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Journal of Mental Health (2001) 10, 2, 223–235
ISSN 0963-8237print/ISSN 1360-0567online/2001/020223-13 © Shadowfax Publishing and Taylor & Francis Ltd
DOI: 10.1080/09638230020023778
Address for Correspondence: Dr John Read, Senior Lecturer, Psychology Department, The University of
Auckland, Private Bag 92019, Auckland 1, New Zealand. Tel: +64-9-373-7599 ext. 5011; Fax: +64 9 373 7450;
E-mail: j.read@auckland.ac.nz
The role of biological and genetic causal beliefs in the
stigmatisation of ‘mental patients’
JOHN READ & NIKI HARRÉ
Psychology Department, The University of Auckland, Auckland, New Zealand
Abstract
Research indicates that the ‘mental illness is an illness like any other’ approach to destigmatisation has
failed to improve attitudes. This study replicated, with 469 New Zealanders, previous findings that the
public tends to reject biological and genetic explanations of mental health problems in favour of
psychosocial explanations focused on negative life events. It also confirmed previous findings
(contrary to the assumption on which most destigmatisation programmes are based) that biological and
genetic causal beliefs are related to negative attitudes, including perceptions that ‘mental patients’ are
dangerous, antisocial and unpredictable, and reluctance to become romantically involved with them.
The amount of reported personal contact with people who had received psychiatric treatment was
correlated with positive attitudes. It is recommended that destigmatisation programmes consider
abandoning efforts to promulgate illness-based explanations and focus instead on increasing contact
with and exposure to users of mental health services.
Introduction
Attitudes towards ‘mental patients’
Prejudice against people with mental health
difficulties has been extensively documented
(Sayce, 1998, 2000). The findings are re-
markably consistent over place and time,
with dangerousness and unpredictability
among the most often reported perceptions
(Green et al., 1987; Riskind & Wahl, 1992).
Nunnally (1961) found that the US public
experienced ‘mentally ill’ people not only as
more dangerous and unpredictable than other
people but also more worthless, dirty, cold
and insincere. In New Zealand, Green et al.
replicated most of these attitudes, adding
delicate, slow, tense, weak and foolish. Patten
(1992) revealed additional perceptions of in-
competence and unreliability and found that
the dominant impression among New Zea-
landers was that psychiatric disorders lead to
unpredictable behaviour, nonresponsibility
and a loss of control.
Such attitudes are readily expressed in ac-
tual behaviour (Sayce, 2000). Discrimina-
tion in the workplace, when seeking housing,
or when applying for loans or insurance, has
been well documented (Farina & Felner, 1973;
Page & Day, 1990; Rothaus et al., 1963;
Wahl, 1999). Social rejection by acquaint-
ances, friends and families is also well docu-
mented (Read & Baker, 1996; Rogers et al.,
1993; Wahl, 1999).
224 John Read & Niki Harré
Health and mental health professionals are
not exempt (Farina et al., 1976). Physicians
were the least likely of six groups to support
a mental health project in their neighbour-
hood (Wilmouth et al., 1987). Many mental
health professionals (Mirabi et al., 1985) and
GPs (Lawrie et al., 1998) prefer not to work
with the more severely disturbed. Although
there is good reason for mental health profes-
sionals’ blaming the media for the promulga-
tion of the violent ‘madman’ stereotype (Allen
& Nairn, 1997; Wahl, 1992), two studies
found that the attitudes of such professionals
are similar to those of journalists (Day &
Page, 1986; Monahan, 1992).
Destigmatisation campaigns
For decades attempts to rectify this alarm-
ing situation have been almost exclusively
based on the belief that the best approach is to
educate the public to adopt the dominant
biological paradigm. Despite debate about
the actual contributions of psychosocial and
biological factors to, for instance, schizo-
phrenia (Bentall, 1990; Boyle, 1990; Read,
1997; Warner, 1985), destigmatisation pro-
grammes have sought to persuade the public
that people with psychological difficulties
are ‘ill’ in the same sense as people with
medical conditions (Jorm, et al., 1997;
Schwartz & Schwartz, 1977; Wahl, 1987).
By 1961 this approach had been deemed a
failure, by the US Joint Commission on Men-
tal Illness and Health: ‘The principle of
sameness as applied to the mentally sick
versus the physically sick... has become a
cardinal tenet of mental health education....
Psychiatry has tried diligently to make soci-
ety see the mentally ill in its way and has
railed at the public’ s antipathy or indiffer-
ence’ (p. 59). Then, as now, the failure was
located in the ignorance of the public rather
than in the validity of the principle.
The public does tend to reject biological
and genetic causal beliefs. Sarbin & Mancuso
(1970) found that the US public uses the
biological ‘mental illness’ metaphor less read-
ily than mental health professionals, prefer-
ring explanations involving environmental
stressors. Wahl (1987) has replicated this
finding in the US, as have Angermeyer &
Matschinger (1996) in Austria and Germany.
(The latter study found an exception to the
public’s psychosocial perspective, in that the
relatives of schizophrenics held more ‘bio-
logical/constitutional’ beliefs, because of
‘greater exposure to the knowledge of psy-
chiatric experts and their having to deal with
their own feelings of guilt’.) A survey of over
2000 Australians also found, in relation to
schizophrenia, explanations focused on ‘day-
to-day problems and traumatic or childhood
events’ rather than ‘inherited or genetic’ fac-
tors (Jorm et al., 1997). However both Wahl
(1987, 1999) and Jorm et al. (1997) like many
others, conclude that the answer is to redou-
ble efforts to persuade the public they are
wrong. So strong is the faith in this approach
that one study (Rahav, 1987) defined agree-
ment with ‘Mental illness is an illness like
any other’ as an example of a ‘liberal, knowl-
edgeable, benevolent, supportive orientation
toward the mentally ill.’
The relationship of causal beliefs to
attitudes
That such efforts have failed seems evident
from research, spanning four decades, of
consistently negative attitudes, including stud-
ies of specific populations showing no im-
provement in attitudes over time (Green et
al., 1987; Huxley, 1993). Recent reviewers
suggest that attitudes are actually worsening
(Crisp, 1999; Sayce, 2000). One study found
that as ‘knowledge’ based on the traditional
‘mental illness’ perspective increased atti-
tudes became increasingly negative (Chou &
Beliefs in the stigmatisation of ‘mental patients’ 225
Mak, 1998). Therefore, the assumption on
which previous destigmatisation programmes
have been based requires careful examina-
tion. Numerous studies show that rather than
biological and genetic causal beliefs being
related to positive attitudes to ‘mental pa-
tients’, the opposite is the case.
Sarbin & Mancuso (1970) found that on the
rare occasions that the public does employ
the ‘illness’ metaphor they tend to reject the
person concerned. Golding et al. (1975)
confirmed that people espousing medical
model explanations were more reluctant than
others to become friends with ‘mental pa-
tients.’ Schwartz & Schwartz (1997) reported
that such views are related to experiencing
‘mental patients’ as not accountable for their
behaviour, a key component of the unpredict-
able aspect of the stereotype. In 1980 a
National Institute of Mental Health report
confirmed that nonresponsibility, unpredict-
ability and dangerousness form the core of
the stereotype, and found that being treated
by medical professionals or modalities, or in
medical settings, is more stigmatising than
alternative approaches. Mehta & Farina
(1997) reviewed studies demonstrating that
‘the disease view engenders a less favourable
estimation of the mentally disordered than
the psychosocial view.’ Their own study
found that participants in a learning task
increased the intensity and duration of elec-
tric shocks more quickly if they understood
their partner’s mental health problems in
disease terms than if they believed they were
a result of childhood events.
Rothaus et al. (1963) found that ‘patients’
who presented to potential employers ex-
plaining their problems in terms of disease
and nervous breakdown were evaluated less
favourably than ‘patients’ explaining similar
problems in terms of relationship difficulties.
Mental health professionals with a biologi-
cal perspective are less inclined to involve
patients in the provision or management of
mental health services than are professionals
with a psychosocial perspective (Kent & Read,
1998). Medical mental health professionals
assessed videotaped ‘patients’ as more dis-
turbed than did professionals with a social
learning perspective (Langer & Abelson,
1974).
‘Psychiatric patients’ tend to have more
positive attitudes than the general population
(Segal et al., 1991) and to reject medical
model explanations (Pistrang & Barker, 1992;
Ruscher, de Wit, & Mazmanian, 1997).
(When ‘patients’ don’t accept that they have
an illness this is often dismissed as a ‘lack of
insight’ and viewed as evidence that they are
still ‘sick.’ This use of the term ‘insight’ is the
opposite of its original psychodynamic mean-
ing – the ability to relate current difficulties to
past life events.)
Organisations of ‘psychiatric patients’ have
long railed against the effects of a ‘medical
model’ perspective on their self-esteem, ac-
cusing it of increasing stigma while minimis-
ing the complexity of their lives and their
capacity for recovery (Campbell, 1992;
O’Hagan, 1992). Lothian (1998) found that
of 74 members of such organizations in New
Zealand 44% experienced their receiving a
psychiatric diagnosis as leading to lower self
confidence, 53% to social rejection and 62%
to difficulty gaining employment.
Presenting a social learning orientation to
clients leads to more efforts to change than
presenting a disease explanation, with the
latter group more often using alcohol and
drugs to relieve their distress (Fisher & Fa-
rina, 1979). Birchwood et al. (1993, p. 387)
found that ‘patients who accepted their diag-
nosis reported a lower perceived control over
illness,’ and that depression in psychotic pa-
tients is ‘linked to patients’ perception of
controllability of their illness and absorption
of cultural stereotypes of mental illness.’
226 John Read & Niki Harré
Hill & Bale (1981) showed that individuals
with medical causal beliefs expect to take a
passive role with mental health profession-
als. Having reviewed the data on this issue
they concluded:
Not only has the attempt to have the
public view deviant behaviour as symp-
tomatic of illness failed, but the premise
that such a view would increase public
acceptance of persons engaging in such
behaviour seems to have been a dubious
one to begin with. The notion that psy-
chological problems are similar to physi-
cal ailments creates the image of some
phenomenon over which afflicted indi-
viduals have no control and thereby
renders their behaviour apparently un-
predictable. Such a viewpoint makes the
‘mentally ill’ seem just as alien to today’s
‘normal’ populace as the witches seemed
to fifteenth century Europeans. (pp. 289–
290)
The purpose of the current study was to
investigate, with a New Zealand sample, the
relationship, documented above in US stud-
ies, between negative attitudes and biologi-
cal/genetic causal beliefs. The sample was
larger than most previous studies to permit
analysis in terms of demographic variables.
Amount of contact with ‘mental patients’
was included to test the hypothesis that such
contact is related to improved attitudes.
Method
Questionnaire
Section A of the ‘Questionnaire on Atti-
tudes towards Mental Health’ (Read & Law,
1999) consists of 10 six-point Likert scale
items (1=strongly disagree; 6=strongly agree).
Seven of these items (see Table 2) are from
the Mental Health Locus of Origin (MHLO)
Scale (Hill & Bale, 1980, 1981) measuring
causal beliefs on a dimension fro m
‘Interactional’ (psychosocial) to ‘Endog-
enous’ (biological/genetic). An additional
item deals with an issue receiving more atten-
tion (Read, 1997) than in 1980: ‘The mental
illness of some people is caused by abuse or
neglect during childhood.’ MHLO scores are
calculated by totalling the eight items (range
8–48), with all items scored so that high
scores represent the ‘Endogenous’ pole of the
dimension. Embedded in these eight items
are two ‘predicted response’ (PR) items con-
cerning romantic involvement with, and liv-
ing next door to, ‘mental patients’ (see Table
1).
Section B asks participants to ‘form a pic-
ture in your mind of a mental patient’ and
respond to five seven-point semantic differ-
ential (SD) items, including safe-dangerous
and unpredictable-predictable (see Table 1).
Total Attitude Scale (TAS) scores are calcu-
lated by totalling the two PR items (range 2–
12) and the five SD items (range 5–35) with
all items scored so that high scores represent
negative attitudes (TAS range 7–47). To
reduce response set all three sets of items
(MHLO, PR and SD) are mixed so that re-
sponding towards one end of the scale doesn’t
always represent the same belief style.
Section C asks about age, gender, ethnic
group and, as an estimate of socioeconomic
status, level of parents’ education. It also
asks, ‘How many people do you know per-
sonally who have received psychiatric treat-
ment?’
Participants
Undergraduates in a first year Introduction
to Psychology course were invited to partici-
pate, prior to the Clinical component of the
course. Approximately 660 attended on the
day of the study. Of the 496 questionnaires
returned (approximately 75%), 27 were in-
sufficiently complete for inclusion. The 469
Beliefs in the stigmatisation of ‘mental patients’ 227
analysed included 32 where some items were
not completed, allowing for the largest possi-
ble sample for individual items. (The small-
est n for analysis was 436, when correlating
MHLO with age).
The average age was 20.5 years (SD 4.66,
range 17–42.). Seventy-two per cent were
women; 72% were European, 15% Asian,
5% Maori, 5% Pacific Islanders, 1% Indian
and 2% described other ethnic identities.
When asked about parents’ highest educa-
tional level 33% circled ‘secondary’, 15%
‘polytechnic’ , 29% ‘undergraduate’ and 21%
‘postgraduate’.
Results
Attitudes
Table 1 shows that five of the seven attitude
items produced means significantly to the
negative side of the midpoint (chi square;
p<0.001). Three of these were the SD items
(in order of distance from the 4.0 midpoint,
towards the negative extreme): unpredict-
able (-1.23), antisocial (-0.51) and dangerous
(-0.31) with the intelligent-simple item being
close to the midpoint (-0.03; nonsignificant).
The cold-hearted-caring item produced a
mean significantly (p<0.001) on the positive
side of the midpoint (+0.35). Both PR items
were significantly (p<0.001) to the negative
side of the midpoint. The Total Attitude
Scale (TAS) mean of 29.80 was significantly
(p<0.001) on the negative side of the mid-
point of 27.
All item-to-total correlations were signifi-
cant (p<0.001). The safe-dangerous item
was the best predictor of overall TAS score.
Cronbach’s Alpha showed a scale reliability
of 0.55.
Table 1: Mean responses for attitude (Semantic Differential and Predicted Response) items; and
item-to-total score correlations
M (SD) Item-to-total TAS
correlation
Predicted Responses (PR)
(1-strongly disagree; 6- strongly agree)
1. I would be less likely to become 4.25 (1.32) 0.561
romantically involved with someone
if I knew they had spent time in a
psychiatric hospital
2. I would not be frightened at all if a 3.18 (1.42) 0.555
house was opened for the community
care of mental patients next door to
my home
Semantic Differentials (SD) (1–7)
3. Safe–Dangerous 4.31 (1.11) 0.655
4. Unpredictable–Predictable 2.77 (1.22) 0.528
5. Sociable–Antisocial 4.51 (1.20) 0.488
6. Cold-hearted–Caring 4.35 (0.93) 0.439
7. Intelligent–Simple 4.03 (1.18) 0.310
Total Attitude Scale (TAS) (midpoint = 27) 29.80 (4.39)
(calculated by reverse-scoring items 2,4,6)
228 John Read & Niki Harré
Demographics
A four-way ANOVA examined if there was
any relationship between Total Attitude Score
(TAS) and gender, ethnicity (European,
Maori, Pacific Island, Asian), age (17–24,
25–42), or parents’ level of education. The
ANOVA revealed a significant main effect for
ethnicity (F (3, 428) = 2.72, p<0.05) and no
other main effects or two-way interaction
effects. Post-hoc Tukey HSD tests (Table 3)
indicated that both Maori (p<0.05) and Euro-
pean (p<0.001) participants had more posi-
tive attitudes than Asian participants.
Causal beliefs
Table 2 shows that the overall MHLO mean
(24.69) was significantly (p<0.001) towards
the Interactional end of the scale (midpoint
28), indicating that the sample favoured ex-
planations involving the psychosocial envi-
ronment over biological or genetic causal
beliefs. The largest differences from the
midpoint (3.5) were: agreement with the items
about abuse or neglect (+1.33) and stressful
situations (+0.91) and disagreement with the
bad nerves (-0.84) and inherited psychologi-
cal defects (-0.60) items.
All item-to-total correlations were statisti-
cally significant (p<0.001), with the disease
of the nervous system (r=0.65) and inherited
psychological defects (r=0.63) items the
strongest predictors of overall MHLO score.
Cronbach’s Alpha was 0.45. The two weak-
est item-to-total-score correlations were for
the items involving interaction with psycho-
social events: stressful situations (r=0.19)
and abuse or neglect (r=0.34). When recal-
culated without these two items Alpha in-
creased to 0.58.
Table 2: Mean responses for MHLO items and item-to-total-score correlations
Item Item-to-total Item-to-total
(1- strongly disagree; 6- strongly agree) M (SD) MHLO END
correlation correlation
Mental illness is usually caused by some disease 3.05 (1.14) 0.651 0.675
of the nervous system
Most people suffering from mental illness were 2.90 (1.25) 0.635 0.657
born with some kind of psychological defect
The cause of many psychological problems is 2.66 (1.08) 0.461 0.478
bad nerves
The cause of most psychological problems is to 3.92 (1.16) 0.449 0.524
be found in the brain
Some people are born with the kind of nervous 3.88 (1.13) 0.412 0.582
system that makes it easy for them to become
emotionally disturbed
The kind of nervous system you are born with has 3.47 (1.08) - 0.389 - 0.477
little to do with whether you become psychotic
The mental illness of some people is caused by 4.83 (1.10) -0.338
abuse or neglect during childhood
Many normal people would become mentally 4.41 (1.12) -0.192
ill if they had to live in a very stressful situation
Total MHLO Score (midpoint 28) 24.69 (4.19)
(Calculated by reverse-scoring the last three items)
Beliefs in the stigmatisation of ‘mental patients’ 229
To further assess whether the Interactional
and Endogenous items represent two related
(i.e. opposite) sets of beliefs or two independ-
ent sets of beliefs, a factor analysis was
conducted. The first factor produced positive
loadings of .43 or greater on all but the two
Interactional items. The second produced
positive loadings of .60 or greater only on the
two Interactional items. Thus subjects were
reasonably consistent in the extent to which
they accepted or rejected the biogenetic model
(measured by the six Endogenous items) but
disagreement with the Interactional items
was not strongly related to agreement with
the Endogenous items. Thus the supposed
relationship between Endogenous and
Interactional beliefs was not supported. Re-
jection of one model did not appear to di-
rectly lead to acceptance of the other.
Demographics
Analysis by demographics, therefore, fo-
cused on total scores for the six Endogenous
items (END) and total scores for the two
Interactional items (INT), rather than on the
eight MHLO items combined. The four way
ANOVA for END revealed an identical pattern
of results to that conducted for TAS. The
only significant main effect was for ethnicity
(F (3, 428) = 4.89, p<0.005), with no two-
way interaction effects. Post-hoc Tukey HSD
tests (Table 3) indicated that Asians had
stronger bio-genetic beliefs (END) than Eu-
ropeans (p<0.005) and Maori (p<0.05). The
corresponding ANOVA f or INT (the two
Table 3: Total attitude (TAS) and total Endogenous Mental Health Locus of Origin Items (END)
analysed by demographics and number of psychiatric patients known.
Mean number of
psychiatric patients
nTAS END known
All 469129.80 19.93 1.62
Gender
male 132 29.97 20.26 1.68
female 320 29.73 19.69 1.60
Age *
25–42 years 47 27.98 19.26 1.98
17–24 years 400 29.99 19.91 1.44
Ethnicity * ** **
Maori 22 28.95218.5032.954
European 324 29.40219.5831.734
Pacific Islander 21 29.95 20.57 1.434
Asian 66 31.80221.3930.714
Psychiatric patients known
none 140 31.11520.23
one or more 310 29.25519.66
1. Subgroups do not total 469 because information is missing for some participants on some
variables.
*ANOVA main effect p<0.05; **ANOVA main effect p<0.005.
2. Tukey HSD: Asian higher TAS than European (p<0.001) and Maori (p<0.05).
3. Tukey HSD: Asian higher END than European (p<0.005) and Maori (p<0.05).
4. Tukey HSD: Maori higher number known than European (p<0.005), Pacific Islander (p<0.005)
and Asian (p<0.001). European higher than Asian (p<0.001).
5. T-test (two-tailed) p<0.001.
230 John Read & Niki Harré
Interactional items combined) revealed no
main or interaction effects.
Relationship between causal beliefs and
attitudes
With MHLO scored in the Endogenous
direction and TAS scored in the direction of
negative attitudes, the MHLO-TAS correla-
tion (two-tailed Spearman) of 0.14 was sig-
nificant (p<0.005). As might be expected
from the finding that the two Interactional
items were not related to the Endogenous
items, the total score for the six Endogenous
items (END) produced a higher correlation
(END-TAS) of 0.19 (p<0.001). Thus the
greater the belief in biogenetic causes the
more negative the attitude towards ‘mental
patients.’ INT was not significantly corre-
lated with TAS, indicating that psychosocial
causal beliefs were not related to attitudes.
Contact with psychiatric patients
Of the 450 participants responding to the
question ‘How many people do you know
personally who have received psychiatric
treatment?’ 140 (31.1%) knew none, 105
(23.3%) knew only one and only 43 (9.6%)
knew five or more. The number of people
known was negatively correlated with TAS
(Spearman r=-0.22, p<0.001), indicating that
the more people known the less negative the
attitudes. The mean TAS of the 140 partici-
pants who knew one or more (29.25) was
significantly lower (p<0.001) than that of the
310 who knew none (31.11). A negative
correlation between number of people known
and biogenetic beliefs (END) did not attain
statistical significance (r=-0.09, p=0.06).
Demographics
When the four way ANOVA for demographics
was conducted on number of psychiatric pa-
tients known main effects were found for
both ethnicity (F (3, 422)=4.65, p<0.005),
and age (F (1, 422)=5.28, p<0.05). There
were no significant two-way interaction ef-
fects. Tukey HSD tests (Table 3) found that
the mean number of people known by Maori
participants (2.95) was significantly greater
than the mean for Pacific Island (1.43;
p<0.005), European (1.73; p<0.005) and
Asian (0.71; p<0.001) participants, and that
the mean for European was significantly
greater than that for Asians (p<0.001). All
Maori participants knew at least one person,
compared to 73% of the European, 57% of
the Pacific Island and 40% of the Asian
participants.
Discussion
This study provides further evidence of
negative attitudes. Sixty-two per cent of this
large sample expressed reservations about
living next door to, and 72% about becoming
romantically involved with, ‘mental patients.’
Even with the opportunity to adopt a neutral
(mid-point) stance 41% deemed ‘mental pa-
tients’ to be dangerous and 75% to be unpre-
dictable. This closely replicates a smaller
sample of New Zealand undergraduates
(measured with identical methodology), in
which 67% had concerns about being neigh-
bours, 70% would be less likely to become
romantically involved, and 47% and 77%
respectively experienced ‘mental patients’ as
dangerous and unpredictable (Read & Law,
1999).
The assumption behind efforts to alter these
attitudes, for the last 50 years, has again been
shown to be more myth than fact. Far from
biological and genetic causal beliefs being
related to more positive attitudes, the central
hypothesis, that such belief s (END) would be
co rrelated with TAS, was conf irmed
(p<0.001). In combination with previous
studies there is now sufficient evidence to
abandon the ‘mental illness is an illness like
any other’ approach to improving attitudes.
Beliefs in the stigmatisation of ‘mental patients’ 231
The biological model replaced the moral
depravity model of medieval origin. It was
hoped that the ‘bad to mad’ transition would
produce less punitive attitudes by bestowing
the dignity of the sickness role and its attend-
ant non-responsibility component. It seems,
however, that ‘illness has lost much of its
power to mitigate and excuse, so that ‘sickos’
are treated as if they were some strange
minority or political sect’ (Feinberg, 1998, p.
475).
The study raises, but leaves unanswered,
the question of whether destigmatisation pro-
grammes should merely avoid medical model
explanations or should also actively promul-
gate a psychosocial perspective. The fact that
neither of the two Interactional items (about
stress in general and child abuse in particular)
were significantly correlated with attitudes,
supports the possibility, suggested by the
factor analysis reported above, that we are
dealing with two independent factors rather
than the bipolar dimension assumed by the
developers of the MHLO Scale (Hill & Bale,
1980,1981). Thus it is conceivable that dif-
ferences in attitudes previously ascribed, by
the studies described earlier, to differential
effects of psychosocial and medical perspec-
tives may have more to do with the rejection
of biological and genetic explanations and
less to do with the adoption of a psychosocial
orientation. A recent study demonstrating
significant improvements in attitudes fol-
lowing a series of undergraduate psychology
lectures (Read & Law, 1999), may have been
successful more (or entirely) because of the
lectures’ critique of the medical model than
because of it’s emphasis on psychosocial
causes. However, recent studies found that
identifying stressors preceding violent be-
haviour reduced the extent to which a ‘schizo-
phrenic’ was believed to have a history of
acting violently (Boisvert & Faust, 1999).
Further research on presenting psychosocial
causal beliefs and destigmatisation would be
valuable. In the meantime if destigmatisation
programmes include exposure to people with
mental health problems, as research findings
recommend, then presenting them in the con-
text of their life events clearly seems prefer-
able to portraying their difficulties as merely
symptoms of biologically based illnesses.
Few studies have investigated differences
in attitudes among demographic groups,
which might be helpful when targeting
destigmatisation efforts. Some studies have
found women to be less prejudiced than men
(Farina, 1981; Morrison et al., 1993), with
one study finding that women show higher
an xiety but more prosocial reactions
(Angermeyer et al., 1998). Other studies
(Chou & Mak, 1998; Vuksic-Mihaljevic et
al., 1998), including the current study, have
found no gender differences. Neither Hill &
Bale (1981) nor the current study found gen-
der differences in causal beliefs.
While a US study found a significant corre-
lation between age and positive attitudes
(Wilmouth et al., 1987), the reverse has been
found in Finland (Ojanen, 1992) and Hong
Kong (Chou & Mak, 1998). In both the
previous New Zealand study (Read & Law,
1999) and the current study those aged 25 or
over were less prejudiced than the younger
participants. There were no significant rela-
tionship between age and causal beliefs in
either of these two New Zealand studies.
Early studies found low socioeconomic
and educational levels to be correlated with
biological causal beliefs (Cohen & Struening,
1962; Nunnally, 1960). Hill & Bale (1981)
found no relationship. Neither the current
nor the previous New Zealand study found
any relationship between parental level of
education and either causal belief s or atti-
tudes.
Differences in attitudes between different
ethnic groups have been found before
232 John Read & Niki Harré
(Whaley, 1997) and may assist in targeting
destigmatisation programmes. In the current
study Maori and European participants were
less prejudiced than Asian participants. This
might be explained by the fact that these two
groups were also less biogenetic in their
causal beliefs than Asians. Alternatively, or
additionally, the attitudinal differences might
be understood in terms of the number of
people who had received psychiatric treat-
ment known by these groups, and the positive
relationship between number known and posi-
tive attitudes. It is impossible to say, how-
ever, whether the relatively greater contact of
Maori and of Europeans with patients caused
their relatively positive attitudes or was caused
by them. Both may be true and operating
reciprocally. Prejudice and stereotyping tends
to result in distancing, which in turn exagger-
ates perceived differences, which in turn re-
inforces distance, and so on.
Targeting destigmatisation efforts on the
basis of ethnic attitudinal differences should
be planned by members of the group in ques-
tion so that the cultural origins of differences
in attitudes and causal beliefs can be incorpo-
rated. For instance, both Maori in New
Zealand (Johnstone & Read, 2000) and Afro-
Americans in the US (Millet et al., 1996)
place more emphasis on spirituality than the
Caucasian-driven medical model permits.
The finding that contact with ‘psychiatric
patients’ is correlated with positive attitudes
confirms previous studies (Chou & Mak,
1998; Penn & James, 1998; Shera & Delva-
Tauiili, 19 96; Whaley, 1997). Any
destigmatisation programme that does not
involve exposure to or interaction with ‘psy-
chiatric patients’ will be significantly reduc-
ing its chances of success.
How does the medical model produce such
negative attitudes? Mehta & Farina (1997)
suggest three reasons. The first is that view-
ing distressed people as sick, while discour-
aging blame, produces a patronizing attitude
in which they ‘... like children, must be treated
firmly. They must be shown how to do things
and where they have erred. Hence the harsher
treatment.’ The second is that believing in
‘biochemical aberrations’ renders them ‘al-
most another species,’ an explanation remi-
niscent of Hill & Bale’s (1981) previously
cited conclusion. The third is that an illness
framework makes us feel vulnerable because
the disease might strike us too, whereas psy-
chosocial explanations suggest that their ‘ex-
ceptional circumstances’ won’t happen to us.
‘And these feelings of vulnerability may give
way to harsher treatment.’
Another factor may be the need to deny our
own fears of ‘going crazy’ and to project
those fears onto others. It does seem that
attitudes are more negative in the more au-
thoritarian (Morrison et al., 1993) and when
we are experiencing high levels of distress
(Segal et al., 1991). A set of causal beliefs
that not only creates the illusion of a categori-
cally separate group (rather than acknowl-
edging the dimensionality of emotional dis-
tress), but also creates or exaggerates the
difference between the two categories by
supposing biochemical or genetic aberrations,
seems likely to fuel the reciprocal processes
of distancing, fear, project ion and
scapegoating. When the type of differences
promulgated imply faulty brain functioning
so severe that a person is denied responsibil-
ity for their actions, then our fear may be
compounded by the notion that this person
could lose control at any moment and by the
belief that this unpredictability, which may
express itself in a violent manner, needs to be
severely, even harshly, controlled. This hy-
pothesis draws support from the finding that
the less we hold ‘mental patients’ responsible
for their failings the more harshly we treat
them, and the less aware we are of the harsh-
ness of that treatment (Mehta & Farina, 1997).
Beliefs in the stigmatisation of ‘mental patients’ 233
Factors that reduce perceived differences,
however, seem likely to break this circle of
fear, distancing and distortion. Two such
factors are establishing contact with mem-
bers of the stigmatised group and ignoring or
challenging, rather than continuing to prom-
ulgate, the sorts of beliefs which not only
exaggerate perceived difference but which
have been repeatedly demonstrated to be
correlated with negative attitudes.
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