Journal of Psychosocial Nursing and Mental Health Services

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CNE Article 

Illness and the Disruption of Autobiography: Accounting for the Complex Effect of Awareness in Schizophrenia

Paul H. Lysaker, PhD; Kelly D. Buck, MSN, APRN, BC

Abstract

Interventions for individuals with schizophrenia often involve helping clients become more aware of their condition so they can make informed decisions about their treatment and recovery. Yet the effect of awareness or admission of schizophrenia has remained elusive. Empirical research has found that awareness of illness is essential for people to make informed decisions about the future, to free themselves from blame for difficulties linked with illness, and to form and sustain bonds with others. However, this awareness has also been linked to depressed mood, lower self-esteem, and a diminished sense of well-being. In this article, we review the evidence and suggest that the effect of awareness on well-being may be mitigated by the meaning clients assign to their illness and whether it disrupts their life story. Evidence linking clients’ internalized, stigmatizing beliefs about illness with demoralization is presented, and clinical implications are discussed.

ABOUT THE AUTHORS

Dr. Lysaker is Clinical Psychologist, Roudebush VA Medical Center and Indiana University School of Medicine, Department of Psychiatry, and Ms. Buck is Clinical Nurse Specialist, Roudebush VA Medical Center, Indianapolis, Indiana.

The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.

Address correspondence to Paul H. Lysaker, PhD, Clinical Psychologist, Roudebush VA Medical Center (116h), 1481 West 10th Street, Indianapolis, IN 46202; e-mail: plysaker@iupui.edu.

Abstract

Interventions for individuals with schizophrenia often involve helping clients become more aware of their condition so they can make informed decisions about their treatment and recovery. Yet the effect of awareness or admission of schizophrenia has remained elusive. Empirical research has found that awareness of illness is essential for people to make informed decisions about the future, to free themselves from blame for difficulties linked with illness, and to form and sustain bonds with others. However, this awareness has also been linked to depressed mood, lower self-esteem, and a diminished sense of well-being. In this article, we review the evidence and suggest that the effect of awareness on well-being may be mitigated by the meaning clients assign to their illness and whether it disrupts their life story. Evidence linking clients’ internalized, stigmatizing beliefs about illness with demoralization is presented, and clinical implications are discussed.

ABOUT THE AUTHORS

Dr. Lysaker is Clinical Psychologist, Roudebush VA Medical Center and Indiana University School of Medicine, Department of Psychiatry, and Ms. Buck is Clinical Nurse Specialist, Roudebush VA Medical Center, Indianapolis, Indiana.

The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.

Address correspondence to Paul H. Lysaker, PhD, Clinical Psychologist, Roudebush VA Medical Center (116h), 1481 West 10th Street, Indianapolis, IN 46202; e-mail: plysaker@iupui.edu.

ABSTRACT

Interventions for individuals with schizophrenia often involve helping clients become more aware of their condition so they can make informed decisions about their treatment and recovery. Yet the effect of awareness or admission of schizophrenia has remained elusive. Empirical research has found that awareness of illness is essential for people to make informed decisions about the future, to free themselves from blame for difficulties linked with illness, and to form and sustain bonds with others. However, this awareness has also been linked to depressed mood, lower self-esteem, and a diminished sense of well-being. In this article, we review the evidence and suggest that the effect of awareness on well-being may be mitigated by the meaning clients assign to their illness and whether it disrupts their life story. Evidence linking clients’ internalized, stigmatizing beliefs about illness with demoralization is presented, and clinical implications are discussed.

ABOUT THE AUTHORS

Dr. Lysaker is Clinical Psychologist, Roudebush VA Medical Center and Indiana University School of Medicine, Department of Psychiatry, and Ms. Buck is Clinical Nurse Specialist, Roudebush VA Medical Center, Indianapolis, Indiana.

The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.

Address correspondence to Paul H. Lysaker, PhD, Clinical Psychologist, Roudebush VA Medical Center (116h), 1481 West 10th Street, Indianapolis, IN 46202; e-mail: plysaker@iupui.edu.

10.3928/02793695-20070901-10

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