Research Article| Volume 12, ISSUE 1, P41-49, February 1998

A scale to measure the impact of a schizophrenic illness on an individual's self-concept

  • Elizabeth A. McCay
    Address reprint requests to Elizabeth A. McCay, RN, PhD, Clarke Institute of Psychiatry, 250 College Street, Toronto, Ontario, Canada, M5T 1R8.
    Clarke Institute of Psychiatry, and the Department of Psychiatry, and Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • Mary V. Seeman
    Clarke Institute of Psychiatry, and the Department of Psychiatry, and Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.
      This study was conducted to assess the reliability and validity of the Modified Engulfment Scale (MES) which measures the impact of schizophrenia on self-concept. The concept of engulfment offers a theoretical framework for understanding how a person's self-concept incorporates the experience of mental illness. In a homogeneous sample of 100 outpatients with a Diagnostic and Statistical Manual of Mental Disorders-III-R diagnosis of schizophrenia or schizoaffective disorder increased engulfment was found to correlate positively with hopelessness and low self-esteem and negatively with self-efficacy. In addition, clinical findings revealed that increased levels of engulfment were associated with an earlier age of onset, a longer illness, a greater number of hospitalizations and decreased social adjustment. These results suggest that individuals with a more severe form of the illness are vulnerable to engulfment. The study results also show substantial evidence for the reliability and validity of the MES.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Psychiatric Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Addington D.
        • Addington J.
        • Schissel B.
        A depression rating scale for schizophrenics.
        Schizophrenia Research. 1990; 3: 247-251
        • Addington D.
        • Addington J.
        • Maticka-Tyndale E.
        • Joyce J.
        Reliability and validity of a depression rating scale for schizophrenics.
        Schizophrenia Research. 1992; 6: 201-208
        • Bachrach L.L.
        Defining chronic mental illness.
        Hospital and Community Psychiatry. 1988; 36: 299-301
        • Bandura A.
        Self-efficacy: Toward a unifying theory of behavioural change.
        Psychological Review. 1977; 84: 191-215
        • Bandura A.
        Self-efficacy mechanism in human agency.
        American Psychologist. 1982; 37: 122-147
        • Beck A.T.
        The development of depression: A cognitive model.
        in: Friedman R. Katz M. Psychology of depression: Contemporary theory and research. Winston, Lewiston, NY1974: 3-47
        • Beiser M.
        • Iacono W.G.
        An update on the epidemiology of schizophrenia.
        Canadian Journal of Psychiatry. 1990; 35: 657-668
        • Beiser M.
        • Waxler-Morrison N
        • Iacono W.G.
        • Lin T.
        • Fleming J.A.E.
        • Husted J.
        A measure of the ‘sick’ label in psychiatric disorder and physical illness.
        Social Science Medicine. 1987; 25: 251-261
        • Carson V.
        • Soeken K.L.
        • Shanty J.
        • Terry L.
        Hope and spiritual well-being: Essentials for living with AIDS.
        Perspectives in Psychiatric Care. 1990; 26: 28-34
        • Corcoran K.
        • Fischer J.
        Measures for clinical practice: A source book.
        The Free Press, Washington, D.C.1987
        • Davidson L.
        • Strauss J.S.
        Sense of self in recovery from severe mental illness.
        British Journal of Medical Psychology. 1992; 65: 131-145
        • Deegan P.E.
        Recovery: The lived experience of rehabilitation.
        Psychosocial Rehabilitation Journal. 1988; 11: 11-19
        • Erikson E.H.
        Identity: Youth and crisis.
        Norton, New York1968
        • Estroff S.E.
        Self, identity, and subjective experiences of schizophrenia: In search of the subject.
        Schizophrenia Bulletin. 1989; 15: 189-196
        • Estroff S.E.
        Everybody's got a little mental illness: Accounts of illness and self among people with severe, persistent mental illness.
        Medical Anthropology Quarterly. 1991; 5: 331-369
        • Falbo T.
        • Belk S.S.
        A short scale to measure self-righteousness.
        Journal of Personality Assessment. 1985; 49: 72-77
        • Goffman E.
        Asylums: Essays on the social situations of mental patients and other inmates.
        Doubleday & Company, Inc., New York1961
        • Gunter N.C.
        • Bedell J.R.
        The peer-managed small group versus the rehabilitation model of treatment of chronic mental illness.
        Hospital and Community Psychiatry. 1983; 8: 724-728
        • Harding C.M.
        • Strauss J.S.
        The course of schizophrenia: An evolving concept.
        in: Albert M. Controversies in schizophrenia changes and controversies. Proceedings of the 74th annual meeting of the American Psychopathological Association. The Guilford Press, New York1984: 339-353
        • Hathaway S.R.
        • Mckinley J.C.
        A multiphasic personality schedule (Minnesota): Construction of the schedule.
        Journal of Psychology. 1940; 10: 249-254
        • Jones W.
        • Kahn M.
        • MacDonald J.
        Psychiatric patients' views of mental illness, hospitalization and treatment.
        Journal of Nervous and Mental Disease. 1963; 136: 82-87
        • Juhasz A.M.
        A role based approach to adult development: The triple helix model.
        International Journal of Aging and Human Development. 1989; 29: 301-315
        • Krauss J.B.
        • Slavinsky A.T.
        The chronically ill psychiatric patient and the community.
        Blackwell Scientific Publications, New York1982
      1. (Unpublished)
        • Lally S.J.
        How psychiatric patients become engulfed in a mentally ill self-concept: “Does being in here mean there is something wrong with me”?.
        (UMI Dissertation Information Service, Ann Arbor, Michigan)in: doctoral disseration. The University of North Carolina at Chapel Hill, Boston1988
        • Lally S.J.
        Does being in here mean there is something wrong with me?.
        Schizophrenia Bulletin. 1989; 15: 253-265
        • Levinson D.
        • Gallagher E.
        Patienthood in the mental hospital.
        Houghton Mifflin, Chapel Hill, Chapel Hill1964
        • Link B.G.
        Understanding labelling effects in the area of mental disorders: An assessment of the effects of expectations of rejection.
        American Sociological Review. 1987; 52: 96-112
      2. (Unpublished)
        • McCay E.
        The construct validation of the modified engulfment scale.
        in: doctoral dissertation. University of Toronto, Boston1994
        • Miller J.F.
        Coping with chronic illness: overcoming powerlessness.
        F.A. Davis Company, 1983
        • Nunnally J.C.
        Popular conceptions of mental health: Their development and change.
        Holt, Rinehart & Winston, Philadelphia1961
        • Nunnally J.C.
        Psychometric theory.
        2nd ed. McGraw-Hill, New York1978
        • Olmstead D.W.
        • Durham K.
        Stability of mental health attitudes: A semantic differential study.
        Journal of Health and Social Behaviour. 1976; 17: 34-44
        • Plum K.C.
        How patients view recovery: What helps, what hinders.
        Archives of Psychiatric Nursing. 1987; 1: 285-293
        • Reid D.
        • Ware E.E.
        Multidimensionality of internal-external control: Implications for past and future research.
        Canadian Journal of Behavioural Sciences. 1973; 5: 264-271
        • Rideout E.
        • Montemuro M.
        Hope, morale and adaptation in patients with chronic heart failure.
        Journal of Advanced Nursing. 1986; 11: 429-438
        • Rosenberg M.
        Conceiving the self.
        Basic Books, Inc. Publishers, Toronto1979
        • Schur E.
        Labelling deviant behaviour: Its sociological implications.
        Harper & Row, New York1971
        • Sherer M.
        • Maddux J.E.
        • Mercandante B.
        • Prentice-Dunn S.
        • Jacobs B.
        • Rogers R.W.
        The self-efficacy scale: Construction and validation.
        Psychological Reports. 1982; 51: 663-671
        • Spitzer R.L.
        • Williams J.B.W.
        • Gibbon M.
        Structural clinical interview for DSM-III-R.
        Biometrics Research Department, New York State Psychiatric Institute, New York1989
        • Stotland E.
        The psychology of hope.
        Jossey-Bass. Inc., New York1969
        • Test M.A.
        Continuity of care in community treatment.
        New directions for mental health services. 1979; 2: 15-23
        • Thompson E.H.
        Variation in the self-concept of young adult chronic patients: Chronicity reconsidered.
        Hospital and Community Psychiatry. 1988; 7: 771-775
        • Townsend J.M.
        • Rakfeldt J.
        Hospitalization and first contact mental patients: Stigma and changes in self-concept.
        Research in Community and Mental Health. 1985; 5: 269-301
        • Warner R.
        • Taylor D.
        • Powers M.
        • Hyman J.
        Acceptance of the mental illness label by psychotic patients: Effects on functioning.
        American Journal of Orthopsychiatry. 1989; 59: 398-409
        • Weinstein R.M.
        Labelling theory and the attitude of mental patients: A review.
        Journal of Health and Social Behaviour. 1983; 24: 70-84
        • Wilson N.
        Colorado client assessment user's guide.
        Colorado Department of Institutions, San Francisco1980
        • Zusman J.
        Some explanations of the changing appearance of psychotic patients.
        in: Price R. B. B. Denner The making of a mental patient. Holt, Rinehart & Winston, Denver1973: 213-280