A Widespread Stigma

Why are negative attitudes toward people with mental illnesses so pervasive? New research from Galen Bodenhausen, a professor of marketing at the Kellogg School of Management, Nicolas Rüsch, a researcher at the University of Freiburg, Andrew R. Todd, a researcher at the University of Cologne, and Patrick W. Corrigan, a professor at the Illinois Institute of Technology, suggests a relationship between mental illness stigma and commonly held worldviews that stress personal responsibility.

Using questionnaires and tests that measure automatic reactions, Bodenhausen found that people with meritocratic worldviews—beliefs that self-reliance and hard work are the keys to success—showed a greater tendency to blame people with mental illness for their disease. These stigmatizing attitudes “represent a barrier to treatment-seeking,” Bodenhausen says. “Understanding how to remove this barrier may help people with mental illness get effective treatment.”

Increasing Stigma

Bodenhausen is interested in social attitudes and social cognition. He studies the nature of stereotypes, prejudice, and discrimination, examining the mental and psychological processes that give rise to and result from mental representations of social groups. Some of his previous research has focused on race.

“Mental illness is an interesting case,” he says. “Stigma is extremely commonplace in our culture. While blatant kinds of racism and sexism have declined in recent times, stigma against mental illness seems to be increasing. It is an important social problem with an impact on individuals with mental illness and a cost to society.”

For his study, Bodenhausen examined the influence of two widely endorsed meritocratic worldviews: the Protestant work ethic (self-reliance and hard work lead to success) and belief in a just world (people get what they deserve). Study participants were 85 people with mental illness, recruited from clinics in Chicago, and 50 people without serious psychological disorders. Members of the two groups were matched for age, gender, and ethnicity.

The researchers administered questionnaires to determine the extent to which subjects endorsed the Protestant work ethic and just-world beliefs for themselves (I get what I deserve) and for others (others get what they deserve). Participants also completed questionnaires to assess whether they thought people with mental illnesses are dangerous or responsible for their condition—two common, negative beliefs about individuals with psychological disorders.

A final set of questionnaires measured agreement with unflattering stereotypes about people with mentally illness, such as, “People with mental illness can’t be trusted.” Participants who had been diagnosed with a mental illness answered an additional set of questions measuring whether they applied negative stereotypes to themselves, including, “I currently respect myself less because I cannot be trusted.”

To assess participants’ automatic reactions, the researchers administered a brief implicit association test (BIAT). In this test, participants viewed a series of word pairings relating to mental illness and to guilt or innocence. Sometimes they were required to use a response key when they saw words related to mental illness paired with words related to guilt; other times they used a response key when they saw words related to mental illness paired with words related to innocence. The theory behind the test is that people will respond faster to pairings that match their automatic, or gut, reactions.

Beliefs Factor Heavily

Overall, the study showed an association between the Protestant work ethic and stigmatizing attitudes—for people with and without mental illness. The BIAT indicated that members of the general public tended to have a mental association between “mental illness” and “guilty.” Bodenhausen and his colleagues found little support for a link between just-world beliefs and stigmatizing attitudes about mental illness. The researchers said the fact that the Protestant work ethic—and not just-world beliefs—appeared to be linked to stigmatizing attitudes could be related to the natures of the questionnaires. The Protestant work ethic questionnaire contains more judgmental statements, they said.

People with mental illness had lower measures of just-world beliefs for self than did people without mental illness, according to the study, an indication that the mentally ill believe life isn’t treating them fairly. The researchers said this attitude may be a response to the discrimination they face.

Just-world beliefs may help people with mental illness cope with social rejection, but may come at the price of increased blame, researchers say. According to the study, participants with mental illnesses viewed people with psychological problems as more responsible for their conditions than did members of the general public.

The research has implications for reducing the stigma of mental illness in society and self-stigma in people with mental illness, Bodenhausen said. Public service campaigns could be used to promote a worldview that acknowledges the role of factors outside an individual’s control in shaping their mental health outcomes. Campaigns might also highlight the ability of people to recover from mental illness. Although the Protestant work ethic is deeply ingrained in the U.S., Bodenhausen is optimistic that such anti-stigma campaigns could have an impact.

Similarly, therapeutic interventions to reduce self-stigma among persons experiencing a mental illness could take worldviews into account, he said. The interventions, he said, “could be as simple as having more examples of favorable outcomes accessible to people who seek help for their problems.”

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