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Psychiatric Stigma: Past, Passing and to Come

The label of mental illness changes the perceptions of observers even in the absence of abnormal behaviour4. The negative symptoms of schizophrenia may give rise to poor personal hygiene and unkempt appearance which, in the context of poor social skills or bizarre behaviour, set that person apart. While all psychiatric illnesses may show some outward manifestation, perhaps the most severe of these is the tardive dyskinesia (TD) seen in schizophrenia and its treatment. TD is associated with poor outcome, but it is also an independent predictor of poor quality of life for its sufferers5; even though the patients may not be aware of their tardive dyskinesia6, it reduces their social acceptability7. Some are stigmatized by their association with a particular service or location: hospital admission itself has adverse consequences8'9. Factual and fictional accounts of psychiatric settings have perpetuated the public's 'Bedlam' image. Because of these associations, users have called for services to be provided in settings of non-medical activity.10