Can the arts be an effective tool to combat psychosis stigma?

There has been a rise in stigma for mental illnesses over the past few decades, particularly for psychotic symptoms. However, artistic representation may be the key to eliminating psychosis stigma

Stigma was originally described by the Canadian sociologist Erving Goffman in 1963 as the ‘situation of the individual who is disqualified from full social acceptance.’⁽¹⁾ The Oxford English Dictionary describes stigma as: “Negative feelings that people have about particular circumstances or characteristics that somebody may have.” Psychotic symptoms, such as hearing voices, being afraid of threats that others do not perceive, or believing in implausible ideas, remain stubbornly stigmatic which can lead to social alienation, impact self-worth, and impede recovery. The arts, such as painting, poetry, and visual arts are receiving increasing attention as potentially powerful interventions at a societal level to facilitate deeper understanding of psychotic symptoms and communicate the experience on a personal level to the public.

Historical stigma of psychosis

The origins of stigma are deeply rooted in historical misrepresentations of psychosis. In ancient times, mental illness was often attributed to supernatural causes, such as possession by evil spirits, necessitating exorcism or isolation, rather than treatment. The establishment of asylums in the 18th and 19th century marked a shift towards medicalisation, yet patients were still stigmatised, a position perpetuated to this day by negative portrayal in the media. Maletta and Vass⁽²⁾ recently conducted a 20-year review comparing the use of ‘schizophrenia’ and ‘psychosis’ in UK newspapers from 2000 to 2019 and found that article tone had worsened for both diagnoses over time, especially in the tabloids. Moreover, marginalised groups frequently report intensified feelings of stigma, not only in media and society, but within their own family networks.⁽⁴⁾ Such findings highlight the importance of targeted stigma reduction campaigns.

Video-based psychosis stigma interventions

Amsalem and colleagues^{(3, 4)} conducted a series of randomised controlled trials (experiments) to examine the effectiveness of social contact-based brief video interventions to reduce public stigma. In the videos, young people attending an outpatient clinic described different aspects of coping with their diagnosis, and how they juggle work, family, and other responsibilities, along with themes of hope and recovery. Stigma was measured before, immediately following and 30 days after watching the videos using a series of questions such as whether participants would like a person with psychosis to live in their neighbourhood, marry into their family, or whether they should have children or oversee their own finances. Compared to a group who did not watch the videos, those who did showed significant reduction in self-reported stigma. By humanising the experience of psychosis, the authors moderately disconfirmed stereotypes⁽⁵⁾ and changed perceptions.

Reducing self-stigma by ‘reclaiming the narrative’

Quite often, psychotic experiences are linked to enhanced artistic creativity. ⁽⁶⁾ The painter Edvard Munch (1863-1944), produced one of the most famous portraits depicting mental illness, ‘The Scream’⁽⁷⁾ saying: “I cannot get rid of my illnesses, for there is a lot in my art that exists only because of them.” Art forms are becoming increasingly popular as a means of communicating internal experiences and improving self-esteem by allowing people with symptoms to make sense of their world, empowering them to create communities such as the Psychosis Arts Collective, a group of Irish artists who meet regularly to express their world through art.

An example of such work is shown in the Figure. Landa and colleagues⁽⁸⁾ recently explored the potential of theatre to demystify psychosis and facilitate empathy and social inclusion. The authors utilised theories from the psychology of art and narrative psychology to examine a play titled ‘Voices,’ crafted by an individual with firsthand experience of hearing voices. This exploration adhered to theories of art as a social psychological system, focusing on the interplay between the art product, artist-author, artist-performer, and recipient. This highlighted theatre’s unique capability to create shared emotional and cathartic experiences among actors and audience members, promoting personal growth and mutual understanding. By presenting psychosis in a theatrical context, the work aimed to foster dialogue, reduce stigma, and support the social integration and recovery of those living with psychosis. The implications for practice suggest that engaging individuals with psychosis in this way can offer new insights and acceptance, underscoring theatre’s unique potential role in promoting broader social change and acceptance of diverse mental experiences.

Reducing psychosis stigma

Online mental health animations for young people have been shown to be an accessible and cost-effective means of transferring knowledge.⁽⁹⁾ The Psychosis Ireland Structured Research and Training Programme (PSI-STAR) will investigate the use of psychoeducational online animations and social media campaigns as a means of stigma reduction.⁽¹⁰⁾ The study will focus on minority groups, in collaboration with the Psychosis Arts Collective⁽¹¹⁾ and experimental theatre company BrokenTalkers.⁽¹²⁾ The ultimate aim is to normalise the discussion surrounding psychosis and ‘bust myths’ associated with the experience.

References

1. Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Simon and Schuster.
2. Maletta, R.M. and V. Vass, A 20-year review comparing the use of ‘schizophrenia’ and ‘psychosis’ in UK newspapers from 2000 to 2019: Implications for stigma reduction. Schizophrenia Research, 2023. 251: p. 66-73. DOI: https://doi.org/10.1016/j.schres.2022.12.012
3. Amsalem, D., et al., Reducing Stigma Toward Individuals With Schizophrenia Using a Brief Video: A Randomized Controlled Trial of Young Adults. Schizophrenia Bulletin, 2021. 47(1): p. 7-14. DOI: https://doi.org/10.1093/schbul/sbaa114
4. Amsalem, D., et al., Reducing public stigma toward individuals with psychosis across race and gender: A randomized controlled trial of young adults. Schizophrenia Research, 2022. 243: p. 195-202.
5. Rebecca R. Reinke, et al., Examining Two Aspects of Contact on the Stigma of Mental Illness. Journal of Social and Clinical Psychology, 2004. 23(3): p. 377-389. DOI: https://doi.org/10.1016/j.schres.2022.03.011
6. MacCabe JH, Sariaslan A, Almqvist C, Lichtenstein P, Larsson H, Kyaga S. Artistic creativity and risk for schizophrenia, bipolar disorder and unipolar depression: a Swedish population-based case-control study and sib-pair analysis. Br J Psychiatry. 2018 Jun;212(6):370-376. doi: https://doi.org/10.1192/bjp.2018.23. Epub 2018 Apr 26. PMID: 29697041
7. Heller, R., Edvard Munch: The Scream. 1973: [New York] : [Viking Press], [1973, c1972].
8. Landa, Y., et al., Who is afraid of Hermy and Jimmy? Relating to and normalizing psychosis through theater. Psychiatric Rehabilitation Journal, 2023. 46(4): p. 299-308. DOI: https://doi.org/10.1037/prj0000572
9. Coughlan, H., et al., Online Mental Health Animations for Young People: Qualitative Empirical Thematic Analysis and Knowledge Transfer. Journal of Internal Medical Research, 2021. 23(2): p. e21338. DOI: https://doi.org/10.2196/21338
10. Psychosis Ireland Structured Training and Research Programme. 2022 [retrieved 02 February 2024]; Available from: https://psistarstudy.eu/
11. Jimenez, N. The psychosis arts collective: how a group of artists who have experienced the condition are challenging perceptions. 2023 [retrieved 01 February2024]; Available from: https://www.independent.ie/life/health-wellbeing/mental-health/the-psychosis-arts-collective-how-a-group-of-artists-who-have-experienced-the-condition-are-challenging-perceptions/a707652515.html
12. BrokenTalkers. 2024 [retrieved 05 February 2024]; Available from: https://brokentalkers.ie/

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