ABSTRACTS

Assessment of Suicide in Schizophrenia: Development of the Interview for Suicide in Schizophrenia

Ralph M. Turner, Kathryn E. Korslund, Belinda E. Barnett, and Richard C. Josiassen, Allegheny University of the Health Sciences, The Arthur P. Noyes Research Foundation, Norristown State Hospital

Persons diagnosed with schizophrenia are at increased risk for suicide and self-harmful behavior. It is currently estimated that between 20% and 40% of individuals diagnosed with schizophrenia will attempt suicide during their lifetime. Despite the prevalence of suicide in this population, no research to date has focused on the development of standardized methods for assessing suicide vulnerability in this high-risk population. This article describes the development of the Interview for Suicide in Schizophrenia (ISIS), a semistructured interview for the assessment of suicide in individuals diagnosed with schizophrenia. Preliminary data describing the instrument's psychometric properties are presented. Transcripts from an administration of the ISIS are then presented to illustrate the administration of this interview. Appendix A includes a copy of the ISIS-Lifetime.



Getting Into the Driver's Seat of the Managed Care Juggernaut

Timothy J. Toole, Blue Cross Blue Shield of Delaware

In 1974 I had the privilege of attending one of the first annual behavioral health-care conferences in Philadelphia. I didn't know at the time that this conference would set the stage for the course of my career. The keynote speaker, Thomas Szasz (1984), was promoting his book The Myth of Mental Illness. Jay Haley was presenting a highly sought-out program on family therapy that was closed due to the great demand to learn about this new and effective way to treat severely dysfunctional families within a predictable and readily taught framework. Many of those attending that 1974 conference were working in community mental health centers (CMHCs). The CMHC movement at the time was dynamic: Many new psychologists and social workers held grand hopes of curing those with serious mental illnesses, or at least helping to improve their clients' quality of life. But what left the greatest impression on me was the conflict between those venerable professionals, who, like high priests, proclaimed that psychodynamic, long-term psychotherapy was the only true path to salvation for those with psychiatric illnesses, and the young upstarts, mainly psychologists and social workers, who were preaching a new gospel of alternative therapies, including what we call today "cognitive behavioral therapy" (CBT). The new gospel advocated predictable, structured therapies, based on research models, that would have consistent results and satisfy the demands for accountability that were just beginning to come onstage. Like many professionals, I struggled with how to help my clients solve the problems they brought to the clinic. No individual model seemed to provide a one-size-fits-all solution.



The Impact of Stigma on Severe Mental Illness

Patrick W. Corrigan, University of Chicago Center for Psychiatric Rehabilitation

Movies, newspapers, magazines, television shows, books, radio programs, and advertisements have all been vehicles for communicating the experience of severe mental illness. This has, however, tended to be a misrepresentation of the experience. Persons with psychiatric disability suffer societal scorn and discrimination because of the stigma that evolves out of these misrepresentations. This kind of rebuff frequently leads to diminished self-esteem, fear of pursuing one's goals, and loss of social opportunities (e.g., landlords are hesitant to rent apartments to persons with severe mental illness). Social psychologists have developed a model of stereotype that frames stigma as a cognitive structure. Their social cognitive paradigm seems especially useful for a model of cognitive behavioral therapy for stigma. This model identifies three targets: (a) persons who hide their mental health experience from the public and suffer a private shame; (b) persons who have been publicly labeled as mentally ill and suffer societal scorn; and (c) society itself, which suffers fears and misinformation based on stigma and myth. Each of these three targets suggest specific behavioral interventions that may alleviate the impact of stigma.



Living With Mental Illness: A Personal Experience

Robert K. Lundin, The University of Chicago

Having lived with a bipolar disorder for nearly 20 years, I discuss my personal struggles with the discrimination, blame, and guilt frequently associated with having a mental illness. I have experienced failed aspirations, feelings of self-depreciation, depression, and denial­all associated with stigma. Stigma has contributed to loss of jobs, loss of status in the community, and loss of health insurance. I have found that one way to cope with stigma is to fully disclose my illness to family, friends, and my employer. I have also found satisfaction in opposing stigma through mental health advocacy.



Individual Strategies for Coping With the Stigma of Severe Mental Illness

E. Paul Holmes, The University of Chicago Center for Psychiatric Rehabilitation, and L. Philip River, The University of Chicago School of Social Service Administration

Persons with severe mental illness must cope not only with the symptoms of their disease but also with social and self-stigma. Societal attitudes toward severe mental illness lead to lost opportunities for education, employment, and housing. Self-stigma occurs when individuals assimilate social stereotypes about themselves as persons with severe mental illness. Self-stigma results in a loss of self-esteem, diminished self-efficacy, and a hesitancy to participate in society at large. This paper will outline a number of cognitive behavioral strategies for coping with social and self-stigma, including secrecy, selective disclosure, Socratic questioning, and cost/benefit analysis.



Changing Societal Attitudes Toward Persons With Severe Mental Illness

Erik Mayville and David L. Penn, Louisiana State University

Persons with severe mental illness are often stigmatized as a result of their psychiatric condition, which likely contributes to their difficulties in interpersonal relations, occupational functioning, and self



Strategies That Foster Empowerment

Faith B. Dickerson, The Sheppard Pratt Health System

Empowerment is an ideology that has emerged in reaction to inadequacies in systems of care for persons with serious mental illness. The empowerment ideology is based on the principle that psychiatric consumers can gain control over their lives, reduce their reliance on professionals, and take action on their own behalf. Empowerment can be divided into three general attributes: self-determination, social engagement, and a sense of personal competence. Scales that have been developed to assess empowerment are measures of attitudes and not direct measures of behavior; further empirical definition and validation of the empowerment concept are needed. Strategies and programs that foster empowerment include the clubhouse model of rehabilitation, self-help groups, consumers who work as providers, participatory action research, and advocacy activities. Traditional therapies may also enhance individuals' empowerment. Clinicians need to be sensitive to issues of stigma and disenfranchisement and to the social context of consumers' lives. Consumer empowerment may also be fostered by emphasizing consumer strengths and competencies and by promoting consumer involvement in services planning and delivery.



Stigma: Critical Issues for Clinicians Assisting Individuals With Severe Mental Illness—Response Paper

Susan L. Gingerich, Delaware Psychiatric Center

Helping persons with severe mental illness cope with symptoms such as psychosis, negative symptoms, and mania is essential, but only part of the battle. Persons with mental illness also suffer from the negative effects of stigma, frequently encountering discrimination from landlords, employers, and neighbors. When clinicians fail to address stigma, they miss an opportunity to provide their clients with important strategies and skills. This paper responds to the five articles in this special series of Cognitive and Behavioral Practice, which focuses on issues related to stigma and mental illness. The author summarizes strategies in three categories of intervention: helping individuals to cope with stigma, empowering individuals to achieve their life goals, and changing society's attitudes. Some examples are give on programs that are implementing these strategies.



Stigma: Compounding the Problem Response Paper

Patrick W. McGuffin, Allegheny University of the Health Sciences

Persons with mental illness have been routinely stigmatized and pushed out of the mainstream of society. This has resulted in inhumane treatment of persons with mental illness and has often led to exacerbation of problematic symptoms. This paper discusses the articles included in this special issue of Cognitive and Behavioral Practice addressing the hardship that social stigma places on persons with mental illness, as well as strategies for addressing the problem of stigma. Comments are made regarding each of these articles. Additional comments are made regarding the role that mental health professionals can and do play in the minimization of stigma.