Perhaps one truism permeating this book is that stigma is a complex phenomenon that is understandable at many levels. The goal of research is to make stigma and stigma change a bit more understandable. The motivation for this book, however, is not scientific speculation for its own sake. Rather, it is concern about the impact of stigma on the lives of people affected by mental illness: How do we help people from being victimized by the prejudice and discrimination that arises from stigma? Note that this chapter focuses on the impact of stigma on a generic category called people affected by mental illness; although consumers of mental health services most likely experience the most harsh consequences of stigma, it also harms their family members and friends, the other stakeholders involved in any aspect of services to this group, and the public as a whole. The review in this chapter attempts to highlight these different experiences.This chapter begins with a simple question: What is mental illness? After a brief review of the phenomenology and epidemiology, we more 11

Self-determination theory (SDT) postulates that satisfaction of three basic psychological needs (i.e., autonomy, competence, and well-being) promotes motivation, well-being, growth across domains of functioning. Thus, per SDT, we examined satisfaction of basic psychological needs among individuals with first-episode psychosis. First, we quantified the level of need satisfaction among a sample of individuals with first-episode psychosis and compared their level of need satisfaction to that of individuals without psychosis. Second, we examined the association between need satisfaction and several domains of well-being among individuals with first-episode psychosis (i.e., symptomatology, social/vocational functioning, and quality of life). Our results indicated that individuals with first-episode psychosis experience less satisfaction of basic psychological needs as compared to their same-aged counterparts. There was a modest association between need satisfaction and well-being among individuals with first-episode psychosis, with the need of relatedness being the need most frequently associated with indices of well-being. Although modest in scope, the results of the current study raise the possibility that further investigation of SDT among individuals with first-episode psychosis may reveal important strategies through which early intervention services can better promote well-being and recovery.

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There is growing recognition that motivation among individuals with psychosis may influence both participation in and response to psychosocial interventions. Consequently, there is an increasing call for organizing treatment settings in ways that increase motivation among individuals with psychosis. However, empirical evidence suggests that whether a specific setting/event promotes motivation depends upon individuals’ idiosyncratic interpretation (i.e., causality orientation) of that setting/event. Thus, the goal of this study is examine causality orientations among individuals with first-episode psychosis and compare these to causality orientations among individuals without psychosis. Our results suggest that, similar to persons without psychosis, individuals with first-episode psychosis show a bias toward interpreting environmental events and personal behavior as determined by personal choice/goals. However, the magnitude of this bias is smaller among individuals with first-episode psychosis, such that they are more likely to perceive events as uncontrollable or regulated by external factors than individuals without psychosis.

Given that there are risks associated with the use of traditional generating-alternatives techniques, the current findings support ongoing development of MEB and similar approaches.