Julie Ryan is not only a well read and respected blogger, she is also the brains behind Chronic Illness Bloggers Network. Today I am featuring a paper she wrote for an Experimental Psychology class on stigma. You can see the original post or check her website Counting My Spoons.
The Stigma of Mental Illness
By Julie Ryan, Counting My Spoons
Last fall (2014) I took Experimental Psychology and one of the projects we worked on was related to mental illness stigma. I’ve wanted to share a part of the paper I wrote for that and thought that since May is Mental Illness Awareness Month now would be ideal. Before I get into the paper, I wanted to share with you that I do understand what it is to deal with mental illness. I have a history of both depression and anxiety. I remember when I began to have anxiety attacks I’d literally break down crying for no reason. I remember getting out of the car to go eat somewhere and I just couldn’t stop crying. I had no idea why I was crying but I couldn’t stop and I knew I couldn’t go in that restaurant to eat. I’ve suffered from depression off and on ever since that time, as well. While I’ve learned a lot of ways to cope and avoid falling into depression completely, it’s still there.
I know I’m not alone, and if you suffer from mental illness (whether it’s chronic issues or something that pops up occasionally as it is for me) you are not alone.
I’m only going to share the first part of my paper below. If you are interested in reading the entire paper, I’ll attach it at the bottom.
“Mental illness is a growing problem that can negatively affect a person’s life. According to the National Institute of Mental Health (2014), in 2012 over 18% of adults had been diagnosed with a mental disorder. The negative stigma often associated with mental illness creates many issues for those diagnosed, often leading to reduced opportunities for housing, employment, and relationships (Kvaale, Gottdiener, & Haslam, 2013). There have been recent efforts to reduce stigma by identifying mental illness as biogenetically (related to biology and genetics) caused and out of the patients’ control; however, these efforts have not had the desired results. Although, associating mental illness with a biogenetic cause results in decreased blame towards the patient for their illness, it may also increase associated negative stigma, ratings of danger, and a desire for social distance. Kvaale, et al. performed a meta-analysis of 25 studies regarding the relationship of biogenetic explanations for mental illness and associated perceptions of blame, dangerousness, and desired social distance. They found that increased perceptions of dangerousness were consistent across the span of mental disorders, and increased desire for social distance and perceptions of blame were high for schizophrenia. These findings indicate that encouraging a biogenetic explanation of mental illness may not be ideal for reducing stigma associations.
The biogenetic label is only one of the labels that psychologists have attempted to apply to mental illness. Angermeyer and Matschinger (2003) examined how the common person would label someone depicted as having either schizophrenia or depression. Over 70% of those surveyed labeled schizophrenia as a “mental illness”, while over 60% labeled depression as such. They also found a positive correlation between labeling someone as “mentally ill” and perceptions of danger, fear, and anger. They also found that these perceptions lead to an increased desire for social distance. These negative attributes were not applied when the person depicted was labeled as having major depression. This indicates that some labels may induce more negative stigma than others may.
A known diagnosis is not required for the label or the stigma of mental illness to be attached to a person. Without knowing that a person is mentally ill, the attributes of mental illness may be applied to them based on social cues (Corrigan, 2004). Correct or incorrect judgments of mental illness are often assigned based on visible symptoms, social-skills issues, and physical appearance. Not only do stigmas associated with mental illness come from others, a person suffering from a mental illness may place stigma on himself based on cultural views related to his illness. The knowledge of this associated stigma is often what leads one to avoid seeking diagnosis and the treatment they need. By avoiding diagnosis, they hope to avoid the label and the stigma. Demographics such as age and race also affect perceived stigma and the likelihood of treatment. Younger people are more likely to attach negative stigma to mental illness diagnoses; however, those over 65, with a greater level of stigma attachment to mental illness, were more reluctant to seek treatment. It is also important to note that African Americans and Hispanics are less likely to seek psychiatric services, than European Americans. It seems that non-Caucasians seem to have a greater prejudice against using the medical system for mental health care, while also expressing a greater worry about potential family reactions. This indicates that there are some cultural differences related to how one perceives stigma.
Mental illness perceptions and stigma may be related to a sense of control. A survey of Chinese adults by Mak, Chong, and Wong (2014) indicated that those who judged mental illness to be something that is not caused by biological, personality, or life events, judged patients as having a lower ability to manage their symptoms, and out of control. This lack of controllability was aligned with increased stigma and decreased acceptance. The unpredictable and uncontrollable nature of mental illness may be what causes fear, leading to an increased sense of danger, and results in the attached stigma. This study indicates focusing the public’s attention on psychosocial causes, rather than on biological causes of mental illness, as Kvaale, Gottdiener and Haslam (2013) indicated, may lead to reduced stigma and negative perceptions of mental illness.
Labels are not the only factor that create social stigma. As Corrigan (2004) noted appearance alone is enough for one to establish perceptions of mental illness and social stigma. Facial attractiveness is assessed on a variety of factors, and may affect judgments about others. Fink and Penton-Voak (2002) noted that attractiveness judgments are determined by factors of symmetry, averageness, and hormone markers. Facial Symmetry is highly correlated to both attractiveness, and assumed health of an individual; yet, asymmetric faces have generally been preferred to symmetric faces in studies. Perrett, et al. (1999) showed that this preference for asymmetry might be a result of a variety of confounding factors, regarding how the composite faces were combined. Increased preference for symmetrical faces may be a result of equating symmetry to health and youth, rather than symmetry itself. Jones, et al. (2001) found a correlation between a participant’s judgment of the health of the individual being rated, and their attractiveness level. The averageness hypothesis states that faces that are more common, or consistent with those seen most often, are considered more attractive. Komori, Kawamura, and Ishihara (2009) compared averageness and symmetry and found that averageness is the most important factor in determining what one finds attractive. Contrary to the averageness theory, the contrast theory of facial attraction states that perceived attraction increases or decreases with distance from mean attractiveness level. The findings of DeBruine, Jones, Unger, Little and Feinberg (2007) supported the contrast theory, and indicated that while averageness is a component in attractiveness, it is not the only component. Rashidi, Pazhoohi, and Hosseinchari (2012), showed that judgment of attraction can occur in as little as .2 s, and that those who viewed facial images for shorter times judged the faces as more attractive than those who viewed them for longer. The qualities of facial attraction can work with other factors to affect the positive and negative attributes that are associated with a person.
There are many negative terms associated with mental illness, some of which evoke more stigma than others. Szeto, Luong, and Dobson (2012) found that there is a distinct difference between general labels, such as “mental illness”, and more specific labels like depression. Their surveys indicated that the more general terms containing the word “mental” were more likely to be judged as something that was biological or caused by external factors. The term “depression” resulted in lower ratings of friendliness, and unpleasantness, and was judged more negative overall. The survey responses indicate a possible lack of understanding of the overlap of general mental disorders and specific labels. Some results also indicated a feeling that depression was more controllable, and temporary, while the more general terms were considered to be biological or functional problems, beyond the patients’ control. When asked to state what terms come to mind in response to the term depression, such negative feelings as hopeless, sad, and stressed were common responses, with less common responses including delusional. Alternatively, the terms that came to mind in response to the more general terms were more severe, and included schizophrenia, psychopath, and delusional. Overall, the study indicated that specific labels carry a higher level of stigma than the more general terms associated with mental illness.”
The full paper details our experiment that examined whether briefly showing a stigma or non-stigma word prior to showing a face would increase the likelihood that a rater would rate the face as belonging to someone that is safe/dangerous, friendly/ unfriendly, attractive/ unattractive. The paper examines the outcomes and what they may mean.
Thanks so much Julie! I will be featuring a follow-up to this post closer to Bell Let’s Talk Day, so please watch for it. Also, check out Julie’s Blog at Counting My Spoons.