Mental illness, stigma, and the media

Society is ingrained with prejudice toward mental illness, and sufferers are often widely perceived to be dangerous or unpredictable. Reinforcement of these popular myths through the media can perpetuate the stigma surrounding mental illness, precipitating shame, self-blame, and secrecy, all of which discourage affected individuals from seeking treatment. Efforts aimed at countering stigma in mental illness are faced with the challenge of centuries of discrimination and must, therefore, replace existing stereotypes with coverage of positive outcomes, as a first step in achieving the daunting task of overcoming these negative stereotypes. Long-term anti-stigma campaigns that encompass human-rights-based, normalization, and educational approaches are needed. The involvement of the media is essential for success, but, in order for the media to be used effectively, its motivations and limitations must first be recognized and understood.     

Mental illness and the media: Part II. Content analysis of press coverage of mental health topics

The public image of psychiatry has been tarnished in recent years. In order to determine the extent to which press coverage has contributed to negative attitudes towards psychiatry, we conducted a content analysis of a random selection of newspaper articles which appeared over a twenty-year period in two different newspapers. We found that although there had been some minor, cosmetic changes over the years, such as more appropriate headlines and more direct quotes from psychiatric experts, on the whole, content and attitudes had changed very little. An accuracy check of media reporting of forensic cases over a 20-year period revealed that when reporters have access to written material, the accuracy levels are greatly improved.     

Mental illness and mortality

For well over a century there have been studies^1–10 demonstrating that the mentally ill carry a greater than expected risk of early death. The observed to expected risk has ranged from fifty fold to two fold and has diminished over time. Organic brain disease usually has been found to have the worst prognosis. All types of physical disease, apart from cancer, have been found in excess, although in the earlier studies tuberculosis was the most noteworthy. The effect has been examined with differing methodologies on psychiatric populations in diverse clinical settings and in various countries in Europe and North America, but certain findings have been consistent. The excess mortality has been greatest in women, younger patients and within the first year after admission. The last result has led to the speculation that the patients, although diagnosed as being psychiatrically ill, were really suffering from physical disease.A confounding feature of this type of research has been that several psychiatric diagnoses are known to have an increased “unnatural” mortality risk. Thus, in comparison with the general population it is known that psychiatric patients are more likely to die by suicide¹¹ and accidents.¹² In order to examine the relationship between mental illness and death nowadays, when psychiatric patients spend only short intervals in hospital, it seems useful to look at “natural” and “unnatural” causes of death separately. Psychiatric patients, in general, are no longer subject to the ill effects of chronic institutionalization and should be receiving the health care provided for the general population. It was hypothesized that psychiatric patients would not show an excess mortality due to natural causes.     

ECT: an assessment of mental health professionals' knowledge and attitudes

The attitudes of four groups of mental health professionals (psychiatrists, nurses, psychologists, and social workers) toward ECT were compared to their levels of clinical experience, knowledge about ECT, and professional background. In each of these four groups a more positive attitude about ECT correlated with increased levels of clinical experience and knowledge.     

Recurrent depression: an assessment of family burden and family attitudes

Recognition that a psychiatrically ill family member has profound effects on family life and significant others has stimulated the need for more precise assessments of family members. The authors evaluated the burden experienced by those in the immediate environment of an individual with recurrent depressive illness as well as the beliefs they hold about the illness. This report presents a preliminary body of data on the level and types of distress shared by family members, especially family members living with the patient. Such information is valuable in designing educational interventions for family members in order to explore their attitudes and belief systems about depressive illness, to decrease the impact of family and other relationship stress on the patient, and to enhance the significant others' support of the patient.     

Mental hospital experience, classroom instruction and change in conceptions and attitudes towards mental illness.

Changes in conceptions and attitudes towards mental illness and the mentally ill were investigated in Israel. Questionnaires were presented to 69 student nurses, assessing stereotyped image, authoritarianism, social restrictiveness, benevolence, mental hygiene ideology and interpersonal aetiology before and after psychiatric affiliation in two kinds of mental hospitals, or before and after classroom instruction only. The findings lend cultural generality to previous observations and demonstrate that: (a) classroom instruction is ineffective as an agent of change; (b) practical experience involving personal confrontation with mental patients in a progressive psychiatric hospital, which contradicts the stereotyped image of mental patients and inculcates positive attitudes towards them, results in a change to a more professional scientific orientation and a more humane, accepting and liberal attitude; (c) under hospital conditions which support the stereotyped conception and authoritarian restrictive attitudes, the confrontation will result in preservation, even consolidation and strengthening, of the stereotyped image and undesirable attitudes towards mental patients. The findings were discussed and the implications for training programmes were drawn.     

Mental illness and employment discrimination

PURPOSE OF REVIEW: Work is a major determinant of mental health and a socially integrating force. To be excluded from the workforce creates material deprivation, erodes self-confidence, creates a sense of isolation and marginalization and is a key risk factor for mental disability. This review summarizes recent evidence pertaining to employment-related stigma and discrimination experienced by people with mental disabilities. A broad understanding of the stigmatization process is adopted, which includes cognitive, attitudinal, behavioural and structural disadvantages. RECENT FINDINGS: Stigma is both a proximate and a distal cause of employment inequity for people with a mental disability who experience direct discrimination because of prejudicial attitudes from employers and workmates and indirect discrimination owing to historical patterns of disadvantage, structural disincentives against competitive employment and generalized policy neglect. Against this background, modern mental health rehabilitation models and legislative philosophies, which focus on citizenship rights and full social participation, are to be welcomed. Yet, recent findings demonstrate that the legislation remains vulnerable to the very prejudicial attitudes they are intended to abate. SUMMARY: Research conducted during the past year continues to highlight multiple attitudinal and structural barriers that prevent people with mental disabilities from becoming active participants in the competitive labour market.     

Mental illness and physical disorders

Close association between mental disorders, e.g. depressive or anxiety disorders, and numerous physical diseases has been consistently reported in clinical studies of patients with specific medical disorders, as well as among persons undergoing treatment for mental disorders. Accurate classification of this comorbidity has major implications for diagnosis, treatment, and course of both the psychological disorders and concomitant somatic diseases. The article summarises studies and reviews of comorbidity of mental disorders and selected somatic conditions (oncological, cardiovascular, endocrinological, and musculo-skeletal disorders). Methodological issues, risk factors, possible mechanisms of comorbidity, and implications of these associations for diagnosis, treatment, and planning of future studies are described.     

Mental illness and criminal violence

This article examines the relationship between criminal violence and mental illness. Our data suggest that mentally ill persons tend to have an increased risk for committing violent offenses, and that the violent offending by these individuals tends to be recidivistic. Our findings suggest that parents who have both committed violent offenses and experienced a psychiatric hospitalization increase the risk of violent offending among their offspring. We propose the hypothesis that mentally ill parents transmit a biological characteristic which may genetically predispose their child towards criminal violence. Prenatal disturbances during critical periods of fetal development may provide clues regarding the etiology of criminal violence.