The effects of viewing patient-related physiological data on students' mental health stigma

Figuring out how to reduce the negative stigma of mental illness could prove useful to patients and mental health professionals. Previous research has suggested that emphasizing the biological and physiological components of mental disorders may affect how people with these disorders are perceived. Biogenetic explanations have been shown to lessen stigma towards mentally ill patients in some respects. The present study compared participants’ evaluations of a hypothetical depressed person whose description was accompanied by either an MRI of the patient’s brain or a picture of the patient’s sad face. Analyses compared participants’ responses on three aspects of stigma: social distance, blame/responsibility, and perceived danger/unpredictability. Results revealed the following trends: 1) Participants who saw an MRI rated John as more trustworthy and predictable. 2) Participants who viewed an MRI also rated John as having more need for medication than the non MRI participants. Participants’ Level of Contact with mentally ill persons was not significantly related to any of the outcome variables measured. Effects of Viewing Patient-Related Physiological Data on Students’ Mental Health Stigma 3 The Effects of Viewing Patient-Related Physiological Data on Students’ Mental Health Stigma Stigma, defined as negative beliefs people have about some thing, has been an everpresent concern in the mental health field. Long-term stigma of people suffering from mental illness has not decreased significantly among the general public, mental health professionals, or those suffering from the mental illness themselves (Smith and Cashwell, 2011). Rose, Thornicroft, Pinfold, and Kassam (2007) argue that stigma is mainly a conglomeration of three parts: ignorance, prejudice, and discrimination. Goffman (1963) describes the damaging effects of stigma, which “reduces the bearer from a whole person to one that is irredeemably tainted. ”(Goffman, p. 3). In Goffman’s view, mental illness was one of the most deeply discrediting and socially damaging forms of stigma, such that people with mental illnesses start out with rights and relationships, but end up with little of either (Goffman, 1963 as cited in Stuart, 2008). Farina and Felner, (1973) cited in Penn, Judge, Jamieson, Garczynski, Hennessy, and Romer (2005) state that individuals with severe mental illness are less likely to receive employment, healthcare, or an apartment lease. Furthermore, individuals with a physical handicap are viewed more positively than individuals with mental illness. The abstract dimension of mental illness instills more fear in people than the more concrete physical ailments (Wahl, 1995, as cited in Penn et al., 2005). The powerful influence of stigma on the mentally ill can determine if or when they seek treatment, and how effective treatment will be. While mental illness is in and of itself debilitating—both physically and emotionally—stigma can inflame the suffering already occurring in the individual, and may in some cases prove more harmful than the actual illness (Smith et al., 2011). Nearly half of Americans meet criteria for diagnosable mental illness at some point in their lifetimes, yet only one third of Americans seek mental health treatment. Effects of Viewing Patient-Related Physiological Data on Students’ Mental Health Stigma 4 Increased stress from stigma may lead those with mental illness to isolate themselves, potentially increasing symptoms and chances of relapse (Penn et al., 2005). Thus, Link, Yang, Phelan, and Collins (2004) write that, “The Surgeon General's 1999 report on mental health notes that there is a strong consensus that, "our society no longer can afford to view mental health as separate and unequal to general health" (p. vii, Executive Summary, U.S. Department of Health and Human Services 1999). Presently, there are over 250 terms used to describe people who are mentally ill; of those, nearly half are derogatory (Rose et al., 2007). These numbers indicate the reach of mental illness stigma in our culture. Research on the development of stigma has shown that, comparatively, children and young adults show far more embarrassment and stigma-related behaviors about their mental illness (Rose et al., 2007). Furthermore, young people are more likely to believe that the actions of a person with mental illness are his or her responsibility, and consequently act with more discrimination toward the person, as well as requiring more social distance (Rose et al., 2007). A study conducted by Rose et al., (2007) explored young people’s (12 to 25) conceptions of people with depression or psychosis. In the study, participants were shown a vignette of the person with depression or psychosis and asked what type of help that person should seek, and when. Those who accurately identified the disorder were more likely to answer that the person should seek help from a therapist or other mental health professional. Rose and colleagues also studied which words students used to describe a person with mental illness. Most words used were negative or emotionally-charged. Factual knowledge about mental illness and the general psychiatric terms was low. This lack of knowledge acts as a contributing force for public stigma against those with mental illness. It stands to reason, then, that the more information provided to Effects of Viewing Patient-Related Physiological Data on Students’ Mental Health Stigma 5 the general public, the more understanding and less ignorance they will display toward people suffering from mental illness (Rose et al., 2007). Theories and Interventions Several theoretical frameworks may prove useful in the attempt to understand and battle the stigma of mental illness. The Stereotype Content Model (see King, Hebl, and Heatherton, 2005) holds that individuals are perceived as varying in regard to two traits deemed positive by society—warmth and competence. Asian Americans, for example, fall low on the warmth scale, but high on the competence scale, leading to an “envious prejudice” (King et al., 2005, p. 111). The warmth and competence scales for obese individuals are thought to be low, because the condition is both overt and thought to be controllable. The perceived controllability of the condition can be correlated with the amount of negative stigma placed on those with obesity (King et al., 2005, p. 111). The Stereotype Content Theory predicts that because those suffering from mental illness may also be perceived as having low warmth and competence (sufferers are often depicted as scary and unable to overcome their illness), they will be stigmatized. Intergroup Emotions Theory states that the more power an ingroup possesses, the more discrimination people in the outgroup will receive (King et al., 2005, p. 112). The ingroup enjoys the aspects of being the “societal ideal,” while the outgroup is disregarded or negatively regarded as not possessing the normalcy shared by the ingroup. This, in turn, can lead to feelings of anger toward the outgroup (Jost and Banaji, 1994). Intergroup Emotions Theory may be applied to those suffering from mental illness; if the societal norm is not having a mental illness such as Major Depressive Disorder, those suffering from MDD are automatically placed in the outgroup, and therefore met with disdain and anger from the ingroup. Effects of Viewing Patient-Related Physiological Data on Students’ Mental Health Stigma 6 The Sociofunctional Approach attempts to delve more deeply into why stigmatization occurs. This approach seeks an evolutionary answer to the question of why stigmatization occurs between ingroups and outgroups (Jost & Banaji, 1994). Neuberg, Smitch, and Asher (2000) argue that, “stigmatization is rooted in an inherent biological need to live in effective groups in order to promote the survival of their genetic makeup. Individuals or groups who are perceived to threaten the survival of one’s ingroup will be stigmatized” (cited in King et al., p. 113). Because of this, ingroups will take certain precautions in order to ensure that the outgroups do not threaten their survival. This can be displayed in forms of prejudice or anger, according to the Intergroup Emotions Theory (Jost & Banaji, 1994). According to the System Justification Approach, both high status and low status individuals view the high status group more positively than the low status group. This could explain why, for example, thin individuals stigmatize those with obesity and obese individuals negatively stigmatize themselves (King et al., 2005). Inability to maintain the “status quo” can recreate the cycle of stigmatization between the high status and low status groups; for example, obese individuals exhibit low self-esteem because they negatively perceive their status. Obese individuals’ low self-esteem can then perpetuate the same negative attitudes toward themselves (King et al., 2005). One way to combat this reinforced social construct is to change the perception obese individuals have about themselves; in other words, increase their self-esteem so that this stigma does not perpetuate. This same approach may be used to combat the negative stereotypes many people suffering from mental illness receive and perceive. Rhaman, (2001) discusses the impact that the modern media has had on perception of mental illness and, thusly how mental health stigma is shaped by the media representation. The inclusion of media into our daily lives means we now have a more sensationalized experience of Effects of Viewing Patient-Related Physiological Data on Students’ Mental Health Stigma 7 people, especially on television. Without knowing anything else about a person on TV, we can see how their actions can deviate from societal norms. Lack of a sufficient background allows us only to view the person as their immediate actions, therefore refusing them any depth other than their illness. (Klin and Lemish, 2008). Mental health sufferers are also