Clinical Applications and Investigation of the Acceptance of Mental Illness

This chapter reviews the 14 key principles of the process of acceptance of mental illness among culturally diverse groups that emerged from the findings in this book. Each principle is accompanied by clinical recommendations for facilitating the process of acceptance of mental illness. Examples are provided as to how clinicians, peer specialists, and researchers might respond to issues of acceptance of mental illness to facilitate hope and recovery. A number of acceptance-related techniques and theories in clinical care are also discussed. To further understanding and promote the process of acceptance of mental illness among persons in recovery, areas of potential development for future research are reviewed. An “Acceptance of Mental Illness Checklist” with scoring information is provided to assess the dimensions of acceptance and barriers and facilitators among people with serious mental illness and to aid further clinical and research examination of this construct.

Acceptance of Mental Illness Among Men

This chapter explores the unique barriers and facilitators to acceptance that men with serious mental illness may experience. The values associated with traditional masculinity are discussed as they pertain to the process of accepting mental illness. Barriers specific to men in our research studies are detailed, including avoidance of help-seeking and self-medication with substance abuse. In addition, the literature on misdiagnosis and underdiagnosis of mental health conditions among men is presented. Facilitators to the process of acceptance for men in the present research are discussed, including accessing supportive relationships and other mental health resources. Several participant case narratives are provided in order to demonstrate the impact of various masculinities on the process of acceptance. A clinical strategies list, discussion questions, activities, the “Men’s Acceptance of Mental Health Worksheet,” and an explanatory table are included at the close of the chapter.

Acceptance of Mental Illness Among Women

This chapter reviews the experiences of women with serious mental illness and the various disparities encountered by them. These disparities include higher rates of victimization, unemployment, poverty, homelessness, and inequities in clinical care. The impact of these disparities and associated stigma on the acceptance process is presented. This chapter centers on a discussion of intersectional stigma, or overlapping, multiple levels of stigma and discrimination, faced by women with serious mental illness. Several participant case narratives are presented in order to demonstrate the impact of intersectional stigma on the process of acceptance for women with serious mental illness. Clinical recommendations are provided to facilitate acceptance among women who experience intersectional stigma. A clinical strategies list, discussion questions, activities, the “Intersectional Stigma Worksheet,” and an explanatory table are included at the close of the chapter.

The History of the Treatment of Mental Illness

Chapter 1 reviews the history of psychiatric treatment of people with mental illness in the United States and Western Europe, highlighting past perspectives in care, such as ancient trephination and exorcism during the demonology era, humorism in early Greek and Roman thought, a return to demonological perspectives in the Middle Ages, as well as mesmerism and psychoanalysis in the 19th and 20th centuries. The 20th-century biological perspective is described, including the use of insulin shock therapy, electroconvulsive therapy, and lobotomy. Next, the development of more humane treatment approaches is discussed, such as the moral treatment movement of the 1800s. The ex-patient’s movement of the 1970s is reviewed, leading up to the contemporary recovery-oriented and psychosocial rehabilitation models of care. The impact of stigma on the acceptance of serious mental illness is explored throughout this history. Discussion questions, activities, and diagrams are also included.

Lesbian, Gay, Bisexual, and Transgender Factors in the Process of Acceptance of Mental Illness

This chapter reviews the multiple levels of stigma encountered by lesbian, gay, bisexual, and transgender (LGBT) individuals with mental illness. Associated disparities in mental health care are discussed. Results from the qualitative case narrative analysis are provided to identify themes related to the facilitators and barriers in the acceptance process for LGBT individuals with mental illness. Three participant narratives are included to assist practitioners in applying these findings to clinical practice. Selected case narratives represent participants from a range of LGBT identities to illustrate facilitators and barriers in the acceptance process among individuals within this group. A clinical strategies list, discussion questions, activities, the “Acceptance and Sexual and Gender Identities Worksheet,” and explanatory diagrams are included at the close of the chapter.

The Multiple Dimensions of the Acceptance of Mental Illness

This chapter explains the multidimensional construct of acceptance, including the five dimensions of this process. Interview excerpts are provided as evidence of each of these five dimensions. The five dimensions include (1) identity dimension (developing a positive sense of self in the face of mental illness); (2) cognitive dimension (developing thoughts, beliefs, and awareness around accepting one’s mental illness); (3) behavioral dimension (engaging in actions and behaviors that signify acceptance of one’s mental illness); (4) emotional dimension (experiencing emotions that signify acceptance of one’s mental illness); and (5) relational dimension (engaging in relationships and interacting with others in a manner that promotes acceptance of the illness). A clinical strategies list, discussion questions, activities, the “Dimensions of Acceptance Worksheet,” and diagrams are also included.

The Process of Acceptance of Mental Illness

In this chapter, findings related to the process of acceptance of mental illness are presented using excerpts from research interviews with individuals with serious mental illness. Acceptance is located within the sequence of stages of the recovery process. Facets of the acceptance process are reviewed, especially with regards to acceptance of a diagnosis, acceptance of the need for mental health treatment, and acknowledgment and acceptance of associated losses and limitations. The stigma attached to diagnostic labels is also discussed. The close of the chapter includes a clinical strategies list, discussion questions, activities, the “Personal Recovery Processes Worksheet,” and a diagram of the relationship of acceptance to other components of personal recovery.

Acceptance and the Recovery Paradigm in Mental Health Care

Chapter 2 offers an overview of the recovery movement in the provision of mental health care for serious mental illness. Within the recovery movement in mental illness treatment, recovery is understood as a process of living a satisfying life of well-being and autonomy, as opposed to mere symptom elimination. Early theory of the recovery paradigm is outlined, highlighting the process of acceptance of serious mental illness within this model. Applications of the recovery paradigm to mental health care are discussed, as well as the various types of recovery from a serious mental illness. Acceptance is examined as the neglected paradox of recovery. Other parts of the chapter include discussion questions, activities, the “Personal Recovery Processes Worksheet,” and diagrams.

Racial–Ethnic Cultural Factors in the Process of Acceptance of Mental Illness

This chapter examines barriers and facilitators to the acceptance process that stem from the norms, values, beliefs, and practices found within various racial and ethnic groups. To illustrate this, five case narratives are provided, representing participants from various racial and ethnic backgrounds. The chapter emphasizes that although barriers may be found across a range of racial and ethnic cultural backgrounds, people with serious mental illness can be supported in drawing from their respective cultures of origin to locate various resources and actions that reinforce a positive sense of self in accepting and dealing with the experience of mental illness. Culturally responsive rehabilitation interventions can help individuals overcome cultural stigma and other barriers to reach an acceptance of their mental illness. A clinical strategies list, discussion questions, activities, the “Cultural Self-Awareness Worksheet,” and an explanatory table are also included.

Barriers and Facilitators to Acceptance of Mental Illness

A number of barriers and facilitators have been theorized to impact the process of accepting serious mental illness. This chapter discusses the identified barriers and facilitators to acceptance of mental illness, using excerpts from research interviews with participants with serious mental illness. Barriers and facilitators are described as occurring at the micro level (cognitive, emotional, behavioral, identity-related), meso level (relational), and macro level (cultural, systemic). The ability of practitioners and clinicians to support change with individual clients at the micro and meso levels is discussed. The need for acceptance of mental illness on a societal level is also explored. A clinical strategies list, discussion questions, activities, the “Barriers and Facilitators to Acceptance Worksheet,” and diagrams are also included.