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The effects of pity on self- and other-perceptions of mental illness

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Abstract

Previous research has demonstrated that pity may have a positive influence on public perceptions of individuals with a mental illness but has not adequately addressed the potential negative impacts of pity perceptions. Seventy-five research participants with serious mental illness completed measures of pity, public stigma, shame, hopelessness, personal empowerment, self-esteem, depression, and quality of life at baseline. Measures of hopelessness, personal empowerment, self-esteem, and depression were repeated six months later. Bivariate correlations found significant associations between pity and “other” effects of stigma including dangerousness, fear, segregation, avoidance and perceived stigma. Baseline pity was significantly correlated with self-effects of stigma such as shame, hopelessness, lower empowerment, lower self-esteem, depression, and decreased quality of life. At six-month follow-up, baseline pity was still associated with increased hopelessness and depression along with decreased empowerment and self-esteem. Anger, avoidance, perceived stigma, shame, and self-esteem were significantly related to pity in multiple linear regressions. Outcomes of path analyses suggest that the significant positive relationship between pity at baseline and depression at six-month follow-up was mediated by self-esteem and hopelessness. Individuals who view mental illness with pity experience negative self- and other-effects of stigma. These effects persist 6-months later. These findings have important implications for stigma-reducing advertising programs.

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... Pity-based responses are affect patients and their families because they overload cognition and emotions and may eventually compromise the health and well-being of the patients (Sinclair et al., 2016). It is also important to point out that pity-based responses not only reflect how "healthy others" pity "sick others," but that such responses can also come to be internalized by the patient, thereby creating self-pity and self-stigma (Fominaya, Corrigan, & Ru¨sch, 2016). Consequently, prevalent pity-based responses can explain the avoidant behavior of patients and families when communicating with people in the society about their sickness and vulnerability. ...
... Due to the "social contagion" of the illness, the patient can be burdened by feeling responsible towards other females in the family. Such attitudes may contribute and reinforce self-pity, self-stigma (Fominaya et al., 2016), and generate negative emotions like shame and guilt. In the same line, Deridi, Asmar, and Al-Rjou (2016) found that a significant proportion of Palestinian cancer patients from the West Bank suffered from moderate to severe depression. ...
... This may potentially encourage cancer patients and their companions to internalize societal responses (e.g. self-pity and self-stigma) (Fominaya et al., 2016). It may also lead to more depressive symptoms, lower social functioning, and a reduction in their overall quality of life. ...
Article
This qualitative research aims to understand the sociocultural complexity and social representations of cancer in the occupied Palestinian territory. The researcher conducted 16 in-depth semi-structured individual interviews with Palestinians from the occupied Palestinian territory, using thematic analysis as a methodology and social representation theory as the theatrical framework. The findings revealed three main themes. The first theme is social representations of cancer and cancer treatments divided into four subthemes: (1.1) manifestations of dilemmatic indeterminacy and vagueness. The second subtheme (1.2) refers to social representations of cancer in close proximity with death. The third subtheme (1.3) is constituted by metaphorical social representations of cancer, and the fourth (1.4) refers to social re-presentations of cancer. The second theme is the paradoxical social representations of cancer patients as divided into three subthemes: (2.1) pity-based societal responses, (2.2) manifestations of stigma, and (2.3) cancer rumors, a form of collective sense-making. The third theme, religious discourses and social representations of cancer, is divided into three subthemes: (3.1) cancer as predestined by the will of God, (3.2) cancer as a punishment or a trial, and (3.3) a spiritual journey of healing. The implications of this research suggest that social representations research can take a lead in promoting social and health change. The biomedical paradigm alone is failing in Palestine to encounter the sociocultural complexity connected to representations of cancer and its impact on future-health behaviors. Thus, stakeholders and policy-makers in Palestine need to build a mutual interaction between scientific encounters and lay thinking encounters. This requires building community-based health interventions and a sustainable health promotion programs to ensure higher penetration to the social outreach (families, hospital setting, clinics, and schools). To combat ill-health beliefs, stakeholders can benefit from utilization of community participation through creating space for dialogue and debate about cancer and its representations, which accordingly moving towards social and health change.
... Therefore, in keeping with previous research the findings of this study suggest that people try to behave in a manner that appears to be moral and maintain a positive social identity through exhibiting what is believed to be positive behaviour towards out-groups (Ellemers et al. 2013). Nevertheless, Fominaya et al. (2016) suggest that being viewed as an object of pity can have detrimental impacts on a person's sense of worth, self-esteem and sense of empowerment. ...
... Pity and benevolent attitudes also aroused a strong desire for social distance among adolescents and in this sense, our findings are consistent with those of Fominaya et al. (2016) who demonstrate that pity regarding mental illness is correlated to decreased anger but also increased social avoidance. It appears therefore that one's desire to provide help may be impended by the desire to maintain a social distance. ...
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... However, the intervention also increased pity, which in this study was conceptualized as a stigmatizing response. The role of pity in stigma is complex-there is some evidence that pity can lead to helping behaviours, while there is other evidence that it can lead to negative outcomes such as paternalism and authoritarian responses (Fominaya et al., 2016). This study's mixed results indicate the need to further clarify outcomes for this particular intervention and highlight the importance of evaluating outcomes for the purposes of health promotion practice to be assured that the intervention is having the desired effect. ...
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Photovoice is theorized to influence those who interact with the photos and captions, and so it is important to examine and further understand this mechanism. This article seeks to further our understanding of this critical process—that is, what is the impact of the Photovoice Artist’s stories on the viewing audience? Herein we demonstrate how an incarnation of photovoice, digital storytelling, and photo elicitation impacted mental illness stigma among health sciences students. By focusing on application beyond the original exhibition, this article highlights how photovoice methods and aims overlap with best practices in stigma reduction, and its fit with multimodal anti-stigma interventions. Overall, this study contributes to addressing the question of how photovoice can be applied to achieve action for social change.
... Stigma-based discrimination is about social relationships, but those where there is a power differential (between stigmatiser and stigmatised): pity from powerful others is internalised and makes people more hopeless over time, just as it lowers self-esteem and has the potential to provoke depression. 33 The employment example makes a wider point. Less than 15 per cent of people with SMI are in paid employment, lower even than low European comparisons. ...
... The nine-point response scale ranged from "not at all" [0] to "very much" (8). Due to the controversy around feeling "pity" toward a person with drug addiction, this item was not assessed (72). ...
Article
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Drug abuse and addiction exist around the world. People addicted to drugs such as opium or heroin often encounter dehumanizing discriminatory behaviors and health-care systems that are reluctant to provide services. Experiencing discrimination often serves as a barrier to receiving help or finding a home or work. Therefore, it is important to better understand the mechanisms that lead to the stigmatization of drug addiction and who is more prone to stigmatizing behaviors. There is also a dearth of research on whether different patterns of stigma exist in men and women. Therefore, this study investigated factors affecting gender-specific stigmatization in the context of drug addiction. In our vignette study (N Mensample = 320 and N Womensample = 320) in Iran, we experimentally varied signals and signaling events regarding a person with drug addiction (i.e., N Vignettes = 32 per sample), based on Attribution Theory, before assessing stigmatizing cognitions (e.g., blameworthiness), affective responses (e.g., anger), and discriminatory inclinations (e.g., segregation) with the Attribution Questionnaire. We also tested assumptions from the Familiarity Hypothesis by assessing indicators of respondents' familiarity with drug addiction (e.g., knowledge about addiction). Results, for example, show higher stigma if the person used "harder" drugs, displayed aggressive behavior, or had a less controllable drug urge. Self-attributed knowledge about addiction or prior drug use increased some forms of stigma, but diminished others. These findings only partially converged between men and women. We suggest that anti-stigma initiatives should consider information about the stigmatized person, conditions of the addiction, and characteristics of stigmatizers.
... Furthermore, the unintended effects of these programs have been of particular concern, especially those which exclusively focused on educating the public in biomedical models of mental illness (3,4). Such models have been found to promote categorical beliefs of difference amongst the public (16)(17)(18)(19), and distance-promoting emotions of fear and pity (20)(21)(22). ...
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Using a knowledge-attitudes-behavior practice (KABP) paradigm, professionals have focused on educating the public in biomedical explanations of mental illness. Especially in high-income countries, it is now common for education-based campaigns to also include some form of social contact and to be tailored to key groups. However, and despite over 20 years of high-profile national campaigns (e.g., Time to Change in England; Beyond Blue in Australia), examinations suggest that the public continue to Other those with experiences of mental ill-health. Furthermore, evaluations of anti-stigma programs are found to have weak- to no significant long-term effects, and serious concerns have been raised over their possible unintended consequences. Accordingly, this article critically re-engages with the literature. We evidence that there have been systematic issues in problem conceptualization. Namely, the KABP paradigm does not respond to the multiple forms of knowledge embodied in every life, often outside conscious awareness. Furthermore, we highlight how a singular focus on addressing the public's perceived deficits in professionalized forms of knowledge has sustained public practices which divide between “us” and “them.” In addition, we show that practitioners have not fully appreciated the social processes which Other individuals with experiences of mental illness, nor how these processes motivate the public to maintain distance from those perceived to embody this devalued form of social identity. Lastly, we suggest methodological tools which would allow public health professionals to fully explore these identity-related social processes. Whilst some readers may be frustrated by the lack of clear solutions provided in this paper, given the serious unintended consequences of anti-stigma campaigns, we caution against making simplified statements on how to correct public health campaigns. Instead, this review should be seen as a call to action. We hope that by fully exploring these processes, we can develop new interventions rooted in the ways the public make sense of mental health and illness.
... One study showed possible ill effects of pity, namely that those with mental illnesses who were pitied by peers reported having less personal empowerment and more hopelessness. 6 The faith helper role may intensify a one-down position between a congregation member and the individual with mental illness. In addition, education generally is not seen as an effective method of challenging stigma. ...
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Faith communities are important to the psychiatric care of people with mental illness. I distinguish the effects of two principles of becoming welcoming communities: compassion, in which the community accommodates members with mental illnesses so they are fully included, and dignity, which rests on the essential worth of everyone.
... They may also experience moral distress based on their personal disapproval of behaviors associated with diseases, which may lead to stigmatizing reactions that impair their abilities to be effective providers, undermining quality of care [3,20]. Healthcare workers may be unaware of how stigma manifests and affects people, and may therefore not be cognizant of the stigmatizing effects of their actions, or of how the health facilities' policies or structures affect clients [3,44,45]. Lack of knowledge regarding the condition may also drive stigma [3,38,46]. For example, transmission misconceptions may drive stigmatizing, unnecessary precautions (e.g., double gloving, unnecessary quarantine), while disbelief in the curability of some stigmatized conditions may bias the provision of care [32,35,39]. ...
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Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge—both approaches and methods—regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development’s Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years. Forty-two studies met inclusion criteria and provided insight on interventions to reduce HIV, mental illness, or substance abuse stigma. Multiple common approaches to address stigma in health facilities emerged, which were implemented in a variety of ways. The literature search identified key gaps including a dearth of stigma reduction interventions in health facilities that focus on tuberculosis, diabetes, leprosy, or cancer; target multiple cadres of staff or multiple ecological levels; leverage interactive technology; or address stigma experienced by health workers. Preliminary results from ongoing innovative responses to these gaps are also described. The current evidence base of stigma reduction in health facilities provides a solid foundation to develop and implement interventions. However, gaps exist and merit further work. Future investment in health facility stigma reduction should prioritize the involvement of clients living with the stigmatized condition or behavior and health workers living with stigmatized conditions and should address both individual and structural level stigma.
... Pity was an additional emotion expressed by the participants in most stages of stigma formation and was associated with both the disability itself and the use of hearing devices. Although, to the best of our knowledge, no previous studies have reported this type of emotion among persons with ARHL, pity was found to be an important emotion in studies assessing stigma in mental illnesses (Corrigan, Edwards, Green, Diwan, & Penn, 2001), although the meaning of its influence on self-stigma is still debatable (Fominaya, Corrigan, & Rüsch, 2016). Although the use of qualitative methodology prevents us from assuming causal relationships (Ritchie & Lewis, 2003), our data seem to hint that this feeling has a negative impact on self-stigma as it was associated with feelings of pity for being not only old but also hearing impaired. ...
Article
Purpose: This study explored experiences of self-stigma among older persons with age-related hearing loss (ARHL) using Corrigan's conceptualization of self-stigma process formation and the attribution model as its theoretical framework. Method: In-depth semistructured interviews were conducted with 11 older persons (mean age = 81 years) with ARHL. Results: Self-stigma was present in the lives of the participants. Analysis revealed the existence of 3 stages of self-stigma in which the 3 core dimensions of stigma (cognitive attributions: being old, stupid, and crippled; emotional reactions: shame, pity, and feeling ridiculed; and behavioral reactions: concealment, distancing, and adapting to hearing aids) were observed. Hearing devices emerged as having a significant influence on stigmatic experiences in all stages and dimensions of self-stigma. Conclusion: The study contributes to the theoretical and practical understanding of self-stigma regarding ARHL as well as to the understanding of the role of hearing devices in the development of this stigma.
... and segregation (p < .001). This is consistent with attribution theory because people misusing drugs per-5 As in several previous studies, we interpret higher pity as beneficial for PWDAs (i.e., because pity can generate more help and acceptance); however, it has also been discussed and found to have negative effects (e.g., being degrading or causing benevolence stigma) (Corrigan, 2000;Corrigan et al., 2015;Fominaya et al., 2016). • No made such a gene-test and the report said that he has a genetic predisposition for • Four times addiction. ...
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Mental illness stigma is common, but it is unclear why it affects some individuals more than others. We tested the hypothesis that the way persons with mental illness perceive their ingroup (people with mental illness) in terms of group value, group identification and entitativity (perception of the ingroup as a coherent unit) shapes their reaction to stigma. Ingroup perceptions, perceived legitimacy of discrimination and reactions to stigma (educating or helping others, social performance, secrecy, social distance, hopelessness) were assessed among 85 people with mental illness using questionnaires and a standardized role-play test. Controlling for depression and perceived discrimination, high group value and low perceived legitimacy of discrimination predicted positive reactions to stigma. High group identification and entitativity predicted positive reactions only in the context of high group value or low perceived legitimacy of discrimination. Group value and perceived legitimacy of discrimination may be useful targets to help people with mental illness to better cope with stigma.
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The study used the Cohen and Struening OMI questionnaire to survey the opinions on mental illness and the mentally ill in Israel's population, and identify underlying domains behind these opinions. Factor analyzing the Israeli respondents' scores on the OMI questionnaire, there was found to be marked similarity in the gestalts underlying the opinions on mental illness in Israel and those found in numerous studies in the U.S.A. The study identified four distinct domains behind people's opinions on mental illness in Israel: social restrictiveness, mental health ideology, authoritarianism and interpersonal etiology. The paper reports the mean score on each of the OMI questionnaire items. These data suggest that people in Israel hold dual, inconsistent opinions on the mentally ill. On the one hand they showed a great deal of liberalism, tolerance and human orientation on issues concerning the treatment of mental illness, their civil rights and their acceptance into the main stream of society. On the other hand, the respondents demonstrated fear, mistrust and rejection of the mentally ill on issues concerning close, more intimate involvement with them. The study found opinions on the mentally ill to be affected by people's education, age and religiosity.
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A survey of attitudes to mental illness was conducted in a quota sample of about 2000 subjects in Malvern and Bromsgrove. Factor analysis showed three main components - benevolence, authoritarianism, and fear of the mentally ill. Residents of Bromsgrove, which is served by a traditional mental hospital, were slightly more tolerant than those living in Malvern, which has a community-based service, and has seen the closure of two mental hospitals in its vicinity during the last 10 years. The main demographic determinants of tolerance are age, education, occupation, and acquaintance with the mentally ill.
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The Mini-International Neuropsychiatric Interview (M.I.N.I.) is a short structured diagnostic interview, developed jointly by psychiatrists and clinicians in the United States and Europe, for DSM-IV and ICD-10 psychiatric disorders. With an administration time of approximately 15 minutes, it was designed to meet the need for a short but accurate structured psychiatric interview for multicenter clinical trials and epidemiology studies and to be used as a first step in outcome tracking in nonresearch clinical settings. The authors describe the development of the M.I.N.I. and its family of interviews: the M.I.N.I.-Screen, the M.I.N.I.-Plus, and the M.I.N.I.-Kid. They report on validation of the M.I.N.I. in relation to the Structured Clinical Interview for DSM-III-R, Patient Version, the Composite International Diagnostic Interview, and expert professional opinion, and they comment on potential applications for this interview.
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Aim of the study is to examine the impact of labelling on public attitudes towards people with schizophrenia and major depression. In Spring 2001, a representative survey was carried out in Germany involving adults of German nationality (n = 5025). Labelling as mental illness has an impact on public attitudes towards people with schizophrenia, with negative effects clearly outweighing positive effects. Endorsing the stereotype of dangerousness has a strong negative effect on the way people react emotionally to someone with schizophrenia and increases the preference for social distance. By contrast, perceiving someone with schizophrenia as being in need for help evokes mixed feelings and affects people's desire for social distance both positively and negatively. Labelling has practically no effect on public attitudes towards people with major depression. Our findings illustrate the need for differentiation, differentiation between the different components of stigma as well as differentiation between the various mental disorders.
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Traditionally, prejudice has been conceptualized as simple animosity. The stereotype content model (SCM) shows that some prejudice is worse. The SCM previously demonstrated separate stereotype dimensions of warmth (low-high) and competence (low-high), identifying four distinct out-group clusters. The SCM predicts that only extreme out-groups, groups that are both stereotypically hostile and stereotypically incompetent (low warmth, low competence), such as addicts and the homeless, will be dehumanized. Prior studies show that the medial prefrontal cortex (mPFC) is necessary for social cognition. Functional magnetic resonance imaging provided data for examining brain activations in 10 participants viewing 48 photographs of social groups and 12 participants viewing objects; each picture dependably represented one SCM quadrant. Analyses revealed mPFC activation to all social groups except extreme (low-low) out-groups, who especially activated insula and amygdala, a pattern consistent with disgust, the emotion predicted by the SCM. No objects, though rated with the same emotions, activated the mPFC. This neural evidence supports the prediction that extreme out-groups may be perceived as less than human, or dehumanized.
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We examined variations in maternal sensitivity at 6 months of child age as a function of child negativity and maternal physiology. We expected maternal vagal withdrawal in response to infant negative affect to facilitate the maintenance of sensitivity, but only for mothers of securely attached children. One hundred and forty-eight infant-mother dyads were observed in multiple contexts at 6 months of child age, and associations among maternal and child variables were examined with respect to 12-month attachment quality. Mothers of later securely attached children were more sensitive than mothers of avoidant children. However, sensitivity decreased for all mothers at high levels of infant negative affect. Furthermore, for mothers of avoidant children, vagal withdrawal was associated with sensitivity to child distress. No association was found between vagal withdrawal and sensitivity for mothers of securely attached children. This suggests that mothers of avoidant children may be uniquely challenged by the affective demands of their infants.