On stigma and the mentally ill

At Blogborygmi, a med student gets a lesson about stigma from a cabdriver.

And Medscape interviews Dr. Patrick Corrigan, PsyD, about stigmatization of the mentally ill.

Medscape: What are effective ways to combat stigma?

Dr. Corrigan: Looking at public stigma, we've broken down change mechanisms into 3 -- education, contact, and protest. Protest is usually a "shame-on-you" kind of statement and an appeal to stop thinking that way. As an attitude changer, protest tends to give you a rebound effect. Research shows that attitudes get worse. Behavior, on the other hand, might see some benefit.

One example is a show on ABC called Wonderland. In the first episode, which aired on March 30, 2000, a person with mental illness shot 5 people and stabbed a pregnant woman in the abdomen. Lots of advocacy groups came out and said, "We're not going to put up with this grossly stigmatizing image." ABC thought this was great because it got them a lot of press, but then the advocacy groups went to the sponsors and ABC eventually pulled the show off the air.

Medscape: In your paper, you focus on contact.

Dr. Corrigan: Let's talk about education first, which is transposing the myths of mental illness with facts. Education is popular because it's exportable -- you can package it up and send it around, such as public service announcements on TV. Unfortunately, the effects of education are small and tend to wash out altogether in a week or two.

Contact is introducing people with mental illness to the rest of the population, and usually that leads to a decrease in stigma. We've done a couple of studies on it. In 2 studies, we compared contact with education, and contact led to significant changes in attitudes and behavior that were maintained until a month later.

We did a study in which we randomly assigned college students to 1 of 3 groups in which they had contact with either a live or videotaped person with mental illness.[3] One we called high contact, which would be meeting a person who would greatly challenge the stereotypes of people with mental illness. An example would be a famous person coming out of the closet, such as Mike Wallace or Patty Duke. A second type would be low contact. This would be people who greatly mirror the stereotype of mental illness, such as a person who's homeless. The third group is in the middle, someone struggling with mental illness who, despite that, is living on their own with a full-time job.

We measured attitudes precontact, postcontact, and at follow-up, and found that low contact does not work very well -- meeting a homeless person on the street does not challenge a stereotype; if anything, it reinforces it. High contact -- knowing about famous people -- did not tend to have a big effect.

What tends to work most is the middle group, when you find out a coworker or person in your church or a neighbor is struggling with a mental illness. That tends to greatly challenge the stereotypes.