Identity and coping with mental illness in long-stay psychiatric rehabilitation

The literature on coping with mental illness is reviewed. A study is reported which was designed to operationalize and measure the responses to chronic psychiatric illness of denial or adoption of a sick role outlined by Wing & Morris (1981) and Shepherd (1984) and to investigate their correlates and relationship to identity as measured by Thompson (1988). On the basis of existing literature, it was anticipated that subjects who identified themselves as 'community members' would tend to cope by denial of psychiatric problems whilst those seeing themselves as a 'typical psychiatric patient' would exaggerate their disabilities. Although both types of response and identity were found within the group studied, this prediction was not confirmed: responses of patients to their illness were independent of identity, and had different sets of correlates. As compared with 'exaggerators', 'deniers', tended to have social networks within the hospital, and showed higher self-esteem and less subjective distress. Community identity, on the other hand, was related to actually going into the community, better overall functioning (especially in the areas of social activities and community skills), and poorer compliance with medication. The theoretical and practical implications of these findings are discussed.