Stigma of Mental Illness Still Exists

Although the American public does not view all people with mental illness uniformly, evidence of stigma toward the mentally ill remains, results of a new national survey reveal.

Adults surveyed said that people with schizophrenia are more likely to have difficulty managing their daily affairs than are those with depression, for example. However, they viewed all people with mental illness, no matter what the severity, as less competent and more violent than others, according to a research team led by Bernice A. Pescosolido, PhD, of Indiana University Bloomington and Bruce Link, PhD, Columbia University.

"The results continue to reflect an underlying stigma towards persons with mental health problems, an exaggeration of the impairments or 'threat' posed by these disorders, and a startling negativity toward individuals with substance abuse problems," Pescosolido said.

The findings also reveal that two-thirds of the people surveyed would use legal means to force drug abusers to get treatment, while only about half favor coercion for those with schizophrenia or alcohol dependence, and a quarter favor it for those with major depression. Well over 90 percent of those surveyed, however, would force patients to get treatment when they present a danger to themselves or others.

"The very negative reactions to those with alcohol and drug abuse problems reflect the widely reported fear of Americans of substance abuse," said Pescosolido.

The investigators examined responses from 1,444 adults surveyed as part of the 1996 General Social Survey conducted by the National Opinion Research Center at the University of Chicago. Respondents read one of five vignettes describing an individual who has schizophrenia, major depression, alcohol abuse, substance abuse, or is generally "troubled." Respondents then evaluated the individuals' ability to make treatment or financial decisions, their propensity to act violently toward themselves or others, and whether they should be forced to obtain treatment.

The research was reported in the current American Journal of Public Health.

In general, people viewed persons displaying symptoms and behaviors consistent with diagnoses of schizophrenia and drug abuse problems as the least capable of making treatment and money management decisions, followed by abusers of alcohol, and depressed patients.

The responses were similar when asked to judge the danger that those with mental illness present to themselves and others, with drug abusers viewed as most dangerous, followed by individuals displaying symptoms of schizophrenia, alcohol abusers, and depressed patients.

"The public appears to hold an exaggerated view of the impairment faced by those with mental illness and the level of danger they present to themselves and others," said Pescosolido.

For example, although three quarters (74.3 percent) of respondents believe schizophrenia patients are unable to make treatment decisions, only about half (52 percent) of the schizophrenia patients in one recent study displayed impaired decision making.

Similarly, although almost two thirds (60.9 percent) of the public believes schizophrenia patients are prone to violence against others, just 17.9 percent of those with a major mental disorder in one recent study committed a violent act against others.

The researchers discovered few differences when they examined people's responses according to their sex, income, or other demographic factors. Older people were less convinced that the mentally ill could manage their treatment and money. Non-whites were more likely than whites to favor coercion, while women, the non-religious, and the more educated were less likely to condone it.

The General Social Survey, conducted by the National Opinion Research Center at the University of Chicago, is funded by the Sociology Program at the National Science Foundation. The Mental Health Module of the General Social Survey, "Problem in Modern Living" was made possible from a grant from the MacArthur Foundation and by a grant from the National Institute of Mental Health.

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The American Journal of Public Health is the monthly journal of the American Public Health Association. For information regarding the journal, contact Francisca Letren at (202) 777-2436.