Biogenetic models of psychopathology, implicit guilt, and mental illness stigma

"Maybe at birth there was an injury": drivers and implications of caretaker explanatory models of autistic characteristics in Kerala, India

Explanatory models (EMs) are the way people explain the presence and meaning of an illness or disability and are reliant on and reflective of culturally specific values of normalcy, disability, health, and illness. EMs about autism spectrum disorder (ASD) are particularly revealing because there is no known cause, and so people can explain this disability in ways more appropriate for and useful to them. This article presents caretaker EMs about children with autistic characteristics in Kerala, India. I argue that the reliance on biological, but not genetic, causal models is reflective of the state's high access to biomedical heath care. These EMs are used to deflect the stigma of 'bad blood' and reflect a nuanced relationship between stigma and biological EMs. Understanding how caretakers talk about ASD and related conditions is critical for anyone interested in engaging in crosscultural or international autism-related work.

Different biogenetic causal explanations and attitudes towards persons with major depression, schizophrenia and alcohol dependence: is the concept of a chemical imbalance beneficial?

OBJECTIVE

It is unclear whether different biogenetic causal beliefs affect stigmatization of mentally-ill patients differently. It has been argued that in particular believing in a 'chemical imbalance' as a cause of mental disorder might be associated with more tolerant attitudes.

METHOD

In a representative population survey in Germany (n=3642), using unlabelled case vignettes of persons with depression, schizophrenia, or alcohol dependence, we elicited agreement with three different biogenetic explanations of the illness: 'Chemical imbalance of the brain', 'brain disease' and 'heredity'. We further investigated emotional reactions as well as the desire for social distance. For each vignette condition we calculated linear regressions with each biogenetic explanation as independent and emotional reactions as well as social distance as dependent variable controlling for socio-demographic variables.

LIMITATIONS

Our cross-sectional study does not allow statements regarding causality and the explanatory power of our statistical models was low.

RESULTS

'Chemical imbalance of the brain' and 'brain disease' were both associated with a stronger desire for social distance in schizophrenia and depression, and with more social acceptance in alcohol dependence, whereas 'heredity' was not significantly associated with social distance in any of the investigated illnesses. All three biogenetic causal beliefs were associated with more fear in all three illnesses.

CONCLUSION

Our study corroborates findings that biogenetic explanations have different effects in different disorders, and seem to be harmful in depression and schizophrenia. A particular de-stigmatizing potential of the causal belief 'chemical imbalance' could not be found. Implications for useful anti-stigma messages are discussed.

An implicit measure of associations with mental illness versus physical illness: response latency decomposition and stimuli differential functioning in relation to IAT order of associative conditions and accuracy

The present study aimed at the definition of a latent measurement dimension underlying an implicit measure of automatic associations between the concept of mental illness and the psychosocial and biogenetic causal explanatory attributes. To this end, an Implicit Association Test (IAT) assessing the association between the Mental Illness and Physical Illness target categories to the Psychological and Biologic attribute categories, representative of the causal explanation domains, was developed. The IAT presented 22 stimuli (words and pictures) to be categorized into the four categories. After 360 university students completed the IAT, a Many-Facet Rasch Measurement (MFRM) modelling approach was applied. The model specified a person latency parameter and a stimulus latency parameter. Two additional parameters were introduced to denote the order of presentation of the task associative conditions and the general response accuracy. Beyond the overall definition of the latent measurement dimension, the MFRM was also applied to disentangle the effect of the task block order and the general response accuracy on the stimuli response latency. Further, the MFRM allowed detecting any differential functioning of each stimulus in relation to both block ordering and accuracy. The results evidenced: a) the existence of a latency measurement dimension underlying the Mental Illness versus Physical Illness - Implicit Association Test; b) significant effects of block order and accuracy on the overall latency; c) a differential functioning of specific stimuli. The results of the present study can contribute to a better understanding of the functioning of an implicit measure of semantic associations with mental illness and give a first blueprint for the examination of relevant issues in the development of an IAT.

Interpreting genetics in the context of eating disorders: evidence of disease, not diversity

How is genetic involvement interpreted for disorders whose medicalisation is contested? Framing psychiatric and behavioural disorders in terms of genetics is expected to make them seem more medical. Yet a genetic aetiology can also be used to frame behaviour as acceptable human variation, rather than a medical problem (for example, sexual orientation). I analyse responses to the idea that there is a genetic component in anorexia and bulimia nervosa (AN or BN) via semi-structured interviews with a sample of 50 women diagnosed with an eating disorder (25 had recovered). All but three volunteered that genetics would medicalise AN or BN by (i) making eating disorders seem more like 'real diseases'; implying that these disorders need (ii) professional treatment or (iii) a biologically based treatment. The results also indicate there are several counter-logics by which genetic framing could support non-medical definitions of AN or BN. I argue that genetic framing reduces perceived individual responsibility, which can support definitions of behaviour as either a reflection of disease (which entails intervention) or a reflection of normal human diversity (which does not). In the context of public scepticism as to the 'reality' of AN or BN, genetic involvement was taken as evidence of disease in ongoing negotiations about the medical and moral status of people with eating disorders.

Genetic attributions and mental illness diagnosis: effects on perceptions of danger, social distance, and real helping decisions

Genetic essentialism suggests that beliefs in genetic causes of mental illness will inflate a desire for social distance from affected individuals, regardless of specific disorder. However, genetic contingency theory predicts that genetic attributions will lead to an increased desire for social distance only from persons with disorders who are perceived as dangerous.

PURPOSE

To assess the interactive effect of diagnosis and attribution on social distance and actual helping decisions across disorders.

METHODS

Undergraduate students (n = 149) were randomly assigned to read one of the six vignettes depicting a person affected by one of the three disorders (i.e., schizophrenia, bipolar disorder, or major depression) with either a genetic or environmental causal attribution for disorder. Participants completed measures of perceived dangerousness, social distance, empathic concern, familiarity with mental illness, and actual helping decisions.

RESULTS

When provided with genetic attributions, participants' desire for social distance was greater for targets with schizophrenia relative to targets with depression or bipolar disorder. This effect was mediated by perceived dangerousness. The indirect effect of diagnosis on helping decisions, through social distance, was significant within the genetic attribution condition.

CONCLUSION

Consistent with genetic contingency theory, genetic attributions for schizophrenia, but not affective disorders, lead to greater desire for social distance via greater perceived dangerousness. Further, results suggest that genetic attributions decrease the likelihood of helping people with schizophrenia, but have no effect on the likelihood of helping people with affective disorders. These effects are partially accounted for by desired social distance from people with schizophrenia.

The implications for the biological and sociodynamic causal explanations of attitudes toward alcohol-dependent patients

This study tested whether sole neurobiological or sociodynamic explanations of alcohol dependence altered respondents' attitudes toward alcohol-dependent patients. We investigated the effect of information leaflets on 444 participants: one group received an information leaflet with a biological explanation of AD; the other received a leaflet with a sole sociodynamic explanation of AD. A third, control group did not receive any leaflet. Afterwards, all three groups completed a questionnaire regarding their attitudes toward ADPs and their opinions of the underlying causes of AD. We found a significant group difference with regard to participants' agreement with a neurobiological explanation of AD. Moreover, respondents in the neurobiological intervention group considered the characteristics of ADP to be significantly more positive than those in the sociodynamic group. Furthermore, they were significantly less likely to accept AD as a self-inflicted disease. Correlation analysis revealed associations between accepting the sociodynamic disease model and all of the stigmatization dimensions tested in our questionnaire. In summary, stigmatization toward ADP was closely associated with the agreement with sociodynamic origins of AD in this study.

Association of lay beliefs about causes of depression with social distance

OBJECTIVE

The aim of this study was to examine the association of lay attributions about causes of depression with attitudes and prejudiced behaviour towards people with depression.

METHOD

Subjects (1631 German-speakers aged 18 and over, randomly selected) were interviewed in two German cities by telephone using a standardized questionnaire. The survey assessed knowledge about depression, stereotypical attitudes and social distance towards persons with depression.

RESULTS

The results indicate that a majority of the respondents holds predominantly non-pejorative attitudes towards persons with depression. The majority estimated psychosocial causes as being most important for the genesis of depression. Stronger social distance was linked to an estimation of personal causes as relevant. Subgroup differences were apparent with respect to age, sex and reported contact to people with depression.

CONCLUSION

Improvements in the education of the public about depression should be based on a multifactorial model. Future interventions should promote contact with people with depression and place special emphasis on conveying information in a suitable manner depending on the needs of different target groups.

Impact of informing overweight individuals about the role of genetics in obesity: an online experimental study

BACKGROUND/AIMS

Increasing public awareness of obesity genetics could have beneficial or harmful effects on overweight individuals. This study examined the impact of genetic information on weight-related cognitions as well as interest in personalized genetic information about obesity among overweight individuals.

METHODS

Online survey respondents (n = 655) were randomly assigned to read either genetic, gene-environment, or nongenetic obesity causal information. Fifty-two percent of the participants were female, 82.4% were White, 45% had an annual income of USD <40,000, and the mean BMI was 32.5. Internalized weight stigma was measured using the Weight Bias Internalization Scale.

RESULTS

Participants in the genetic and gene-environment conditions were more likely to believe genetics increase obesity risk than participants in the nongenetic condition (both p < 0.05); however, they did not differ regarding internalized weight stigma. Sixty-four percent of the participants expressed interest in receiving personalized genetic information about their obesity risk.

CONCLUSION

Dissemination of information about obesity genetics may have neither a beneficial nor a harmful impact on how overweight individuals perceive themselves. Some overweight individuals may be interested in receiving personalized genetic information. The actual effects of obesity genetic information being incorporated into public health messages and of personalized genetic information on obesity prevention and treatment interventions remain to be seen.

Stigma and bipolar disorder: a review of the literature

BACKGROUND

Psychiatric stigma is pervasive injustice that complicates the course of illness and reduces quality of life for people with mental illnesses. This article reviews the research examining stigma towards bipolar disorder (BD) with a view to guiding the development of stigma reduction initiatives and ongoing research.

METHODS

PsychInfo, Medline, and Embase databases were searched for peer-reviewed studies addressing stigma in BD.

RESULTS

Stigma is a serious concern for individuals with BD and their families. Stigma occurs within affected individuals, families, social environments, work and school environments, and the healthcare industry. With stigma often come a loss of social support and occupational success, reduced functioning, higher symptom levels and lower quality of life. BD stigma is comparable to that of other severe mental illnesses, such as schizophrenia. Few interventions are available to specifically target stigma against BD.

LIMITATIONS

Most studies have used explicit, attitude-based measures of stigma without controlling for social desirability, which may not translate into real-world stigmatizing behaviors. Furthermore, many studies have not clearly delineated results in a manner consistent with the conceptual framework of stigmatization.

CONCLUSIONS

Stigma toward BD is ubiquitous and has insidious consequences for affected individuals and their families. Stigma reduction initiatives should target individuals living with BD, their families, workplaces, and the healthcare industry, taking into account the experiences and impacts of BD stigma to improve social support, course of illness, and quality of life.

Implicit attitudes, emotions, and helping intentions of mental health workers toward their clients

The attitudes of mental health care workers toward their clients may influence the quality of care they provide. There is growing recognition of the role of implicit attitudes in behavior toward people with stigmatized illnesses, such as mental illness, and of the need to measure these separately from explicit attitudes. Seventy-four mental health workers completed implicit and explicit measure of attitudes toward people with mental illness. The participants were also asked about their intention to help people with mental illness and their emotional reactions toward people with a mental illness. The findings show that the implicit attitudes of the health workers toward clients with a mental illness are somewhat negative despite the fact that their explicit attitudes are somewhat positive. Although both implicit and explicit attitudes predicted negative emotions, only implicit attitudes were related to helping intentions. This study highlights the association between implicit attitudes and behavioral intentions and confirms the importance of addressing implicit attitudes in mental health research.

Implicit Association Test: a possible tool for screening patients for orthognathic surgery

In orthognathic surgery, many serious medical disputes and postsurgical dissatisfactions are not caused by the doctors' reasons, but due to the patients' psychological problems. These adverse events obsess not only surgeons, but also patients to a great extent. An effective method is expected to screen patients for orthognathic surgery. So far, most selecting approaches in orthognathic surgery are based on explicit cognition, which inevitably include the following faults: patients' intentional concealment, uncertain errors, and imprecise subjective judgment from the doctors. However, these errors can be avoided by the tests based on implicit cognition, i.e., Implicit Association Test (IAT). Avoiding the faults of explicit cognition, IAT is an objective, quantitative, and easily applicable mental measurement method. We hypothesized that all the patients for orthognathic purpose should have an IAT screening before treatment. By IAT method, the right patients for orthognathic surgery can be picked out. As a result, postoperative dissatisfaction, medical dispute, and even violent conflict can be avoided to a great extent. To the best of our knowledge, there is no relevant report on the use of IAT as a tool to select the right orthognathic patients to avoid postsurgical dissatisfaction, medical disputes and violent conflict events.

Does labeling matter? An examination of attitudes and perceptions of labels for mental disorders

PURPOSE

Labeling research in various domains has found that attitudes and perceptions vary as a function of the different labels ascribed to a group (e.g., overweight vs. obese). This type of research, however, has not been examined extensively in regards to labels for mental disorders. The present study examined whether common psychiatric labels (i.e., mental disease, mental disorders, mental health problems, and mental illness) elicited divergent attitudes and perceptions in a group of participants. These labels were also compared to the specific label of depression.

METHODS

Undergraduate psychology students (N = 124) were given identical questionnaire packages with the exception of the label used. That is, each participant received a set of questionnaires that referred to only one of the five labels. The questionnaire package contained various quantitative measures of attitudes and social distance, in addition to a short qualitative measure.

RESULTS

Analyses demonstrated equivalence among the four general psychiatric labels on measures of attitudes, social distance, and general perceptions. However, results also suggested that the general labels diverged from the depression label, with the latter being generally more negatively perceived. Some analyses demonstrated that participants' understanding of the terminology might be incorrect. The results of the investigation are discussed with a focus on its relationship with current research in stigma.

CONCLUSION

Within the current sample, general psychiatric labels did not appear to distinguish themselves from each other on measures of attitude and social distance but did so when compared to a relatively more specific term. Future research should examine the underlying mechanism driving this finding, with the ultimate goal of reducing the stigma faced by those with mental disorders.

A qualitative inquiry into consumer beliefs about the causes of mental illness

This paper examines consumer or service user beliefs about the causes of mental illness. It presents a qualitative, participatory action research study involving semi-structured in-depth interviews with 16 people who had been diagnosed with a mental illness and attended a community mental health centre in metropolitan South Australia. Inductive thematic analysis was undertaken, with a range of beliefs about the possible cause of mental illness identified. Findings are organized within two key areas: social or environmental factors and physical or biological factors. The social or environmental category included varied situations, clustered under the subcategories of: stress during childhood, events in adulthood and religious beliefs. Physical or biological factors included beliefs that mental illness was inherited, caused by brain malfunction or chemical imbalance. Of note, one-third of consumer participants who discussed possible causes of mental illness identified multiple potential causes. Implications for service delivery, specifically related to therapeutic trust and engagement, are also considered.

The more information, the more negative stigma towards schizophrenia: Brazilian general population and psychiatrists compared

Findings on stigmatizing attitudes toward individuals with schizophrenia have been inconsistent in comparisons between mental health professionals and members of the general public. In this regard, it is important to obtain data from understudied sociocultural settings, and to examine how attitudes toward mental illness vary in such settings. Nationwide samples of 1015 general population individuals and 1414 psychiatrists from Brazil were recruited between 2009 and 2010. Respondents from the general population were asked to identify an unlabeled schizophrenia case vignette. Psychiatrists were instructed to consider "someone with stabilized schizophrenia". Stereotypes, perceived prejudice and social distance were assessed. For the general population, stigma determinants replicated findings from the literature. The level of the vignette's identification constituted an important correlate. For psychiatrists, determinants correlated in the opposite direction. When both samples were compared, psychiatrists showed the highest scores in stereotypes and perceived prejudice; for the general population, the better they recognized the vignette, the higher they scored in those dimensions. Psychiatrists reported the lowest social distance scores compared with members of the general population. Knowledge about schizophrenia thus constituted an important determinant of stigma; consequently, factors influencing stigma should be further investigated in the general population and in psychiatrists as well.

Measuring mental illness stigma with diminished social desirability effects

BACKGROUND

For persons with mental illness, stigma diminishes employment and independent living opportunities as well as participation in psychiatric care. Public stigma interventions have sought to ameliorate these consequences.

AIMS

Evaluation of anti-stigma programs' impact is typically accomplished with self-report questionnaires. However, cultural mores encourage endorsement of answers that are socially preferred rather than one's true belief. This problem, social desirability, has been circumvented through development of faux knowledge tests (KTs) (i.e., Error-Choice Tests); written to assess prejudice.

METHOD

Our KT uses error-choice test methodology to assess stigmatizing attitudes. Test content was derived from review of typical KTs for façade reinforcement. Answer endorsement suggests bias or stigma; such determinations were based on the empirical literature.

RESULTS

KT psychometrics were examined in samples of college students, community members and mental health providers and consumers. Test-retest reliability ranged from fair (0.50) to good (0.70). Construct validity analyses of public stigma indicated a positive relationship with the Attribution Questionnaire and inverse relationships with Self-Determination and Empowerment Scales. No significant relationships were observed with self-stigma measures (recovery, empowerment).

CONCLUSIONS

This psychometric evaluation study suggests that a self-administered questionnaire may circumvent social desirability and have merit as a stigma measurement tool.

Components of implicit stigma against mental illness among Chinese students

Although some research has examined negative automatic aspects of attitudes toward mental illness via relatively indirect measures among Western samples, it is unclear whether negative attitudes can be automatically activated in individuals from non-Western countries. This study attempted to validate results from Western samples with Chinese college students. We first examined the three-component model of implicit stigma (negative cognition, negative affect, and discriminatory tendencies) toward mental illness with the Single Category Implicit Association Test (SC-IAT). We also explored the relationship between explicit and implicit stigma among 56 Chinese university college students. In the three separate SC-IATs and the combined SC-IAT, automatic associations between mental illness and negative descriptors were stronger relative to those with positive descriptors and the implicit effect of cognitive and affective SC-IATs were significant. Explicit and implicit measures of stigma toward mental illness were unrelated. In our sample, women's overall attitudes toward mental illness were more negative than men's were, but no gender differences were found for explicit measures. These findings suggested that implicit stigma toward mental illness exists in Chinese students, and provide some support for the three-component model of implicit stigma toward mental illness. Future studies that focus on automatic components of stigmatization and stigma-reduction in China are warranted.

Holding blame at bay? 'Gene talk' in family members' accounts of schizophrenia aetiology

We provide the first detailed analysis of how, for what purposes and with what consequences people related to someone with a diagnosis of schizophrenia use ‘gene talk'. The article analyses findings from a qualitative interview study conducted in London and involving 19 participants (mostly women). We transcribed the interviews verbatim and analysed them using grounded theory methods. We analyse how and for what purposes participants mobilized ‘gene talk' in their affectively freighted encounter with an unknown interviewer. Gene talk served to (re)position blame and guilt, and was simultaneously used imaginatively to forge family history narratives. Family members used ‘gene talk' to recruit forebears with no psychiatric diagnosis into a family history of mental illness, and presented the origins of the diagnosed family member's schizophrenia as lying temporally before, and hence beyond the agency of the immediate family. Gene talk was also used in attempts to dislodge the distressing figure of the schizophrenia-inducing mother. ‘Gene talk', however, ultimately displaced, rather than resolved, the (self-)blame of many family members, particularly mothers. Our article challenges the commonly expressed view that genetic accounts will absolve family members' sense of (self-)blame in relation to their relative's/relatives' diagnosis.

Laypersons' choices and deliberations for mental health coverage

Insurance coverage for mental health services has historically lagged behind other types of health services. We used a simulation exercise in which groups of laypersons deliberate about healthcare tradeoffs. Groups deciding for their "community" were more likely to select mental health coverage than individuals. Individual prioritization of mental health coverage, however, increased after group discussion. Participants discussed: value, cost and perceived need for mental health coverage, moral hazard and community benefit. A deliberative exercise in priority-setting led a significant proportion of persons to reconsider decisions about coverage for mental health services. Deliberations illustrated public-spiritedness, stigma and significant polarity of views.

"Not all my fault": genetics, stigma, and personal responsibility for women with eating disorders

Medical researchers and clinicians increasingly understand and present eating disorders (anorexia and bulimia nervosa) as biologically-based psychiatric disorders, with genetic risk factors established by high heritability estimates in twin studies. But there has been no research on interpretation of genetic involvement by people with eating disorders, who may hold other views. Their interpretations are particularly important given the frequent presumption that biogenetic framing will reduce stigma, and recent findings that it exacerbates stigma for other mental illnesses. To identify implications of genetic framing in eating disorders, I conducted semi-structured interviews with 50 US women with a history of eating disorders (half recovered, half in treatment; interviewed 2008-9 in the USA). Interviews introduced the topic of genetics, but not stigma per se. Analysis followed the general principles of grounded theory to identify perceived implications of genetic involvement; those relevant to stigma are reported here. Most anticipated that genetic reframing would help reduce stigma from personal responsibility (i.e., blame and guilt for eating disorder as ongoing choice). A third articulated ways it could add stigma, including novel forms of stigma related to genetic-essentialist effacing of social factors. Despite welcoming reductions in blame and guilt, half also worried genetic framing could hamper recovery, by encouraging fatalistic self-fulfilling prophecies and genetic excuses. This study is the first to elicit perceptions of genetic involvement by those with eating disorders, and contributes to an emerging literature on perceptions of psychiatric genetics by people with mental illness.

What is a mental illness? Public views and their effects on attitudes and disclosure

OBJECTIVE

'Mental illness' is a common label. However, the general public may or may not consider various conditions, ranging from major psychiatric disorders to stress, as mental illnesses. It is unclear how such public views affect attitudes towards people with mental illness and reactions to one's own potential mental illness, e.g. in terms of help-seeking or disclosure.

METHODS

In representative English population surveys the classification of six conditions (schizophrenia, bipolar disorder, depression, drug addiction, stress, grief) as a mental illness was assessed as well as attitudes towards, and contact with, people with mental illness, intentions to disclose a mental illness and to seek treatment.

RESULTS

A factor analysis of how strongly respondents perceived the six conditions as a mental illness yielded two factors: (i) major psychiatric disorders and (ii) stress- and behaviour-related conditions including drug addiction. In regression analyses, higher scores on the first, but not the second, factor predicted less perceived responsibility of people with mental illness for their actions, and more support for a neurobiological illness model and help-seeking. Classifying stress-related/behaviour-related conditions as mental illnesses, as well as not referring to major psychiatric disorders as mental illnesses, was associated with more negative attitudes and increased social distance, but also with stronger intentions to disclose a mental illness to an employer. Negative attitudes and social distance were also related to ethnic minority status and lower social grade.

CONCLUSIONS

Referring to major psychiatric disorders as mental illnesses may reflect higher mental health literacy, better attitudes towards people with mental illness and help-seeking. A broader concept of mental illness could, although increasing negative attitudes, facilitate disclosure in the workplace. Public views on what is a mental illness may have context-dependent effects and should be taken into account in anti-stigma campaigns.

Stigmatizing attitudes in relatives of people with schizophrenia: a study using the Attribution Questionnaire AQ-27

BACKGROUND: Family members of people with mental disorders can contribute to stigmatization. Because of the lack of adequate information and resources, and the fatigue resulting from daily care, the family can reinforce social exclusion of the mentally ill and disbelieve recovery. Furthermore, family members may also suffer from self-stigma, experiencing a decrease in their own self-esteem and self-worth. OBJECTIVE: To evaluate the presence of stigmatizing attitudes towards patients diagnosed with schizophrenia in a group of relatives of patients with this disorder. METHODS: In this exploratory study, we surveyed 40 family members of patients with schizophrenia seen at the Community Psychiatry Unit of the Psychiatry Department at Centro Hospitalar de São João (CHSJ), in Porto, Portugal, using a preliminary version of the Attribution Questionnaire AQ-27 in Portuguese. RESULTS: The questionnaire dimensions with the highest mean scores were help, pity, and coercion, followed by segregation, anger, avoidance, dangerousness, responsibility, and fear. These results suggest that relatives do not see people with schizophrenia as responsible for their illness and that they show concern and willingness to help. They avoid but do not fear people with schizophrenia and neither consider them dangerous. CONCLUSION: The participants expressed positive, little stigmatizing attitudes towards people with schizophrenia, probably as a result of their familiarity with severe mental disorder, an adequate attribution process, and low levels of perceived dangerousness. However, the high scores of coercion, pity, and segregation may reflect concealed stigmas that may influence the self-determination of the mentally ill, suggesting the need for psychoeducational interventions aimed at family members.

Automatic stereotyping against people with schizophrenia, schizoaffective and affective disorders

Similar to members of the public, people with mental illness may exhibit general negative automatic prejudice against their own group. However, it is unclear whether more specific negative stereotypes are automatically activated among diagnosed individuals and how such automatic stereotyping may be related to self-reported attitudes and emotional reactions. We therefore studied automatically activated reactions toward mental illness among 85 people with schizophrenia, schizoaffective or affective disorders as well as among 50 members of the general public, using a Lexical Decision Task to measure automatic stereotyping. Deliberately endorsed attitudes and emotional reactions were assessed by self-report. Independent of diagnosis, people with mental illness showed less negative automatic stereotyping than did members of the public. Among members of the public, stronger automatic stereotyping was associated with more self-reported shame about a potential mental illness and more anger toward stigmatized individuals. Reduced automatic stereotyping in the diagnosed group suggests that people with mental illness might not entirely internalize societal stigma. Among members of the public, automatic stereotyping predicted negative emotional reactions to people with mental illness. Initiatives to reduce the impact of public stigma and internalized stigma should take automatic stereotyping and related emotional aspects of stigma into account.

Do people with mental illness deserve what they get? Links between meritocratic worldviews and implicit versus explicit stigma

Meritocratic worldviews that stress personal responsibility, such as the Protestant ethic or general beliefs in a just world, are typically associated with stigmatizing attitudes and could explain the persistence of mental illness stigma. Beliefs in a just world for oneself ("I get what I deserve"), however, are often related to personal well-being and can be a coping resource for stigmatized individuals. Despite these findings in other stigmatized groups, the link between worldviews and the stigma of psychiatric disorders is unknown. We measured just world beliefs for self and others as well as endorsement of the Protestant ethic in 85 people with schizophrenia, schizoaffective or affective disorders and 50 members of the general public. Stigmatizing attitudes toward people with mental illness (perceived responsibility, perceived dangerousness, general agreement with negative stereotypes) were assessed by self-report. Using a response-latency task, the Brief Implicit Association Test, we also examined guilt-related implicit negative stereotypes about mental illness. We found a consistent positive link between endorsing the Protestant ethic and stigmatizing self-reported attitudes in both groups. Implicit guilt-related stereotypes were positively associated with the Protestant ethic only among members of the public. Among people with mental illness, stronger just world beliefs for self were related to reduced self-stigma, but also to more implicit blame of persons with mental illness. The Protestant ethic may increase (self-)stigmatizing attitudes; just world beliefs for oneself, on the other hand, may lead to unexpected implicit self-blame in stigmatized individuals. Public anti-stigma campaigns and initiatives to reduce self-stigma among people with mental illness should take worldviews into account.

Changing stigmatizing perceptions and recollections about mental illness: the effects of NAMI's in Our Own Voice

In Our Own Voice (IOOV) is a 90-min anti-stigma program that comprises face-to-face stories of challenges of mental illness and hopes and dreams commensurate with recovery. We pared down IOOV to a 30-min version, using information from two focus groups. In this study, effects of 90- versus 30-min IOOV are contrasted with 30 min of education. Two hundred research participants were randomly assigned to one of these three conditions and completed a measure of stigmatizing perceptions and recollections. People in the education group remembered more negatives than the two IOOV groups. To control for overall response rate, a difference ratio was determined (difference in positive and negative recollection divided by overall recollections). Results showed the two IOOV conditions had significantly better ratios than education. These findings suggest the 30 min version of IOOV is as effective as the 90 min standard.

SELF-STIGMA AND COMING OUT ABOUT ONE'S MENTAL ILLNESS

Self-stigma can undermine self-esteem and self-efficacy of people with serious mental illness. Coming out may be one way of handling self-stigma and it was expected that coming out would mediate the effects of self-stigma on quality of life. This study compares coming out to other approaches of controlling self-stigma. Eighty-five people with serious mental illness completed measures of coming out (called the Coming Out with Mental Illness Scale, COMIS), self-stigma, quality of life, and strategies for managing self-stigma. An exploratory factor analysis of the COMIS uncovered two constructs: benefits of being out (BBO) and reasons for staying in. A mediational analysis showed BBO diminished self-stigma effects on quality of life. A factor analysis of measures of managing self-stigma yielded three factors. Benefits of being out was associated with two of these: affirming strategies and becoming aloof, not with strategies of shame. Implications for how coming out enhances the person's quality of life are discussed.

Automatically activated shame reactions and perceived legitimacy of discrimination: A longitudinal study among people with mental illness

Perceived legitimacy of discrimination shapes reactions to mental illness stigma among stigmatized individuals. We assessed deliberately endorsed versus automatic shame-related reactions to mental illness as predictors of change in perceived legitimacy of discrimination over six months among 75 people with mental illness. Automatically activated shame-related associations with mental illness were measured using the Brief Implicit Association Test, deliberately endorsed beliefs via self-report. Controlling for depression and perceived stigma, stronger baseline automatic shame-related associations, but not deliberately endorsed beliefs, predicted higher perceived legitimacy of discrimination after six months. Automatically activated shame reactions may increase vulnerability to mental illness stigma.