Stigmatization of the mentally ill: Can exposure and education eliminate it?

 by Meagan R. Gelinas


Abstract
Introduction
Methods
Results
Discussion
References     Appendices
Relevant Links
 
 

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Key Terms:  Contact Theory, Labeling Theory, Stigma
 
 

Abstract 

The present study explores whether there is a relationship between the label of a mental illness and how a person thusly labeled is perceived.  It further explores whether or not the level of education and previous contact with the mentally ill diminishes the likelihood of the participant to stigmatize the mentally ill. This is contrasted with how they would treat the control group or the group with a physical ailment.  Past research has found that the mentally ill have been treated poorly due to their label, and not to their behavior (Link, et. al. 1989, Socall & Holtgraves, 1992).  Research also shows that contact with and knowledge about the mentally ill, or any minority group, lessens the amount of prejudice against them (Allport, 1954). 

Participants were randomly assigned to receive a description of one of three individuals: schizophrenic controlling his condition with medication, asthmatic who uses an inhaler, and a control group given no explanation.  All three groups were given the exact same vignette that explained the actions of a man in a coffee shop. The only difference between the groups was the label.  The participants were then administered two questionnaires.  The first, Stigma Questionnaire, was given to ascertain the level of stigma associated with each of the groups.  The second questionnaire was the Marlow Crowne Social Desirability Scale, used to ascertain whether or not the participants were answering their stigma questions for the socially desirable response. 

A Univariate Analysis of Variance was run on the data with social desirability as a covariate, and significance was found between the groups with means indicating that the label schizophrenia was stigmatized significantly less than either no label or the asthma label.  Also, a Pearson Product Moment Correlations revealed a significant negative correlation between stigma and contact and between stigma and education showing that the level of contact and education does in fact mitigate the level of stigma that participants associate with the mentally ill. 

The results show that participants stigmatized the schizophrenic label less than the asthmatic label or no label.  This is the opposite of what was hypothesized. One explanation is perhaps the significant, positive relationship within the schizophrenic label between more education and exposure and less stigma.  In other words, the participants randomly assigned to the schizophrenic label had more exposure to and education about the mentally ill and also stigmatized the mentally ill significantly less.  This relationship could explain why the schizophrenic label was stigmatized less. 

The results of this study show a hopeful trend for the mentally ill.  Through education and exposure to the mentally ill, stereotypes may be shown to be false and thus eradicated.  It would lessen the likelihood that the mentally ill may incorporate the stereotypes into their own personalities (Meile & Whitt, 1985).  It would enable the mentally ill to not fear reintegration into society and it would ease their transition from the mental hospitals into society.  The possibilities are various and potentially powerful should they be applied to society at large. 

 

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Introduction

Labeling Theory

As suggested by the Basic Behavioral Science Task Force of the National Advisory Mental Health Council in Rockville, Maryland, stereotyping is the application of social beliefs and expectations regarding groups or categories of people used to predict the thoughts, behavior and feelings of specific individuals (Task Force, 1996).  When people stereotype they are likely to lose sight of the mentally ill’s individual attributes.  This means that one is depersonalized as an individual and given an identity based on the stereotype.  It has been shown that one’s strong stereotypic expectations can actually evoke the expected behavior from the stereotyped person (Task Force, 1996). 

The mentally ill can be stigmatized by stereotyping and this can potentially cause adverse behavioral and cognitive consequences (Markowitz, 1998).  The stigma associated with mental illnesses is directly linked to the labeling of the mental illness. According to Wright, Gronfein & Owens (2000), this problem has been under scrutiny since 1966 by Scheff who called it the labeling theory in his book, Being Mentally Ill.  It was asserted that a mental illness diagnosis actually stabilizes deviant behavior rather than helping to end it (Wright, Gronfein, Owens, 2000).  According to what is reported of his study, it is assumed that the process of becoming mentally ill includes a resocialization process through which individuals enter the role of the mentally ill person.  During this process, Scheff asserts that the mentally ill person begins to apply the role of “mentally ill” which he learns from the members of the community, to himself.  Once these behaviors have been incorporated into the self-concept of the mentally ill person, they become the basis for future behavior regarding that person’s social role (Meile & Whitt, 1985). 

Modified Labeling Theory:

Link, Cullen, Struening, Shrout, and Dohrenwend (1989) have developed a modified version of Scheff’s labeling theory.  They agree with many of Scheff’s positions, but maintain that it required modifications.  Scheff did not focus on the consequences of labeling; instead he focused on the chain of events prior to the labeling. He also posited that labeling could actually produce a mental illness.  Link, et. al. do not agree that it could produce a mental illness, but rather may lead to detrimental outcomes (Link, et. al. 1989).  Therefore, Link, et. al. only partially incorporate Scheff’s theory in their modified version. 

The modified labeling theory has five sequential levels.  The first level involves a socialization period.  Actually receiving the label, or when the doctor informs the patient that he is mentally ill, is often a terribly shocking experience for the mentally ill person.  She or he then has to go out and face society.  The recently labeled mentally ill person learns the prevailing attitudes of the community in a way that he or she never has before.  He or she is now looking at it through the lens of a mentally ill person. The jokes, cartoons, media coverage and innocuous comments are perceived as being personal attacks.  The second level is accepting the official medical label from a professional.  This acceptance ties into the first level insofar as now it is irrevocably a personal label. 

The third level in the labeling process that Link, et. al. suggest is the patient’s response to his stigmatizing status.  Link, et. al. see three possible responses:  secrecy, or withholding information about their illness from people, withdrawal, or limiting social interactions, or finally, education, in which patients try to educate folks on their condition in hopes of limiting their stigma.  This third option implies that they are disclosing their illness to others and thus are risking direct discrimination.

The fourth level involves consequences that the stigma process has for a patient’s life.  These may result directly from one’s beliefs about community attitudes toward the status of the mentally ill, or may arise from withdrawal. Usually the result ii negative affect, negative social interaction, and low self-esteem of the effected person. These reactions of the mentally ill which are the results from how the community reacted to them, may also produce negative consequences; it limits their life chances. For example, it limits social interactions, and also limits satisfying, higher-paying jobs. 

The fifth, and final level is the culmination of levels one through four: patients lack self-esteem, social network ties, and employment because of their own and others’ reactions to labeling (Link et al,1989). As suggested by Socall & Holtgraves (1992) the negative stereotyping of the mentally ill is internalized by those with mental illnesses, eventually becoming an integral part of their identity.  For the purpose of the present study, it is critical to understand what the results will be should the stereotypical response to the mentally ill remain the same as it did when these past studies were conducted.  Therefore I will be testing participants to assess whether stereotyping of the mentally ill still occurs.  If this is the case, the question remains, does stereotyping increase or decrease with the level of contact with the mentally ill? 

An important aspect of either labeling theory is the belief that the stereotype exists prior to any abnormal behavior by the mentally ill person.  In order to examine this, methodology must be carefully selected for experimentation.  An illustration of this concern is exhibited in work by Socall and Holtgraves (1992) who highlighted flaws with the methodological manner in which previous studies had been run.  For example, other experiments done by Farina and Hagelauer (1975), Lehman (1976), Kirk (1974) and Farina, Murray, and Groh (1978) have paired a person behaving erratically with either a label or no label/normal status.  This is a problem because if there is no label, or if the person is called normal, then why the erratic behavior?  In their study, Socall and Holtgraves (1992) attempted to solve this problem by saying that the person behaving erratically is either mentally ill or physically ill.  This way there would be no untoward bias. 

Another problem in the method of some studies is evident in the vignettes that use a normal person and a special vignette for behaviors associated with mental illnesses.  The problem with this is that the special vignettes use informal labels, such as “afraid of people,” and so the implied behavior, due to the informal label could confound the studies as they are already suggestive of a certain label, such as a nervous disorder.  Finally, a third critique offered by Socall and Holtgraves regards the general label, “mentally ill.”  This label is too vague and too broad; people don’t have a clear meaning of what being mentally ill entails.  This ambiguity could cause the results of the study to be as vague as the label “mentally ill” (Socall & Holtgraves, 1992). 

Socall and Holtgravesconducted a study in which they improved upont the methodological weakensses of previous studies.  Using the information Socall and Holtgraves generated regarding methodology, the present study is going to ascertain whether or not participants are likely to stereotype a person based on a label only, rather than on the behavior of the person. It will do this by giving the same vignette to each of the three groups.  In this way, each participant will have a vignette describing the same behavior, any differences will be due to the differing label. It will also use schizophrenia as a specific label for mental illness.  In addition, this study goes further to ascertain whether level of contact with the mentally ill and level of education regarding mental illnesses diminishes the level of stigma.

Community Perceptions

If a mentally ill person is subjected to stigmatizing stereotypes, his identity begins to suffer (Link et al, 1989).  Now, the battle is twofold. Not only is he fighting an illness, but he is also fighting unfair stereotypes and his own likelihood to conform to them. 

There are two types of identity crucial to mental health, personal and social identity (Task Force, 1996).  Personal identity involves one’s sense of continuity, stability and predictability.  These all contribute to one’s sense of personal control and self-esteem.  Social identity comes from being a part of one or more groups and provides a sense of connectedness and belonging.  It is very important, for one’s mental health, to have a positive sense of both of these identities (Task Force, 1996).  When patients who have been diagnosed with a mental illness are released out into the public, they are faced with the task of restructuring their personal identities to incorporate their mental illness, and what’s more, they are forced to also restructure their social identities.  This process is made more difficult by the resistance to the mentally ill found within the community. 

Many mentally ill patients leave the hospital and take up residence in a group home or assisted living facility.  These residential facilities have often been met with loud and insistent opposition in communities (Severy, Starr, Silver, Wilmoth, 1987).  Baron and Piasecki in their 1981 survey found that for every facility open at that time, another was either closed or never actually opened due to community opposition.   Respondents to a questionnaire by Boquet, Bowen, and Twemlow (1978) believed that mental illness was either due to deficiency in either physical health or nurturing.  Forty-five percent responded true to “Mental illness results from lack of parental love during childhood.”   Thirty-eight percent of respondents believed that “Former mental patients cannot be trusted, need supervision, and are a cause for concern.”  Fifty-two percent of respondents would not take a mentally ill patient into their homes (Boquet, Bowen, and Twemlow, 1978).  The present study will ascertain whether or not, in a college population, stigmatization such as this still occurs. 

In a different study by Baumohl, Moyles, and Segal (1980), no simple or direct relationship was found between negative community reaction and the social integration of ex-mental patients in community care.  However an extreme negative reaction was found to have a profoundly adverse influence on social integration of community-care residents (Baumohl et al. 1980). In other words, those mentally ill people who encountered a negative reaction in the community had a very difficult time becoming integrated into the community.  Why do communities have such a negative opinion of the mentally ill, and is it warranted? 

Contact Theory

Exposure to the mentally ill has been shown to reduce the stigma that people associate with them.  The tendency to reduce stigma is directly related to the amount and quality of contact that one has with the mentally ill. 

According to Baron and Byrne (2003), contact theory is the concept that more contact between members of different social groups can help reduce prejudice between the groups.  These efforts only appear to work when the contact takes place under specific, favorable conditions (Baron & Byrne, 2003). 

Gordon W. Allport first expressed his contact theory in a book titled The Nature of Prejudice.  Allport (1954) made it clear that prejudice is caused by many different things, and therefore to eliminate or reduce it, is a multifaceted task.  At its bare bones, contact theory states that prejudice and discrimination toward a minority group will be reduced when the contact between the individuals has the following qualities:  the groups involved must feel that they are equals, the community supports the groups, the groups must be pursuing the same goals, and the relationship between the groups must be deep, genuine and intimate.  Furthermore, Allport claims that casual contacts are more likely to increase prejudice, rather than reduce it. 

Allport (1954) stated that the evidence showed that knowledge about and acquaintance with the minority group makes for more friendly and tolerant attitudes.  He acknowledges that the relationship is not perfect, nor does he know if there is a reciprocal relationship between knowledge and friendliness.  Nonetheless, there is a positive relationship. 

There are many examples supporting this theory.  One involves the military; the more contact white seaman had with black seaman, the more positive their attitudes towards blacks became (Pettigrew, 1998).  Desegregated projects in certain cities, when surveyed, showed that whites held black in higher esteem than those of segregated projects (Pettigrew, 1998).  The actions of the whites in the desegregated and segregate projects were regulated by social norms.  Those of desegregated projects expected approval from fellow tenants for their acceptance of blacks, while segregated whites feared ostracism from tenants for interacting with blacks (Pettigrew, 1998). 

Pettigrew found contact theory proves most operable over a period of time in which a friendship may develop (Pettigrew, 1998).  Indeed, repetition of intergroup contacts was found to lead to “liking” (Pettigrew, 1998).  The repeated contact between the groups dispels the stereotypes because the groups see how similar they are to one another (Baron & Byrne, 2003).  Due to the contact between the groups, Pettigrew discovered there was less negative stereotyping, less prejudice, and less discrimination (Pettigrew, 1998).  Baron and Byrne (2003) report that sometimes it is enough to simply know a member of one’s own group who has a friendship or high regard for a member of another group to lessen the prejudices between the groups (Baron & Byrne, 2003). 

The contact theory has been tested among several different groups including the elderly, homosexuals, mentally ill, disabled persons and AIDS victims (Pettigrew, 1998).  This is important for the present study as it is hypothesized that those with a higher level of contact with the mentally ill, or a greater knowledge of mental illness, will be less likely to stigmatize the mentally ill based on the stereotypes they may have formed. 
 
 
 

 

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Methods

Method

Participants

 The participants were pulled from the Saint Anselm College population.  They were mainly comprised of white, middle class people ranging from 18 to 22 years of age.  The majority of the sample population was from a suburban community.  The participants had completed high school and were attending college.  The participants were either volunteers or required to partake in several studies as as alternative to writing a paper for one of their courses. 

Materials

The main stimulus in this study of exposure to a label is done using the same vignette.  The vignette is a brief description of a young man in a coffee shop.  There is a short physical description followed by behavior that could be interpreted differently based on a label (see Appendix A-C). There were three different groups, each given the same vignette.  One group was told that the man from the vignette was a schizophrenic managing his condition with medication, one group was told that the man from the vignette was an asthmatic who uses an inhaler, and the third group was told nothing. The group given no identifying label accompanying the vignette was the control group. 

The participants were given a questionnaire that assessed the degree of intimacy with the man in the story with which the participant was comfortable. The questionnaire contains questions regarding the subject’s beliefs on how predictable, violent, or dangerous the person from the vignette may be.  For example, one question asked “Do you believe that this man is a dangerous person?” This questionnaire also assessed the level of contact the participant has had with a man like the one described in the vignette, and the amount of education in the field of psychology that the participant has (See Appendix D). 
The questions were rated on a one to five Likert scale with five points representing the highest level of stigma, in other words, the least amount of intimacy with which the participant would be comfortable.  Each individual item was assigned a different weight according to the level of stigma it was assessing.  For example, the following was rated a mild stigma question, “How willing would you be to speak to the man from the vignette over the telephone?”  A scoring system was used to weight particular items heavier than others.  The items assessing stigma ranged from mild and medium to major.  The mild stigma scores were taken on the one to five points scale. The medium stigma questions took the one to five points score and multiplied it by two. The major stigma question took the one to five points score and multiplied it by three.  The final stigma score was the cumulative score of all the individual stigma questions.

The Marlow Crowne Social Desirability Scale was also administered to ascertain how likely it was that the participants answered the questionnaire based on how they think they should answer it, and not based on how they really think (See Appendix E). 

A suspicion check and a manipulation check were also used (See Appendix F). These checks ascertained whether the participants knew the true purpose of the study, and whether or not the actual manipulation was noted. 
Procedure

This study is similar to that run by Socall and Holtgraves (1992).  Participants were told that this was a study on first impressions.  Participants were randomly assigned to one of three conditions.  One-third of the sample was told that the man in the vignette had paranoid schizophrenia but was on medication, one-third was told that the person in the vignette suffered from chronic asthma, and the final third was not given any identifying information.  The questionnaire assessing the level of stigma was then administered, followed by the social desirability scale.  The suspicion check and manipulation check were given last to the participants.  Upon completion, the participants were debriefed (See Appendix G) and thanked for their participation.
 

 

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Results

 The dependent variables in this study were the scores on the Stigma Questionnaire and the scores on the Social Desirability scale.  The higher the score for each test indicated higher level of stigma and a greater desire for social desirability, respectively.  The questions on the Stigma Questionnaire were weighted in accordance with the level of stigma they represented.  There were mild, medium and major stigma questions; each type was worth a certain amount, beginning at a score of one and ranging to a score of fifteen as the stigma increased.
The manipulation check showed that everyone remembered the description of the man from the vignette.  However, some people did not report that the man was asthmatic or schizophrenic, depending on what group they were in.  In the schizophrenic group, nine out of twenty two participants reported that he was schizophrenic.  In the asthmatic and control group the man often was described in words that were not in the vignette, such as “grungy and unclean,” or  “tall, oily man.” 

A Univariate Analysis of Variance was performed on the stigmatization score with social desirability as a covariate. There was a significant effect for social desirability (F(1, 54) = 5.17, p = .027).  This means that the participants’ desire to seem socially accepted was a significant factor for each group.  The ANOVA also showed that there was a significant effect for vignette (the control, schizophrenic man on medication, and an asthmatic man who uses an inhaler)  (F(2,54) = 4.20, p = .02). 

The mean stigma scores for these three groups showed that those exposed to the story about the schizophrenic had the lowest mean stigma score of 101.57, followed by the control group with a mean of 112.86 and then the asthmatic group with a mean of 114.69 (see Table 1). These means show that the stigma associated with the schizophrenic group was actually less than the other two groups.  Interestingly, this is the opposite of what was hypothesized.
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Table 1

Mean stigma scores for each vignette

Independent Variable       N        Mean        Standard Error
Schizophrenic w/meds     18       101.565        3.521
Asthmatic w/inhaler          21      114.689        3.257
Control                            19      112.862        3.394
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To explain the unexpected results, only the schizophrenic group was examined to see how the participants responded to the stigma questions as compared to those about level of contact with a man such as the man in the vignette, and also their level of education in the field of psychology.  It had been hypothesized that the higher the level of education and the higher the level of contact, the lower the level of stigma.  Pearson Product Moment Correlations with a significant negative correlation between stigma and contact (r=-.85) and between stigma and education (r=-.59) revealed this to be the case, (see Table 2)

---------------------------------------------------------------------------------------------- Table 2

Correlations Between Stigma score, Level of Contact and Level of Education

N = 22                                           Stigma Score
Level of Contact                              -.847**
Level of Education                           -.593**
Note:  ** p < .01

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Discussion

It was hypothesized that those who were given the vignette with the schizophrenia label would be more likely to stigmatize the man based on his label as opposed to his behavior.  It was further hypothesized that those who had had more exposure to the mentally ill, and more education in the field of psychology, would not stereotype the mentally ill as much as those who have had less exposure and less education. 

The results showed that there was indeed a significant difference in the way the three groups were perceived.  The results showed that the schizophrenic group was stigmatized less than the other two groups.  A difference in the perception of the groups was predicted, but it came as a surprise that the schizophrenic group was stigmatized less than the other two groups.  However, there was support for the second part of the hypothesis; there was a low level of stigma associated with the schizophrenic group as opposed to the asthmatic variable and the control group, for those who had more education and exposure to the mentally ill.  This significant negative correlation between stigma and education and stigma and exposure demonstrated that the increased level of education and the more exposure to the mentally ill, the less likely that person is to stigmatize. 

As Socall and Holtgraves (1992) have pointed out, an important aspect of the labeling theory is the belief that the stereotype exists prior to any abnormal behavior by the mentally ill person.  Since all the groups were given the same vignette, the behavior was not the distinguishing feature, the label was.  The fact that a significant difference was found between the groups shows that the label was what was affecting the participants.  The labeling theory is still quite powerful in the subject pool that participated. 

To explain the reversed nature of this finding related to the variable of label, one could examine the population that made up the subject pool.  The majority of the participants were psychology majors, perhaps making them more sensitive to the plights of the mentally ill, and thus less likely to stigmatize them.  The more knowledge the participants had about the mentally ill, the more they would know that the behavior of the mentally ill stems from an illness, and not a deficit in character.  In other words, they would be less likely to stereotype the mentally ill because they know how erroneous such stereotypes can be. 

Another explanation of the results is the subject pool was a homogenous group comprised of middle class white suburbanites who were perhaps less likely to have ever been exposed to the type of man described in the vignette, regardless of the group to which they were randomly assigned.  This would therefore make the man’s behavior perhaps seem more radical than it actually is.  This could explain why the asthma label or no label resulted in a higher level of stigma than the schizophrenic label.  It would seem that at least the schizophrenic label would lend itself to some erratic behavior, thus explaining the lower level of stigma associated with the schizophrenic label. 

According to Smith (1981) those who were exposed to mental patients more often, due to their proximity to a mental hospital, were less likely to reject the mentally ill.  This shows that those who have more exposure to the mentally ill know that the mentally ill are no more frightening than any other person.  This concept is known as the contact theory and is further explained by Pettigrew (1998) in regards to a racial population.  The more contact with people of another race, the less likely stigmatization of the race was to occur.  This was demonstrated in the present study with mental illnesses.  There was a significant negative correlation between the amount of contact with the mentally ill and the level of stigma associated with the illness. 

A couple of improvements for this study have been proffered.  First, a wider population covering a broader social, racial, economic and age range could be sampled.    Second, within the group assigned to the schizophrenia label, a pretest could be conducted in which all those with a higher level of education and exposure to the mentally ill could comprise a group of their own.  This would allow the experimenter to ascertain the level of stigma they would associate with a man based on a label, and it would not affect the stigma score that people with little or no contact and education would score.  In other words, that would more accurately enable the experimenter to assess whether or not there is a greater likelihood for people to stigmatize the mentally ill based only on the label and not the behavior without the previous exposure and education.  It would control for the confounding variables of exposure and education and allow the experimenter to measure the amount of stigmatization that occurs without previous exposure or education, which have been shown to lessen the level of stigma associated with the mentally ill. 

The information gathered in this study highlights the critical importance of establishing programs to educate the general public on mental illnesses.  The results show a significantly lower level of stigma associated with the schizophrenic group when the levels of contact and education were higher.  If the general public was educated about mental illnesses, according to the results of this study, stigmatization would occur less. 

It also demonstrates the importance of programs that work on the reintegration of the mentally ill into communities.  The findings would suggest that prior to reintegration into the community, the community should be exposed to and educated about the mentally ill, thus lessening the likelihood that they would stereotype and thus stigmatize the mentally ill patients.  In this way, the mentally ill, who are already struggling with their identity as mentally ill, would feel more comfortable in the community. In addition, they would be less likely to conform to the stereotype that would be associated with them (Meile & Whitt, 1985) which would enable them to find more success in a broader social context.

The results from this study show that there is a significant difference in the way that people are treated based on the label they are given.  It also shows that the more exposure and education to the mentally ill, the less likely people are to stigmatize the mentally ill based on their label.  This information can be applied to many different avenues of life.  For those working in public arenas, from supermarkets to train stations, this information could help the employees to serve more people in a more humane manner. It would lessen the likelihood that the mentally ill may incorporate the stereotypes into their own personalities (Meile & Whitt, 1985).  It would help the mentally ill transition and reintegrate into society from the mental hospitals.  The possibilities are various and potentially powerful should they be applied to society at large. 

In summary, the results of this study show a hopeful trend for the mentally ill.  Through education and exposure to the mentally ill, stereotypes may be proven false and thus eradicated.  No longer will the mentally ill be plagued both by their illness and the reaction that society has to them.  This study shows that instead of fighting battles on all sides, should the public be exposed more and educated more, the mentally ill will only have to fight their illness.   This brings hope to the mentally ill, to their families, and to society. 

 

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References

Allport, G.W. (1954).  The nature of prejudice.  Cambridge,   MA:  Addison-Wesley.

Baron, Robert A., Byrne, Donn. (2003). Prejudice: Its   causes, effects and cures. Social Psychology, Tenth   Edition. (pp233-234).  Boston, A&B 

Baron, R., Piasecki, J. (1981).  The community versus community care. In R. Budson (Ed), New directions for mental health services: Issues in community residential care (pp63-76).  San Francisco: Jossey-Bass. 

Baumohl, Jim, Moyles, Edwin W., Segal, Steven P. (1980).  Neighborhood Types and Community Reaction to the Mentally Ill:  A Paradox of Intensity, Journal of Health and Social Behavior, 21, 345-359 

Boquet, Rudolph E., Bowen, William T., Twemlow, Stuart W.  (1978).  Assessing Community Attitudes Toward Mental  Illness. Hospital and Community Psychiatry, 29, 
251- 253.

Link, Bruce G., Cullen, Francis T., Struening, Elmer,  Shrout, Patrick E., Dohrenwend, Bruce P. (1989). A   Modified Labeling Theory Approach to Mental   Disorders:  An Empirical Assessment. American  Sociological Review, 54. 400-421

Markowitz, Fred E. (1998). The Effects of Stigma on the  Psychological Well-Being and Life Satisfaction of  Persons with Mental Illness. Journal of Health and  Social Behavior, 39, 335-347

Meile, Richard L., Whitt, Hugh P. (1985). Alignment,  Magnification,  and Snowballing:  Processes in the  Definition of  “Symptoms of Mental Illness.” Social  Forces 63, 682-696. 

Pettigrew, Thomas F. (1998). Intergroup Contact Theory.   Annual Review Psychology, 49, 65-85.

Severy, Lawrence J., Starr, Silver, Wilmoth, Gregory H.  (1987). Receptivity and Planned Change:  Community  Attitudes and Deinstitutionalization. Journal of  Applied Psychology, 72, 138-145.

Smith, Christopher J. (1981). Hospital Proximity and Public  Acceptance of the Mentally Ill. Hospital and Community  Psychiatry, 32, 178-180. 

Socall, Daniel W., Holtgraves, Thomas. (1992). Attitudes  Toward the Mentally Ill:  The Effects of Label and  Beliefs, Sociological Quarterly, 33, 435-446.

Wright, Eric R., Gronfein, William P., Owens, Timothy J.  (2000). Deinstitutionalization, Social Rejection, and  the  Self-Esteem of Former Mental Patients. Journal  of  Health and Social Behavior, 41, 68-90.

Basic Behavioral Science Task Force of the National  Advisory Mental Health Council Rockville, Maryland.  (1996). Basic Behavioral Science Research for Mental  Health,  Social Influence and Social Cognition,  American  Psychologist, 51, 478-484.
 
 

 

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Appendices

Appendix A

Please read the following vignette and then answer the attached questionnaire.  Upon completion, return the questionnaire to the experimenter and pick up the second questionnaire.  Thank  you!
 
 

You are in your favorite coffee shop, sitting at your favorite table, watching the customers come and go.  You see a young man, probably in his late teens, early twenties, enter the shop and glance around before settling on a table that is in the corner and allows him a view of the entire establishment.  He is tall and very thin.  His hair is longer than average, and he looks tired and rumpled, like maybe he slept in his clothes.  He orders a drink, and then waits for its delivery, all the while tapping his fingers on the table.  The waitress brings him his drink, and he stares at it for a minute before taking the first sip.  He leans back in his chair and tilts his head to one side.  A moment later he laughs to himself, and then takes another sip of the drink.  He quickly finishes the drink and then throws a couple of dollars on the table and exits the coffee shop. 
 
 

Appendix B

Please read the following vignette and then answer the attached questionnaire.  Upon completion, return the questionnaire to the experimenter and pick up the second questionnaire.  Thank  you!

The man in the following vignette is an asthmatic who uses an inhaler. 

You are in your favorite coffee shop, sitting at your favorite table, watching the customers come and go.  You see a young man, probably in his late teens, early twenties, enter the shop and glance around before settling on a table that is in the corner and allows him a view of the entire establishment.  He is tall and very thin.  His hair is longer than average, and he looks tired and rumpled, like maybe he slept in his clothes.  He orders a drink, and then waits for its delivery, all the while tapping his fingers on the table.  The waitress brings him his drink, and he stares at it for a minute before taking the first sip.  He leans back in his chair and tilts his head to one side.  A moment later he laughs to himself, and then takes another sip of the drink.  He quickly finishes the drink and then throws a couple of dollars on the table and exits the coffee shop. 
 
 

Appendix C

Please read the following vignette and then answer the attached questionnaire.  Upon completion, return the questionnaire to the experimenter and pick up the second questionnaire.  Thank  you!

The man in the following vignette has paranoid schizophrenia, but he is managing his condition with medication.

You are in your favorite coffee shop, sitting at your favorite table, watching the customers come and go.  You see a young man, probably in his late teens, early twenties, enter the shop and glance around before settling on a table that is in the corner and allows him a view of the entire establishment.  He is tall and very thin.  His hair is longer than average, and he looks tired and rumpled, like maybe he slept in his clothes.  He orders a drink, and then waits for its delivery, all the while tapping his fingers on the table.  The waitress brings him his drink, and he stares at it for a minute before taking the first sip.  He leans back in his chair and tilts his head to one side.  A moment later he laughs to himself, and then takes another sip of the drink.  He quickly finishes the drink and then throws a couple of dollars on the table and exits the coffee shop. 
 
 

Appendix D

Age:
Year of Graduation:
Sex:
Major:

Based on your first impressions from the vignette, please answer the following questions:

___How willing would you be to make small talk with this man in a social situation?

1 = Not at all 2 =Rarely   3 = Occasionally 4 = Often 5 = Always

___ How willing would you be to work in a group with this man?

1 = Not at all 2 = Rarely   3 = Occasionally 4 = Often 5 = Always

___How likely do you think it is that this man may have a decent job?

1 = Not at all 2 = Rarely  3 = Occasionally 4 = Often 5 = Very

___How likely do you think it is that this man has any close friends?

1 = Not at all 2 = Hardly  3 = Possibly  4 = Often 5 = Very

___Do you believe that this man is a violent person?

1 = Not at all 2 = Rarely  3 = Occasionally 4 = Often 5 = Always

___Do you believe that this man is a dangerous person?

1 = Not at all 2 = Rarely  3 = Occasionally 4 = Often 5 = Always

___How willing would you be to speak to the man from the vignette over the telephone?

1 = Not at all 2 = Slightly      3 = Possibly  4 = Likely 5 = Very likely

___Do you believe that this man has predictable behavior? 

1 = Not at all 2 = Rarely  3 = Occasionally 4 = Often 5 = Always

___Do you think that his man has a hygiene problem? 

1 = Not at all 2 = Not likely      3 = Possibly  4 = Likely 5 = Very likely
 

___Do you think this man has a close family?

1 = Not at all 2 = Not likely     3 = Possibly  4 = Likely 5 = Very likely

___How likeable do you think this person is?

1 = Not at all 2 = Tolerable  3 = Neutral 4 = Most of the time 5 = Always

___How attractive do you think this person is?

1 = Not at all 2 = Hardly  3 = Occasionally 4 = Often 5 = Always

___How intelligent do you think this person is?

1 = Not at all 2 = Hardly 3 = Average 4 = Above average 5 = Genius

___Do you think that it is likely that this person has a girlfriend?

1 = Not at all 2 = Not likely      3 = Possibly  4 = Likely 5 = Very likely

___How likely would you be to remember anything about this person the next time you saw him?

1 = Not at all 2 = Not likely      3 = Possibly  4 = Likely 5 = Very likely

___ How willing would you be to ride in an elevator with this man?

1 = Not at all 2 = In an emergency 3 = Occasionally 4 = Often 5 = Always

___How willing would you be to exchange emails with the man from the vignette?

1 = Not at all 2 = Slightly     3 = Possibly  4 = Likely 5 = Very likely

___If you have had contact with a person like the man from the vignette, how much contact have you had?

1 = None 2 = Little 3 = Occasional  4 = Often 5 = All the time

___How willing would you be to hang out with this man on a Friday night?

1 = Not at all 2 = Rarely  3 = Occasionally 4 = Often 5 = Always

___How much education in the field of psychology have you had? 
1 = 1 course  2 = 2 courses    3 = 3 courses      4 = 4 courses  5 = 5 or more courses 
 

Appendix E

Marlow Crowne Social Desirability Scale Sample Questions
INSTRUCTIONS:  The following statements concern personal attitudes and traits.  Read each item and decide whether the statement is true or false as it pertains to you personally. 

2. ___I never hesitate to go out of my way to help someone in trouble.
1 = True 2 = False

5. ___On occasion I have had doubts about my ability to succeed in life. 
1 = True 2 = False
1
0. ___On a few occasions, I have given up doing something because I thought too little of my ability
1 = True 2 = False

14. ___I can remember “playing sick” to get out of something.
1 = True 2 = False

21. ___I am always courteous, even to people who are disagreeable. 
1 = True 2 = False

26. ___I have never been irked when people expressed ideas very different from my own.
1 = True 2 = False

33. ___I have never deliberately said something that hurt someone’s feelings.
1 = True 2 = False
 
 
 

Appendix F

Please answer the following questions:
 

Tell me everything that you remember about the man from the vignette:
 
 

Do you think that the experimenter is testing exactly what she said she is testing? If so, what?
 
 

Did this affect your behavior in anyway?  If so, how?
 
 
 

Appendix G

Feedback to Participants
Thank you for participating in my study.  The purpose of the present study is to explore whether there is a relationship between the label of a mental illness and how a person thusly labeled is perceived.  It further delves into whether there is a relationship between the level of contact of those who encounter the mentally ill and the likelihood to “jump to conclusions” about expected behavior from the labeled person.  Past research suggests that when one is “labeled,” the general public has a tendency to treat the person according to the label, or to make judgments about that person which may be consistent with the stereotype associated with that label.  It is my hypothesis that the more exposure one has to the mentally ill, the less likely one is to engage in any stereotyping of that labeled person.

You were assigned to one of three different groups.  Each group was given the same vignette.  One group was told nothing, another group was told the man in the vignette had paranoid schizophrenia and is being treated with medication, and the third group was told that the man had a physical ailment, asthma.  The questions you answered were designed to assess your reactions to the label, taking into account exposure to these groups.  It is important to note that there are no “right” or “wrong” answers here.  There are many reasons for reaction to people in different ways.  This study just attempts to address one of the reasons.  It is also important to note that I am interested in group data only, not individual differences.  Your personal information will remain anonymous and confidential. 

In order to maintain the integrity of this study, the details you are now privy to need to remain confidential until I have gathered all my data.  If the details of the study were known before the questionnaire was administered, the questions may be answered in a biased way.  I am enlisting your aid in keeping this information confidential until November 26th.  After that date you are free to openly discuss the study with your classmates, friends, professors, family, etc.  If you have any questions/comments regarding my study, or would like to know the results, please contact me at mgelinas@anselm.edu
Thank you very much for your participation and cooperation!
 

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Relevant Links (examples)

Saint Anselm College
NAMI
Psych Info