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In the next set of blog posts, I wish to digress from the power of contact into an anti-stigma approach that unexpectedly does not work well: education. This might be counterintuitive to most readers because teaching away problems is a commonly voiced response to dealing with social problems. Teach people to quit smoking, exercise more, do breast exams, and maintain safe neighborhoods. Health literacy has value in helping people meet wellness goals.
Education, however, does not positively impact stigma, at least not in adults. The next several blogs will give examples. I start with an oft-used approach, which is not only feckless but probably worsens stigma.
“Mental Illness Is a Brain Disorder.”
In 1990, the NIMH launched the decade of the brain where the Institute was trying to bring modern psychiatry into the age of neuroscience, seeking to ground understanding of diagnosis and treatment in bench science. Advocates thought this might also be the medium by which the responsibility myth `is erased. People do not choose to be schizophrenic, but rather are victims of biological disease. Mental illness became branded as a “brain disorder.”
Several studies tested the impact of this assertion soon after the campaign launch, with the results showing harmful findings! While it is true that the public blames people with serious mental illness less after learning the genetic roots of schizophrenia, they are also likely to believe the person will not recover.
“You may look good now, but psychosis is hard-wired into your neurons. You don’t recover.”
It is a lack of belief in recovery that leads employers to not hire people with mental illness, landlords to not rent to them, or primary care doctors to offer substandard care.
These findings echo concerns about a parallel educational approach: framing mental illness like any illness.
"Schizophrenia is just like diabetes. The public does not blame people for diabetes, so it should not blame people with schizophrenia."
It yields an easy slogan. Research, however, is less sanguine about its effects, instead showing unintended consequences (Read, Haslam, Sayce, & Davies, 2006). Not only has “mental illness just like any illness” failed to yield benefits, but findings also show the slogan is associated with greater perceptions of dangerousness and unpredictability. This, in turn, leads to more fear of people labeled with mental illness and a desire for greater social distance: “I don’t want to work alongside those people.”
Over the past decades, two ongoing programs of population research have provided a broader and more definitive picture of the limitations of education. The first looked at the degree to which the general public agrees that mental illness is a brain disorder, that symptoms are not chosen by the person with the illness. The second examined whether this change in knowledge corresponded with improvement in stigma.
A meta-analysis of 16 population studies from around the globe examined the change in knowledge and in stigma from 1990 to 2006 (Schomerus, Schwann, Holzinger et al., 2012). As expected, knowledge about schizophrenia and about depression significantly increased during this time. Between 40 and 60 percent of study participants during this time learned that schizophrenia was genetically inherited; between 50 and 70 percent of participants agreed that schizophrenia was a brain disease.
Despite this significant increase, the impact on stigma worsened. The index of stigma here was the degree to which survey participants would accept a person with schizophrenia as a neighbor. Responses got worse, with acceptance decreasing from about 50 percent in 1990 to 30 percent in 2006. Similar glum findings were found in labor, with acceptance decreasing from 50 percent in 1990 to a little above 30 percent in 2006. Beware the educational fix.
