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The Stigma of Psychosis: Lived Experience, Psychological Consequences and Strategies

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The Stigma of Psychosis: Lived Experience, Psychological Consequences and Strategies The stigma of psychosis: lived experience, psychological consequences and strategies to overcome stigma A thesis submitted to the University of Manchester for the degree of Doctor of Philosophy in the Faculty of Medical and Human Sciences 2013 Melissa Wardle School of Psychological Sciences Contents List of Tables.............................................................................................................. 10 List of Figures ............................................................................................................ 11 List of appendices ...................................................................................................... 11 List of abbreviations ................................................................................................... 12 Abstract ...................................................................................................................... 14 Declaration ................................................................................................................. 15 Data ............................................................................................................................ 15 Published work ........................................................................................................... 15 Collaborators and authorship ..................................................................................... 15 Analysis and write up ................................................................................................. 16 Copyright statement ................................................................................................... 17 Acknowledgements .................................................................................................... 19 The Author ................................................................................................................. 19 Chapter 1: Literature review ...................................................................................... 20 1.2 Defining key stigma concepts .......................................................................... 21 1.2.1 Erving Goffman’s Stigma Theory ............................................................. 21 1.2.2 The Social Cognitive Model of Stigma ..................................................... 22 1.2.3 Summarising key stigma terms and concepts ........................................... 28 1.3 Causes of stigma .............................................................................................. 30 1.3.1 Social constructs, norms and social institutions ........................................ 30 1.3.2 Functional and motivational models of stigma: threat management and system justification ............................................................................................ 35 1.4 Psychosis and the stigma of psychosis ............................................................. 37 1.4.1 Overview of Psychosis .............................................................................. 38 2 1.4.4 Summary of the biomedical model of psychosis ...................................... 42 1.4.3 Overview of Cognitive Models of Psychosis ............................................ 46 1.4.4 Research into the stigma of psychosis. ..................................................... 51 1.5 Measuring public and personal stigma ............................................................. 53 1.5.1 Measures of public stigma ........................................................................ 54 1.5.2 Measures of internalised stigma ................................................................ 60 1.5.3 Qualitative research ................................................................................... 62 1.6 The Consequences of Stigma and Discrimination ........................................... 64 1.6.1 Identity threat ............................................................................................ 64 1.6.2 Labelling and modified labelling theory ................................................... 66 1.6.3 Social Distance and Isolation ........................................................................ 69 1.6.4 Internalised Stigma........................................................................................ 71 1.6.5 Internalised stereotypes of psychosis and emotional dysfunction in people with psychosis ........................................................................................................ 73 1.6.6 Psychosis stigma and early detection, and intervention with people at risk of psychosis: an ethical debate on the effects of stigma ........................................ 75 1.7 Interventions to reduce the stigma of psychosis .............................................. 77 1.7.1 Mental illness is an illness like any other’: Biogenetic frameworks ......... 78 1.7.2 The psychosocial model to reducing stigma. ............................................ 84 1.8 Summary of the literature................................................................................. 94 1.9 Broad aims of this thesis .................................................................................. 95 Chapter 2 Methodology employed across the thesis .................................................. 96 2.1 Summary of research aims and the studies which address these aims ............. 96 2.2 Overview of approaches: qualitative and quantitative methods ...................... 97 2.3 Qualitative methodology .................................................................................. 98 3 2.3.1 Overview of qualitative methodologies .................................................... 98 2.3.2 Sampling and ethical considerations ....................................................... 102 2.3.3 Qualitative interviews and analysis ......................................................... 103 2.3.4 Credibility ............................................................................................... 104 2.3.5 Strengths and limitations ......................................................................... 109 2.4 Quantitative methodology across the continuum of psychosis ...................... 110 2.4.1 Cross sectional design ............................................................................. 110 2.4.2 Longitudinal methods ............................................................................. 111 2.4.3 Key Measures used in studies 2, 3 and 4 ................................................ 112 2.4.4 Recruitment and sampling strategy across studies 2, 3 and 4 ................. 117 2.4.5 Statistical procedures .............................................................................. 119 2.4.6 Ethical considerations ............................................................................. 121 2.5 Methodology used to explore the effectiveness of psychosocial interventions for psychosis stigma in young people .................................................................. 122 2.5.1 Randomised controlled trial (RCT) ......................................................... 122 2.5.2 Measures of public stigma ...................................................................... 123 2.5.3 Power calculation and Statistical analyses .............................................. 124 2.5.4 Ethics ....................................................................................................... 125 Chapter 3 Study 1 - It’s just a very taboo and secretive kind of thing really’: making sense of what it is like to live with stigma and discrimination from the accounts of nine people with experience of psychosis ................................................................ 127 3.1 Abstract .............................................................................................................. 129 3.2 Introduction ........................................................................................................ 130 3.3 Method ............................................................................................................... 132 3.3.1 Participants .................................................................................................. 132 4 3.3.2 Procedure..................................................................................................... 132 3.3.2.1 Data collection ..................................................................................... 132 3.3.2.2 Data analysis ........................................................................................ 133 3.3.3 Credibility ................................................................................................... 133 3.4 Results ................................................................................................................ 135 3.4.1. Judgement .................................................................................................. 136 3.4.1.1 Stereotypes ........................................................................................... 136 3.4.1.2 The media as a primary source of judgement ...................................... 137 3.4.1.3 Lowered social status ........................................................................... 137 3.4.1.4 Multiple Judgements ............................................................................ 139 3.4.2. Disclosure ................................................................................................... 139 3.4.2.1
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