![\"Double](\"\/sargent\/files\/2016\/09\/article-banner-double-stigma.jpg\")
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Adam* received the first diagnosis\u2014obsessive-compulsive disorder\u2014when he was 17. Other diagnoses followed, including bipolar disorder. He later experienced depression, had failed relationships, and made a suicide attempt, all while wrestling with what he calls the \u201cchameleon\u201d nature of his gender identity. Adam, who identifies as transgender, was assigned male at birth, but sometimes presents as female. He typically uses masculine pronouns.<\/p>\n Research has found that those in the LGBT community are at elevated risk for depression, anxiety, bipolar disorder, substance use, and suicide. \u201cThey\u2019re already dealing with the stigma attached to their gender or sexual identity\u2014and they may not feel they have the energy to address another stigma associated with a mental illness,\u201d which can make the road to recovery from mental illness especially long and difficult, says Lauren Mizock<\/a>, doctoral faculty at the Fielding Graduate University and a former postdoctoral fellow at BU\u2019s Center for Psychiatric Rehabilitation<\/a>. In collaboration with her fellowship mentor, Zlatka Russinova<\/a>, Mizock is exploring the journey to recovery, which involves accepting the mental illness, rather than denying it.<\/p>\n \u201cPeople who struggle with double stigma need to work through multiple layers of challenges,\u201d says Russinova, a research associate professor of occupational therapy and a senior research specialist\u00a0at the center. \u201cOften people blame themselves for their illness. They go into a downward spiral of self-blame and are not able to forgive themselves\u2014but self-forgiveness is critical to achieving acceptance,\u201d a milestone in the recovery process.<\/p>\n For a study on acceptance and recovery, Mizock recruited 32 participants with serious mental illness (men, women, racial-ethnic minorities, and members of the LGBT community) who were recipients of services at the center. In 60-minute in-person interviews, Mizock gathered data on three issues: the participants\u2019 sense of themselves as individuals diagnosed with mental illness, their experiences associated with mental illness, and the factors that contributed to their acceptance of their diagnosis. Participants were also asked to define what \u201cacceptance\u201d means to them.<\/p>\n Because this study required examining the perspectives of many individuals\u2014and for those individuals to interpret their own experiences\u2014Mizock used a grounded theory approach to analyze their responses. A common method for investigating the complex experiences and narratives of mental illness, the approach begins with exploratory questions and builds a theory \u201cgrounded\u201d in observation and data, as opposed to a more traditional qualitative approach in which a researcher collects data and may impose preexisting theory onto the data. The participants\u2019 responses shed light on their perceptions of themselves, the challenges they faced after diagnosis, and the changes they noticed in themselves once they accepted their illnesses.<\/p>\n The participants identified four components that contributed to their acceptance of mental illness: positive sense of self, acceptance of illness, willingness to seek help, and overcoming shame about illness. For example, Adam described to Mizock \u201ca lack of interest in and acceptance of his gender expression and identity by his therapists.\u201d By switching to a supportive care provider, he began to participate in his recovery. He became willing to learn about managing his bipolar disorder and to pursue effective treatment, accepting, for instance, \u201cthat I have to take as much medicine as I do.\u201d<\/p>\n \u201c\u0007People blame themselves for their illness.\u2009.\u2009.\u2009but self-forgiveness is critical to achieving acceptance.\u201d<\/p>\n \u2014Zlatka Russinova<\/span><\/p><\/blockquote>\n Language was equally important for Adam, who developed affirmative ways to describe his identity as a transgender \u201cchameleon,\u201d a term that helped him explain his identity both to himself and to others. \u201cIn order to overcome the stigma [of mental illness], one has to integrate this new part of themselves positively into the rest of their identity,\u201d Mizock says, stressing that patients also advance their recovery when they realize they can manage their illness, and that they can help others as a peer counselor or activist.<\/p>\n![\"Zlatka](\"\/sargent\/files\/2016\/09\/16-10039-LGBT-002-424x636.jpg\")
![\"Lauren](\"\/sargent\/files\/2016\/09\/16-10039-LGBT-001-424x636.jpg\")
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