Meaning in life, insight and self-stigma among people with severe mental illness Shir Ehrlich-Ben Or a, ⁎ , Ilanit Hasson-Ohayon a , Daniel Feingold a , Kobi Vahab a , Revital Amiaz b , Mark Weiser b , Paul H. Lysaker c,d a Department of Psychology, Bar-Ilan University, Ramat Gan, Israel b Department of Psychiatry, Sheba Medical Center, Tel Hashomer, Israel c Roudebush VA Medical Center, Indianapolis, USA d Department of Psychiatry, Indiana University School of Medicine, Indianapolis, USA Abstract Recapturing meaning in life has been described as an essential element in the process of recovery from severe mental illness (SMI), but limited quantitative research still restricts our understanding of this phenomenon. The purpose of the current study was to explore the meaning in life among people with SMI and variables that may influence it such as internalized stigma and insight into the mental illness. We expected a significant negative correlation between internalized stigma and meaning in life, and that internalized stigma would moderate the relationship between insight and meaning in life. To explore these assumptions, 60 persons with SMI completed questionnaires that assessed their meaning in life, insight into their mental illness and internalized stigma, after which the data were analyzed using correlation and cluster analysis. Both hypotheses were confirmed. The mechanism behind the relationship between self-stigma and meaning in life and the theoretical and clinical implications of the moderation model are discussed. © 2012 Elsevier Inc. All rights reserved. 1. Introduction Recapturing the sense that one's life has meaning has been described as an essential element in the process of recovery from severe mental illness (SMI) [1-3]. For instance, recovery is defined as a process that “involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of psychiatric disability” [2]. A study that explored the meaning of the recovery process from the perspective of mental health consumers found that people with SMI perceive meaning in life as a core aspect of recovery. From their point of view meaning can be achieved through work, social relationships, spirituality, pursuing goals, and through the process of recovery [1]. Although the concept of meaning in life is a core issue in the process of recovery, there is a lack of quantitative research regarding this phenomenon. In partic- ular, it is unknown which variables contribute to the ongoing process of recapturing one's meaning in life. Accordingly, in the current study, we sought to explore the relationship between meaning in life, insight into their mental illness and internalized stigma among people with SMI. Insight into their mental illness is defined as the ability of people with SMI to demonstrate awareness of being sick, of having symptoms and of the illness's implications [4-6]. It reflects a narratized account of psychiatric challenges which can vary in terms of its coherence, plausibility and adaptiveness. Research has shown that approximately 50%–80% of persons with schizophrenia exhibit varying degrees of lack of insight into their illness [7]. There is a disagreement in the literature regarding the ways in which insight into mental illness influences functioning and quality of life. On the one hand, there is evidence indicating that high levels of insight are related to treatment adherence and functioning [5,8-12]. On the other hand, there are also findings showing that high levels of insight into one's mental illness can impair functioning, hope and quality of life of people with SMI [13-16]. It has recently been suggested that these associations occur via self-stigma [17,18]. Available online at www.sciencedirect.com Comprehensive Psychiatry xx (2012) xxx – xxx www.elsevier.com/locate/comppsych ⁎ Corresponding author. E-mail address: shirehrlich@gmail.com (S. Ehrlich-Ben Or). 0010-440X/$ – see front matter © 2012 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.comppsych.2012.07.011