Disclosure of their diagnosis impairs the social functioning of people with schizophrenia

People don't need to be treated as a stereotype for harm to occur; their mere belief that they could be viewed in a stereotyped fashion is enough - a phenomenon known as 'stereotype threat'. For example, women reminded of the stereotype that men are better at maths tend to perform more poorly in a subsequent maths task, even if they are actually treated fairly. Now Julie Henry and colleagues have extended this line of research to the domain of mental health. They've found that patients with a schizophrenia diagnosis function less well socially, when they think that the person they're chatting with knows their diagnosis.

Thirty people diagnosed with schizophrenia or schizoaffective disorder spent a few minutes chatting on their own to one research assistant and then they did the same with another assistant an hour later. There were a few points of deception: first, the participants were led to believe that the assistants were participants from another study. Also, most importantly, before one of the conversations began, they were told that the assistant knew about their diagnosis of schizophrenia; before the other, they were told the assistant did not know. They were also told, truthfully, that both the people they were to chat with did not themselves have a diagnosis of schizophrenia.

In reality, the research assistants didn't know whether each participant had a diagnosis of schizophrenia or not. This was achieved by having them chat to the participants diagnosed with schizophrenia plus a number of control participants. Crucially, they weren't told in advance who was who.

After each conversation, the research assistants rated the social behaviour of the person they'd just chatted with. The participants in turn rated the behaviour of the assistant they'd just chatted with and they said how they felt the conversation had gone.

The key finding is that the social functioning of the participants with schizophrenia seemed to deteriorate when they thought their conversational partner knew their diagnosis (even though they didn't). Specifically, when they thought their diagnosis had been disclosed, the participants were rated by the research assistants as being more impaired at initiating conversations and at switching topics appropriately, and the assistants also found these conversations less comfortable.

Henry's team can't be sure, but they think these apparent deficits emerged because the participants' concern about how they would be judged, in light of their diagnosis having been disclosed, interfered with their ability to converse in a more effective manner.

A further twist was that the participants with schizophrenia seemed unaware of these effects - they reported finding the conversations, in which they thought their diagnosis was known, just as comfortable and successful as when they thought their diagnosis had been kept hidden. This contrasts with non-clinical research on stereotype threat, in which people seem to be aware of the effects on their performance.

The results provide food for thought regarding when and how mental health diagnoses should be disclosed. The researchers said their findings suggest 'that one of the defining qualities of [schizophrenia] - social skill impairment - is not caused solely by the disorder per se, but rather, also derives from feelings of being stereotyped.'
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Henry, J., Hippel, C., & Shapiro, L. (2010). Stereotype threat contributes to social difficulties in people with schizophrenia. British Journal of Clinical Psychology, 49 (1), 31-41 DOI: 10.1348/014466509X421963