1

AN ANTI-OPPRESSIVE ANALYSIS OF STIGMA TOWARD PERSONS WITH
SCHIZOPHRENIA
By
Beppie Yuzwa
Bachelor of Social Work, University of the Fraser Valley 2018
MAJOR PAPER SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF
MASTER OF SOCIAL WORK
in the
School of Social Work and Human Services
© Beppie Yuzwa 2022
UNIVERSITY OF THE FRASER VALLEY
Spring 2022
All rights reserved. This work may not be reproduced in whole or in part, by photocopy or other
means, without permission of the author.

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Approval
Name: Beppie Yuzwa
Degree: Master of Social Work
Title: An Anti-Oppressive Analysis of Stigma Toward Persons with Schizophrenia
Examining Committee:
Leah Douglas
Graduate Program Committee Chair
PhD, MSW, RCSW, School of Social Work and Human Services
Timothy Dueck
Senior Supervisor
BSW, MSW, PhD (c), RSW, School of Social Work and Human Services
Karun Karki
Second Reader
BA, BEd, MA (Eng.), MA (Soc.), MSW, PhD, RSW (ON), School of Social Work and
Human Services
Date Defended/Approved:

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Abstract
Despite the growing movements to improve public attitudes toward mental health, schizophrenia
remains a heavily stigmatized mental illness. The stigma greatly impacts the lives of individuals
with schizophrenia, who often internalize the stigma they experience. This paper uses an antioppressive social work perspective to examine the general themes that influence stigma against
persons with schizophrenia, which include the myth of violence and dangerousness and
biogenetic cause. In addition, this paper highlights stigma-reduction interventions that have
shown to be effective in research, such as educational interventions and contact interventions.
Key words: anti-oppressive theory, discrimination, schizophrenia, social work, stigma

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Table of Contents
Approval ………………………………………………………………………………………….2
Abstract …………………………………………………………………………………………...3
Table of Contents …………………………………………………………………………………4
Introduction ……………………………………………………………………………………….6
Anti-Oppressive Theory …………………………………………………………………………..7
Positionality ………………………………………………………………………………………8
Methods …………………………………………………………………………………...………9
History of Schizophrenia …………………………………………………………………………9
Diagnostic and Statistical Manual of Mental Disorders ………………………………………...12
What is Stigma …………………………………………………………………………………..14
Impact of Stigma …………………………………………………………………………….......14
Themes of Stigma ……………………………………………………………………………….18
Violence and Dangerousness ……………………………………………………………18
Biogenetic Causality …………………………………………………………………….20
The Medical Model ……………………………………………………………...22
Media Influence …………………………………………………………………………………22
Reducing the Stigma …………………………………………………………………………….23
Specification ………………………………………………………………………….…24
Educational Interventions ………………………………………………………….……25
Contact Interventions ……………………………………………………………………28
Media Interventions …………………………………………………………..…………30
Other Considerations ……………………………………………………………………31

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Future Research and Limitations ………………………………………..………………………32
Practice Implications for Social Workers ……………………………………….………………33
Conclusion ………………………………………………………………………………………36
References ……………………………………………………………………………………….39

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An Anti-Oppressive Analysis of Stigma Toward Persons with Schizophrenia
Introduction
Schizophrenia is considered one of the most stigmatizing mental disorders (Zimbres et
al., 2020). Persons with schizophrenia face increased stigma compared to persons with other
mental health diagnoses. They experience negative reactions from the general public based on
the public’s stigmatizing attidues and beliefs (Theriot, 2013). When researched, participants
show the strongest negative reaction toward schizophrenia compared to other mental illnesses
(2013). This stigma is transnational – there does not seem to be a difference in stigma across
different cultures (Rose et al., 2011). “Despite sustained efforts on behalf of governments,
charities, and other opinion leaders, stigma against people with mental illnesses, and particularly
schizophrenia, has remained a persistent problem … internationally” (Bowman & West, 2019, p.
174). With this stigma being so strong and pervasive, it is important to examine what causes it
and what can be done to resolve it.
This paper uses an anti-oppressive theoretical stance to examine schizophrenia stigma,
what perpetuates it, and how to reduce it. It is important to know what drives discrimination in
order to develop anti-stigma campaigns (Thonon & Larøi, 2017). Thus, common misconceptions
about schizophrenia were explored, including the belief that persons with schizophrenia are
violent or dangerous and the idea that the diagnosis has a solely biogenetic cause. The
misconceptions, especially that of violence, creates a tenacity of stereotypes (2017).
Thus, anti-stigma interventions must be employed in order to combat these stereotypes.
There are multiple methods for anti-stigma interventions that have mixed results regarding
effectiveness at reducing stigma. There are educational interventions, contact interventions,
media interventions, and some other less-common interventions. While there has been some

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success from these interventions at reducing stigma, more research must be done and different
interventions must be created, as there is still a large prevalence of schizophrenia stigma in our
society.
It is important for social workers to be aware of this stigma as they are often deemed the
practitioners with social justice roles in organizations (2008). Mental health social workers using
anti-oppressive perspectives have opportunity in their agencies to educate about stigma and its
effects. In addition, they can promote anti-stigma interventions in and beyond the workplace to
actively promote social justice in the community.
Anti-Oppressive Theory
The theoretical background of this paper is anti-oppressive theory. Martin (2003) states
that the key features of anti-oppressive practice are about making a commitment to social justice
and challenging the social relations in society that perpetuate injustice. This paper aims to
highlight the injustices and oppression that persons with schizophrenia face and to examine
interventions that reduce stigma to pursue social justice for this population.
Anti-oppressive perspectives promote egalitarianism and power-sharing (Larson, 2008).
It also promotes self-reflection and awareness of one’s own social location and how it informs
relationships and practice behaviours (Larson, 2008). This is important when looking at
relationships between members of the general public and persons with schizophrenia because the
stigma against persons with schizophrenia leads to these people being marginalized and often
isolated from relationships. This is important for practitioners to be aware of as well when trying
to form therapeutic alliances with persons from this population. This is because people with
mental illness do not have power equality with the people that are treating them (Rose et al.,
2011). It is important to combat these paternalistic relationships so that power imbalances

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between persons with schizophrenia and persons without are deconstructed and people with
schizophrenia are empowered (Larson, 2008).
Anti-oppressive practice at times goes against the norms of Western mental health
ideologies and practices. In Western culture, medical perspectives leave little room for holistic
strategies and culturally sensitive approaches (Larson, 2008). In this paper, the power structures
and systems that perpetuate stigma against persons with schizophrenia are examined holistically,
and larger effects on the lives of persons with schizophrenia are identified.
Positionality
In keeping with an anti-oppressive perspective, the writer has examined their social
location in order to position themselves in writing this paper. The writer of this paper is a
Caucasian female with no lived experience of schizophrenia. They are a social worker that has
worked in mental health for three years and have experience working with persons with
schizophrenia. This is what inspired the writer to write this paper. Clients that the writer has
worked with who have a schizophrenia diagnosis often deny that they have the disorder or state
that their diagnosis is incorrect. At times, they refuse to take medication or go to treatment
because they deny the disorder. They have expressed that people think they are crazy and have
limited social supports. In addition, they are often facing poverty, homelessness, and
unemployment.
The writer believes that this denial and negative consequences are partially a result of the
public stigma of schizophrenia, which persons with the disorder have internalized. To increase
treatment adherence and help-seeking and decrease the negative effects mentioned above, it is
important to combat the stigma against persons with schizophrenia. This has become a passion of
the writer’s since working in mental health and is the reason for this paper.

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Methods
In order to find the research articles used for this paper, the writer conducted a search of
the online University of the Fraser Valley Library. The databases utilized to find applicable
articles included Academic Search Complete, PsycInfo, and PsycArticles. The articles found on
these databases were published within the past ten years, but some articles specifically related to
theoretical background were over 10 years old. The search terms used included: schizophrenia,
mental health, violence, dangerousness, prejudice, discrimination, stigma, oppression,
internalized stigma, stigmatization, self-stigma, help seeking, interventions, anti-stigma, antioppressive theory, social work, and negative attitudes. These terms were used to find peerreviewed, academic articles to be used as research for the topic of this paper: the stigma against
persons with schizophrenia and the interventions used to reduce it.
Older data was used to collect statistical information on the prevalence of violence
perpetrated by persons with schizophrenia, as this was the most recent statistical information that
could be found. These pieces of data were from Swanson et al. (1990) and the Department of
Health (2002). This data was used to provide an understanding of actual violence prevalence
versus the perception of violence by the public. In addition, there were some articles found on
the PsycInfo database that were over 10 years old that provided information on anti-oppressive
theoretical background. These papers were by Larson (2008) and Martin (2003). This
information was solely used to inform the theoretical aspect of this paper. Articles included were
only from developed countries that utilize the Diagnostic and Statistical Manual of Mental
Disorders (DSM). This was to ensure that a common, universal definition was being referred to
by all articles as the DSM diagnosis of schizophrenia is the one referred to in this paper.
History of Schizophrenia

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To learn about schizophrenia, it is important to understand the actual meaning of the
word. The word schizophrenia originated from the green words “phren” and “schizein”
(Katschnig, 2018). The word phren means mind, and the word schizein means to fall to pieces.
Schizophrenia can roughly be translated to a broken or split mind. This at times can lead to a
confusion with split personality disorder. Because of this, in Japan the disorder was renamed
from the original name, which meant “split-mind disease” to Togo Shitcho Sho, which translates
to “integration disorder” (Katschnig, 2018, p.1096). There has been some research in Japan into
the impact of this name change on stigma surrounding the disorder, but North America has not
adopted this name change. The name schizophrenia is still used today.
The first person to define schizophrenia was Emil Kraepelin, a psychiatrist (Katschnig,
2018). Kraepelin diagnosed people with progressive disorders that are not improving with
schizophrenia from the mid to late 1800s. This contributed to the idea that schizophrenia was a
deteriorating, chronic and incurable psychiatric disorder (2018). This idea remains to this day,
and this myth will be further explored later in this paper.
Another psychiatrist, Eugen Bleuler, disagreed with Kraepelin’s definition of
schizophrenia (Katschnig, 2018). He changed and evolved the definition that Kraepelin
introduced. In the mid to late 1800s, he defined schizophrenia as a disorder classified by
symptoms of incoherence in psychic functioning in cognitive and affective areas. Bleuler
believed that hallucinations and delusions were only accessory symptoms of the disorder.
However, this led to a lack of clarity in symptoms for the disorder and made it hard to diagnose.
It was also often confused with split personality disorder (2018). Symptoms with this definition
were hard to identify, quantify and measure. Thus, the diagnosis continued to involve over time.
The definition and evolution of the diagnosis of schizophrenia continued into the early

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1900s. In 1911, psychiatrist Kurt Schneider changed the diagnosis and made hallucinations and
delusions a key diagnostic feature of the disorder, otherwise called “First Rank Symptoms”
(Katschnig, 2018). Hallucinations and delusions remain the leading symptoms for a diagnosis of
schizophrenia to this day. These hallucinations and delusions “represent a complete detachment
from ‘reality’ and have become a core component of the public stereotype of schizophrenia” (p.
1097). Because they are the key diagnostic feature, hallucinations and delusions are the primary
symptoms focused on in treatment. When antipsychotics were discovered in the 1950s, they were
prescribed to work against delusions and hallucinations, not the other symptoms of
schizophrenia, such as withdrawal and inactivity (2018). Thus, people with schizophrenia taking
these medications are only having some parts of the disorder addressed, and may continue to
experience other negative symptoms.
Schneider’s definition of schizophrenia was quite different from the original definitions
put forward by Bleuler and Kraepelin. The original schizophrenia diagnosis was classified by
impoverishment of affect, disturbance of personal contact and rapport, lack of motivation,
ambivalence, and depersonalization (Katschnig, 2018). This former definition has now been
mostly rejected, and the new diagnosis of schizophrenia focuses primarily on hallucinations and
delusions.
This has led to the current Diagnostic and Statistical Manual for psychiatric disorders
definition of schizophrenia today, and it has led to hallucinations and delusions being major
criterion required for a diagnosis of schizophrenia (Katschnig, 2018). Hallucinations and
delusions play a large role in the symptom diagnosis, because they are measurable, quantifiable,
and standardized symptoms. It is straightforward to assess the presence or absence of these
symptoms. Hallucinations and delusions are easy to put into checklists and report onto

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computers, making this definition of schizophrenia the most favourable for practitioners using
the medical model. They are also more easily addressed with antipsychotic medications.
The disease of schizophrenia and how it has been constructed has consequences, the
focus on hallucinations and delusions contribute to a stereotype of craziness, split personality,
and unpredictable and dangerous behaviour (Katschnig, 2018). This is a “public stereotype
resulting from a scientifically unjustified disease conglomerate” (p. 1098). A diagnosis that has
evolved overtime has led to many false ideas surrounding the disorder. There are alternative
approaches to this constructed disease model including multi-dimensional approaches, personcentered approaches, or the use of a vulnerability stress coping model (2018). However, with the
disease model being more easily measurable and medicalized, it is the model that is continuously
favoured by psychiatrists.
Diagnostic and Statistical Manual of Mental Disorders
The diagnosis of schizophrenia referred to in this paper is that defined by the DSM 5th
edition (American Psychological Association, 2013). Schizophrenia appears in approximately
0.3-0.7% of the population. There is variation across different countries and ethnicities. For
males, the diagnosis is often longer in duration and has poorer outcomes; females often have
more brief presentations of the disorder. The disorder usually emerges between the late teens to
mid-thirties; onset prior to this age range is rare.
The main diagnostic criterion for schizophrenia include two or more of the following
symptoms: delusions, hallucinations, disorganized speech (e.g., being incoherent), grossly
disorganized or catatonic behaviour, and negative symptoms, which include diminished
emotional expression and lack of motivation (American Psychological Association, 2013). In
order for the diagnosis, one of the first three symptoms mentioned (delusions, hallucinations,

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disorganized speech) must be present. There are cognitive, behavioural and emotional
dysfunctions present in persons diagnosed with schizophrenia. Some examples of these
dysfunctions are inappropriate displays of emotion, such as laughing at inappropriate times,
disturbed sleep and eating habits, and cognitive deficits that lead to vocational and functional
impairments (2013).
An important fact to note is that while hostility and aggression can be symptoms of the
disorder, “spontaneous or random assault is uncommon” (American Psychiatric Association,
2013, p. 101). This is important because violence and dangerousness are commonly associated
with schizophrenia by the public and increase the stigma against these individuals; this will be
discussed further later in this paper. The American Psychiatric Association (2013) states that
some individuals with schizophrenia lack insight or awareness of their disorder. This is
associated to non-adherence to treatment, poorer prognosis and lower social functioning. The
writer queries whether this is also associated with denial of the illness due to internalized stigma.
The risk and prognostic factors for schizophrenia include both environmental and genetic
or physiological causes (American Psychiatric Association, 2013). While genetic risk factors are
strong in determining risk for schizophrenia, it is important to note that most people diagnosed
with schizophrenia have no family history of psychosis. This is contrary to the general public’s
belief that the cause of schizophrenia is mostly biogenetic (Hinkley & Waldron, 2020). The
American Psychiatric Association (2013) explains that there are environmental factors that may
be responsible for a schizophrenia diagnosis. Some of these include the season a person is born,
children growing up in an urban environment, and being a part of some minority ethnic groups. It
is important to be aware of the DSM explanation of schizophrenia description of the disorder in
the manual, as some of these items can either contribute to or conflict with stigmatizing beliefs

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about the disorder.
What is Stigma
Stigma can be defined as negative beliefs, attitudes, emotions and behaviours held by the
general public toward people of a certain group, such as people with mental illness (Zimbres et
al., 2020). This often includes a devaluation of this group of people (Hinkley & Waldron, 2020).
Mental illness stigma includes negative attitudes, beliefs and actions toward people with mental
illness, including persons with schizophrenia (Firmin et al., 2015). The beliefs and attitudes are
centered on a group, and may be based on false information. “It is the label that attracts stigma
and not the behaviour of the person as such” (Rose et al., 2011, p. 194). In other words, a
person’s real behaviour and characteristics may have no bearing on the stigmatized attitudes
others have toward them, the stigma is often based on outside factors.
Stigma is greater for schizophrenia than any other disorder, (Thorsteinsson et al., 2019)
and it is among the most stigmatized of mental illnesses (Flanigan & Climie, 2020). Common
themes that people experiencing stigma identify are being shunned, mocked, and abused (Rose et
al., 2011). In addition, some feel that there is a lack of understanding from others. The
experience of stigma has a negative effect on persons in the stigmatized groups, including
internalization.
Impact of Stigma
It is important to discuss stigma is because of the impact it has on persons from
stigmatized populations. The negative impact of stigma, prejudice, and discrimination reduces
the quality of life for these individuals. This is true for persons with schizophrenia.
Stigma has an impact on many areas in people’s lives. In a research study by Thonon and
Larøi (2017), more than half of respondents stated that they would not have persons with

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schizophrenia care for their children, over a quarter stated that they would not want them married
to their family, or recommend them for a job, twenty percent would not rent a room to them or
want them as a neighbour, and ten percent would not want them as a colleague or introduce them
to family and friends. This stigma is detrimental to employment, and housing for persons with
schizophrenia. This is reflected by other research as well. Hinkley and Waldron (2020) and
Zimbres et al. (2020) reiterate that stigma limits access to education and employment and de C.
Silva et al. (2017) agree that it creates difficulty in interpersonal and professional relationships.
This is because the public’s negative attitudes toward persons with schizophrenia lead to
avoidance and exclusion (Morgan et al., 2021) and bring out emotions of pity and fear (Thonon
& Larøi, 2017). This alienation causes damage to persons with schizophrenia, even more than
the perpetuation of stereotypes (Morgades-Bamba et al., 2019).
One of the impacts of public stigma is internalized stigma. Internalized stigma is when a
person from a stigmatized group, such as persons with schizophrenia, become aware of stigma
and stigmatizing beliefs and start agreeing with it and applying it to oneself (Firmin et al., 2015).
Thus, public stigma leads to the internalization of negative beliefs for persons with
schizophrenia. Internalized stigma is prevalent in persons that experience psychosis, which is a
common symptom of schizophrenia (2015).
When people start internalizing stigmatizing beliefs and stereotypes and begin agreeing
with them, they develop low self-esteem and self-efficacy (Morgades-Bamba et al., 2019;
Pescosolido et al., 2013; Theriot, 2013). This low-self esteem may be connected with
embarrassment over having the disorder. As Thorsteinsson et al. (2019) report, individuals are
ashamed to have schizophrenia and often fear what their families will think about their diagnosis.
In addition, the discrimination that some persons with schizophrenia experience increases

16
feelings of worthlessness and hopelessness about the future, sometimes it may even increase
feelings of suicidality (Morgan et al., 2021). Thus, it can be said that stigma and discrimination
has negative psychological effects on persons with schizophrenia.
Stigma also has a negative effect on persons with schizophrenia’s willingness to seek
treatment (Katschnig, 2018; Pescolosido et al., 2013) and thus delays the start of treatment (de C.
Silva et al., 2017). This may be due to anticipated discrimination for people who are in early
stage psychosis (Firmin et al., 2015). Stigma creates a major barrier to treatment, which
negatively effects the amount of support persons with schizophrenia receive and their quality of
life (Gilmore & Hughes, 2021). Therefore, many persons with schizophrenia are not seeking
treatment, or delaying their start of treatment. This may be why the internalization of stigma
reduces the chances that persons will recover from schizophrenia (Morgades-Bamba et al.,
2019).
A study by Rose et al. (2011) highlights well the experience of discrimination and stigma
from the perspective of participants with a diagnosis of schizophrenia. The self-reports from
participant demonstrated the great impact that stigma has on their lives and the negativity they
experience. Some of the reported experiences of stigma from participants included being
shunned, mocked and abused, having people misunderstand, and the feeling that they can only be
around other service users. They reported that often people they interact with are well meaning in
interactions but negative about schizophrenia, and that the stigma toward them limits their
romantic prospects. Some even reported sexual and physical abuse from family, partners, friends
and mental health professionals. Several even reported that they observed mental health staff
abusing other service users. This all contributes to withdrawal from social relationships on the
part of the respondents. Some reported that they did not want to be in romantic relationships, had

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drifted away from friends, avoided going outside and just generally avoided other people and
social situations. This isolation comes from an anticipation of negative consequences from
interacting with others, since most acute discrimination is in the personal domain of respondents
lives, in relationships with family, friends, and intimate relationships.
Participants in Rose et al.’s (2011) study reported that lack of understanding of
schizophrenia extended sometimes to medical professionals, such as family doctors. The
misunderstandings reported were an expectation of violence from persons with schizophrenia
and a misunderstanding of the cause of the illness. These are themes of stigma that will be
spoken about later in the paper. Participants with schizophrenia stopped themselves from doing
certain things because of anticipated discrimination and misunderstanding. This may be related
to delayed help or treatment seeking spoken about previously, and thus a lack of help and
support received.
Another negative aspect of schizophrenia diagnosis reported in the study was the impact
of treatment and medications. Many reported that they did not like side effects of medication,
and some of these visible side effects they felt led to others avoiding them and consequently led
to participants being further isolated. Some other side effects included reduced libido, vision
impairment, lack of concentration, weight gain, diabetes, and tooth decay. Some of these side
effects, such as lack of concentration and vision impairment, led to a decrease in ability to
function in daily life by impacting ability to drive and work. This further marginalizes persons
with schizophrenia from society and their ability to meaningfully participate in society.
In summary, stigma has tangible negative effects on persons with schizophrenia. This
population is marginalized from society due to the stigma against them and delays them from
seeking treatment. In addition, at times treatment and medications lead to side effects that further

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isolate and marginalize persons with schizophrenia. Misunderstandings of the disorder are
common, with major themes reported being lack of understanding of the cause of illness and the
idea that persons with schizophrenia are violent (Rose et al., 2011). These themes will be further
explored in the following section.
Themes of Stigma
There are two major themes when it comes to stigma against schizophrenia. These
themes include the assumption that persons with schizophrenia are violent, unpredictable, and
even dangerous, and the idea that the cause of schizophrenia is purely biogenetic. These
stereotypes and assumptions are not necessarily true, as per the facts previously mentioned in
this paper. Despite this, many people believe that people with schizophrenia are unpredictable
and have a poor prognosis (Thonon & Larøi, 2017). These themes of stigma will be discussed
further in the coming sections.
Violence and Dangerousness
One of the biggest misconceptions when it comes to schizophrenia is the idea that
persons with schizophrenia are violent, unpredictable and dangerous. Multiple sources have
reported that this perception is prevalent in society (Bowman & West, 2019; Flanigan & Climie,
2020; Gilmore & Hughes, 2021; Katschnig, 2018; Thonon & Larøi, 2017; Zimbres et al., 2020;
Zvonkovic & Lucas-Thompson, 2015). Persons with schizophrenia are also regarded as being
cold and unapproachable (Thonon & Larøi, 2017). Because of this stereotype, people often want
to avoid interactions with persons with schizophrenia out of fear (Thonon & Larøi, 2017). Thus,
this misconception perpetuates stigma and increases discrimination and the desire to distance
from persons with schizophrenia, further marginalizing, ostracizing and isolating these
individuals from society.

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It is important to note that this idea is indeed a misconception. As Zvonkovic and LucasThompson (2015) explain, “there is no empirical support for the general public’s perception of
people with schizophrenia as a violent threat to the community” (p. 203). While individuals with
schizophrenia may be more likely to commit violence than persons without the disorder, violence
rates for those with schizophrenia are much lower than those for persons in other mental illness
groups (e.g., addiction) (Zvonkovic & Lucas-Thompson, 2015). Also, after controlling these
findings of increased violence for factors like non-compliance with medication and substance
use, the percentage of persons with schizophrenia with violent tendencies drops to almost zero
(2015). Thus, violent tendencies may be more due to outside factors than to the diagnosis of
schizophrenia itself. Variables like male sex, young age, and lower socioeconomic status
contribute more highly to violence than the small amount attributable to mental illness (Swanson
et al., 1990).
To further oppose this misconception, a United States study showed that 16% of men
aged 18-24 years from low economic classes were violent, presenting a far greater risk than all
people with schizophrenia in the sample being studied (Swanson et al., 1990). A National
Confidential Inquiry into Homicide and Suicide in the United Kingdom found that one third of
homicide offenders had a lifetime diagnosis of a mental disorder, but the most common disorders
were personality disorders and substance use disorders (Department of Health, 2002). Only 5%
of these individuals had schizophrenia, showing once again the low prevalence for violence in
this population.
It is important that these findings be more public, and that these facts are presented to the
public when advocating against stigma. Gilmore and Hughes’ (2021) research they found that
some people are aware that their perceptions of persons with schizophrenia as crazy or dangerous

20
are socially unacceptable, but they still voiced these views and expressed that they believed these
perceptions. This may show that the public is starting to have an awareness of the inaccuracy of
the violence perception, but there is still work to be done to abolish this stereotype.
Biogenetic Causality
Another theme of stigma is the idea that the cause of schizophrenia is solely
psychological or genetic. This is the public’s causal attribution of the problem. Their beliefs on
the cause of the problem impact their stigmatizing attitudes (Hinkley & Waldron, 2020).
However, this causal attribution is inaccurate. As formerly discussed, the American Psychiatric
Association (2013) shows that environmental factors also contribute to the development of
schizophrenia (e.g. being a member of a minority group and childhood experiences). Despite
this, the misconception remains, and there is a general endorsement of the biogenetic illness
model of schizophrenia (Gilmore & Hughes, 2021).
The belief that schizophrenia is caused solely by biogenetics increases stigmatizing
attitudes of the public. People who believe in biogenetic cause are more likely to want to social
distance themselves from persons from schizophrenia than people that recognize the
psyschosocial causes (Zvonkovic & Lucas-Thompson, 2015). In addition, the biogenetic
explanation of schizophrenia may contribute to a genetic essentialist bias (Hinkley & Waldron,
2020). As Hinkley and Waldron explain, genetic essentialist bias leads to people perceiving that
a person is unchanging or unable to change, and this makes them different from others and
influences their behaviours. They explain that this increases the public’s desire to be distant from
people with schizophrenia and lead to the belief that people with schizophrenia cannot get better.
In a study by Thonon and Larøi (2017), half of the respondents in their study believed that a
diagnosis of schizophrenia had a poor prognosis. A diagnosis of schizophrenia is “perceived as a

21
virtual death sentence in terms of referring to a chronic, deteriorating and incurable disease”
(Katschnig, 2018, p. 1094). Lampropoulos and Apostolidis (2018) further explain that this leads
people to believe that people with schizophrenia are abnormal people with no control over their
thoughts and acts. This is a misconception, as only about one third of first episode schizophrenia
patients are chronic, recovery from the disease is not infrequent (Katschnig, 2018). Thus, the
biogenetic causal attribution for schizophrenia increases misconceptions on recovery and
increase stigmatizing behaviours.
Biogenetic causal attribution has also been shown to amplify the misconception of
dangerousness and violence that was previously spoken about. Lampropoulos and Apostolidis
(2018) state that biogenetic causal attribution enforces the idea that people with schizophrenia
have no control over their thoughts or acts and thus they are dangerous. Other researchers echo
this finding (Gilmore & Hughes, 2021; Hinkley & Waldron, 2020). Thus, the themes of stigma
spoken about interact and reinforce each other and perpetuate misconceptions about
schizophrenia.
It is important to also note that believing in biogenetic causality does increase sympathy
and the idea that persons with schizophrenia need support (Gilmore & Hughes, 2021).
Furthermore, it reduces blaming persons with schizophrenia for their negative symptoms
(Hinkley & Waldron, 2020). These are positive ideas, but the misconception of causality still
causes other negative stereotypes.
Ultimately, it is most important that the misconception of biogenetic causality is
addressed to reduce stigma. “[B]iogenetic explanations for mental illness are more common in
the case of schizophrenia and have more powerful adverse effects on stigma for schizophrenia
than many other mental health conditions” (Hinkley & Waldron, 2020, p. 369). Thus, in the case

22
of schizophrenia it is important that causality be looked at and people are properly educated on
the psychosocial contributors to schizophrenia diagnoses in order to combat stereotypes and
reduce stigma.
The Medical Model. Part of the reason for the misconception of the solely bio-genetic
cause of schizophrenia is because of the concentration on the medical model for mental illness.
“[T]he dominant discourse in mental health organizations is the medical model … which is
imbued with hierarchy, patriarchal structures, and power differentials” (Larson, 2008, p. 40).
Thus, the medical model creates an idea of persons with mental illness being less than and
“othered.” Attention is paid to diagnosis, assessment and DSM features when educating
practitioners (2008). Biology is the focus along with medication, which emphasizes the
biological and genetic causal factors for schizophrenia, furthering the misconception that these
are the only causes.
Media Influence
The media is an important source of information about mental illness (Zimbres et al.,
2020). When people have not been exposed to persons with mental illness, they often rely on the
media for explanations of the disorders. However, much of the information on mental illness
provided by the media has negative and inaccurate information about mental illness (Theriot,
2013). This means that many people are basing their beliefs and ideas about mental illness on
incorrect information. In media, people with mental illness are often portrayed as violent and
unpredictable in news and entertainment programming (Zimbres et al., 2020). As Theriot (2013)
explains, “media depictions of people with mental illness frequently highlight negative images of
disorders, promote stereotypes, and endorse the link between mental illness and violence” (p.
119). This perpetuates the idea that people with mental illness, including persons with

23
schizophrenia, are violent and dangerous, which is one of the stigma themes previously
mentioned in this paper. Therefore, the media is increasing the stigma toward persons with
schizophrenia.
Bowman and West (2019) give an example of the impact of media on stigmatizing
attitudes toward mental illness. In their research, Bowman and West (2019) examined the impact
that exposure to a “psycho ward” Halloween costume had on attitudes of the public toward
persons with schizophrenia. The costume referred to was made to represent a person with mental
illness who is staying in the psychiatric ward at a hospital or other psychiatric facility. The
researchers hypothesized that exposure to this Halloween costume would increase prejudicial
attitudes toward persons with schizophrenia, and their hypothesis was correct. The result of study
participants seeing the psycho ward Halloween costume increased their negative behavioural
intentions toward persons with schizophrenia and increased prejudice toward these people. Thus,
the authors concluded that stereotypical representations of persons with schizophrenia, such as
the aforementioned Halloween costume, will have a long-term, negative effect on public
attitudes and behaviours toward persons with the disorder. They also stated that these
stereotypical and negative portrayals can undermine anti-stigma efforts. For this reason, media
needs to be addressed in anti-stigma efforts.
Reducing the Stigma
Considering the prevalence of stigma toward schizophrenia and the impact that it has on
the lives of persons with the diagnosis, it is important that efforts be made to reduce the stigma.
This is necessary to improve the lives of persons with schizophrenia (Zimbres et al., 2020). As of
now, it is hard to identify anti-stigma interventions that actually lead to reduced stigmatizing
behaviours, and there are not many that have routine evaluation, assessment or monitoring

24
(Pescolosido et al., 2013). The current anti stigma campaigns are largely lacking and there is a
need for development of further interventions (Thonon & Larøi, 2017). In order to develop
appropriate anti-stigma interventions, it is important to know what drives discrimination. The
themes of stigma identified above and the false information about schizophrenia put forward by
the media have driven stigma against persons with schizophrenia. Thus, the anti-stigma
campaigns and interventions address these factors.
There are different types of anti-stigma interventions that have been identified in the
research. There are multiple factors that contribute to the effectiveness of interventions,
including specification, education, contact, and media interventions. These factors will be
discussed further in the following sections.
Specification
Specification is a very important factor to remember in anti-stigma efforts regarding
schizophrenia. Many anti-stigma interventions currently available focus on stigma toward nonspecific mental illness, rather than particular diagnostic labels such as schizophrenia (Morgan et
al., 2021). While it is important to address mental illness stigma as a whole, it is also important
to address stigma against particular mental illnesses individually because stigma varies by mental
health problem. This is particularly important for anti-stigma interventions targeting
schizophrenia, as schizophrenia is considered one of the most stigmatizing of mental disorders
(Zimbres et al., 2020).
Thus, with mental health interventions now, a general decrease in stigma against
generalized mental health is addressed. There are face to face programs, online resources,
awareness campaigns, and advocacy work to combat stigma against mental illness (Morgan et
al., 2021). As a result, there has been an improvement in understanding of common mental

25
illnesses, such as depression and anxiety, but there is still widespread misunderstanding and
ignorance about other disorders. Thus, stigma against persons with schizophrenia remains. There
are only small parts of programs that address poorly understood mental illnesses (e.g.,
schizophrenia). It is important that anti-stigma campaigns address schizophrenia specifically, and
specific factors such as misconceptions about violence and dangerousness, which are specific to
schizophrenia stigma, are addressed in these campaigns (Thonon & Larøi, 2017). Anti-stigma
efforts that are more specifically targeted at the diagnosis of schizophrenia may be more
effective at reducing stigma toward the disorder than the other generalized anti-stigma
interventions that are currently most prevalent.
Educational Interventions
Educational interventions are the most practical and efficient intervention types
(Zvonkovic & Lucas-Thompson, 2015). This is because many people do not have time or
willingness to attend meetings with persons with schizophrenia, in the way that contact
interventions would encourage. Thus, educational interventions were the interventions most
commonly found in research about anti-stigma interventions.
The purpose of educational interventions is to increase knowledge about schizophrenia.
With increasing knowledge, members of the public will have improved attitudes and behaviours
toward persons with schizophrenia (Thorsteinsson et al., 2019). In addition, educational
interventions can correct myths and misunderstandings that perpetuate stereotypes about this
population (Morgan et al., 2021). Contradicting the puplic’s misconceptions about schizophrenia
and replacing stereotypes with facts can diminish stigma (Zimbres et al., 2020). Thus, through
education the public can be informed about stereotypes of schizophrenia solely being caused by
biological and genetic factors, and about persons with schizophrenia being violent and

26
dangerousness. This is important, because as mentioned above, these misconceptions are the
most prevalent and they perpetuate stigmatization and marginalization of persons with
schizophrenia. Improving our understanding of the negative and positive perceptions that are
pervasive around schizophrenia can assist in developing targeted campaigns that are aimed at
increasing the public’s support for this population and thus improve the well-being and quality of
life for persons with schizophrenia (Zimbres et al., 2020). This is why interventions to reduce
stigma should focus on approaches that target false beliefs toward mental disorders; educational
interventions have the power to do this.
Hinkley and Waldron (2020) address a myth of the biogenetic cause for schizophrenia. In
their study, two groups of participants were split up. One group received a genetic explanation
for the cause of schizophrenia, and the other was given an environmental explanation.
Participants that were given a genetic explanation tended believe in permanence of the disorder
and pessimism regarding the prognosis for the disorder. However, when this group was given
information on the treatability of schizophrenia, their pessimism decreased. As a result, the
participants given treatability information on the disorder had behavioural improvement and
desired less social distance from persons with schizophrenia. As Hinkley and Waldron (2020)
explain, “how people teach and talk about mental illnesses may have significant effects on their
attitudes toward those effected by mental illness” (p. 375). Thus, dispelling myths about
schizophrenia through education and advocacy in society can improve attitudes of the public
around this mental illness.
However, while it is important that campaigns target causal beliefs and the belief that
people with schizophrenia are dangerous, they also need to take into consideration the issues of
power and intergroup domination. As Lampropoulos and Apostolidis (2018) explain, stigma is

27
not just about lack of literacy. It is also related to oppression in our society. It is important that
issues of power, rights, and social discrimination are also addressed in educational anti-stigma
interventions. From an anti-oppressive social work standpoint, it is important that people are
educated on oppression and its cause and effect.
Educational interventions are also important for people with schizophrenia and their
families. This way, people with first-episode psychosis and their families can recognize
symptoms and start seeking help right away. Thorsteinsson et al. (2019) state that education
around schizophrenia has been shown to improve identification and help seeking. This is
important, because as previously mentioned, stigma has reduced help-seeking and treatment
adherence for people with schizophrenia. Educational interventions can improve this.
There are mixed results around the success of educational interventions, but there has
been some effectiveness in educational anti-stigma interventions reducing stigma and negative
attitudes toward people with mental illness (Theriot, 2013). Certain factors increase the
effectiveness of educational interventions. For example, increased duration and clarity of
interventions. In addition, there needs to be room for discussion and reflection in education
(2013). This way, people can ask questions about misconceptions and discuss their ideas about
schizophrenia, and have their thoughts on the diagnosis fully explored and improved. Lastly, it is
important that educational interventions be stimulating and emotionally arousing to ensure that
participants in the interventions are engaged and avoid boredom (2013).
While the factors mentioned above are shown to increase the effectiveness of educational
interventions, and there is some effectiveness shown in different studies, education is still shown
to only bring a small reduction in stigma. In Zimbres et al.’s (2020) study, the improved
knowledge about schizophrenia did not decrease participant’s desire to distance themselves from

28
people with the disorder. This was also reflected in the results of Zvonkovic and LucasThompson’s (2015) educational intervention study. The intervention improved explicit attitudes,
and possibly some willingness to interact with the population, but it did not change unconscious
attitudes about the dangerousness of schizophrenia. Therefore, people who go through
educational anti-stigma interventions may continue to stereotype and stigmatize people with
schizophrenia (2015).
To summarize, while they can be effective, educational interventions my not be sufficient
to improve the lives of people with schizophrenia as they may not reduce the stigmatization
against them (Zvonkovic & Lucas-Thompson, 2015). Educational interventions have increased
sympathy and awareness of the need for support for persons with schizophrenia, but stigma
remains (Gilmore & Hughes, 2021). Lampropoulos and Apostolidis (2018) state that including
people with lived experience in anti-stigma campaigns is important. Furthermore, Flanigan and
Climie (2020) state that interventions with a combination of education and contact with persons
with schizophrenia are shown to be effective in reducing desired social distance from this
population and decrease endorsement of negative attitudes and discrimination. Therefore, while
education is important, including contact in anti-stigma interventions is also important.
Contact Interventions
As previously mentioned, it is recommended to include contact with persons with
schizophrenia in anti-stigma interventions. This is called the contact approach: bringing people
with mental illness together with people who stigmatize (Zimbres et al., 2020). There has been
some research in regard to these contact interventions and their effectiveness; however, the
prevalence of these interventions is much less than educational interventions. This may because
there is a low prevalence of complex mental illness in society, so people do not have much

29
contact with people with these diagnoses (Morgan et al., 2021). In addition, this entails a lot of
cost and time (Zimbres et al., 2020). There would be time recruiting participants with
schizophrenia, who may be reluctant due to previous experience with discrimination and stigma.
There may need to be financial incentive for these folks to participate. Thus, these interventions
are less practical and efficient than educational interventions, which may be why they are less
commonly used.
Nonetheless, contact interventions with persons with mental illness have shown to be
effective. As Morgan et al. (2021) explains, hearing stories about the lived experiences of
recovery have an emotional resonance that makes the impact of mental illness more tangible and
understandable to program participants. Thus, it is a strength for programs to have a combination
of contact and input from people with lived experience and educational aspects.
Zvonkovic and Lucas-Thompson (2015) echo these ideas, they state that contact with
persons with mental illness is more effective at reducing stigma and they recommend
incorporating contact interventions in early education to try to combat and prevent stigma from a
young age. They stated that if contact interventions are put forward to people at an earlier age,
people with schizophrenia may experience a higher quality of life as a result of reduced stigma.
In addition, it may improve help-seeking behaviours if stigma is reduced.
Participating in contact interventions also has benefits for persons with schizophrenia that
are involved. When persons with schizophrenia have the opportunity to share their lived
experience, they have reported feeling reduced self-stigma, increased confidence, sense of
meaning and connection to peers with the same diagnosis (Morgan et al., 2021). In witnessing
the impact of their stories, empathy, and reduced stigmatizing attitudes of intervention
participants, self-stigma is also reduced. An added benefit is connection with others with lived

30
experience if more than one person with schizophrenia is involved in the intervention. Thus,
these interventions are both beneficial in reducing stigma the general public’s stigma and
improving internalized beliefs of persons with schizophrenia.
It is important to note that contact with persons with schizophrenia does not always
reduce stigma. In Rose et al.’s (2011) study, while they acknowledged that contact with persons
with schizophrenia has been shown to reduce stigma, people with schizophrenia stated that the
people that they had the most contact with discriminated the most strongly against them. This
may be because people that are less interacted with are unaware of the disorder, or because of
other familial or friend conflict, but it is still an important factor to be aware of. However, the
overwhelming evidence supports that contact interventions with persons with schizophrenia are
effective at reducing stigma toward this population.
Media Interventions
The media has a large role to play when it comes to how schizophrenia as a disorder is
presented to the general public, and thus, the public’s perceptions. This is why it is important to
have the media involved in anti-stigma interventions, because the media is a major source of
information to society. Most information from the media regarding mental illness is negative or
inaccurate (Theriot, 2013). It is important that this be corrected in order for misconceptions to be
challenged and for attitudes to change.
Theriot (2013) conducted an anti-stigma intervention with college students involving the
media. The students were involved in a seminar called “Maniacs and Psycho Killers: Myths and
Realities of Mental Illness in Pop Culture” (p. 119). The intervention involved showing
participants popular film and media with lectures and class discussions around this media. The
reason that Theriot used the media with this group is because college students are mass

31
consumers of media. The seminar taught students the true relationship about mental health and
violence: violence is rare with this population and often comes along with the use of alcohol or
drugs and specific circumstances. The result of this study was an improved attitude toward
persons with schizophrenia. It is important to note that the attitudes toward persons with
schizophrenia did not necessarily go from negative to positive. Some attitudes remained
negative, but there was an overall improvement in attitudes. This suggests that media
interventions can be partially successful at improving stigmatizing attitudes toward mental
illness, but they may need to be used in combination with other interventions (e.g., contact
interventions) to increase effectiveness.
Another benefit to using media in anti-stigma campaigns is the amount of exposure. The
media has the capacity to reach a large portion of the population (Thonon & Larøi, 2017). With a
larger amount of people reached by these campaigns, the larger opportunity there is for change in
attitudes in the larger population. Many people state that the only contact that they have with
schizophrenia is through media sources, such as internet and television (2017), so it is important
that these media sources provide accurate information, rather than furthering myths that
contribute to stigma and discrimination. In conclusion, the media is a useful tool in providing
information to the public, so long as the information provided is accurate and furthering the
agenda of ending stigma.
Other Considerations
There are other considerations to consider when creating anti-stigma campaigns, and
some unique interventions have been researched that may prove to be useful in the future. The
way that interventions are presented to participants can have an effect on the outcome. Zimbres
et al. (2020) emphasizes that it is important not to guilt participants. For example, make

32
participants feel guilty about the false beliefs that they hold or stigmatizing attitudes that they
have perpetuated. This can create anger on behalf of the participants and therefore make these
people resistant to change. It will be important in interventions to use empathy and understand
that the information provided to participants in the past has been inaccurate. The goal of people
running anti-stigma interventions should not be to guilt participants, but instead to correct
misconceptions and inspire change.
It is also important to keep an open mind about unique and different interventions being
presented to diminish stigma. An example of one of these interventions was put forward in a
study by de C. Silva et al. (2017). In this study, a new tool was used that simulates the typical
symptoms of schizophrenia and the sensory and perceptual changes that persons with
schizophrenia experience. This created an immersive experience that allowed participants to
experience the pathology of a schizophrenia diagnosis. Voices and figures used in the virtual
reality tool were based on narratives from patients with schizophrenia to make the experience as
genuine as possible. The tool was used on medical students and psychiatrist with good results.
Participants reported that they thought this tool was a great educational resource for both health
professionals and society in general in order to reduce schizophrenia stigma. This creative
intervention had a positive effect on participants, and this shows that there may be future
possibilities for unique anti-stigma interventions that can create more effectiveness than the
general educational and contact interventions currently being used.
Future Research and Limitations
While there has been some progress in anti-stigma interventions targeting schizophrenia,
research is still somewhat lacking in this area. Most research found is on educational
interventions, other types of interventions seem to be scarce. Thus, it is important for future

33
research to include other types of anti-stigma interventions or incorporate other methods into
educational interventions. For example, Theriot (2013) suggests considering opportunities for
people to interact with people with mental illness (e.g., schizophrenia) during education, and see
if this increases effectiveness. It is also important to look at the type of contact that is being used
in anti-stigma interventions and how interactions with persons with schizophrenia are created.
This is because different types of contact with persons with schizophrenia are linked to different
kinds of discriminatory attitudes, so type and frequency of contact should be looked at when
doing anti-stigma interventions (Thonon & Larøi, 2017) to ensure that appropriate types of
contact are being put forward during anti-stigma interventions. The impact of contact on antistigma interventions needs to be further explored (Theriot, 2013).
It is also important for more information on the prevalence of stigma. For example,
Bowman and West (2019) suggest research on the quantity and degree of stigmatizing view and
information on mental illness across the web and social media. This would be helpfully
specifically for schizophrenia. If the presence of stigmatizing information can be found, there
will be a better baseline to measure from when looking for stigma reduction.
Existing stigma measures in much of the research may be inaccurate. This is because
much of the stigmatizing attitudes are measured by participants self-reporting. Thonon and Larøi
(2017) explain that self report of participants may be impacted by desirability bias. Participants
may want to state that their stigmatizing attitudes have improved because they believe it is
“right” or what researchers want, even if their attitudes have not improved. Therefore, it is
important to find assessment strategies for stigma that do not solely rely on self-report
(Zvonkovic & Lucas-Thompson, 2015).
Practical Implications for Social Workers:

34
Social workers in the field of mental health need to be aware of the existing stigma and
power structures that are working against persons with schizophrenia. They must employ antioppressive practice in their workplaces. It is important that there is awareness of stigma and
marginalization as this may get in the way of therapeutic alliances. It is important that social
workers work from an anti-oppressive perspective to eliminate power imbalances between
themselves and their clients with schizophrenia and constantly engage in self-reflection
throughout this process (Larson, 2008). It should be stressed that relationships with clients in
practice settings are important in providing help and contributing to the quality of life of our
clients, and self-awareness is critical in developing genuine relationships with clients (2008).
One way of improving therapeutic alliance and working against paternalistic working
relationships is to move away from a formal relationship between practitioner and client. Larson
(2008) explains that this includes avoiding the use of titles, positions, and educational
qualifications when referring to self and other professionals. It is also important not to use
diagnostic categories and labels when describing clients. The purpose of eliminating these titles
and labels is so that the perceived power of professionals is understood and diminished. This is
especially important because the label of schizophrenia comes with so much attached stigma. It
can help to empower clients with schizophrenia who have often internalized society’s
stigmatizing attitudes toward them.
It is also important to educate clients with schizophrenia about their disorder. This
education can help to combat the misconceptions spoken about previously in this paper.
Explaining all relevant information about the diagnosis also demystifies mental health practice
and gives clients the education they need to make appropriate decisions around their care
(Larson, 2008). Providing explanations of schizophrenia and including information on treatment

35
possibilities and prognosis could lead to more optimistic outlooks on the condition so that
persons with schizophrenia are more supported and motivated to seek treatment (Hinkley &
Waldron, 2020). Clients should also be encouraged to ask questions and get feedback about how
they feel regarding oppressive features of service relationships so that social workers and
agencies as a whole can improve their services and eliminate stigma to as large of an extent as
possible.
Social workers also need to work to deconstruct the medical model and its dominance in
discourse and practice in mental health (Larson, 2008). Using an anti-oppressive lens, social
workers are moving away from the medical model. Right now in mental health care there is little
focus on holistic practice (2008). Encorporating strengths-based, holistic, structural perspectives
empowers persons with schizophrenia and their families to create change in structure, policy and
attitude. It also moves the focus away from pathology and diagnosis and toward other aspects of
the person.
Perhaps the most important practice implication for social workers is the need for the
education of other mental health practitioners and the public. The research has made it clear that
there is stigma against persons with schizophrenia and misconceptions about this diagnosis are
prevalent in society. Social workers should seek out and organize activities that support antioppressive beliefs and practices regarding persons with schizophrenia (Larson, 2008). They can
also engage in anti-stigma and anti-discrimination education in the community and with specific,
relevant groups such as public schools, justice systems, social services, health care systems,
recreational organizations, religious organizations and the media. Social workers are wellpositioned to take action in this anti-stigma education as they have experience in community
development and can tailor interventions to the needs of their local community (2008).

36
Social workers also need to be active participants in social action and reform (Larson,
2008). Take public stances against stigma and join with persons with schizophrenia to advocate
on their behalf, using every opportunity available to join anti-stigma campaigns and promote
stigma-reducing interventions. Developing a partnership with persons with schizophrenia in
political action is important rather than just their care and treatment (2008). In creating a
partnership with clients with schizophrenia, social workers promote equity between themselves
and persons with schizophrenia, which is an important part of anti-oppressive practice.
Conclusion
While different types of anti-stigma interventions have been utilized and explored in the
research, stigma against persons with schizophrenia remains today. There are not enough antistigma campaigns focused specifically on schizophrenia in society, and much of the public has
no interaction with persons with schizophrenia because of its low prevalence of 0.3-0.7% of the
population (American Psychological Association, 2013). Thus, there is a reliance on stereotypes
and media representation in the public understanding of schizophrenia (Thonon & Larøi, 2017)
which often perpetuates misconceptions.
One of the major misconceptions that perpetuate social distance and marginalization of
persons with schizophrenia is the belief that persons with schizophrenia are violent and
dangerous. While statistical research has shown that the prevalence of violence in this population
is low (Department of Health, 2002; Swanson et al., 1990) the misconception remains. This leads
to fear and avoidance of persons with the diagnosis.
The other major misconception around schizophrenia is that it is solely caused by
biological factors and genetics. This leads to a false belief that there is also a poor prognosis for
the disorder (Thonon & Laroi, 2017). While even the DSM highlights psychosocial causes for

37
schizophrenia (American Psychological Association, 2013), this is not the dominant discourse in
public with the focus on the medical model.
The attention paid to the medical model and the DSM leads to labels and othering of
persons with schizophrenia (Larson, 2008). There is a general endorsement for the biogenetic
illness model of schizophrenia (Gilmore & Hughes, 2021). This leads to pathologizing and labels
for persons with schizophrenia, further perpetuating the stigma (Larson, 2008).
Stigma has a negative impact on persons with schizophrenia. These people often feel
worthless and hopeless about the future after facing exclusion (Morgan et al., 2017) and rejection
(Pescolosido et al., 2013). It also hinders the recovery process for persons with schizophrenia
(Morgades-Bamba et al., 2019) as it leads to a decreased willingness to seek treatment
(Pescolosido et al., 2013). Therefore, the result of stigmatization negatively impacts multiple
areas of life for this population.
There is still improvement needed when it comes to anti-stigma interventions. Many are
focused on mental illness in general (Morgan et al., 2021), but there need to be more
interventions focused specifically on schizophrenia since it is more stigmatized than other mental
illnesses (Zimbres et al., 2020).
The most common type of intervention is the educational intervention, most likely
because of its efficiency and practicality (Zvonkovic & Lucas-Thompson, 2015). While multiple
studies showed improvement in attitudes around schizophrenia, stigma still remains after
interventions (Gilmore & Hughes, 2021). Thus, educational interventions may not be sufficient
to reduce stigma against persons with schizophrenia (Zvonkovic & Lucas-Thompson, 2015).
Contact interventions that involve participants interacting with persons with
schizophrenia have shown some effectiveness. However, it is important that types of contact are

38
further explored so that these interventions can be improved. Media interventions have shown to
be effective as well. The media has perpetuated stigma in the past. However, with its ability to
reach a large number of people, it may also be effective at challenging stigma and correcting
misconceptions.
An awareness of stigma against schizophrenia is important for social workers to be aware
of. Social workers using anti-oppressive theory in their practice must examine their social
location constantly and self-reflect on their social location and how it impacts relationships with
their clients (Larson, 2008). Regarding working with persons with schizophrenia, social workers
should be aware that they are a part of the larger population and the health care field that has
perpetuated the stigma against this population. They must work to promote an egalitarian
relationship with clients and dismantle the power imbalance so that clients with schizophrenia
feel empowered (2008).
Social workers also need to promote anti-stigma campaigns and actively advocate for
persons with schizophrenia in their agencies and the community (Larson, 2008). This education
and advocacy is the first step toward stigma reduction and equality for persons with
schizophrenia. In conclusion, the pervasiveness of stigma against schizophrenia highlights the
need for anti-stigma campaigns and interventions. Reducing stigma will improve quality of life
of persons with schizophrenia, who so often internalize the public’s stigmatizing attitudes against
them. Future research must be done on schizophrenia-specific anti-stigma interventions in order
to ensure effective interventions are found and can be reproduced in our society.

39
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