David Baxter PhD
Late Founder
To Fight Stigmas, Start With Treatment
y SALLY SATEL, M.D., New York Times
April 21, 2009
Last fall, British television broadcast a reality program called How Mad Are You? The plot was simple: 10 volunteers lived together for a week in a castle in the Kent countryside and took part in a series of challenges.
The twist was the lack of a prize.
Five of the volunteers had a history of a serious mental illness, like obsessive compulsive disorder and bipolar disorder, and five did not. The challenges, meant to elicit latent symptoms, included mucking out a cowshed, performing stand-up comedy and taking psychological tests.
But the real test came at the end of the week.
Could a panel of experts — a psychiatrist, psychologist and a psychiatric nurse — tell them apart?
They could not. After watching hours of videotape, the experts correctly identified only two of the five people with a history of mental illness. And they misidentified two of the healthy people as having a mental illness.
The point was made: even trained professionals cannot reliably determine mental illness by appearances alone.
“Having a mental illness doesn’t have to become your defining characteristic,” wrote the producer, Rob Liddell, in describing the program. “It shouldn’t set you apart in society.”
The leading mental health advocacy group in England and Wales, MIND, praised the program for encouraging viewers “to re-examine their preconceptions.”
But what would re-examination yield? The belief that people with serious mental illness are no different from everyone else?
I hope not.
Such a soothing fiction distracts from the true reason the experts were stumped. It is not because people with psychiatric problems are indistinguishable from others. The experts floundered because the participants’ most dramatic symptoms — immobilizing depression, agitated mania, relentless hand washing and so on — had been treated and were under control.
How Mad Are You? might be the first reality show of its kind, but it fits within a well-established genre of social marketing aimed at toppling stereotypes and dispelling negative attitudes about people with mental illness.
The World Psychiatric Association sponsors antistigma campaigns in 20 countries. In the United States, the federal Substance Abuse and Mental Health Services Administration has a Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health. The National Alliance on Mental Illness has a program called StigmaBusters “to break down the barriers of ignorance, prejudice or unfair discrimination by promoting education, understanding, and respect.”
But do such campaigns work? There have been few rigorous evaluations. According to a 2006 article in Psychiatric Services, a journal of the American Psychiatric Association, “education produces short-term improvements in attitudes, but the magnitude and duration of improvement in attitudes and behavior may be limited.”
That conclusion isn’t surprising. It is notoriously hard to change attitudes through appeals to compassion and education. Keith Humphreys, a psychologist at Stanford University, offers a good analogy in the form of 19th-century Americans’ initial hostility toward groups of immigrants — Irish, Italian, Jewish. Aversion did abate after time, not because of campaign advertising and posters but because these immigrants succeeded in America — and nothing destigmatizes like success.
If How Mad Are You? improved viewer attitudes, the credit should go to treatment, the most effective destigmatizing force there is.
Imagine poor psychotic souls cowering in doorways, shuffling along in stinking rags or arguing loudly with themselves in the park. No public service announcement will make the public less fearful of them or reassure prospective neighbors when a group home for the mentally ill wants to settle on their block.
Altering public attitudes toward the mentally ill depends largely on whether they receive treatment that works. This, in turn, sets in motion a self-reinforcing momentum: the more that treatment is observed to work, the more it is encouraged.
We see this in some of the more recent trends in treatment promotion: Psychiatric medications are routinely advertised on television. The military is taking meaningful steps to make treatment for combat stress standard. And last fall, President George W. Bush signed a law that prohibits health insurance discrimination against patients with mental illness.
Antistigma campaigns are well-meaning but they lack a crucial element. No matter how sympathetic the public may be, attitudes about people with mental illness will inevitably rest upon how much or how little their symptoms set them apart.
y SALLY SATEL, M.D., New York Times
April 21, 2009
Last fall, British television broadcast a reality program called How Mad Are You? The plot was simple: 10 volunteers lived together for a week in a castle in the Kent countryside and took part in a series of challenges.
The twist was the lack of a prize.
Five of the volunteers had a history of a serious mental illness, like obsessive compulsive disorder and bipolar disorder, and five did not. The challenges, meant to elicit latent symptoms, included mucking out a cowshed, performing stand-up comedy and taking psychological tests.
But the real test came at the end of the week.
Could a panel of experts — a psychiatrist, psychologist and a psychiatric nurse — tell them apart?
They could not. After watching hours of videotape, the experts correctly identified only two of the five people with a history of mental illness. And they misidentified two of the healthy people as having a mental illness.
The point was made: even trained professionals cannot reliably determine mental illness by appearances alone.
“Having a mental illness doesn’t have to become your defining characteristic,” wrote the producer, Rob Liddell, in describing the program. “It shouldn’t set you apart in society.”
The leading mental health advocacy group in England and Wales, MIND, praised the program for encouraging viewers “to re-examine their preconceptions.”
But what would re-examination yield? The belief that people with serious mental illness are no different from everyone else?
I hope not.
Such a soothing fiction distracts from the true reason the experts were stumped. It is not because people with psychiatric problems are indistinguishable from others. The experts floundered because the participants’ most dramatic symptoms — immobilizing depression, agitated mania, relentless hand washing and so on — had been treated and were under control.
How Mad Are You? might be the first reality show of its kind, but it fits within a well-established genre of social marketing aimed at toppling stereotypes and dispelling negative attitudes about people with mental illness.
The World Psychiatric Association sponsors antistigma campaigns in 20 countries. In the United States, the federal Substance Abuse and Mental Health Services Administration has a Resource Center to Promote Acceptance, Dignity and Social Inclusion Associated with Mental Health. The National Alliance on Mental Illness has a program called StigmaBusters “to break down the barriers of ignorance, prejudice or unfair discrimination by promoting education, understanding, and respect.”
But do such campaigns work? There have been few rigorous evaluations. According to a 2006 article in Psychiatric Services, a journal of the American Psychiatric Association, “education produces short-term improvements in attitudes, but the magnitude and duration of improvement in attitudes and behavior may be limited.”
That conclusion isn’t surprising. It is notoriously hard to change attitudes through appeals to compassion and education. Keith Humphreys, a psychologist at Stanford University, offers a good analogy in the form of 19th-century Americans’ initial hostility toward groups of immigrants — Irish, Italian, Jewish. Aversion did abate after time, not because of campaign advertising and posters but because these immigrants succeeded in America — and nothing destigmatizes like success.
If How Mad Are You? improved viewer attitudes, the credit should go to treatment, the most effective destigmatizing force there is.
Imagine poor psychotic souls cowering in doorways, shuffling along in stinking rags or arguing loudly with themselves in the park. No public service announcement will make the public less fearful of them or reassure prospective neighbors when a group home for the mentally ill wants to settle on their block.
Altering public attitudes toward the mentally ill depends largely on whether they receive treatment that works. This, in turn, sets in motion a self-reinforcing momentum: the more that treatment is observed to work, the more it is encouraged.
We see this in some of the more recent trends in treatment promotion: Psychiatric medications are routinely advertised on television. The military is taking meaningful steps to make treatment for combat stress standard. And last fall, President George W. Bush signed a law that prohibits health insurance discrimination against patients with mental illness.
Antistigma campaigns are well-meaning but they lack a crucial element. No matter how sympathetic the public may be, attitudes about people with mental illness will inevitably rest upon how much or how little their symptoms set them apart.
