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Mitigating Stigma and Barriers to Care 67
Protest involves reviewing the stigmatizing images of people with mental illness
and saying shame on us for that. There are many tabloid examples of this, such as “Get
the violent crazies off our streets.” The problem with protest is that it tends to lead to
a rebound effect. Many of you may remember this from Introduction to Psychology:
“For the next two minutes I do not want you to think about white bears. Keep them
out of your head.” Like most people in the audience you probably have the Klondike
bear bouncing around in your head right now. The problem with trying not to
think about something is that it actually raises its prominence in a group. There is an
interesting study in which people were divided into two groups. One group looked at
skin-head pictures with a caption that said, “Don’t think bad things about skinheads.”
That group had a much worse attitude toward skinheads than the group that were
provided no caption.
Contact, as I said before, is a very important way of looking at changing stigma.
Bob Lundin is a friend and colleague of mine and a person with schizoaffective disorder,
so the contact situations I will talk about today involve Bob. The way contact
works is, Bob will get up and tell his story. He will say, “My name is Bob and I have
a serious mental illness. I have schizoaffective disorder. We are not talking about test
anxiety. This is a major thing that affects my life. It did not happen as a kid.” There
are still frequent attitudes that serious mental illness started in childhood. If it comes
later in life it is just because you are weak. One interesting thing that comes out of
this is the ‘for real’ effect. “For real You look too good. There is no way somebody
like you could have a mental illness.” Bob has to qualify, and the way he qualifies in
groups is to ask what it means to be seriously mentally ill. “I have been hospitalized
and I have taken drugs for years.”
Now I want to give you a sense of what some of our research looks like. We did
a randomized control trial with a sample of 152 people. The participants took a
pretest on mental and physical illness stigma. Then they were randomized into four
conditions: education, protest, contact, or a control group. The significant finding
here is that education and contact improved in terms of their ability to respond to
treatment. Social psychiatrists call this stability, the idea that you are not stuck in
your mental illness but you can get out of it. The control condition produced an
interesting finding pertaining to social desirability. If I come around and ask you
what you think of enkephalins—an actual study was conducted on this made-up
word—your attitude is going to get better when I ask you twice because you are
thinking, “Well, he’s trying to show if I am a bigot.”
Another study we did involved randomizing people into four groups; two were
education groups and two were contact groups, each containing a responsibility
group and a dangerousness group. The results are clear: contact has a huge effect
over education. What is interesting about this data is not just that contact shows a
big effect but that follow up to any education diminished over time while changes
due to contact were sustained. Perhaps one of the best ways to challenge stigma is
to have people with mental illness come and tell their stories.
I also want to look at the vehicles of changing stigma, the way we get protest,
education, or contact out there. We divided the vehicles into media-based, with PSAs
being the best example of that, and in vivo, which involves inviting an outside expert
to educate people about mental illness.
The media is a population-based vehicle and its strength is that it is likely to
hit huge numbers. In vivo is a face-to-face approach and, therefore, localized to
individual groups.