Human Consciousness and the Social Construction of Reality

Lack of Freedom and Choice as a Contributing Factor to the Mental Illness Stigma

Cognitive Biases as a Contributing Factor to the Mental Illness Stigma

Media Confusion as a Contributing Factor to the

Mental Illness Stigma

Differences between Feeling Productive and Being Productive

Cognitive Closure and Productivity

Cognitive Closure and the Mental Illness Stigma

Does Generalization Influence Perception?

The Influence of Memory on Stigma

The Free Will Illusion and the Mental Illness Stigma

Chapter 10   Denial, Loss Of Freedom, Cognitive Closure, And Stigma

Denial as a Primitive Coping Mechanism

When Does Denial Turn to Harm?

Free Will and Self-Control

Loss of Freedom and Free Will and the Increase in Stigma

Recovery from Mental Illness

Recovery-Oriented Language

To my beloved wife, Tatiana, and my children, Lazar, Gaia, and David.

PREFACE

S tigma significantly hinders people affected by mental illness from seeking help. The second edition of Without Stigma: About the Stigma of the Mental Illness endeavours to look into stigma and the various factors that influence it. Also, the ways through which stigma against people affected by mental illne ss can be reduced are discussed in the book. As discussed in the first edition, some beliefs—such as the inheritance of mental illness—hinder those affected from seeking treatment. There are various factors, such as resilience and positive attitude, which help them overcome the stigma they could be experiencing because of mental illness.

The book further looks into how developing a new identity can assist a person affected by mental illness in overcoming both the self-perceived and public stigmas they might be going through. People affected by mental illness often live in denial; the book provides ways on how they can come out of denial. Also, the factors that can enhance mental health recovery are looked into; they include employment, relationships, spirituality, resilience, and recovery-oriented language.

CHAPTER 1

Maslow’s Hierarchy Of Needs Theory And Stigma

Introduction

M aslow’s hierarchy of needs is a theory which is popular with most people; in this theory, the needs of human beings are portrayed in the shape of a pyramid. The most essential, which are physiological needs, are placed at the bottom, and self-actualization needs are at the top of the pyramid. In this first chapter, we will look at how Maslow’s hierarchy of needs theory relate to the mental illness stigma.

The structure of the theory begins at the bottom with the physiological or basic needs, which include food, shelter, water, and clothing. The second is safety or security needs, which arise after a person’s basic needs are met. Safety needs include having security as a person, being healthy, and attaining financial security. After the safety needs have been met, a person develops the desire to belong socially, which is the third level in Maslow’s hierarchy of needs theory; the needs here comprise having friendship, family, and intimacy. In this level, there are other needs that a person may desire; they include having a sense of accomplishment and prestige.

After the social needs are fulfilled, a human being—according to Maslow’s hierarchy of needs theory—develops needs regarding their esteem. These needs relate to one’s status or ego as well as gaining respect from other people. These needs demonstrate the human desire to be valued and accepted by others. When these needs are not met, a person may feel inferior, weak, or helpless. The fifth level in Maslow’s hierarchy of needs theory is self-actualization or fulfilment needs, which involve a person’s longing for realizing their full potential. In this level, Maslow holds the view that a person has the need or desire to attain their goals, which may vary from one person to another.

These needs, as described in Maslow’s hierarchy of needs, can be closely linked to the stigma which people affected by mental illness experience. This first chapter is dedicated to looking at how each level of needs, if unmet, can enhance the mental illness stigma. Additionally, the therapies that are relevant in assisting those affected by the stigma due to the unmet needs will also be discussed.

Image of Maslow’s Hierarchy of Needs

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Physiological Needs and the Mental Illness Stigma

The physiological or basic needs, according to Maslow’s hierarchy of needs theory, include shelter, clothing, water, and sleep. People who are affected by mental illness and who constantly experience stigma and discrimination are often deprived of these essential needs, which may be equated to physical abuse. Some examples of unmet physiological needs for those who are mentally ill involve some situations where inmates tend to be isolated and are not provided with either water or food (Shrivastava, 2012). Depriving the inmates food is perceived as a way of instilling discipline to them since they are regarded as behaving in an irresponsible manner compared with the others.

Moreover, there have been incidences where some of the prisoners who are affected by mental illness have died out of starvation or dehydration. An example is a case that has been reported in the New York Post on 18 February 2018 where an inmate affected by mental illness in Milwaukee County Jail has been deprived of water for one week, resulting in his death. The officials involved have deprived this inmate water as a way of punishing him for flooding his mattress with water. This act demonstrates the extent to which those affected by mental illness, because of the stigma attached to the disease, get deprived of their basic needs.

Furthermore, in some cultures, especially in Asian countries, mental illness is viewed as a curse and having originated from evil spirits. The people in these kinds of societies tend to discriminate and stigmatize those affected by mental illness, together with their families. Therefore, since society limits their association with those affected, cases of them being deprived of their basic necessities—like food, shelter, clothing, and water—are highly prevalent. In some instances, those affected by mental illness and living in these societies tend to become malnourished due to poor diet or lack of food.

Additionally, in comparison to the general population, people affected by mental illness may suffer from various physical health issues like diabetes, obesity, and cardiovascular diseases (Hayes, 2015). Some of these physical health conditions are often triggered by their medications to manage their mental health conditions. Physical health conditions further worsen the stigma these people face as some of them are incapable of having a well-balanced diet to manage the physical illness.

Obesity, which is often caused by unhealthy eating habits, is one of the physical health conditions which people affected by schizophrenia, a mental disorder, may experience. This condition may further aggravate the stigma which these people face in society. Some of these people may not have any source of income because of the mental illness and hence are unable to have a healthy diet.

Additionally, the inability to remain in employment due to mental illness makes it hard for the affected person to have a healthy diet, further worsening the stigma which they experience. Most of the homeless people tend to be those who are affected by various mental illnesses. Several factors can be associated with lack of homes or shelters for the mentally ill. They include, among others, lack of employment; since many employers are unwilling to provide jobs to people who have been diagnosed with a mental illness (Brohan & Thornicroft, 2010). These employers see these people as not being resourceful and unable to sustain employment or even perform their duties at work. Therefore, the lack of income causes these people not to afford any kind of shelter, leading them to homelessness.

The lack of employment or income may also lead to poor hygiene among those who are affected by mental illness. Poor hygiene, which includes lack of clean water and sanitation, further exposes people who are affected by mental illness to risks of contracting infectious diseases.

There are forms of mental illnesses, like depression and anorexia, where the affected person declines to take any food or water, and it has to be forced on them. The caregivers may deny the affected person food and water because of the stigma which they associate with mental illness or the effort involved in feeding the person. Furthermore, the caregivers may refuse to give food or water to the affected person in the hope that they will die so as to save themselves and the family the stigma which they could be facing by having one of them being affected by mental illness. In some cultures, especially in the developing world like some parts of Asia and Africa, the affected people, due to lack of food, may end up eating out of garbage bins, which subjects them to bad physical health conditions. The lack of shelter, which is everyone’s physiological or basic need, may lead the affected person to develop other mental health conditions like depression, substance abuse, anxiety, and insomnia, among others.

For people who are affected by mental illness and can afford to get a home, the discrimination and stigma associated with mental illness causes society to isolate them, which often drives them out from their shelters (Henwood et al., 2015). In such circumstances, the families and neighbours of the affected person may stigmatize and discriminate against them by not wanting to associate with them. This causes them to leave their homes and become homeless.

The loss of shelter or homes can arise as a result of mental illness. An example is where the person who has a mental illness becomes hospitalized often or for long periods, leading to the loss of their homes. Furthermore, constant hospitalizations may make it difficult for them to pay for their housing, consequentially leading to the loss of their homes or accommodations.

The lack of shelter or housing further makes it difficult to provide medical care to the people who are affected by mental illness. In a number of instances, some of them end up staying for long periods without treatment as they are unable to access medical care. There are several factors which makes it difficult for these people to access healthcare, which includes lacking awareness regarding their health status, not having the transportation means to get to healthcare facilities, and being reluctant to access healthcare services because of the stigma that is associated with the illness.

The lack of constant healthcare services due to homelessness may have an adverse impact on these people’s mental well-being. Lack of shelter due to mental illness can also result in extended stays in healthcare facilities. The affected persons may also not be able to stick to the treatment schedule provided, which may further complicate their mental health issues.

Furthermore, being homeless or lacking shelter—which is a basic human need—may cause the affected people to engage in unlawful acts. These criminal acts may include substance and drug abuse, offences related to alcohol consumption, and shoplifting, among others. Therefore, lack of shelter among those affected by mental illness can lead to constant arrest and imprisonment.

There are various consequences which come as a result of lacking shelter for people who are affected by mental illness. They include developing a low self-esteem, depression, becoming socially isolated, assaults, accidents, and developing other mental health conditions. Also, research shows that people affected by psychosis and who have no accommodation tend to experience more adverse effects in comparison to those who have shelter.

The stigma which is associated with mental illness may cause those who are affected to lack accommodation since few landlords are willing to deal with people who behave differently from the rest of the community. The neighbours may also involve the police owing to their failure to understand the behaviour of the person who is affected by mental illness. Some of these behaviours may include talking loudly or to themselves and being very anxious, which the neighbours may not be able to cope up with, leading to loss of accommodation. In circumstances where the affected person tries to disclose that their actions are related to mental illness, further alienation and stigmatization follows. Also, the stereotypes which the community holds towards mental illness may cause the landlord and the neighbours to chase away the affected person from their community.

Stigmatization which is linked to mental illness has caused the affected people not to have access to basic or physiological needs like food, shelter, water, and clothing. This has caused their recovery to slow down, which has further worsened their condition. There are various forms of therapies which can be applied to help the affected people deprived of their physiological needs and facing stigma associated with mental illness. One of them is exposure and acceptance and commitment therapy.

Exposure and Acceptance and Commitment Therapy

Acceptance and commitment therapy is intended to enhance psychological health by increasing a person’s capability to perform in harmony with their values even when faced with negative feelings and thoughts (McCracken & Martinez, 2011). An example is where a person who has an anxiety disorder learns to experience anxiety and not allow the anxious thoughts and emotions to hinder their actions which are based on their values. Through exposure and acceptance and commitment therapy, the affected person learns to accept themselves by learning how to live a valued life, which means that they are able to respond to life issues in a manner that positively reinforces them. The values that are emphasized in acceptance and commitment therapy involve positive support and not just the avoidance of adverse consequences.

This therapy has also been proved effective in reducing attitudes that are held by society as associated with those affected by mental illness. Acceptance and commitment therapy often targets the knowledge which a person has regarding mental illness or the psychological connection they have about stigmatizing thoughts (Corrigan et al., 2013).

This therapy also helps those who hold stigmatizing attitude towards those affected by mental illness to realize that it is inevitable for them to have negative thoughts, but they need not act on them. The community, through acceptance and commitment therapy, receives training on how to disconnect from their negative thoughts, rather than trying to eradicate them. Acceptance and commitment therapy is done with the purpose of changing the emotions, attitudes, and thoughts of the community towards people who are affected by mental illness.

The people affected by mental illness do not only experience stigma from the public but also suffer self-stigma. Acceptance and commitment therapy helps these people overcome self-stigma by making them understand the challenges which they are able to overcome and accept the ones which they are not able to change. This therapy composes of six essential processes which assist the affected person in learning how to recognize the strategies which they have embraced as a way of overcoming the challenges which they may be experiencing (Hayes et al., 2012).

The person, through acceptance and commitment therapy, learns how to accept their feelings, thoughts, and urges—though uncomfortable—without fighting them. Trying to gain control over their thoughts, feelings, and urges may aggravate them. Therefore, by learning to tolerate these feelings, thoughts, and urges, the affected person is able to accept the discomfort, making their lives easier, which eventually reduces self-stigma (Hayes et al., 2012).

The person further, through cognitive defusion, learns how to improve on the adverse effect of the thoughts and not try to adjust or change them. The approaches used in cognitive defusion are aimed at helping the affected person look at thoughts as not being harmful. These approaches help lessen the credibility and anguish which are produced by these thoughts.

The techniques used in cognitive defusion include exercises which are intended to help the client understand the correct meaning of thoughts as being merely thoughts. An example is where a person affected by mental illness may suffer from self-stigma by believing that they are unable to work, which may cause them to be unwilling to look for employment. Cognitive defusion also trains a person how to detach themselves from these thoughts by looking at them as mere thoughts that have no impact (Hayes et al., 2012). Through this, the person learns how to become more flexible in their responses and not engage themselves with destructive thoughts and feelings.

Acceptance and commitment therapy also helps the person who is affected by mental illness and is suffering from self-stigma or public stigma to learn to embrace the experiences which they may be undergoing currently. By focusing on what is happening now, a person’s opportunities to hand-pick behaviours which are founded on value is enhanced. The affected person is further trained on how to focus on the present moment by describing the existing events without any judgement. Through acceptance of the current events without any judgement, the person learns to accept whatever they are experiencing, which helps in reducing self-stigma (Hayes et al., 2012).

The person also learns to cultivate better consciousness regarding the values which are significant to them as a way of inspiring willingness, dedicated action, and acceptance. Through this, the person is able to gain control over their lives, which makes them become less tangled in emotional evasion techniques which are unhelpful.

The stigmatized person may benefit from acceptance and commitment therapy by receiving training on how to have committed actions, where the person gets to set goals that agree with the values which they hold. The person further learns to pursue their values despite the adverse circumstances which they could be facing. By becoming engaged in a meaningful life, the stigma which the person may be experiencing reduces as they get engaged in activities which are beneficial to both them and society.

The various processes which are used in acceptance and commitment therapy are beneficial to the affected people since they assist them in living a more valuable life. This happens by developing new traits which are connected to the valued ones. Furthermore, the therapy assists in developing an enhanced psychological flexibility, which means being able to carry on with a particular behaviour or transform it based on the values one has (McCracken &Vowles, 2014).

The stigmatizing attitude by the general public to those affected by mental illness is greatly reduced by acceptance and commitment therapy. The reason for this is that the therapy targets the knowledge the public has regarding mental illness. Through acceptance and commitment therapy, society gets to accept those in their midst who are affected by mental illness. Trying to avoid or control negative or unacceptable thoughts in the long term often leads to much distress. Avoiding or suppressing these uncontrollable thoughts may cause the person who is affected by mental illness to become socially withdrawn or engage in substance abuse, among other damaging behaviours.

Through acceptance and commitment therapy, both the affected person and the community learn that becoming exposed to unpleasant situations is a better way of dealing with mental illness, rather than avoiding or running away from them. By getting exposed to what one wants to run away from, the person who is affected by mental illness is able to deal with the psychological suffering. The provision of knowledge, which is the purpose of acceptance and commitment therapy, helps in incorporating into society those who are affected by mental illness.

The knowledge provided through acceptance and commitment therapy reduces the stigma which society may have towards those affected by mental illness. Therefore, the physiological needs of people who are affected by mental illness are met.

Safety Needs and the Mental Illness Stigma

According to Maslow’s hierarchy of needs theory, after the physiological needs are met, a person has the desire for their safety or security needs to also be met (Ellerby, 2013). These needs include, among others, becoming financially secure, being healthy, and being safe against injuries and accidents. In connection to those affected by mental illness, these needs often remain unmet because of the stigma which is connected to the illness. Insecurity or feeling unsafe may lead to lack of confidence in the various phases of life of the affected person.

When a person suffers stigma due to mental illness, oftentimes they may be unwilling to leave the confines of their homes to seek mental health care services which they require. Lack of treatment tends to aggravate the mental health condition which these people may be experiencing.

Often a person who is affected by mental illness may not feel safe in the community which they live in, but because of public stigma, they may not have a safer place to live in. These people may end up living in abandoned places or shelters, or they may become homeless. The stigmatizing circumstances may become a hindrance to obtaining treatment for those affected by mental illness.

There are mental disorders, like schizophrenia, where the affected person tends to hear voices (Ellerby, 2013). The family members or the community may not want to live or be near them. These people may tend to feel vulnerable and insecure especially in mental health institutions, where their treatment method, at times, is torturous. Also, the medical health professionals may hold stigmatizing attitude towards them, causing them to feel more insecure (Shrivastava, 2012). In some circumstances, the mental health practitioners—because of the stigma they attach to those affected by mental illness—may threaten or coerce them to use a particular form of treatment which they may be unwilling to undergo (Hamilton et al., 2016). By forcefully administering treatment, the affected person often tends to feel insecure.

The affected person who may be experiencing physical health problems, because of feelings of fear and insecurity, may be unwilling to seek medical health services. The cause may be that some health professionals, owing to the stigma which they attach to mental disorders, ignore the physical symptoms which the affected person may present, considering them as just part of their imagination (Shrivastava, 2012). Because of the feelings of insecurity and fear, the person’s physical health needs may remain unmet, further complicating their general health.

Financial and Employment Insecurity in Relation to the Mental Health Stigma

People who are affected by mental illness face various hurdles in the course of their lives, which include stigma. These hurdles may hinder them from getting sufficient education and employment opportunities (Brohan & Thornicroft, 2010).

The lack of employment may affect the capacity to earn sufficient income, eventually ending in poverty. Additionally, lack of sufficient income may cause the affected person not to access necessary services like healthcare services and affordable housing. Lack of these services may cause them to become socially isolated and insecure, further worsening their health condition.

Research shows that employment or work is significant to the recovery of the people affected by various mental disorders. Social contacts at the workplace have been linked to improved mental health. Therefore, lack of employment due to mental illness may lower their self-esteem, slow down their recovery, and increase their mental distress. Financial insecurity may also lead to homelessness among those affected, leading to loss of respect, job, and status.

The families of the affected people are not left behind regarding the stigma which is linked to mental illness. These families, in most instances, are unable to bear the financial burden which comes as a result of lack of employment. Often these families may be required to be absent from work to take care of their loved one who is affected by mental illness. As a result, the family member may end up losing their job, especially if the employer realizes they are absent due to mental-illness-related issues (Brohan & Thornicroft, 2010).

Personal Insecurity in Relation to the Mental Health Stigma

The stigma which is linked to mental illness may lead to personal insecurity issues among those affected. Some of these issues include experiencing violence in the community which they live in, being treated in an inhumane manner, being tortured, and receiving medical experiments without consent. Society or the family of the affected people may also view them as being violent or dangerous. Because of lack of understanding of their behaviours, the community may become violent towards them, further causing them to feel insecure.

There have been incidences where treatments have been forcefully administered to people who are affected by various mental disorders. In such situations, the consent of those concerned has not been sought, leading to more fear among these people. During the forceful administration of treatment, some of the healthcare professionals have handled the affected people in an inhumane way (Shrivastava, 2012). At times, these people have been put in chains so as to administer the treatment, providing them or their families with no opportunity to give their views concerning their feelings and the mode of treatment that is preferable to them.

Associating those affected by mental illness with various acts of violence often leads to personal security issues and social isolation. There have been instances when criminal acts of violence have been linked to those affected by mental illness, leading to their unlawful incarceration. Also, becoming linked to violent acts causes the affected person to have feelings of not being safe or secure. Therefore, the lack of personal security has led many of them to become homeless due to fear of being harmed or becoming wrongly accused of violent acts.

There have been several incidences of law enforcers gunning down or even killing people who are mentally ill because of the stigma which they associate with mental illnesses. An example of such kind of incident has been reported in the New York Daily on 19 August 2017, where a 63-year-old man reacting negatively to medication has been shot by a police officer. Such incidences clearly demonstrate the lack of personal security which people who are affected by mental illness encounter daily.

The feelings of insecurity among those affected by mental illness may become enhanced by thoughts of paranoia and psychosis. When a person has such thoughts, they often have a biased view regarding reality. An example is where the unintended behaviour or actions of those surrounding this person may become interpreted as threatening or aimed at harming the person. Therefore, this person may end up mistrusting the intentions of everyone, hence living in fear.

The affected person who has paranoid thoughts, in most circumstances, tends to act based on their beliefs, which may not be real. They may also become hypersensitive, become insulted easily, and feel like a victim. Additionally, these thoughts may cause them to be always on the lookout for danger.

Paranoid thoughts may also evoke feelings of insecurity to the affected person, even though their environment may not pose any danger to them. These kinds of actions and behaviours may further cause them to experience more stigmas in society, which may not understand them.

Personal insecurity, which is real or imagined, may make it challenging for the affected person to form any lasting relationship. Trust, which is a significant factor in forming any relationship, is usually absent when personal security is threatened. Therefore, the ability to form and maintain a relationship becomes difficult to these people, further strengthening the stigma which they experience.

The two types of insecurities above clearly show that when safety needs are not met, there is an increase in the stigma to the people affected by mental illness. On the other hand, safety needs may remain unmet because of self-stigma which the affected person attaches to the illness. Cognitive behavioural therapy can be applied as a means of overcoming the stigma of mental illness, which comes because safety or security needs are not being met.

Cognitive Behavioural Therapy

Cognitive behavioural therapy is a combination of two types of therapies, namely, cognitive and behavioural therapies. Cognitive therapy puts its attention on a person’s beliefs and thoughts and in what way they influence their actions and attitudes. This therapy aims at changing a person’s thoughts to make them healthier and more adaptive. Behavioural therapy, on the other hand, focuses on the actions of a person and aims at changing their harmful behavioural patterns.

In relation to feelings of insecurity which a person who is affected by mental illness may be experiencing, cognitive behavioural therapy assists them in substituting their thoughts of insecurity and fear with those of courage. During therapy, this person who may be facing both public stigma and self-stigma learns how to recognize negative thoughts and feelings and restructure them. The affected person also practises during therapy how to substitute adverse thoughts and feelings with thoughts that are realistic. Recording or writing these thoughts and feelings in a journal is another way in which the person experiencing stigma due to feelings of insecurity is able to develop positive thoughts.

Cognitive behavioural therapy involves six stages. The first stage or phase is psychological assessment, where the therapist does an exhaustive evaluation of the problem to come up with an accurate diagnosis. Additionally, the information provided by both the affected person and their family is evaluated by the therapist to identify the course of action which is suitable.

The second stage is reconceptualization, where the person who is affected by mental illness is requested to share their feelings and thoughts of insecurity. The person also learns new perceptions regarding the issues which they could be facing. An example is if the person feels insecure such that they cannot leave their house to look for medical services, they are encouraged to face their fear by going out of their house. Furthermore, in this stage, the therapist assists the client in challenging the negative and unhealthy thoughts and feelings that they may be experiencing.

The third phase of cognitive behavioural therapy involves acquisition of skills. Here, the therapist helps the client, who has feelings of insecurity due to paranoia or psychosis, acquire healthy thoughts and behavioural patterns. This is to support the affected person in dealing efficiently with their feelings of insecurity. Acquisition of new skills involves assisting the affected person in reframing their past by letting it go and not allowing it to define them. Whichever mistake or failure the person may have experienced, they should look at it as a learning experience. The next thing that the person should do is to remind themselves of their achievements, despite the failures they may have faced earlier.

To overcome the feelings of insecurity caused by thoughts of paranoia and psychosis, the affected person should let go of any negative description which they hold. An example is where the person may feel insecure due to unemployment; they can overcome this by looking for employment. This stage is often the most challenging and longest as the person is trying to change thoughts and views that he has upheld for a long time.

The fourth phase involves consolidating skills and applying the training received. After acquiring new skills, the client or patient will need to practise what they have learned; this is often done in an environment which is controlled. In this phase, the affected person is exposed to techniques aimed to help them adjust their thought pattern positively. The techniques used include relaxation, coping techniques, and setting goals, among others—all targeted at developing new thought patterns.

The fifth phase is where maintenance