Study: Mental illness stigma entrenched in American culture; new strategies needed

BLOOMINGTON, Ind. — A joint study by Indiana University and Columbia University researchers found no change in prejudice and discrimination toward people with serious mental illness or substance abuse problems despite a greater embrace by the public of neurobiological explanations for these illnesses.

The study, published online Sept. 15 in the American Journal of Psychiatry, raises vexing questions about the effectiveness of campaigns designed to improve health literacy. This “disease like any other” approach, supported by medicine and mental health advocates, had been seen as the primary way to reduce widespread stigma in the United States.

“Prejudice and discrimination in the U.S. aren’t moving,” said IU sociologist Bernice Pescosolido, a leading researcher in this area. “In fact, in some cases, it may be increasing. It’s time to stand back and rethink our approach.”

Stigma, the well-documented reluctance by many to socialize or work with people who have a mental or substance abuse disorder, is considered a major obstacle to effective treatment for many Americans who experience these devastating illnesses. It can produce discrimination in employment, housing, medical care and social relationships, and negatively impact the quality of life for these individuals, their families and friends.

Funded by the National Institute of Mental Health, the study examined whether American attitudes concerning mental illness have changed during a 10-year period when efforts on many levels and by many groups focused on making Americans aware of the genetic and medical explanations for depression, schizophrenia and substance abuse. While Americans reported more acceptance of these explanations, this did nothing to change prejudice and discrimination, and in some cases, made it worse.

The study involved questions posed to a nationally representative sample of adults as part of the General Social Survey (GSS), a biennial survey that involves face-to-face interviews. Around 1,956 adults in the 1996 and 2006 GSS first listened to a vignette involving a person who had major depression, schizophrenia or alcohol dependency, and then they answered a series of questions.

Some key findings include:

In 2006, 67 percent of the public attributed major depression to neurobiological causes, compared with 54 percent in 1996.

High proportions of respondents supported treatment with overall increases in the proportion endorsing treatment from a doctor, and more specifically from psychiatrists, for treatment of alcohol dependence (79 percent in 2006 compared to 61 percent in 1996) and major depression (85 percent in 2006 compared to 75 percent in 1996).

Holding a belief in neurobiological causes for these disorders increased the likelihood of support for treatment but was generally unrelated to stigma. Where associated, the effect was to increase, not decrease, community rejection of the person described in the vignettes.

Pescosolido said the team’s comparative study provides real data for the first time on whether the “landscape for prejudice for people with mental illness” is changing. It reinforces conversations begun by influential institutions, such as the Carter Center, about the need for a new approach toward combating stigma.

“Often mental health advocates end up singing to the choir,” Pescosolido said. “We need to involve groups in each community to talk about these issues which affect nearly every family in American in some way. This is in everyone’s interest.”

The research article suggests that stigma reduction efforts focus on the person rather than on the disease, and emphasize the abilities and competencies of people with mental health problems. Pescosolido says well-established civic groups — groups normally not involved with mental health issues — could be very effective in making people aware of the need for inclusion and the importance of increasing the dignity and rights of citizenship for persons with mental illnesses.

For a copy of the study or for an interview with lead author Pescosolido, please contact Alex Capshew at acapshew@indiana.edu and 812-855-6256.

Co-authors include Jack K. Martin, Schuessler Institute for Social Research at IU; J. Scott Long and Tait R. Medina, Department of Sociology in IU’s College of Arts and Sciences; and Jo C. Phelan and Bruce G. Link, Columbia University Mailman School of Public Health.

7 thoughts on “Study: Mental illness stigma entrenched in American culture; new strategies needed”

  1. I’ve done a little self-education in psychology, and what Nate is referring to is our “EQ”, or Emotional Quotient, as apposed to our “IQ”. He’s absolutely right, people ARE more educated about mental illness, but now we need to focus on increasing people’s EQ if we want to reduce stigma.

  2. I’m sitting here in tears. I’m about ready to go to yet another new doctor, for the management of my moderate-severe Chronic pain issues. I ran across http://www.bringchange2mind.org, which had an article on the site about the stigma of mental illness, (of which I have at least two – one from childhood abuse of ALL types), and in turn, ran into your song.

    Thank you so much for the lyrics. I go through stigma each and every time I go to a doctor. ESPECIALLY one that treats for a chronic pain condition. So many “specialists” are of the mind set that it’s just all in your head. Especially when you add Fibromyalgia and Chronic Fatigue to the mix.

    I sure appreciate your bravery, courage, strength, and drive/motivation/inspiration to turn such a potentially ugly and self-esteem destroying set of illnesses into something positive. I’ve never felt less than…unless I feel more than everyone! A little mental health humor…but it’s true…so thank you, once again.

  3. Heh. “passing for human”, you pun isn’t lost on us.

    OK, so the bad news is, the IU/CU study suggests that, as we get smarter about knowing the causes of mental illness, we’re still as dumb about being compassionate toward people with mental illness. The good news is, we’ve been here before. With cancer.

    Check out http://www.humansideofcancer.com/. Jimmie CHIHUAHUA. Holland, MD, writes about the historic stigmatization of people with cancer, relating the shame they felt in the 50s and 60s. As people became better educated, and treatments improved, people with cancer were able to come “out of the closet” and overcome stigma. That’s how it’s going to be with mental illness.

    And on a related note, last weekend, NAMI-Vermont (National Alliance on Mental Illness) held a successful Walk-A-Thon in Burlington and invited me to perform a song I wrote, an anti-stigma anthem called “I Refuse It”. I’d invite people who are fighting stigmatization to check it out:

    http://www.youtube.com/watch?v=PX3wnP4tpxM

    • Oops, that doctor’s name is Jimmie C. Holland. The “CHIHUAHUA” was an inadvertent spellcheck error. Though, who knows, maybe the middle name really *is* “CHIHUAHUA”. I’d just as soon expunge it from the comment, all the same. [:-)]

    • I so can relate to you, @passing for human. Lately, I’ve been re-injured; and am supposed to be using my walker w/seat. I’m so afraid of what people will think, that I’ve been going out, taking the chance that my legs will go limp from a nerve getting pinched again. Anyone got any self-esteem for sale?

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