Family shroud for the mentally ill.

Definitions of psychiatric disorders may incite controversy, but mental health researchers and practitioners agree that people who receive treatment for mental illness often encounter rejection and condescension from others who learn of it.

The stigma extends to the families of discharged psychiatric patients as well. About half of the parents and spouses of people recently hospitalized for severe mental ailments try in some way to conceal the hospitalization from close friends, neighbors, and others, according to a study in the current Schizophrenia Bulletin (vol. 24, no. 1).

Epidemiologist Jo C. Phelan of the Columbia University School of Public Health and her coworkers interviewed 156 parents and spouses of individuals who had been discharged 6 months previously from any of 10 suburban New York psychiatric facilities. In each case, treatment involved an initial bout of psychosis, which includes delusions and hallucinations.

Family members concealed a mental illness most often if they did not live with the ill relative, if the relative was female, and if the relative had less severe symptoms that did not recur after discharge. It may simply be harder to hide the condition of an ill relative who lives at home and continues to exhibit signs of psychosis, the scientists say.

Concealment was also more common among family members with at least some college education and a white-collar job than those with no college and a blue-collar job. In an apparent contradiction, earlier studies have found more tolerance toward mental illness in affluent communities.

"This raises the question of whether highly educated people really have more enlightened attitudes toward mental illness or whether they are merely more likely to express socially acceptable views," the investigators note.