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1 Three Strategies for Changing Attributions about Severe Mental Illness by Patrick W. Corrigan, L. Philip River, Robert K. Lundin, David L. Penn, Downloaded from https://academic.oup.com/schizophreniabulletin/article-abstract/27/2/187/1870993 by guest on 05 May 2019 Uphoff'Wasowski, John Campion, James Mathisen, Christine Kyle Qagnon, Qoldstein, and Mary Anne Kubiak Maria Bergman, Hiliel groups believe that eliminating stigma is essential to Abstract wholly improve the lot of persons with mental illness. Social psychologists who study strategies for chang- The effects of three strategies for changing stigmatiz- ing racial stereotypes have identified three approaches for ing attitudes—education (which replaces myths about changing stigmatizing attitudes: education, which seeks to mental illness with accurate conceptions), contact replace stigmatizing attitudes with accurate conceptions (which challenges public attitudes about mental illness about the disorders; contact, which challenges public atti- through direct interactions with persons who have tudes about mental illness through direct interactions with these disorders), and protest (which seeks to suppress persons who have these disorders (Corrigan and Penn, in stigmatizing attitudes about mental illness)—were and protest, which suppresses stigmatizing atti- press); examined on attributions about schizophrenia and tudes toward mental illness and behaviors that promote other severe mental illnesses. One hundred and fifty- these attitudes. The purpose of this study is to contrast the two students at a community college were randomly effects of these strategies on stigmatizing attitudes about assigned to one of the three strategies or a control con- mental illness. dition. They completed a questionnaire about attribu- tions toward six groups—depression, psychosis, cocaine addiction, mental retardation, cancer, and Research on Education, Contact, and AIDS—prior to and after completing the assigned con- Protest dition. As expected, results showed that education had no effect on attributions about physical disabilities but Several studies have examined the impact of education on led to improved attributions in all four psychiatric public attitudes about severe mental illness based on the groups. Contact produced positive changes that finding that persons who seem to be more knowledgeable exceeded education effects in attributions about tar- about mental illness are less likely to endorse stigma and geted psychiatric disabilities: depression and psy- discrimination (Roman and Floyd 1981; Link and Cullen chosis. Protest yielded no significant changes in attri- Link et al. 1987; Brockington et al. 1993). For 1986; butions about any group. This study also examined the example, graduate students who participated in brief effects of these strategies on processing information courses on mental illness showed improved attitudes about mental illness. about persons with psychiatric disabilities (Morrison Keywords: Recent life events, suicide, schizophre- 1980; Morrison et al. 1980; Morrison and Teta 1980; nia. Keane 1990, 1991). Members of the general public also Schizophrenia Bulletin, 27(2): 187-195,2001. demonstrated improved attitudes after completing short information sessions (Penn et al. 1994, 1999; Thornton Social stigma has a significant impact on the quality of and Wahl, 1996) and semester-long courses on severe life of persons with schizophrenia and other severe mental mental illness (Holmes et al. 1999). illnesses. Research suggests, for example, that citizens are Protest seeks to suppress negative attitudes and repre- less likely to hire persons who are labeled mentally ill sentations of mental illness. For example, newspaper and (Farina and Felner 1973; Bordieri and Drehmer 1986; Link 1987) and less likely to lease them apartments (Page Send requests to Dr. P. Corrigan, University of Chicago Center for 1983; Alisky and Iczkowski 1990). As a result, vari- 1977, Psychiatric Rehabilitation, 7230 Arbor Drive, Tinley Park, IL 60477; e- ous advocacy, government, and community service mail: [email protected]hicago.edu. 187

2 Schizophrenia Bulletin, Vol. 27, No. 2, 2001 P.W. Corrigan et al. poster advertisements for a film titled Crazy People were considerably by using an attributional analysis of stereo- types experienced by physically and psychiatrically dis- patently offensive; they included a picture of a cracked egg with hands and arms and the caption "Warning: Crazy peo- abled groups (Corrigan, in press). Research in this area ple are coming" (Wahl 1995). Paramount Pictures changed suggests that psychiatric disabilities are viewed more neg- atively than physical disabilities like cancer (Weiner et al. marketing strategies after pointed discussions with repre- Lin 1993; Weiner 1995). These findings suggest 1988; sentatives from several advocacy groups. The new adver- that the effects of stigma are specific to the disability. tisement had pictures of the film's stars, Dudley Moore Additional analyses showed that the relative severity of and Daryl Hannah, with the revised header "You wanna Downloaded from https://academic.oup.com/schizophreniabulletin/article-abstract/27/2/187/1870993 by guest on 05 May 2019 laugh tonight?" Citizens may be encountering far fewer stigma varies across groups depending on the attribution (Turk et al. 1986; Long 1990; Crandall and Moriarty sanctioned examples of stigma and stereotypes because of Perhaps, for example, research participants tend to protest efforts like this (Wahl 1995). There is, however, lit- 1995). tle empirical research on the psychological impact of assign more blame for their disorder to persons with cocaine addiction and psychosis than to persons with protest campaigns on people's prejudice about mental ill- depression and mental retardation. Researchers do not know, for example, whether a ness. "just say no to negative stereotypes" effort actually leads The present study examined the effects of brief edu- to more enlightened views of mental illness. cation, contact, and protest programs on attributions about physical and psychiatric disabilities; these programs Social psychological research on suppression of minority group prejudice has yielded some interesting specifically focused on the stigma related to severe mental findings that may answer questions about the short-term illnesses like depression and psychotic disorders. Hence, impact of protest. Suppression occurs when there is con- we expected education and contact to yield specific trolled inhibition of unwanted stereotypic thoughts and is improvements in stigma about psychiatric disability; no changes were expected in attributions about the physically evinced when persons either no longer endorse prejudice disabled group. In addition, our study also examined rela- or fail to recall specific stereotypes (Devine 1989; Macrae tive change in attributions within the spectrum of psychi- et al. 1996). Unfortunately, protest and suppression may atric disabilities. Specifically, how would strategies that yield an unwanted rebound effect. Namely, persons who are ordered to suppress negative stereotypes tend to be target attributions about psychotic disorders and depres- sion affect attributions about persons with mental retarda- more sensitized to them; this sensitization leads to tion or substance abuse? Given the rebound effects mat unwanted recollections about the stigmatized group result from protest, we expected that study participants in (Macrae et al. 1994a; Macrae et al. 1996). the protest group would show no changes. A third way to change public attitudes about mental illness is to facilitate interactions between citizens and The purpose of this study was not limited to examin- ing the effects of education, contact, and protest on persons with psychiatric disabilities. Studies have shown knowledge structures. We also examined how diese strate- an inverse relationship between having contact with a per- gies affected the subsequent processing of social informa- son with mental illness and endorsing psychiatric stigma tion. Related research on minority groups has shown that (Link and Cullen 1986; Penn et al. 1994; Holmes et al. 1999; negative attributions affect perceptions of those groups Penn et al. 1999). However, it is unclear from these persons who endorse stigma about minority groups studies whether contact led to diminished stigma or per- (i.e., are more likely to attend to and recall negative character- sons who do not stigmatize were more likely to seek con- tact. Other research on racial stereotypes showed that per- istics of representatives of that group) (Johnston and sons randomly assigned to contact with a minority group Macrae 1994; Macrae et al. 1994Z>). Hence, a final goal of member (versus no contact) have diminished prejudice this study was to determine the effects of education, con- tact, and protest on recollection of positive and negative toward that group (Desforges et al. 1991; and reviews by statements about a person labeled as "mentally ill." Hamburger 1994; Gaertner et al. 1996). Research is still needed to determine the effects that contact with a person with psychiatric disability has on public attitudes about mental illness. Methods Research participants in this study were ran- Overview. domly assigned to one of four stigma-changing condi- An Attributional Analysis of Strategies tions: education, contact, protest, or control groups. That Challenge Stigma Participants completed measures of attributions about dis- abilities prior to the stigma-changing condition and after The purpose of this study is to compare the effects of edu- completion. They were also tested on their recollections cation, contact, and protest on knowledge structures about about a videotape of a person with mental illness. mental illness. Research has advanced theory in this area 188

3 Schizophrenia Bulletin, Vol. 27, No. 2, 2001 Three Strategies Adults enrolled at a community college in they are incapable of caring for themselves.") followed by Participants. metropolitan Chicago were recruited for this study. All of a rebuke against continuing these dioughts (e.g., "This is the 152 adults solicited for the study agreed to participate untrue. Shame on us for wanting to keep persons with and completed all measures. The sample had an average mental illness away from their communities."). To facili- age of 25.7 years (standard deviation [SD] = 9.7) and was tate this goal, the presentation included 14 slides that 67.8 percent female. Of the sample, 72.3 percent were reviewed disrespectful ways in which persons with mental illness are portrayed in die media. Poignant examples single, 11.2 percent were married, and 16.5 percent were separated, divorced, or widowed. The sample was 51.3 Media Madness. were taken from Ward's (1995) book, Downloaded from https://academic.oup.com/schizophreniabulletin/article-abstract/27/2/187/1870993 by guest on 05 May 2019 percent European-American, 35.3 percent African- New One slide, for example, featured a headline from die American, and 13.4 percent other. One-way analyses of that read "Freed Mental Patient Kills Mom." York Post These examples were followed by condemnations against variance (ANOVAs) failed to show a significant differ- > 0.25). Moreover, media representations of mental illness and societal reac- ence in any variable across groups (p demographic variables were not found to be significantly tion in general along with clear commands mat "We must stop dunking diat way!" Discussion questions included associated with change in attribution factors; die largest asking participants to recall examples of stigma about value from 72 correlations among change in 12 attribution r = 0.20. Hence, mental illness from books, television, and die media as a factors and six sets of demographics was whole. it is unlikely that minor differences in demographics across groups confounded die results of this study. Three group leaders were trained to provide the edu- cation, protest, and control conditions for die study. The scripts for these presentations were written out and read Stigma-Changing Conditions. Each condition was con- verbatim by die leader. The presentation for education, ducted by a single leader with four to eight participants in a quiet room wim no distractions. Each program included protest, and control conditions included slides to illustrate key points. Leaders from all conditions were also pro- two parts: a 10-minute presentation immediately followed vided widi a set of open-ended questions about the corre- by a 5-minute discussion. Written copies of the presenta- sponding presentation to facilitate discussion. Group lead- tions and discussion questions are available from the first ers rotated through all conditions and were assigned using author. Earlier research has shown that short stigma- changing programs lead to significant change in attitudes a Latin square. Analyses showed no effect related to die leader of the presentation, so we reported results col- (Penn et al. 1994, 1999). The goal of the education, protest, and contact presentations and discussions was to lapsed across leaders. diminish specific stigma about depression and psychotic Research participants in uie contact condi- Contact. disorders. Hence, the presentations did not discuss stereo- tion listened to a 10-minute presentation by one of two types commonly experienced by persons with other physi- persons who discussed tiieir history of severe mental ill- cal disabilities or psychiatric disorders, such as mental These persons had at least a 7-year history of psy- ness. retardation or addictions. The control presentation chotic symptoms, suicide attempts, and hospitalization for reviewed "Hobbies and Technology in the 90s" and dis- bipolar disorder. Bodi persons now live independently, are cussed no issues related to mental illness or physical dis- relatively symptom-free, work, and report a satisfactory ability. quality of life. Analyses of outcome data showed research participants did not differ by contact group leader; hence, Education and protest The key component to edu- data were collapsed across contacts for subsequent analy- cation programs is replacing myths about mental illness ses. with correct information (Corrigan and Penn, in press). Hence, die education presentation reviewed seven myths Several factors have been shown to augment the drawn from the literature (Harding and Zahniser 1994; impact of contact on public attitudes and were incorpo- Penn et al. 1999) and facts that challenge these myths. rated into die contact condition (Stephan 1987). Contact The presentation included discussions about die relation- effects are enhanced when members of die public meet ship between psychoses and violence, homelessness, and persons who mildly disconfirm die stereotype (Weber and independence. Leaders augmented dieir presentation with Crocker 1983; Johnston and Hewstone 1992); despite suc- 14 photographic slides that specifically paired myths (e.g., cessful outcomes, the two contact group leaders still "Persons with mental illnesses like schizophrenia are vio- struggled with recurring symptoms and discussed this lent and should be avoided.") with research findings (e.g., struggle in dieir presentation. The effects of contact are "Most persons with mental illness are no more violent facilitated when participants are able to interact with con- than die average citizen."). tacts (Johnson et al. 1984; Worchel 1986); hence, contact group leaders provided a 5-minute discussion in which The goal of protest programs is to present a morally participants questioned diem about living widi mental ill- untenable position regarding a minority group (e.g., ness. "Mentally ill patients should be institutionalized because 189

4 Schizophrenia Bulletin, Vol. 27, No. 2, 2001 P.W. Corrigan et al. After com- Measuring stigma-changing processes. disability are to blame for their disorder and should be avoided. High stability scores meant the sample believed pleting the two measures discussed below, research partic- that persons with disability do not benefit from counseling ipants answered a five-item pencil-and-paper survey of their experience of the stigma-changing condition to or medical care and do not recover from that disability. which they were assigned. Participants rated topics and Hence, a decrease from baseline indicated improved attri- butions about mental illness. group leaders on 7-point Likert Scales (1 = leader was not very believable; 7 = leader was very believable). A factor We used a method Life Story Memory Test. analysis on responses provided by participants in this designed by Macrae and colleagues (Johnston and Macrae Downloaded from https://academic.oup.com/schizophreniabulletin/article-abstract/27/2/187/1870993 by guest on 05 May 2019 study yielded two factors with eigenvalues greater than 1994; Macrae et al. 1994fe) to assess the impact of stigma- 1.00. The first factor represented participants' views of changing strategies on the perception and recollection of leaders —whether they seemed knowledgeable, their persons with severe mental illness. Participants viewed believable, and likeable. The second factor represented two videotapes, each about 3 minutes long, of an actor the topic —whether it seemed important and interesting. labeled "mentally ill" who is telling his or her life story. We will examine relationships between these factors and The narrative contained 20 items, 10 that were reliably attribution changes that result from education, contact, = 29) as negative and stereotypic (n rated by a pilot group and protest to identify process variables that enhance statements about mental illness (e.g., "Sometimes I stigma change. believe I'm George Washington.") and 10 that were rated as positive statements (e.g., "I work as an engineer."). Dependent Measures These items were randomly ordered and then written into Psychiatric Disability Attribution Questionnaire. a coherent narrative that the actor read on the videotape. The Psychiatric Disability Attribution Questionnaire Ten minutes after viewing each videotape (during which (PDAQ) was based on earlier work by Weiner (1988, time participants were instructed to complete an interfer- 1995) who examined ratings of controllability and stabil- ence task: to draw a map of their childhood home or ele- ity attributions for physical and disability groups. The mentary school), participants were asked to write down as PDAQ comprised similar items to represent controllabil- many of the statements as they could remember. A rater ity and stability attributions for a broader set of psychi- counted the number of positive and negative statements in atric disabilities (Corrigan et al., in press). Four of the six the list. Two independent raters counted positive and neg- disability groups represented commonly stigmatized psy- ative statements from the lists of 30 percent of the partici- chiatric diagnoses: mental retardation, cocaine addiction, they showed 100 percent agreement in their ratings. pants; psychosis, and depression. Attributions about this group Participants were administered the task only once, are contrasted with two physical disabilities from the after completing the stigma-changing condition. Pre- and study by Weiner et al. (1988): cancer and AIDS. posttest administration of the Life Story Memory Test Research participants rated each group on six items would have led to a learning effect that might have con- using a 7-point agreement scale (1 = agree; 7 = disagree). founded test results. Two indices were determined from These ratings were completed prior to and immediately the data for this study: negative ratio (the number of nega- after participating in the assigned condition. Four of the tive statements divided by the number of total recalled items were selected from the controllability (blame for statements) and positive ratio (the number of positive problems, pity) and stability (benefit from counseling and statements divided by the number of total recalled state- benefit from medicine) attributions tested by Weiner et al. ments). Two additional items were added to address controllabil- ity and stability issues discussed in literature about mental illness: Should persons with mental illness be avoided Results (Brockington et al. 1993), and will persons with mental illness recover (Fisher 1994; Miller et al. 1997)? Results Means and SDs of PDAQ factor scores for each of the six of a factor analysis showed that these items yielded two disability scores are summarized in table 1. These scores factors for each of the six disability groups that were con- were determined from pre- and posttest administrations of sistent with controllability and stability attributions. These the scale and are listed by stigma-changing condition. factor scores have adequate test-retest reliability (ranging Then 4X2 ANOVAs were completed to examine condi- from 0.57 to 0.83, depending on disability) and concur- tion by trail interactions for the attribution factors specific rent validity (Corrigan et al., in press). to each of the six disability groups. This generated a set of 12 4X2 ANOVAs: six representing the variance of con- The PDAQ yielded 12 scores: controllability and sta- trollability attributions across the six disability groups, and bility factor scores for each of the six disability groups. six representing stability attributions across the six groups. High controllability scores suggested that the sample Results of the ANOVAs are summarized in table 2. agreed with the view that persons with the corresponding 190

5 Three Strategies Vol. 27, No. 2, 2001 Schizophrenia Bulletin, Table 1. Means and standard deviations of disability attribution questionnaire factors by condition and trial Control Education Protest Contact Pre Post Pre Post Pre Post Pre Post Cancer Controllability 2.5(1.0) 3.0(2.0) 2.8(1.3) 3.0(2.0) 2.8(1.9) 2.9(1.5) 3.0(1.6) 3.3(1.8) Stability 7.9(2.9) 8.2(3.7) 8.3(3.8) 7.5(3.7) 8.4(3.9) 8.2(3.8) 7.4(3.3) 6.9(3.4) Downloaded from https://academic.oup.com/schizophreniabulletin/article-abstract/27/2/187/1870993 by guest on 05 May 2019 Depression Controllability 3.7 (2.3) 4.5 (2.5) 4.2 (2.8) 4.1 (2.9) 3.8 (2.4) 3.7 (2.2) 4.7 (2.5) 4.1 (2.5) Stability 5.9 (2.7) 6.1 (3.0) 7.7 (3.7) 6.1 (3.0) 7.3 (3.9) 7.1 (4.0) 7.0 (2.7) 6.0 (2.4) Psychosis Controllability 5.4(2.9) 4.7(2.4) 5.3(2.6) 4.5(2.5) 4.9(2.5) 4.7(2.3) 5.6(2.1) 4.7(2.0) Stability 9.7(3.2) 8.2(3.5) 10.3(3.5) 8.1(3.5) 9.1(3.4) 8.9(4.2) 9.5(3.5) 7.6(3.2) Cocaine addiction Controllability 8.5(3.2) 8.7(3.3) 8.9(3.9) 7.5(3.8) 9.2(3.6) 8.6(3.7) 10.1(3.1) 9.2(3.1) Stability 11.0(3.9) 9.9(3.9) 11.2(3.7) 9.7(3.7) 10.1(3.5) 10.6(4.7) 10.3(3.6) 9.7(4.2) Mental retardation Controllability 3.3(1.7) 3.2(1.8) 3.7(2.5) 3.5(2.4) 2.7(1.2) 2.7(1.3) 3.5(1.8) 3.7(1.8) Stability 14.1(4.4)12.9(5.0) 13.5(4.2) 9.6(4.3) 13.4(4.0) 12.1(4.4) 12.5(3.7) 11.2(4.7) AIDS Controllability 5.6(3.1) 5.7(3.2) 4.8(3.2) 4.7(3.0) 5.4(3.3) 5.0(3.4) 5.2(2.8) 5.4(2.2) Stability 10.8(3.9)10.6(4.2) 11.3(4.2) 9.6(4.0) 10.2(4.1) 10.3(4.3) 10.5(3.3) 10.3(4.0) Table 2. Summary of 4 x 2 ANOVAs with controllability and stability factors listed for each disability group Condition Trial Interaction Post hoc contrasts Cancer fl(1,148) = 4.36, p< 0.05 F{3, 148) =0.27, ns ns Controllability ^3,148) = 0.50, 148) = 1.63, ns F\3,148) = 0.67, ns Stability F{3,148) = 0.90, ns F{1, Depression ns ns fl[3,148) = 4.15, p< 0.05 ct>cl Controllability /^3,148) = 0.56, F(1,148) = 0.00, 148) = 1.20, /^I,148) = 7.56, p<0.05 F{3, 148) =2.68, p<0.05 edu = ct>cl; edu>pro F{3, Stability ns Psychosis F{3, ns F^1,148)= 14.77, p< 0.05 F{3, 148) = 0.91, ns Controllability 148) = 0.44, F{3, 148) = 0.23, ns fl(1,148) = 32.00, p< 0.05 F{3, Stability 148) = 3.43, p<0.05 edu = ct = cl > pro Cocaine addiction F(3, 148) = 2.82, p<0.05 edu>cl = pro Controllability ^3,148) = 1.20, ns /=(1,148) = 18.94, p<0.05 148) = 0.12, F(1,148) = 6.26, p< 0.05 F(3,148) = 2.48, p< 0.10 edu = cl>pro Stability F{3, ns Mental retardation fl[1,148) = 0.04, ns F(3,148) = 0.52, ns Controllability ^3,148) = 2.28, ns 148) = 1.91, ns fl[1,148) = 41.46, p< 0.05 F\3, 148) =4.99, p< 0.05 edu > cl = ct = pro Stability F{3 t AIDS F{3, 148) = 0.45, Controllability fl[1,148) = 0.40, ns F[3, 148) = 0.88, ns ns Stability 148) = 0.10, ns fl[1,148) = 5.99, p< 0.05 ^3,148) = 3.49, p< 0.05 edu > cl = ct = pro F{3, education; ANOVA = variance; cl = Note.— ct = contact; edu = analysis of ns = nonsignificant; pro = protest Post hoc contrasts rep- control; resent pairwise 2x2 ANOVAs. Conditions yielding the largest positive changes in Psychiatric Disability Attribution Questionnaire factor scores are listed first. 191

6 Schizophrenia Bulletin, Vol. 27, No. 2, 2001 P.W. Corrigan et al. Significant interactions were noted for controllability Table 3. Means and standard deviations of and/or stability attributions about each of the psychiatric positive and negative items recalled from the disability groups as well as the AIDS group. A significant Life Story Memory Test interaction was not found for controllability and stability Negative Positive ratings about cancer. Table 2 also includes post hoc Mean (SD) Mean (SD) Tukey's test for variables that yielded significant interac- 1 1 Control 0.55 (0.11) 0.42 (0.12) tions for the 4 X 2 ANOVA. Post hoc comparisons exam- 1 1 ined pre- and posttest changes in pairs of stigma-changing Education (0.12) 0.40 0.53 (0.14) Downloaded from https://academic.oup.com/schizophreniabulletin/article-abstract/27/2/187/1870993 by guest on 05 May 2019 conditions for each PDAQ variable. Several trends are 1 1 Protest 0.55 (0.12) (0.09) 0.42 apparent by examining these comparisons. 2 2 Contact 0.62(0.14) (0.11) 0.33 Contact yielded significant changes in three of four attri- Note. —SD = standard deviation. Results of post hoc contrasts butions about the target groups of this study: persons with Indicate that means in each column with different superscripts dif- psychoses and depression. Education seemed to have a fer significantly (p < 0.05). broader effect, yielding significant change in stability attribu- tions about depression, psychosis, cocaine addiction, mental retardation, and ADDS. Protest, on the other hand, yielded no Discussion significant change in attributions about psychiatric or physi- cal disability. This is especially notable given that partici- The effects of three stigma-changing conditions—educa- pants in the control condition changed in stability attributions tion, contact, and protest—on attributions about mental as the result of taking the PDAQ twice during the study. illness were examined in this study. Results suggested that education and contact led to attitude change, while protest yielded no improvement. Moreover, compared to the Pearson's product moment correla- Process Variables. other groups, contact seemed to improve public percep- tions between the two factors of the process measure and tions and recollections of persons with mental illness. selected PDAQ attribution change scores for contact and Education seemed to produce relatively broad effects, education conditions were determined. Only PDAQ attri- bution scores that changed significantly as the result of improving attributions about mental retardation and cocaine addiction as well as psychoses and depression. contact and education were included in these analyses. Interestingly, education also seemed to improve attribu- Results showed no clear trends between change in attribu- tions because of contact and the process measure factors; tions about AIDS. To explain this finding, consider the group of disabilities that Weiner and colleagues (1988) only the relationship between the leader factor of the called "mental-behavioral" in their study; they included process measure and change in controllability attributions 0.05). p about depression was significant (r = 0.28, < drug addiction, child abuse, and ADDS. This group was characterized by "aberrant behavior" that led to the dis- The leader factor, however, seemed to correlate with ability. Hence, the more positive attributions about change in attributions as a result of education. Research cocaine addiction that resulted from education seemed to participants who rated their leaders as more knowledge- spread to AIDS. Despite the breadth of these findings, able or believable showed greater improvements in attri- note that education had no effect on attributions related to butions about mental illness after participating in the edu- physical disabilities like cancer. Hence, education seemed cation program (r ranged from 0.31 to 0.38). Impressions to yield a specific effect on attributions related to mental- about whether the topic was interesting or important did behavioral disabilities. not seem to significantly predict attribution change as a result of contact and education. The effects of education were most noticeable on sta- bility attributions. Namely, research participants who completed the education condition seemed more willing Recollections About Persons with Mental Illness to agree that persons with mental-behavioral disabilities Means and SDs of the positive and negative ratio scores benefit from medical and psychotherapeutic treatments from the Life Story Memory Test are summarized in table 3. and, therefore, have the potential to recover. Views about Results of a one-way ANOVA for the positive ratio score controllability seemed less amenable to education; this 0.05). Post hoc p < were significant (F(3,148) = 3.05, finding is unfortunate because controllability attributions Tukey's tests showed that the ratio of positive to overall have been found to be related to family attitudes and soci- recalled items was significantly greater (p < 0.05) for partic- etal rejection (Weissman et al. 1993; Crandall and ipants in the contact group compared to the other three Moriarty 1995; Hooley and Licht 1997). groups. A second ANOVA also yielded positive results (F(3,148) = 4.27, 0.01). Once again, post hoc tests Analyses of participants' comments about the educa- p < showed that participants from the contact group recalled tion process provided additional information about the fewer negatives than persons from the other three groups. impact of this stigma-changing strategy. Namely, research 192

7 Vol. 27, No. 2, 2001 Schizophrenia Bulletin, Three Strategies Failure to show change in attributions after protest participants who rated the leader as more interesting, does not suggest protest should be discounted as a stigma- believable, and likeable showed greater improvement in changing strategy altogether. Typically, protest in relation stability attributions. The importance of and interest in to psychiatric stigma has been used to suppress behavior, education topics did not seem to correlate with change in not attitudes and attributions (Corrigan and Penn, in stability attributions. Hence, having a reasonable argu- For example, advocates have used protest strate- press). ment that challenges myths about mental illness may not gies to challenge stigmatizing representations of mental be sufficient; participants also value credible and compe- illness in the media. Future investigations need to adopt a tent leaders. Downloaded from https://academic.oup.com/schizophreniabulletin/article-abstract/27/2/187/1870993 by guest on 05 May 2019 controlled research design, like the one used in this study, The effects of contact on attributions seemed to yield to test the impact of protest on behavior. For that matter, narrower and more specific results. Research participants future research also needs to examine the impact of edu- showed improved attributions about the groups targeted in cation and contact on behavior. Do improved attributions the study: depression and psychoses. Contact led to lead to more affirming behaviors on the part of the public improved attributions about the controllability and stabil- (e.g., joining stigma-changing campaigns against stigma- ity of depression and the stability of psychosis. In addi- tizing media sources)? Of equal importance, do improved tion, contact was the only stigma-changing strategy that attributions lead to diminished discriminatory behavior? affected subsequent processing of information about per- For example, are landlords less likely to withhold housing sons with mental illness. Namely, participants who com- opportunities as a result of programs like these? pleted the contact condition recalled more positive and less negative information about the life story of individu- The strategies tested in this study were relatively lim- als with mental illness. Future research should examine ited. Future research needs to determine whether the how characteristics of contact affect change in public atti- immediate effects of stigma change persist over time. Do tudes. Surprisingly, participants' ratings about the credi- participants who change attributions as the result of edu- bility of contacts did not correlate with attribution change. cation and contact continue to endorse the more positive attributions months or years later? Perhaps longer pro- Protest seemed to have no significant effects on attri- grams that provide distributed exposure to myths and con- bution change; in fact, it failed to change attributions for tacts are needed. Moreover, future research needs to scales that were shown to improve significantly in the con- trol group as the result of completing the attribution mea- include field-based designs where the impact of educa- sure twice. Moreover, protest seemed to have no effect on tion, contact, and protest efforts of advocacy groups can be examined. Although there is much to be studied, recollections of the life stories of persons with mental ill- ness. What factors account for the absence of attribution research like this suggests that a combination of stigma- changing strategies and biopsychosocial treatments will change after protest? Studies of memory rebound because provide the best outcomes and opportunities for persons of attitude suppression suggest that protest may have lim- ited social cognitive effects. According to this model with mental illness. (Macrae et al. 1994a; Macrae et al. 1996), the act of trying to suppress a negative attitude about a minority group References actually maintains that knowledge structure in working memory. As a result, individuals who participate in protest Alisky, J.M., and Iczkowski, K.A. Barriers to housing for programs are more sensitized to, and thus more likely to Hospital and deinstitutionalized psychiatric patients. recall, negative information about mental illness. Research Community Psychiatry, 41:93-95, 1990. on this model suggests, however, that negative recollec- Bordieri, J., and Drehmer, D. Hiring decisions for dis- tions are significantly greater in control groups, a hypothe- abled workers: Looking at the cause. Journal of Applied sis that was not supported in this study. Moreover, research Psychology, Social 16:197-208, 1986. has not directly examined the effects of suppression rebound on attitude and attribution change. Brehm, J. W. A Theory of Psychological Reactance. New Alternatively, the absence of change because of York, NY: Academic Press, 1996. protest may be explained by Brehm's (1966) notion of Brockington, I.; Hall, P.; Levings, J.; and Murphy, C. The psychological reactance (Clark 1994; Dowd et al. 1994; British Journal community's tolerance of the mentally ill. Fogarty 1997). According to this theory, persons are less 162:93-99, 1993. of Psychiatry, likely to comply with a request when that request is per- Clark, R.D. The role of censorship in minority influence. ceived as limiting choices. Increasing external pressure 24:331-338,1994. European Journal of Social Psychology, decreases compliance. Participants in the protest group Corrigan, P.W. Mental health stigma as social attribution: were less likely to view disabled groups benignly because Implications for research methods and attitude change. they were ordered to do so. Reacting to the perceived Clinical Psychology: Research and Practice, in press. restriction of choice leads to no change in attributions. 193

8 Schizophrenia Bulletin, Vol. 27, No. 2, 2001 P.W. Corrigan et al. Corrigan, P.W., and Penn, D.L. Lessons from social psy- Hooley, J.M., and Licht, D.M. Expressed emotion and American causal attributions in the spouses of depressed patients. chology on discrediting psychiatric stigma. 106:298-306, 1997. Journal of Abnormal Psychology, Psychologist, in press. Corrigan, P.W.; River, L.P.; Lundin, R.K.; Uphoff- Johnson, D.W.; Johnson, R.; and Maruyama, G. Goal interdependence and interpersonal attraction in heteroge- Wasowski, K; Campion, J.; Mathisen, J.; Goldstein, H.; neous classrooms. In: Miller, N., and Brewer, M.B., eds. Bergman, M.; and Gagnon, C. An attribution^ analysis of New York, NY: Academic Press, Groups in Contact. the stigma of mental illness. Journal of Community 1984. pp. 187-213. Psychology, in press. Downloaded from https://academic.oup.com/schizophreniabulletin/article-abstract/27/2/187/1870993 by guest on 05 May 2019 Johnston, L., and Hewstone, M. Cognitive models of Crandall, C.S., and Moriarty, D. Physical illness stigma stereotype change: HX Subtyping and the perceived typi- and social rejection. British Journal of Social Psychology, Journal of cality of disconfirming group members. 34:67-83, 1995. Psychology, Experimental Social 28:360-386, 1992. Desforges, K.M.; Lord, C.G.; Ramsey, S.L.; Mason, J.A.; Johnston, L.C., and Macrae, C.N. Changing social stereo- Van Leeuwen, M.D.; West, S.C.; and Lepper, M.R. European types: The case of the information seeker. Effects of structured cooperative contact on changing neg- Journal of Social Psychology, 24:581-592, 1994. ative attitudes toward stigmatized social groups. Journal of Personality and Social Psychology, 60:531-544, 1991. Keane, M. Contemporary beliefs about mental illness among medical students: Implications for education and Devine, P.G. Stereotypes and prejudice: Their automatic 14:172-177, 1990. Psychiatry, practice. 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Health care reform based on an empower- American Sociological Review, tions of rejection. ment model of recovery by people with psychiatric dis- 52:96-112,1987. Hospital and Community Psychiatry, abilities. 45:913-915, 1994. Link, B.G., and Cullen, FT. Contact with the mentally ill and perceptions of how dangerous they are. Journal of Fogarty, J.S. Reactance theory and patient noncompli- Health and Social 27:289-303, 1986. Behavior, 45:1277-1288, 1997. Social Science and Medicine, ance. Link, B.G.; Cullen, FT; Frank, J.; and Wozniak, J.F The Gaertner, S.L.; Rust, M.C.; Dovidio, J.F.; Bachman, B.A.; social rejection of former mental patients: Understanding and Anastasio, PA. The contact hypothesis: The role of a American Journal of Sociology, why labels matter. common ingroup identity on reducing intergroup bias 92:1461-1500, 1987. among majority and minority group members. In: Nye, What's Social about Social J.L., and Brower, A.M., eds. Long, A. Dimension of illness. Unpublished doctoral dis- Cognition? Thousand Oaks, CA: Sage, 1996. pp. sertation, University of California at Los Angeles, 1990. 230-260. Macrae, C.N.; Bodenhausen, G.V.; Milne, A.B.; and Hamburger, Y. The contact hypothesis reconsidered: Jetten, J. Out of mind but back in sight: Stereotypes on Effects of the atypical outgroup member on the outgroup Journal of Personality and Social the rebound. stereotype. Basic and Applied Social Psychology, 67:808-817, 1994a. Psychology, 15:339-358, 1994. Macrae, C.N.; Bodenhausen, G.V.; Milne, A.B.; and Harding, CM., and Zahniser, J.H. Empirical collection of Wheeler, V. On resisting the temptation for simplification: seven myths about schizophrenia with implications for Counterintentional effects of stereotype suppression on Acta Psychiatrica Scandinavica, 90(Suppl treatment. 14:1-20, 1996. social memory. Social Cognition, 140-146, 1994. 384): Macrae, C.N.; Milne, A.B.; and Bodenhausen, G.V. Holmes, E.P.; Corrigan, P.W.; Williams, P.; Canar, J.; and Stereotypes as energy-saving devices: A peek inside the Kubiak, M. Changing public attitudes about schizophre- cognitive toolbox. Journal of Personality and Social Schizophrenia Bulletin, 25:447^56, 1999. nia. Psychology, 66:37^7, 194

9 Three Strategies Schizophrenia Bulletin, Vol. 27, No. 2, 2001 Turk, D.C; Rudy, T.E.; and Salovey, P. Implicit models of Manual of Miller, N.S.; Gold, M.S.; and Smith, D.E., eds. Journal of Behavioral Medicine, illness. 9:453-474, 1986. New York, NY: Wiley-Liss, Therapeutics for Addictions. 1997. OF. Media Public Wahl, Images of Mental Illness. Madness: Morrison, J.K. The public's current beliefs about mental New Brunswick, NJ: Rutgers University Press, 1995. illness: Serious obstacle to effective community psychol- Weber, R., and Crocker, J. Cognitive processes in the revi- ogy. American Journal of Community Psychology, Journal of Personality and sion of stereotypic beliefs. 8:697-707, 1980. Social Psychology, 45:961-977, 1983. Morrison, J.K.; Cocozza, J.J.; and Vanderwyst, D. An Downloaded from https://academic.oup.com/schizophreniabulletin/article-abstract/27/2/187/1870993 by guest on 05 May 2019 Weiner, B. Judgments of Responsibility: A Foundation for attempt to change the negative, stigmatizing image of a Theory of Social Conduct. New York, NY: Guilford Psychological mental patients through brief reeducation. Press, 1995. Reports, 47:334, 1980. Weiner, B.; Perry, R.P.; and Magnusson, J. An attribu- Morrison, J.K., and Teta, D.C. Reducing students' fear of tional analysis of reactions to stigmas. Journal of mental illness by means of seminar-induced belief Personality and Social Psychology, 55:738-748, 1988. 36:275-276, Journal of Clinical Psychology, change. Weisman, A.; Lopez, S.R.; Karno, M.; and Jenkins, J. An 1980. attributional analysis of expressed emotion in Mexican- Page, S. Effects of the mental illness label in attempts to Journal of American families with schizophrenia. obtain accommodation. Canadian Journal of Behavioural Abnormal Psychology, 102:601-606, 1993. Sciences, 9:85-90, 1977. Worchel, S. The role of cooperation in reducing inter- Page, S. Psychiatric stigma: Two studies of behavior group conflict. In: Worchel, S., and Austin, W.G., eds. Canadian Journal of when the chips are down. Chicago, IL: Nelson- Psychology of Intergroup Relations. Community Mental Health, 2:13-19, 1983. Hall, 1986. pp. 288-304. Penn, D.L.; Guynan, K.; Daily, T.; Spaulding, W.D.; Garbin, C.P.; and Sullivan, M. Dispelling the stigma of The Authors schizophrenia: What sort of information is best? Schizophrenia Bulletin, 20(3):567-577, 1994. Patrick W. Corrigan, Psy.D., is Associate Professor of Penn, D.L.; Kommana, S.; Mansfield, M.; and Link, B.G. Psychiatry and Executive Director at the University of Dispelling the stigma of schizophrenia: II. The impact of Chicago Center for Psychiatric Rehabilitation. L. Philip Schizophrenia Bulletin, information on dangerousness. River is a Research Fellow; Robert K. Lundin is Director 25(3):437^46, 1999. of Publications; Kyle Uphoff-Wasowski is a Consultant; Roman, P.M., and Floyd, H.H., Jr. Social acceptance of John Campion is Research Assistant; James Mathisen is Social psychiatric illness and psychiatric treatment. Research Assistant; Christine Gagnon is Research Psychiatry, 16:16-21, 1981. Assistant; Maria Bergman is Research Assistant; and Stephan, W.G. The contact hypothesis in intergroup rela- Hillel Goldstein is Research Assistant, all at the In: Hendrick, C, ed. Group Processes and tions. University of Chicago Center for Psychiatric Beverly Hills, CA: Sage, 1987. pp. Intergroup Relations. Rehabilitation, Chicago, IL. David L. Penn, Ph.D., is 13-40. Assistant Professor of Psychology at the University of North Carolina at Chapel Hill. Mary Anne Kubiak is Thornton, J.A., and Wahl, O.F. Impact of a newspaper Professor of Psychology, Prairie State College, Chicago article on attitudes toward mental illness. Journal of Heights, IL. Community Psychology, 24:17-24, 1996. 195

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