The Stigma Process: Part 3
Posted by Tammy Daily
In the second part of this discussion, we explored how the normal and typically adaptive ways in which people think about their social worlds works in the expression of negative attitudes about people with mental illness. Now we need to discuss how people can mindfully reshape this process using controlled rather than automatic processing.
First, what do I mean by automatic processing or automatic thinking? Aronson et al. (2010) define automatic thinking as “thinking that is nonconscious, unintentional, involuntary, and effortless.” People use categories, stereotypes, and schemas automatically all day long usually with good results. In contrast, controlled processing or controlled thinking is “thinking that is conscious, intentional, voluntary, and effortful.” There are pros and cons to both kinds of thinking. Controlled thinking requires a fair amount of motivation and attention meaning that the person has to choose to use it. What does it look like when we get people to shift out of auto pilot and into a controlled state of mind?
1. I redefine my category in terms of “people living with mental illness” placing the person first in the phrase. Doing this requires effortful attention to my choice of words. When I present this in class (I require the use of person first language in all written work) I am often met with narrowed eyes, crossed arms, and a scowl. This resistance is based at least in part on an assumption that tweaking language is nothing more than political correctness. I believe, however, that how we use language impacts how we think which impacts how we feel and that our emotions in turn affect what we choose to do. Seeing another person as a unique individual rather than as a label, changes the attributional landscape shifting us toward greater attention to the wide range of things that can and do influence behavior. This requires the motivation and attention of controlled or effortful thinking rather than the inattention and mindlessness of automatic thinking.
2. I redefine this category based on new, accurate attitudes and beliefs. One of the best ways to do this is by actually meeting people who live every day with mental illness. Students are often a bit taken aback by the fact that people with mental illnesses don’t look or act anything like the characters that have so often been presented to them on film. A group of students in the spring completed their Stigma Buster at a long-term care facility which also houses individuals with mental illnesses who require inpatient care. The students did art work with residents under direction of the facility’s art therapist. As they (students and residents) became comfortable with each other they started talking about themselves, their lives, the weather, politics, etc. What surprised the students was that the residents were so “normal”. They were also touched to hear from the staff that before their visit one resident had been mute. She had been speaking during their visit. I won’t speculate as to why. It could have been pure coincidence. It’s also possible that this is a population unaccustomed to being visited let alone by young, vibrant, and interested college students. Recognizing that the group composed of people living with mental illness is actually not homogeneous and involves tremendous diversity is a big step for students in the class. Taking that step challenges what social psychologists call the outgroup homogeneity effect which is the false sense we tend to have that people in outgroups (e.g., “the mentally ill”) are all alike. Another important part of this process is becoming more knowledgeable about mental illnesses and their treatment. When students are thinking about mental illness, their schema is typically dominated by schizophrenia specifically and psychosis generally. Pushing them out of that schema and toward of greater appreciation of the full range of psychological problems and treatment options is critical.
3. I recognize that the images used to create my stereotype are largely based on what I have seen on TV and in film. After the first semester of Movies & Madness, I read a course evaluation on which the student wrote, “Thanks for ruining TV for me! I can’t watch now without noticing how often people with mental illness aren’t presented right. My boyfriend won’t watch TV with me anymore because I’m always complaining about the characters.” I may have an evil streak, but I took that as a win. Another thing that happens regularly is that former students will email or Facebook message me with film or TV recommendations or to point out egregious acts of stigma. This suggests that they have continued to watch and pay attention long after leaving the class.
4. I use more accurate information to make new, more positive predictions and attributions about what individuals in the category will be like and how they will behave. One of the most powerful things that happens in the class is that students will come to realize that most of what they thought they knew about mental illness and mental health was inaccurate and begin to do their own research. On the first day of class, each student receives a small card which has a standard DSM-IV diagnostic category on it. These cards are handed out randomly (those of us with diagnoses don’t get to pick ours so they shouldn’t either). Their job is to find a reliable resource on the internet (yes, I did just say that) that will provide accurate diagnostic, descriptive, and treatment information. I warn them that the great god Google is a bit of a trickster and that search results are not random. When I searched “bipolar disorder” today, a pinkish box is shown at the top which contains a seemingly informative link for aboutbipolardepression.com which is actually an ad page for the antipsychotic SeroquelXR, a link (bipolarhelpforwomen.com) for an upscale treatment center for women, and a site (jannsencns.com) advertising RisperdalCONSTA (at least they don’t try to hide the fact that they are a drug company). Those “pink box” search results are followed by PubMed Health (through NIH and a .gov), NIMH.gov, Wikipedia.org, Mayo Clinic (a .com), Helpguide.org, WebMD.com, and NAMI.org. Only four of the first ten hits are .org or .gov sites. I tell them to avoid the .com sites and sites sponsored by pharmaceutical companies and instead focus on .org and .gov sites that are ad-free in order to avoid bias. And I don’t let them use Wikipedia although they are permitted to follow the links cited as references.
5. I begin to notice more and more examples of people with mental illnesses who are successful and productive as opposed to dependent and destructive. Within the first few weeks of the class, students must choose a first person narrative account of a person living with a mental illness to read and reflect on. I use an eight book series for this assignment which is available at www.copecaredeal.org. The books were developed as a part of the The Annenberg Foundation Trust at Sunnylands’ Adolescent Mental Health Initiative. The authors write about their experiences with bipolar disorder, depression, social anxiety disorder, anorexia, OCD, schizophrenia, suicidality, and drug addiction. Students’ responses to reading these books tend to center on three themes: they didn’t know mental illnesses were so serious and hard to deal with, they were unaware that these illnesses affect the whole family, and they didn’t know that people with these illnesses actually recover and become productive.
6. I will tend to make more nuanced attributions about the causes of the behavior I see in individuals that fit my newly defined category. One student wrote her first person narrative on Jared Kant’s The Thought That Counts. When she reflected on the impact of reading the book on her, she disclosed that her father had been diagnosed with OCD and that they were largely estranged. She had been angry with him and felt that he could stop being the way he was voluntarily. She felt he was being selfish and childish. After reading the book, she said she felt ashamed. She then turned that shame into reconnecting with her father because she now had a better grasp of what OCD really is.
7. When my image of people with mental illness is activated, the emotions I experience involve empathy and understanding. This student’s transformation involved moving from anger, embarrassment and disgust which were related to her belief that her father was causing his own problems to empathy because she could now make more appropriate attributions about the causes of his behavior. Another student chose to read Patrick Jamieson’s Mind Race which is about bipolar disorder. While he was reading the book, the student’s roommate asked what the book was about. He replied that it was about a guy with bipolar. The roommate said something like, “I have that.” My student was surprised at this revelation and they talked about the author’s experiences as well as those of the roommate.
8. The experience of empathy and understanding prompts acts of support, approach, advocacy, and other forms of meaningful, positive interaction. One final student story involves my nearly causing a fight in the local Walmart. A group of students, one from my class, went shopping for Halloween costumes. While they were looking, one man pulled a costume off the rack which involved an orange jumpsuit with the words “Cell Block Psycho” on it plus a Hannibal Lecter restraint mask and said how funny and cool it was. My student commented that he believed the costume was stigmatizing and explained why. Apparently there was a bit of a shouting match.
These shifts in perception require an effortful, intentional, mindful attention. I would argue that such effort is well worth it.
Aronson, E., Wilson, T.D., & Akert, R.M. (2010). Social psychology (7th Ed.). Upper Saddle River, New Jersey: Prentice Hall.
Kant, J.D., Franklin, M., & Andrews, L.W. (2008). The thought that counts: A firsthand account of one teenager’s experience with obsessive-compulsive disorder. New York: Oxford University Press.
Jamieson, P.E., & Rynn, M.A. (2006). Mind race: A firsthand account of one teenager’s experience with bipolar disorder. New York: Oxford University Press.