The Stigma(s) of Mental Illness

By Neuroskeptic | February 21, 2012 7:10 am

Fighting “the stigma of mental illness” is big business at the moment. But does “the stigma” really exist?

As I said back in 2010 :

There is a stigma of schizophrenia, and there’s a stigma of depression, etc. but they’re not the same stigma. We’re told it’s a myth that “the mentally ill are violent” – [but] no-one thinks depressed or anorexic people are violent. They think (roughly) that people with psychosis are. They have other equally silly opinions about each diagnosis, but there’s no monolithic “stigma of mental illness”.

Now a paper has come out which explores this idea in some detail: Stereotypes of mental disorders differ in competence and warmth. The title says it all : people have stereotypical views of people suffering from different mental disorders, but these stereotypes vary substantially.

The authors use the “Stereotype Content Model” framework, which despite the fancy name is very simple. On this view stereotypes are characterised by two dimensions, “competence” and “warmth”. These are pretty self-explanatory. Warmth is whether you’re seen as nice and friendly, or hostile and dangerous. Competence is whether you’re thought to be good at it.

We all know that warmth and competence are distinct and indeed orthogonal concepts, and they crop up in other languages and in popular culture.

Anyway, in two Mechanical Turk online surveys of American adults, they first showed that respondants felt that “people with mental illness” were low on competence and (slightly) low on warmth, compared to other social and ethnic groups. That’s similar to the ratings of the homeless, poor, and welfare recipients.

However in the second study, they asked about specific diagnoses, and this revealed a more complex pattern. I’ve shown the results above (colors are mine). There seemed to be four clusters. Mental retardation and Alzheimer’s were perceived as warm, but incompetent; sociopaths and violent criminals were the opposite.

Schizophrenia clustered with homelessness and addiction in a worst-of-both-worlds category of low warmth and competence, while what could broadly be called “emotional” disorders, like bipolar, depression and anxiety, were rated more favorably. For what its worth, OCD was the least bad diagnosis.

These are interesting results. The only oddity about the method was that people weren’t actually asked what they thought about these people; they were asked “In general, how much do Americans believe that…” This is, apparantly, standard procedure in this kind of stereotype research, but it seems a little strange to me.

ResearchBlogging.orgSadler, M., Meagor, E., and Kaye, K. (2012). Stereotypes of mental disorders differ in competence and warmth Social Science and Medicine DOI: 10.1016/j.socscimed.2011.12.019

  • http://www.blogger.com/profile/13832862073297092984 Gurdur

    The reason why they get asked what they believe “what do Americans think…” is it actually gives a more accurate picture in general of what the respondant thinks (if not always). There was some paper or post about this a fair while back, I'll see if I can dig it out.

  • http://www.blogger.com/profile/08166102068735214940 Martin

    @Gurdur: That paper would be very interesting to read! I hope you can dig it out.

  • Paul W

    If people were asked “Would you be content to have a mentally ill person move next door to you?” or “Would you want a mentally ill person to marry your sister?”, I believe the answers would reveal the stigma against mental illness.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    True, but I bet the answers to those questions would vary a lot by diagnosis too.

  • Anonymous

    Its the same reason why Sentence Completion Tests often use pronouns like “he” or “she” rather than “I”: You get more honest answers.

  • Ivana Fulli MD

    What's trouble me is that “the public” just know about mental Illnesses from the cases that “went public with their difficulties ” like if “the public” knew about mariage just from divorced people.

  • Serenity

    Hope you don't mind but I am encouraging my colleagues (psychology teachers) to use some of your discussions with their students. As a maths teacher and a schizophrenic & BPD (apparantly this distinguishes me from normal people) I found this particular article interesting, especially given I have to pretend like I am not disabled! :) I will endeavour to encourage my students to pay particular attention to sample sizes!

  • Anonymous

    @Gurder

    I remember that in the run-up to the 2008 U.S. presidential election, pollsters were asking people, “Do you think the country is ready to elect a Black president?” and “Do you think the country is ready to elect a woman president?”

    When they asked, “Would you vote to elect…?” most people answered “yes” because they did not want to appear racist or misogynistic.

    I don't know if any formal paper was done on this, but it sure got a lot of press at election time.

    RH

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Gurdur & Anonymous: Right. I understand the rationale, it just seems like it might have unexpected results.

    I mean if you asked me, do you think America is ready for an atheist President, I would say no. Not because I'd have a problem with that but because I honestly don't think they'd win an election at the moment.

  • Anonymous

    So the less serious the disorder, the less stigmas? Such as alzheimers with 2 and anxiety with 5.

  • Ivana Fulli MD

    Neuroskeptic 21 February 2012 17:34

    You are absolutely right to question that kind of pollsters ‘s enquiries. Those people makes money and publications with it and provide lazy journalists with quick and sexy material .

    Lazy journalists love to comment on that kind of pollsters “enquiries” and political activists abuse it in a vicious unethical circle.

    To give a blatant example-albeit a political front one- I hope you will forget me for choosing it NS since it is very demonstrative:

    In 2002 the French discovered to their utmost shame that they will have to cast their vote for old crook Jacques Chirac to be elected French president. He was old with a life history of indulging in unhealthy habits. JC finished his presidency with half a brain and he has been condemned in 2012 after a 12 years judiciary battle for financial misconducts everybody could and should have known about when he was the Paris city mayor.

    But casting one’s vote for JC in 2002 was the only democratic way to use in order to prevent a far right presidency to take place and Jacques Chirac was elected almost with an African dictator score.

    That ludicrous Jacques Chirac 2002 score -a very sad event- could take place only because journalists kept repeating to the French voters that only a minority of them intended to vote for the far-right candidate (Jean-Marie Le Pen )- be it because they wanted the far right candidate to be president or just to protest the lack of decent candidate or whatever.

    Those pollsters are polluting the scientific and political debates with good earning ( money earnings or publications) ways of misleading the public.

    They are very far from good epidemiological work as you can be.

  • Ivana Fulli MD

    Neuroskeptic :

    Of course I intended to write that in 2002 the pollsters and journalists were claiming and repeating to the French voters that the far right candidate to the 2002 presidential French election race had not the shadow of a chance to be part of the final round between the two candidates having received the most votes in their favor- although not enough to be elected at the first cast of votes with an above 50 percent score.

    I should have written:

    “That ludicrous Jacques Chirac 2002 score -a very sad event- could take place only because journalists kept repeating to the French voters that not enough people intended to vote for the far-right candidate (Jean-Marie Le Pen )at the first cast of vote to permit him to be present on the second and final cast of votes- be it because they wanted the far right candidate to be president or just to protest the lack of decent candidate or whatever.”

  • Ivana Fulli MD

    For Condorcet the power of corruption was founded on ignorance and he thought that if the “people” were to become educated enough – a wish of dear practiCal fRMI to instruct the people on scientific issues-, then the educated mind of the common man would prevent him to be the prey of false informations.

    I cite Condorcet:
    /// Que ferait-elle (la corruption) en effet, si la raison du peuple, une fois formée, pouvait le défendre contre les charlatans que l’on paye pour le tromper ; si l’erreur n’attachait plus à la voix du fourbe habile un troupeau docile de stupides prosélytes ; si les préjugés, répandant un voile perfide sur toutes les vérités, n’abandonnaient pas à l’adresse des sophistes l’empire de l’opinion ? Achèterait-on des trompeurs, s’ils ne devaient plus trouver des dupes ?///

  • omg

    Keep the academia subservient to capitalism. Dumb down anything that's not serving industrial growth. That's just the tenants of capitalism. Pluck out Maths geniuses to do redundant work for big banks and so on. Turning knowledge into mere observations without thought. It's what power cliques wanted right ? and they achieved it beautifully. Today's institutionalized knowledge has no soul. No one cares.

  • Anonymous

    Mental retardation and Alzheimer's disease are *not* mental illnesses. Mental retardation is, for the most part, a human variation. Alzheimer's is an established neurological condition. The idea that the so-called mental disorders listed in the DSM are mainly neurological is an unsubstantiated hypothesis.

  • http://www.blogger.com/profile/15579272589604671824 Lucy

    Anon- human variation and neurological ? Huh? Depression could be a human variation or a neurological base- who really knows, and why would it matter?

  • http://www.blogger.com/profile/17207837776193380053 Ase

    It may have been Patricia Devine that started that type of question, on work on prejudice against blacks. In some ways it gets tothe kind of surrounding cultural stereotype which may be affecying you, whether or not you agree with it ( which i think was in part the rationale). I have considered using it for other work, in part because in a student body ( in sweden where i am now) there are strong norms against some stereotypes that are Interesting, and would exhibit very strong social desirability, while they would be better informants if they felt it wasn't their own opinion that was probed. But it kind of shows you need multiple approaches to get to this.

  • http://www.blogger.com/profile/06647064768789308157 Neuroskeptic

    Anonymous: The authors generated their list of diagnoses by asking a sample of people (different people from the ones in the main study) to say what came to mind when thinking about “mental illness”.

    So while you may be right, it seems not everyone agrees with you…

  • Anonymous

    I was so upset to overhear our administrator (who is a BSN), telling the staff psychologist that his client could not see the psychiatrist for medication management because the ct. Was too dangerous. Mind you, the administrator hired this person to work on our inpatient unit. This ex-employee always received raises based on work ethic, and was employed for 12 years. I've spoke to this individual who took complete responsibilty for their behavior involving an incident where a staff member was left alone with a psychotic male ct who had choked the female staff member while she was pinned against the wall. Instead of blaming others, this person had higher expectations and stated he did not meet his own standard of behavior. Such an unfortunate, reactionary lapse of judgemernt, has now become stigmatized. It's confusing that he is allowed to continue therapy, yet too dangerous for med management. I've seen this so often, where administration requires that our clients deserve respect, yet the rules are different for them. Talk about classifying someone as less than human. Not only that, our administrator has never provided therapy to any client here, and in this instance she is dictating what our staff psychologist(who is very good by the way), what referrals are best based on what amounts to a damaging opinion. Personally, if I were this client I'm not sure how anyone could overcome the shame of stigma. So many have left therapy because they don't see the point. Just very sad, because stigma is here to stay in my opinion.

  • Lisa

    When you get a group of people with mental illness together, they will start ranking themselves. If you put together a group of people with eating disorders, compulsive overeaters will rank the lowest, among the bulimics purging bulimia ranks lower than exercise bulimia, and anorexics tend to see themselves as higher than bulimics because they perceive themselves as having better control while the bulimics rank themselves higher than anorexics because they are a more normal weight.

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Neuroskeptic

No brain. No gain.

About Neuroskeptic

Neuroskeptic is a British neuroscientist who takes a skeptical look at his own field, and beyond. His blog offers a look at the latest developments in neuroscience, psychiatry and psychology through a critical lens.

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