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Educating the public that mental illness is a brain disease is a popular strategy for combating mental illness stigma. Evidence suggests that while such an approach reduces blame for mental illness, it may unintentionally exacerbate other components of stigma, particularly the benevolence and dangerousness stigmas. Conversely, psychosocial explanations have proven promising, yet they ignore the growing evidence regarding genetic and biological factors. We propose a balanced approach that combats the various myths about mental illness with factual information.
At Issue:
Stop the Stigma: Call Mental Illness
a Brain Disease
by Patrick W.
and Amy C. Watson
The At Issue section of the Schizophrenia Bulletin con-
tains viewpoints and arguments on controversial issues.
Articles published in this section may not meet the strict
editorial and scientific standards that are applied to
major articles in the Bulletin. In addition, the viewpoints
expressed in
following article do not necessarily rep-
resent those of
staff or the Editorial Advisory Board of
the BuUetin.—The Editors.
Educating the public that mental illness is a brain dis-
ease is a popular strategy for combating mental illness
stigma. Evidence suggests that while such an approach
reduces blame for mental illness, it may unintention-
ally exacerbate other components of stigma, particu-
larly the benevolence and dangerousness stigmas.
Conversely, psychosocial explanations have proven
promising, yet they ignore the growing evidence
regarding genetic and biological factors. We propose a
balanced approach that combats the various myths
about mental illness with factual information.
Keywords: Stigma, brain disease, mental illness.
Schizophrenia Bulletin, 30(3):477-479, 2004.
During the past decade, several groups have become con-
cerned about the harmful effects of stigma on people with
mental illness. In an effort to change public attitudes,
some advocates have called for equating mental illness
with other medical disorders. Perhaps most prominent of
the many public service campaigns and educational cur-
ricula that promote this view is NAMI's slogan that men-
tal illness is a brain disease. Although this equation seems
to have face validity, a review of the evidence that might
support the slogan for education efforts that seek to
diminish stigma is mixed.
Many studies have found that the public views people
with mental illness as responsible for their disorders:
because of poor character or lack of moral backbone, peo-
ple with disorders like schizophrenia and major depres-
sion choose to have their mental illness and are to blame
for the symptoms and the disabilities that result (Weiner et
1988; Corrigan et al. 1999,
Watson et al., sub-
mitted). In his theory of human attribution, Weiner (1995)
argued that blaming someone for a negative life condition
such as mental illness leads to anger and social avoidance
("I don't want that weak-willed person around me!").
Hence, educating the public about the biological roots of
mental illness—for example, comparing people with men-
tal illness to those with other chronic disorders such as
diabetes—should decrease blame for psychiatric illness.
There is some limited research that supports this hypothe-
namely, people are less likely to endorse blame, anger,
and social avoidance toward people with mental illness
after they have been educated about how mental illness is
a biological disorder that people do not choose (Corrigan
et al. 2002).
There is, however, another facet to Weiner's attribu-
tion model that suggests that framing mental illness as a
brain disorder may have its limitations. People make attri-
butions about not only the onset of a disorder (Is schizo-
phrenia caused by weak character or biology?) but also its
offset (Will the person get better so he or she can live a
normal life?). Framing mental illness as a brain disorder
may resolve onset questions but exacerbate offset issues.
There is some evidence that suggests that the public views
mental illness as a disorder from which people do not
recover—that diey do not regain productive lives (Weiner
et al. 1988; Corrigan et al. 1999). This kind of attitude
may support what is called the benevolence stigma;
namely, that people with mental illness are innocent chil-
dren whose lives need to be controlled by a parental figure
(Brockington et al. 1993). While well intentioned, this
type of stigma can be disempowering, leading persons
with mental illness (and others) to view themselves as dif-
Send reprint requests to Dr. P.W. Corrigan, Center for Psychiatric
Rehabilitation at Evanston Northwestern Healthcare, 1033 University
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ferent from other people, less competent, and less accept-
able as friends. This suggests that the public also needs to
be educated that people with mental illness recover.
Whether recovery from mental illness is viewed as a natu-
rally occurring phenomenon (Harding and Zahniser
the result of competent treatment (Liberman and
Kopelowicz, in press), or a psychological process (Ralph
the public needs to be taught that mental illness is
a chronic disease from which people can recover—a dis-
ease not unlike diabetes.
Biological explanations may also imply that people
with mental illness are fundamentally different or less
human. Research has shown, for example, that disease
explanations for mental illness reduced blame but pro-
voked harsher behavior toward an individual with mental
illness (Mehta and Farina 1997). The studies suggest that
this harsher behavior may have been the result of seeing
the person with mental illness as physically distinct
almost as a different species. Phelan (2002) reminds us
that in the not-so-distant past, biological and genetic
explanations for stigmatized conditions were linked to a
range of harsh policies, including marriage restrictions,
sterilization, and even extermination.
The biological explanation may also exacerbate yet
another key stereotype of mental illness, the belief that
people with mental illness are dangerous. Many
researchers believe that the stereotype that people with
mental illness are violent ranks among the most prejudi-
cial and discriminating of attitudes (Phelan et al. 2000).
Unfortunately, there is evidence that biological arguments
may actually strengthen dangerousness stereotypes, sug-
gesting that people with mental illness have no control
over their behavior and therefore are unpredictable and
violent (Read and Law 1999).
In contrast to biological arguments, psychosocial
explanations of mental illness have been found to effec-
tively improve images of people with mental illness and
reduce fear (Morrison et al. 1979; Morrison and Teta
1980; Morrison 1980; Read and Law 1999). Instead
of arguing that mental illness is like any other medical ill-
psychosocial explanations of mental illness focus on
environmental stressors and trauma as causal factors.
These may include childhood abuse, poverty, and job
The idea is to reframe psychiatric symptoms as
understandable reactions to life events (Read and Law
Does this mean we should abandon the "brain dis-
explanation of mental illness? As scientists compile
more and more evidence of the genetic and biological
components of many mental illnesses, it would be unethi-
cal to exclude this information from educational programs
(Phelan 2002). In addition, reducing blame is an impor-
tant goal of any antistigma campaign, particularly if we
are interested in increasing the public's willingness to
allocate resources for mental health treatment (Watson
and Corrigan, in press). Hence, challenging the stigma of
mental illness is going to require a multidimensional
approach, providing the public with facts that challenge
the variety of myths that maintain mental illness stigma.
Such an approach would address the contributions of both
biological and psychosocial factors, the effectiveness of
mental health treatment, and accurate information about
violence and mental illness. Combining education with
contact with a person with mental illness can enhance the
effect of an intervention (Corrigan et al. 2002), perhaps by
diminishing the perception of "otherness." Challenging
the stigma of mental illness is an essential item on the
public health agenda. However, just as other public health
concerns need to be informed by data, so efforts to build
antistigma programs need to be evaluated empirically.
Brockington, I.; Hall, P.; Levings, J.; and Murphy, C. The
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This article was made possible in part by National
Institute of Mental Health grant MH-62198, which sup-
ports the Chicago Consortium for Stigma Research. Many
thanks to the anonymous reviewers who provided feed-
back on earlier drafts of this article.
The Authors
Patrick W. Corrigan, Psy.D., is Professor of Psychiatry,
and Amy C. Watson, Ph.D., is Assistant Professor of
Psychiatry, Northwestern University, Evanston, IL.
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by guest on December 30, 2011 from
... stigmatising) attitudes towards people with mental health issues simultaneously, which may partly explain seemingly conflicting results across studies (Ireland & Quinn, 2007;Lavoie et al., 2006). It should also be noted that positive attitudes may give rise to more benevolent forms of stigma, which are well-intended but involve paternalistic views and can be disempowering (Corrigan & Watson, 2004). ...
... Yet, if the information provided is conflicting, children and parents may well be left with incoherent integration of the information provided and feel confused as to how to understand themselves or their children. Subsequently, this could affect expectations of coping, recovery and future development [13,[40][41][42][43]. ...
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Background Psychiatric classifications are understood in many different ways. For children with ADHD and their parents, psychoeducation is an important source of information for shaping their understanding. Moreover, psychoeducation is often taken by children and parents to represent how their story is understood by the therapist. As a result, the way psychoeducation is formulated may affect the therapeutic alliance, one of the most robust mediators of treatment outcome. In addition, psychoeducation may indirectly influence the way we understand psychological differences as a society. Methods To better understand how the classification ADHD is given meaning through psychoeducation, we analyzed 41 written psychoeducational materials from four different countries; the USA, UK, Netherlands and Hungary. Results We identified five patterns of how the materials construct the discourse on ADHD. Notably, tension between biomedical and psychosocial perspectives resulted in conflict within a single thematic stance on ADHD as opposed to a conflict between parties with a different vision on ADHD. There were only few differences between countries in the way they constructed the discourse in the materials. Conclusions These conflicts cause confusion, misrepresentation and decontextualization of ADHD. Ultimately, for those diagnosed with ADHD and their parents, conflicting information in psychoeducation materials may hamper their ability to understand themselves in the context of their difficulties.
... stigmatising) attitudes towards people with mental health issues simultaneously, which may partly explain seemingly conflicting results across studies (Ireland & Quinn, 2007;Lavoie et al., 2006). It should also be noted that positive attitudes may give rise to more benevolent forms of stigma, which are well-intended but involve paternalistic views and can be disempowering (Corrigan & Watson, 2004). ...
This review aimed to examine (1) stigmatising attitudes of probation, parole and custodial officers (hereafter referred to as correctional staff) towards people with mental health issues, (2) the potential impacts of these attitudes on client treatment and (3) what is currently known about anti‐stigma interventions in correctional settings. Academic databases were searched for peer‐reviewed and dissertation literature published between 1 January 2000 and 10 February 2022. Eligible studies included observational and intervention studies investigating stigmatising attitudes of correctional staff towards people with mental health issues. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of studies. A meta‐analysis of anti‐stigma intervention studies was performed. A total of 35 studies were included for data extraction, including eight interventions, one longitudinal, 18 cross‐sectional and eight qualitative studies. Some studies indicated neutral or positive attitudes, but the majority showed a range of stigmatising attitudes towards people with mental health issues. The findings indicate these stigmatising attitudes can lead to negative treatment of justice‐involved clients, such as more coercive, restrictive and punitive approaches. The meta‐analysis of six intervention studies focussed on education found a small positive effect on stigmatising attitudes (d = .31, 95% CI: 0.16–0.45). The various stigmatising attitudes of correctional staff towards people with mental health issues can have detrimental impacts on the well‐being and treatment outcomes of clients presenting with mental health issues. Anti‐stigma interventions may be effective in mitigating these impacts; however, more rigorous evidence is needed.
... They are the non psychotic affective disorders (depressive and anxiety disorders) and are classified as separate diagnostic category in the International Statistical Classification of Diseases 10 as "neurotic, stress-related and somatoform disorders" 5 . The concept of CMDs is highly suited in community and primary health care settings due to its high degree of co morbidity among the categories of disorders and the comparable epidemiological profile and treatment responses 6,7 .Women's health is not dependent on just biological factors and reproductive factors and is beyond it ,like violence, self inflicted injuries, workload ,stress, migration ,nutrition and gender-based discrimination which directly contribute to the burden of disability caused by poor mental health 8 . ...
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Context/Background: Common Mental Disorders, are non psychotic affective disorders (depressive and anxiety disorders). These disorders predominantly occur in women, is a serious public health problem. Majority of these are either undiagnosed or not satisfactorily treated. In most of the low- and middle-income countries, the idea of primary care for mental health is yet to be understood. Aims/Objectives: We undertook this study to estimate the prevalence of common mental disorders among ever married women in rural Puducherry, and to assess the associated risk factors Methodology: This cross-sectional study included 900 ever- married women in Bahour - a rural Puducherry between March 2015 and May 2016. Subjects were interviewed with semi-structured questionnaire & General health Questionnaire-12 using Bimodal scoring. Chi-square test and multiple logistic regression was done. p value < 0.05 was considered statistically significant. Results: Prevalence of common mental disorders was 11.4%. Age < 20 years, being Widowed/divorced/separated, being Pre obese women/obese, having adverse pregnancy outcome and physical abuse were identified as risk factors. Conclusions: The preliminary estimate prevalence of this disorder which was found to be high. Further research is needed to identify various other factors that influence the mental health of women.
... While stigma not only contributes to wider social harms, research has shown it can also create a barrier to public support for DCRs [35,36]. The levels of public support for DCRs in Scotland have not been extensively tested: one study found that, among a representative sample of the Scottish public, support was higher in those provided with a combination of clear, factual information and personal narratives [7,37,38]. Prior studies have also suggested that personal narratives promote an 'ethical consciousness' by introducing an emotional element that counters dominant discourses and opposition [39][40][41]. While rarely the sole driver of policy change, the personal narratives of affected family members can play a critical role in policy advocacy. ...
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Background People who use drugs in Scotland are currently experiencing disproportionately high rates of drug-related deaths. Drug consumption rooms (DCRs) are harm reduction services that offer a safe, hygienic environment where pre-obtained drugs can be consumed under supervision. The aim of this research was to explore family member perspectives on DCR implementation in Scotland in order to inform national policy. Methods Scotland-based family members of people who were currently or formerly using drugs were invited to take part in semi-structured interviews to share views on DCRs. An inclusive approach to ‘family’ was taken, and family members were recruited via local and national networks. A convenience sample of 13 family members were recruited and interviews conducted, audio-recorded, transcribed, and analysed thematically using the Structured Framework Technique. Results Family members demonstrated varying levels of understanding regarding the existence, role, and function of DCRs. While some expressed concern that DCRs would not prevent continued drug use, all participants were in favour of DCR implementation due to a belief that DCRs could reduce harm, including saving lives, and facilitate future recovery from drug use. Participants highlighted challenges faced by people who use drugs in accessing treatment/services that could meet their needs. They identified that accessible and welcoming DCRs led by trusting and non-judgemental staff could help to meet unmet needs, including signposting to other services. Family members viewed DCRs as safe environments and highlighted how the existence of DCRs could reduce the constant worry that they had of risk of harm to their loved ones. Finally, family members emphasised the challenge of stigma associated with drug use. They believed that introduction of DCRs would help to reduce stigma and provide a signal that people who use drugs deserve safety and care. Conclusions Reporting the experience and views of family members makes a novel and valuable contribution to ongoing public debates surrounding DCRs. Their views can be used to inform the implementation of DCRs in Scotland but also relate well to the development of wider responses to drug-related harm and reduction of stigma experienced by people who use drugs in Scotland and beyond.
... The recent preference for referring to mental illnesses as brain diseases is also challenged in many studies, revealing a complex situation. Corrigan and Watson (2004) argue that emphasising a biological cause removes blame from the person but leads to othering and may in fact increase the perception of dangerousness since it suggests that the person has little control over their illness. There is strong support for presenting mental illness in a continuum model (Schomerus et al., 2016), however, even this can be problematic because stressing affinity with people without mental illness may minimise illness severity and inadvertently put blame back on the person (Gergel, 2014). ...
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Disorders of behavior represent some of the most common and disabling diseases affecting humankind; however, despite their worldwide distribution, genetic influences on these illnesses are often overlooked by families and mental health professionals. Psychiatric genetics is a rapidly advancing field, elucidating the varied roles of specific genes and their interactions in brain development and dysregulation. Principles of Psychiatric Genetics includes 22 disorder-based chapters covering, amongst other conditions, schizophrenia, mood disorders, anxiety disorders, Alzheimer's disease, learning and developmental disorders, eating disorders and personality disorders. Supporting chapters focus on issues of genetic epidemiology, molecular and statistical methods, pharmacogenetics, epigenetics, gene expression studies, online genetic databases and ethical issues. Written by an international team of contributors, and fully updated with the latest results from genome-wide association studies, this comprehensive text is an indispensable reference for psychiatrists, neurologists, psychologists and anyone involved in psychiatric genetic studies.
This experiment examined how two language features-linguistic agency and assignment of causality-of online support-seekers' messages regarding depression influenced viewers' perceived stigma and features of their support messages. Participants (N = 254) read and responded to an online support-seeking post about depression. Our results revealed that personal stigma toward a depressed individual was lower when the individual disclosed a biological cause for the depression and assigned agency to depression than agency to human. Additionally, when agency was assigned to depression with a biological rather than non-biological cause, more positive emotion words were utilized in participants' response posts. Cognitive process words were used more often in response to messages with non-biological causality than biological causality.
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This study examined the widely held belief that a disease view of mental disorder reduces stigma. Behavioral and self-report measures were used to assess 55 male students' treatment and attitudes toward another, whom they believed either to be a typical student or to have a history of mental disorder. The mental difficulties were characterized in either disease or psychosocial terms. The results indicate that the way in which mental disorder is represented does have an effect on behavior and on some aspects of evaluation. In general, the disease view did not improve attitudes, except in terms of blame. It did, however, tend to provoke harsher behavior. In contrast, the psychosocial view induced treatment no different from that toward normal others. The results provide little support for the claim that regarding the mentally disordered as sick or diseased will promote greater acceptance and more favorable treatment.
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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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Two stigmatizing attitudes related to dangerousness and personal responsibility may undermine the opportunities of persons with serious mental illness. This study set out to examine path models that explain how these attitudes lead to discriminatory behavior and to assess the impact of antistigma programs on components of personal responsibility and dangerousness models. Two hundred thirteen persons were randomly assigned to one of five antistigma conditions: education on personal responsibility, education on dangerousness, contact with a person with serious mental illness where personal responsibility is discussed, contact where dangerousness is discussed, or no change. Persons completed an attribution questionnaire (AQ) representing personal responsibility and dangerousness path models at pretest, posttest, and 1-week followup. They also completed tasks that represented helping behavior. Goodness of fit indexes from linear structural modeling were mixed for both models but suggested that fear of dangerousness was a key attitude leading to discriminatory behavior. Results also showed that subjects who had contact with persons with serious mental illness experienced greater changes than subjects in the education or control groups did on measures of attribution and helping behavior.
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In this study, we build on previous work by developing and estimating a model of the relationships between causal attributions (e.g., controllability, responsibility), familiarity with mental illness, dangerousness, emotional responses (e.g., pity, anger, fear), and helping and rejecting responses. Using survey data containing responses to hypothetical vignettes, we examine these relationships in a sample of 518 community college students. Consistent with attribution theory, causal attributions affect beliefs about persons' responsibility for causing their condition, beliefs which in turn lead to affective reactions, resulting in rejecting responses such as avoidance, coercion, segregation, and withholding help. However, consistent with a danger appraisal hypothesis, the effects of perceptions of dangerousness on helping and rejecting responses are unmediated by responsibility beliefs. Much of the dangerousness effects operate by increasing fear, a particularly strong predictor of support for coercive treatment. The results from this study also suggest that familiarity with mental illness reduces discriminatory responses.
After participating in a brief, demythologizing seminar, 24 high school juniors reported significantly changed attitudes toward mental illness on a paper-and-pencil measure. These new attitudes reflected a rejection of the “mental illness” metaphor and, generally, less acceptance of the traditional medical model approach. Demythologizing also appeared to reduce significantly the students' ratings of fear of an hypothesized mental patient neighbor. A 5-wk. followup confirmed the stability of the changes in reported attitudes and fear ratings. Results are discussed within the context of their implications for community psychology. Replication is needed.
A demythologizing, educational approach to the community is outlined and recent empirical studies are summarized which demonstrate that beliefs in favor of the mental illness concept can be significantly changed. Such conceptual change, reflecting an acceptance of a psychosocial paradigm of psychological problems, apparently induces a seminar participants a number of desirable effects from a community psychology perspective: an increased positive image of the mental patient, increased positive self-attributions, decreased fear ratings of mental patients, and a decreased fear of becoming insane. The importance of these findings for community psychology is discussed.
Demonstrated that through brief demythologizing, college students' (N = 32) attitudes toward mental illness could be changed significantly in a non-medical model or psychosocial direction and that this attitude change apparently induced students to report a significantly reduced fear of contracting mental illness. Pretest-follow-up data comparisons confirmed the validity of these findings.
This paper presents empirical evidence accumulated across the last two decades to challenge seven long-held myths in psychiatry about schizophrenia which impinge upon the perception and thus the treatment of patients. Such myths have been perpetuated across generations of trainees in each of the mental health disciplines. These myths limit the scope and effectiveness of treatments offered. These myths maintain the pessimism about outcome for these patients thus significantly reducing their opportunities for improvement and/or recovery. Counter evidence is provided with implications for new treatment strategies.
Recovery from schizophrenia: A criterion-based definition Recovery and Mental Illness: Consumer Visions and Research Paradigms
  • R P Liberman
  • A Kopelowicz
Liberman, R.P., and Kopelowicz, A. Recovery from schizophrenia: A criterion-based definition. In: Ralph, R., and Corrigan, P., eds. Recovery and Mental Illness: Consumer Visions and Research Paradigms. Washington, DC: American Psychological Association, in press.