The Importance of First Person Accounts in Education: Teacher and Student Perspectives

We come together as an educator (L.M.R.) and undergraduate university student (S.J.H.) to emphasize the importance of first person accounts of mental illness in education and research. Undergraduate and graduate students often lack knowledge about severe mental illness partly because education concerning severe mental illnesses is not a compulsory component of primary or secondary school health education curriculums, and media portrayal of severe mental illness is often inaccurate and biased to serve a dramatic purpose. Many students acquire advanced degrees in fields directly related to brain-behavior disorders with little firsthand experience of those afflicted. Coursework in psychology and neuroscience frequently presents theories and models of mental illness without the personal dimension. A major challenge is to provide the student with insight into how severe mental illness is experienced by the person. An appreciation of the effects of illness on a person may humanize the condition, foster empathy and compassion, reduce stigma, and provide hope. Direct discussions with people who experience severe mental illness are ideal but often not feasible for the classroom and lecture hall environments. First person accounts are a shortcut to the direct experience and an important tool that helps address this challenge. First person accounts help take severe mental illness out of the theoretical domain and place it in the context of those affected. First person accounts are useful beyond the description of symptoms listed in textbooks and vividly illustrate how someone’s life has been changed. This requires some degree of imagination, but first person accounts can diminish the burden by providing a direct, factual example of what someone with severe mental illness experiences. One striking example for me (S.J.H.) came from a 31-year-old graduate student with onset of delusions that rapidly progressed to full blown psychosis. She describes her condition as “a disease of information.”1 She recalled how, “without warning my life became suffused with meaning like light.” She would interpret many random patterns or situations as secret messages directed at her; a movie poster or the way a leaf fell acted as a “courier of meaning.”1 The author recalls being disoriented and frightened during this confusing time, which is clearly presented by her detailed, intense descriptions. I (S.J.H.) gained a better appreciation for what it is like to experience delusional thought from this first person account. This story struck me (S.J.H.) as poignant and meaningful. First person accounts are especially important so that one can empathize with and gain a better understanding of the experiences of those with severe mental illness. Another remarkable account illustrated to me (S.J.H.) how schizophrenia impacted a promising life. A young man was in the midst of his graduate work when he experienced his first psychotic episode. His relationships slowly deteriorated. He lost his girlfriend, his immediate family, and friends and he became homeless for 10 years.2 This first person account provides an important example of a person with severe mental illness who became marginal in society, a concept often underappreciated by students with limited mental health education. But, this first person account also touches on improvement (eg, “my life has been improving a little each year”) and fosters hope, which is also important discussion point for students. Other lessons that I (S.J.H.) have gleaned from first person accounts relate to the uninformed impressions that I had developed about someone with schizophrenia. The heterogeneity of severe mental illness is dramatic and eye opening, characterized by accounts that differ substantially in symptomatology and personal narrative. Similarly, the functional outcomes associated with different lives also differed greatly. Some achieve an effective and successful lifestyle, while others struggle daily for years after their first psychotic episodes. The first person accounts reveal stories ranging from constant struggle to hope and recovery. Another striking contrast between different accounts is how the authors view their illness. Some despise it and others are comforted by it. First person accounts have important limitations. Some argue that they reduce people to “curiosities” and others argue that they only represent a minority of persons with severe mental illness. It is important to note that the individuals with severe disorganization and/or very low motivation are not likely to prepare first person account for publication. Educators need to enforce the appreciation that these accounts are individual, unique, and subjective; they do not generalize precisely to others with severe mental illness. The diversity in accounts represents the heterogeneity of severe mental illness, which is a key point in mental health education. Schizophrenia Bulletin’s first person accounts are an accessible (free online at http://schizophreniabulletin.oxfordjournals.org/ after 1 year in press) and widely available educational resource to students, clinical and nonclinical researchers, family members trying to better understand a relative with severe mental illness, and the general public. First person accounts continue to be vital in our own ongoing education as student (S.J.H.) and educator/researcher (L.M.R.).