Mental health policy and practice across Europe: an overview

Tackling social exclusion 49
in this particular case, schizophrenia – the more social distance they desire
between themselves and the affected individual (Angermeyer and Matschinger
2005).
It is unsurprising that people afflicted by discrimination want to benefit from
the more benign attitudes towards people with, say, coronary heart disease than
to those with schizophrenia (Lai et al. 2001). This can lead to the naïve view that
emphasizing illness terminology – and explaining aetiology in disease terms –
will transfer the acceptance of physical illness directly across to the mental
health sphere. There are a number of problems with this assumption, the first
being that the disease conception does not disrupt the link between mental
illness and violence. In popular culture, ‘sickness’ can sometimes co-exist too
readily with the idea of ‘evil’ – as ‘sick monster’ newspaper headlines in some
countries attest. A second problem is that the disease conception also fails to
disrupt the link between mental illness and incompetence; in fact, it may
re-enforce it. Physical impairments can be linked to assumed incompetence, as
with the ‘Does he take sugar?’ comment often addressed to the companion of a
wheelchair user (rather than to the wheelchair user her/himself). We would not
respond to that patronizing attitude by explaining the facts of the accident that
broke the disabled person’s spine. The cause is simply irrelevant. The effective
challenge is a demonstration of competence and/or assertion of how the person
wishes to be treated. In the same way, we should not assume that explaining the
causes of schizophrenia will moderate discriminatory attitudes. Why should it?
If people with physical illnesses can be subjected to pity and stigma, when the
diseased organ is the brain itself – the site of the personality, or mind – the whole
person’s credibility and capability is thrown into question. Add to that the fear
of mental illness as a metaphor for wider disorder and lack of control (Sontag
1978) and it seems clear that simply stating that ‘madness’ is a brain disease is
unlikely to ‘use up’ the metaphor, in Sontag’s terms – to remove its sting.
A third problem associated with the brain disease/illness model is the removal
from the individual of the burden of responsibility for his or her condition and
the behaviour flowing from it; if it is an illness, it is not a person’s fault. This can
be cited as a positive outcome, and indeed research in the United States does
show a link between biological understandings of mental illness and reduced
blame of the individual (Phelan et al. 2002). However, now Angermeyer and
Matschinger (2005) have replicated this study in Europe, results opposite to
those achieved in America have been reported. American citizens are considerably
more likely than Europeans to see individuals as responsible for poverty
(Wilson 1997) – and for ‘their own fate’ more broadly. While Angermeyer and
Matschinger (p. 331) report that ‘parallel to an increase in the public’s tendency
to endorse biological causes, an increase in the desire for social distance from
people with schizophrenia was found’. The report authors suggest that in
Germany, the more the survey respondents endorsed biological factors as a
cause, the more lacking in self-control, unpredictable and dangerous they
believed individuals with schizophrenia to be. This, in turn, was associated with
a higher degree of fear, which resulted in a stronger desire for social distance.
Read and Harre (2001) found a similar result: when a sample of the public
understood the ‘brain disease’ message they became more, not less, likely to
believe the person was incapable and not responsible: a poor unfortunate,