The Impact of the Environment in Schizophrenia

Colorado Recovery founder Richard Warner considered schizophrenia a bio-psycho-social disorder significantly affected by the environment surrounding the person with the mental health condition on multiple levels.

In his book The Environment of Schizophrenia, Dr. Warner drew upon the “knowledge of the environmental factors that affect schizophrenia in order to suggest changes which could decrease the rate of occurrence of the illness, improve its course, and enhance the quality of life of sufferers and their relatives.”

Warner divided those environmental factors into three levels: individual, domestic, and community. 

The Individual Level

Among the individual factors, Dr. Warner listed the strong correlation between substance misuse and schizophrenia. “It seems to be true that people with schizophrenia use more drugs than others in the population,” he wrote in The Environment of Schizophrenia. Frequently, that behavior has a detrimental effect. Research has shown time and again that “people with serious mental illness who abuse substances have a worse course of illness.” However, Warner was adamant that substance misuse cannot cause schizophrenia although that is often how it seems to family members and other people. 

On the other hand, a mental health condition can be a driver of addiction. “Many in this population feel a need to find relief from chronic affective symptoms and medication side effects,” Warner wrote. Since the reasons for the substance misuse are complex, treatment approaches need to be individualized. 

Stress is another important factor on the individual level. Stress can trigger episodes of schizophrenia. “People with schizophrenia are more likely to report a stressful life event preceding an episode of illness than during a period of remission,” explained Warner. One of the hallmarks of schizophrenia is “a deficit in the regulation of brain activity so that the brain over-responds to environmental stimuli, reducing the person’s ability to regulate his or her response to new stresses.” 

The Domestic Level

Stress also plays a significant role on the domestic level. People with schizophrenia who live with relatives (by birth or marriage), who are “critical or over-involved” have a much higher relapse rate than those living with relatives who are less critical or intrusive. Outcomes can be improved if families are involved in a more supportive way. 

Studies have shown that “family psychoeducational interventions can lead to a change in the level of criticism and over-involvement among relatives of people with schizophrenia and so reduce the relapse rate.” With appropriate support, domestic stress can be mitigated for all parties involved. 

Dr. Warner included “alienating environments” at the domestic level. “Many people with mental illness face lives of aimlessness and boredom,” wrote Warner. While the traditional state hospital incarceration frequently led to an “instituional neurosis,” featuring restless pacing, unpredictable violence, and posturing, more recent treatment approaches may lead to an “existential neurosis,” which similarly stands in the way of recovery.

Open-door, domestic alternatives to hospitalization, on the other hand, offer a number of benefits, Warner wrote in The Environment of Schizophrenia. “They provide care which is much cheaper than hospital treatment, less coercive and less alienating, and they produce a different result.

The Community Level

On the community level, people with schizophrenia have to contend with numerous misconceptions and false assumptions about their disorder. “People with mental illness are subject to prejudice, discrimination, and stigma,” Warner wrote. 

Unfortunately, after being exposed to discrimination and stigma for a long time, people with schizophrenia start to accept negative labels about themselves and conform to the stereotype of a mentally ill person as being incapable and worthless. Frequently, they become socially withdrawn and dependent. 

The many harmful misconceptions about schizophrenia include the belief that

  • Nobody recovers from schizophrenia
  • Schizophrenia is untreatable
  • People with schizophrenia are usually violent and dangerous
  • Schizophrenia is contagious
  • Schizophrenia is the result of a certain weakness of willpower
  • People with schizophrenia cannot make rational decisions about their lives
  • People with schizophrenia are unable to work

Not only are most people with schizophrenia able to work, many of them should.  “Work helps people recover from schizophrenia,” Warner found. “Productive activity is basic to a person’s sense of identity and worth. Given training and support, most people with schizophrenia can work.”

At Colorado Recovery, the psychosocial clubhouse offers a rehabilitation model with a vocational focus that harnesses the benefits of client empowerment to increase members’ skills and work preparedness and assist them in obtaining employment.

Colorado Recovery—created by Dr. Warner—approaches care for mental health based on a path of self-reliance through developed practiced skills. This non-institutionalized philosophy offers comprehensive levels of care supported by an expert medical and clinical team, engaging patients in increasing community participation.

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses which are specific to each individual. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.


How Stigma Prevents Recovery From Mental Illness

Recovery from serious mental illness requires that people with such a condition retain a sense of empowerment—a belief in their ability to take charge of their lives and manage the complex challenges of their illness.

Empowerment is essential if people with a mental illness are to overcome the many prejudices that too many Americans still carry with them: the stereotype that makes them believe a person with a mental illness is incapable, unpredictable, even violent, and worthless. 

Colorado Recovery founder Richard Warner dedicated most of his life to fighting the stigmatization of people with mental illness. Shortly before his death in 2015, Dr. Warner explained the impact of this stigmatization on treatment outcomes.



Popular television programs often depict people with mental illness as dangerously violent. A 2007 study found that 37 percent of mentally ill characters in US primetime drama were violent criminals while only four percent of characters without mental illness were violent offenders. 

It’s a long-established bias, explained Warner. Surveys from Illinois in the 1950s showed that people across the board regarded “the mentally ill as relatively dangerous, dirty, unpredictable, and worthless” (Nunally 1961). This is the stereotype many of us grew up with. Among other things, it is based on a lack of understanding.  

A 1992 study found that an astonishing 58 percent of respondents considered “lack of discipline” a cause for mental illness, while 93 percent blamed “drug and alcohol abuse” (Borenstein 1992). This is similar to blaming “lack of willpower” for substance use disorders, suggesting people with mental illness (or addiction) are themselves largely responsible for their condition.

Common misconceptions about schizophrenia include the notion that it is caused by “bad parenting,” that nobody recovers from schizophrenia, that people with schizophrenia are usually violent, and that they are unable to make rational decisions. Sadly, while being perceived as violent, in reality, people with mental illness are themselves much more frequently the victims of violent crime compared to the general population. 


Stereotyping Leads to Discrimination

The result of evidence-free assumptions about mental illness is discrimination and stigmatization. As Dr. Warner explained, many landlords will automatically reject all applicants with mental illness. No surprise then that many people with mental illness feel the need to hide their diagnosis from others. Many who could work productively shy away from applying for jobs because they lack self-confidence and expect rejection. 



Internalizing stigma is a self-fulfilling prophecy. People who accept negative labels then conform to the stereotype of a mentally ill person as being incapable and worthless. They become socially withdrawn and dependent. 

In 1961, psychiatrist Frantz Fanon made a similar point about the dehumanizing effects of colonization upon colonized people who internalize the value judgments of their colonizers. The internalization of stigma leads to poor mental health outcomes unless the patient is able to reject the stigmatization and regain a sense of power and competence.

According to Warner, acceptance of mental illness (insight) with an internal locus of control can lead to empowerment and good outcomes while acceptance of mental illness with an external locus of control (internalized stigma, controlled by others) leads to poor outcomes.

“People who accept that they have an illness and have the greatest sense of internalized stigma have the worst self-esteem and the weakest sense of mastery over their lives,” Warner said. “Insight must be associated with decreased internalized stigma and with empowerment to lead to a good outcome.” This is the Warner method in a nutshell: treatment of serious mental illness must aim at decreasing internalized stigma and empowering patients to attain a certain degree of control over their lives. 

Many studies have since confirmed a strong, negative relationship of self-stigma with hope, self-esteem, and empowerment. Part of that empowerment is shared decision-making. More than ninety percent of “people with psychosis are competent to make choices about their medications,” said Warner. Unfortunately, many psychiatrists still show only minimal interest in involving patients in treatment decision-making. 

Another important element is utilizing mental health patients as peer support. The benefits of involving peer staff include reducing substance misuse and symptoms of depression and psychosis, while increasing hope, quality of life, and a sense of community inclusion. 

Colorado Recovery has been utilizing the Warner method to empower adults with mental illness for many years now. Our program approaches mental healthcare based on a path of self-reliance through developed practiced skills. Recognizing the importance of empowerment for recovery, our non-institutionalized philosophy offers comprehensive levels of care supported by an expert medical and clinical team, engaging patients in increasing community participation. 

Our treatment facility provides the services needed to address schizophrenia, bipolar disorder, and other serious mental illnesses. Call us at 720-218-4068 to discuss treatment options for you or the person you would like to help.