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Social support is widely known to be positively associated with health and well-being. For people living with schizophrenia, social support is associated with improved stability and community integration, provides linkages to employment, and has been found to moderate the recovery process. Despite this research, rates of social isolation remain high for people living with schizophrenia contributing to the marginalization of this vulnerable group.
One reason for the persistence of social isolation may be found in the direction given to treatment providers mandated to provide evidence-based treatments (EBTs). Considering the importance of social support in schizophrenia, and the intended restorative function of the recovery paradigm and evidence-based treatments (EBT’s), my aim in this paper is to examine the ways in which these professional discourses conceptualize social support for individuals with schizophrenia.
Methods:
Discourse analysis evaluates the use of language in text to describe and interpret social practices with the intention of identifying and problematizing taken for granted assumptions within these texts. Data for this analysis were macro-level mental health policy texts (Anthony, 1993; President’s New Freedom Commission Report, 2003; SAMHSA Consensus Statement on Recovery, 2010; SAMSHA Working Definition of Recovery, 2012) and the practice/fidelity guidelines of six EBT’s for schizophrenia identified as best practices by SAMHSA and the most recent Schizophrenia PORT Study (Assertive Community Treatment, Illness Management & Recovery, IPS Supported Employment, Social Skills Training, Multifamily Psychoeducation & Integrated Dual Disorder Treatment.) The association with and description of social support was coded in each document and examined for underlying meanings.
Results:
The analysis revealed a professional discourse that focused almost exclusively on treatment of the individual with minimal attention on the social supports needed to enhance recovery. The underlying discourse in these documents implies that the individual is responsible for “overcoming” mental illness by internally managing the disease rather than the professional community’s responsibility to help clients repair and rebuild social networks. Language such as “instilling hope”, “empowering the individual” and “person-centered” operationalize these individualistic value assumptions. With one exception, these EBTs target the individual as the unit of change and neglect the critical importance of social support in the lives of those with schizophrenia.
Conclusions/Implication
The language used in foundational documents such as national policy statements and EBTs both reveal and suppress ways of understanding the world. The dominant individualistic ideology running throughout recovery and within EBT’s for schizophrenia indicate a lack of recognition of the need for social supports and directs practitioners’ energy towards interventions that do little to help a person with schizophrenia reestablish themselves within a community. As a result, social isolation remains the norm. Future implications include examining both the micro-level practice discourse as it relates to emphasizing stronger social support and the assumptions within mental health practice guidelines across professions.