Persistent efforts to reduce the stigma associated with mental illness haven't succeeded as well as hoped, suggesting that new strategies might be necessary.
For decades, a number of organisations have been trying to persuade the public that mental illnesses such as depression, alcohol dependence and schizophrenia are neurobiological disorders, not just people behaving badly, hoping that harsh judgments would subside.
Even drug ads unintentionally bolstered the view of the mentally ill as having "lifelong" or permanent problems, with their emphasis on science-focused explanations of the brain mechanisms behind some mental illness, claims a study appearing in the American Journal of Psychiatry.
This study compared people's responses to vignettes describing individuals with mental illness in surveys conducted a decade apart, in 1996 and 2006.
Mental illness in the shadows
Certain attitudes did change for the better. For instance, in 2006, 67% of respondents believed major depression had a neurobiological basis, compared with only 54% in 1996.
And support for treatment rose over the years, with 79% supporting treatment for alcoholism in 2006, up from 61% in 1996. The proportion of respondents supporting treatment for depression also rose from 75% in 1996 to 85% a decade later.
But these changes didn't bring mental illness out from the shadows. Respondents still preferred to keep their distance from people with mental illness and still perceived them as dangerous - attitudes the researchers described as "surprisingly fixed".
If anything, the "stigma seems to be getting worse," said Patrick Corrigan, associate dean of psychology research and a distinguished professor with the Illinois Institute of Technology in Chicago.
Mentally ill children stigmatised
A 2007 study found that respondents to a survey who labeled children as mentally ill were more likely to want to keep their distance from them, as opposed to labeling the children as physically ill.
"I really do think people respond differently to problems of the body and problems of the mind. When you inject the genetic or biological explanation, it may convey a sense of permanence," said Bernice A. Pescosolido, lead author of the American Journal of Psychiatry article.
"If it's [cast as] biological or genetic, all of a sudden it takes on this air of permanence which people start to worry about."
So what might be the next strategy to reduce this pervasive stigma?
Corrigan believes the answer - or at least part of it - lies in stories, "having people with a condition tell their story. This, he said, might include a "way-down story" and a "way-up story": "the way-down proving you are a person with a mental illness and the way-up proving that you have recovered."
"Most people with serious mental illness do recover, so that's why way-up stories are so important," he added. "We would suggest that [these stories] be told to key power groups - instead of trying to change popular opinion, trying to change important power groups like landlords [and employers]."
'Everyone has something'
Pescosolido, who is a distinguished professor of sociology and director of the Indiana Consortium for Mental Health Services Research at Indiana University in Bloomington, believes that targeting youth would be helpful.
"Let's start working with the kids. The first two words that kids use to hurt each other are 'crazy' and 'gay'. Kids are already picking those things up," she said. "We need to get them early."
Does that mean handing teachers one more curriculum on top of race, safe sex and various other issues?
"I don't think so," she said. "We have to help [children] understand difference. She suggests making mental illness "part of a spectrum of illness, an 'Everyone Has Something' tag line," she said.
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