At Issue:
Stop the Stigma: Call Mental Illness
a Brain Disease
by Patrick W. Corrigan and Amy C. Watson
The At Issue section of the Schizophrenia Bulletin contains viewpoints and arguments on controversial issues.
Articles published in this section may not meet the strict
editorial and scientific standards that are applied to
major articles in the Bulletin. In addition, the viewpoints
expressed in the following article do not necessarily represent those of the staff or the Editorial Advisory Board of
the BuUetin.—The Editors.
Abstract
Educating the public that mental illness is a brain disease is a popular strategy for combating mental illness
stigma. Evidence suggests that while such an approach
reduces blame for mental illness, it may unintentionally exacerbate other components of stigma, particularly the benevolence and dangerousness stigmas.
Conversely, psychosocial explanations have proven
promising, yet they ignore the growing evidence
regarding genetic and biological factors. We propose a
balanced approach that combats the various myths
about mental illness with factual information.
Keywords: Stigma, brain disease, mental illness.
Schizophrenia Bulletin, 30(3):477-479, 2004.
During the past decade, several groups have become concerned about the harmful effects of stigma on people with
mental illness. In an effort to change public attitudes,
some advocates have called for equating mental illness
with other medical disorders. Perhaps most prominent of
the many public service campaigns and educational curricula that promote this view is NAMI's slogan that mental illness is a brain disease. Although this equation seems
to have face validity, a review of the evidence that might
support the slogan for education efforts that seek to
diminish stigma is mixed.
Many studies have found that the public views people
with mental illness as responsible for their disorders:
because of poor character or lack of moral backbone, peo-
477
ple with disorders like schizophrenia and major depression choose to have their mental illness and are to blame
for the symptoms and the disabilities that result (Weiner et
al. 1988; Corrigan et al. 1999, 2003; Watson et al., submitted). In his theory of human attribution, Weiner (1995)
argued that blaming someone for a negative life condition
such as mental illness leads to anger and social avoidance
("I don't want that weak-willed person around me!").
Hence, educating the public about the biological roots of
mental illness—for example, comparing people with mental illness to those with other chronic disorders such as
diabetes—should decrease blame for psychiatric illness.
There is some limited research that supports this hypothesis; namely, people are less likely to endorse blame, anger,
and social avoidance toward people with mental illness
after they have been educated about how mental illness is
a biological disorder that people do not choose (Corrigan
et al. 2002).
There is, however, another facet to Weiner's attribution model that suggests that framing mental illness as a
brain disorder may have its limitations. People make attributions about not only the onset of a disorder (Is schizophrenia caused by weak character or biology?) but also its
offset (Will the person get better so he or she can live a
normal life?). Framing mental illness as a brain disorder
may resolve onset questions but exacerbate offset issues.
There is some evidence that suggests that the public views
mental illness as a disorder from which people do not
recover—that diey do not regain productive lives (Weiner
et al. 1988; Corrigan et al. 1999). This kind of attitude
may support what is called the benevolence stigma;
namely, that people with mental illness are innocent children whose lives need to be controlled by a parental figure
(Brockington et al. 1993). While well intentioned, this
type of stigma can be disempowering, leading persons
with mental illness (and others) to view themselves as difSend reprint requests to Dr. P.W. Corrigan, Center for Psychiatric
Rehabilitation at Evanston Northwestern Healthcare, 1033 University
Place, Suite 450, Evanston, IL 60201; e-mail: [email protected].
P.W. Corrigan and A.C. Watson
Schizophrenia Bulletin, Vol. 30, No. 3, 2004
ferent from other people, less competent, and less acceptable as friends. This suggests that the public also needs to
be educated that people with mental illness recover.
Whether recovery from mental illness is viewed as a naturally occurring phenomenon (Harding and Zahniser
1994), the result of competent treatment (Liberman and
Kopelowicz, in press), or a psychological process (Ralph
2000), the public needs to be taught that mental illness is
a chronic disease from which people can recover—a disease not unlike diabetes.
Biological explanations may also imply that people
with mental illness are fundamentally different or less
human. Research has shown, for example, that disease
explanations for mental illness reduced blame but provoked harsher behavior toward an individual with mental
illness (Mehta and Farina 1997). The studies suggest that
this harsher behavior may have been the result of seeing
the person with mental illness as physically distinct—
almost as a different species. Phelan (2002) reminds us
that in the not-so-distant past, biological and genetic
explanations for stigmatized conditions were linked to a
range of harsh policies, including marriage restrictions,
sterilization, and even extermination.
The biological explanation may also exacerbate yet
another key stereotype of mental illness, the belief that
people with mental illness are dangerous. Many
researchers believe that the stereotype that people with
mental illness are violent ranks among the most prejudicial and discriminating of attitudes (Phelan et al. 2000).
Unfortunately, there is evidence that biological arguments
may actually strengthen dangerousness stereotypes, suggesting that people with mental illness have no control
over their behavior and therefore are unpredictable and
violent (Read and Law 1999).
In contrast to biological arguments, psychosocial
explanations of mental illness have been found to effectively improve images of people with mental illness and
reduce fear (Morrison et al. 1979; Morrison and Teta
1979, 1980; Morrison 1980; Read and Law 1999). Instead
of arguing that mental illness is like any other medical illness, psychosocial explanations of mental illness focus on
environmental stressors and trauma as causal factors.
These may include childhood abuse, poverty, and job
stress. The idea is to reframe psychiatric symptoms as
understandable reactions to life events (Read and Law
1999).
Does this mean we should abandon the "brain disease" explanation of mental illness? As scientists compile
more and more evidence of the genetic and biological
components of many mental illnesses, it would be unethical to exclude this information from educational programs
(Phelan 2002). In addition, reducing blame is an important goal of any antistigma campaign, particularly if we
are interested in increasing the public's willingness to
allocate resources for mental health treatment (Watson
and Corrigan, in press). Hence, challenging the stigma of
mental illness is going to require a multidimensional
approach, providing the public with facts that challenge
the variety of myths that maintain mental illness stigma.
Such an approach would address the contributions of both
biological and psychosocial factors, the effectiveness of
mental health treatment, and accurate information about
violence and mental illness. Combining education with
contact with a person with mental illness can enhance the
effect of an intervention (Corrigan et al. 2002), perhaps by
diminishing the perception of "otherness." Challenging
the stigma of mental illness is an essential item on the
public health agenda. However, just as other public health
concerns need to be informed by data, so efforts to build
antistigma programs need to be evaluated empirically.
References
Brockington, I.; Hall, P.; Levings, J.; and Murphy, C. The
community's tolerance of the mentally ill. British Journal
of Psychiatry, 162:93-99, 1993.
Corrigan, P.W.; Markowitz, F.E.; Watson, A.C; Rowan,
D.; and Kubiak, M.A. An attribution model of public discrimination toward persons with mental illness. Journal of
Health and Social Behavior, 44:162-179, 2003.
Corrigan, P.W.; River, L.P.; Lundin, R.K.; Wasowski,
K.U.; Campion, J.; Mathisen, J.; Goldstein, H.; Gagnon,
C ; Bergman, M.; and Kubiak, M.A. Predictors of participation in campaigns against mental illness stigma.
Journal of Nervous and Mental Disease, 187:378-380,
1999.
Corrigan, P.W.; Rowan, D.; Green, A.; Lundin, R.; River,
P.; Uphoff-Wasowski, K.; White, K.; and Kubiak, M.A.
Challenging two mental illness stigmas: Personal responsibility and dangerousness. Schizophrenia
Bulletin,
28(2):293-3O9, 2002.
Harding, CM., and Zahniser, J.H. Empirical correction of
seven myths about schizophrenia with implications for
treatment. Acta Psychiatrica Scandinavica, 90(384,
Suppl): 140-146, 1994.
Liberman, R.P., and Kopelowicz, A. Recovery from schizophrenia: A criterion-based definition. In: Ralph, R., and
Corrigan, P., eds. Recovery and Mental Illness: Consumer
Visions and Research Paradigms. Washington, DC:
American Psychological Association, in press.
Mehta, S., and Farina, A. Is being "sick" really better?
Effect of the disease view of mental disorder on stigma.
Journal of Social and Clinical Psychology, 16:405—419,
1997.
Morrison, J.K. The public's current beliefs about mental
illness: Serious obstacles to effective community psychol-
478
Schizophrenia Bulletin, Vol. 30, No. 3, 2004
Stop the Stigma
ogy. American Journal of Community
8:697-707, 1980.
Comprehensive Review of the Stigma of Mental Illness:
Implications
for Research and Social
Change.
Washington, DC: American Psychological Association, in
press.
Psychology,
Morrison, J.K.; Becker, R.E.; and Bourgeois, C.A.
Decreasing adolescents' fear of mental patients by means
of demythologizing. Psychological Reports, 44:855-859,
1979.
Watson, A.C.; Corrigan, P.W.; and Angell, B. What motivates public support for legally mandated mental health
treatment? Submitted for publication.
Morrison, J.K., and Teta, D.C. Impact of a humanistic
approach on students' attitudes, attributions, and ethical
conflicts. Psychological Reports, 45:863-866, 1979.
Weiner, B. Judgments of Responsibility: A Foundation for
a Theory of Social Conduct. New York, NY: Guilford
Press, 1995.
Morrison, J.K., and Teta, D.C. Reducing students' fear of
mental illness by means of seminar-induced belief
change. Journal of Clinical Psychology, 36:275-276,
1980.
Weiner, B.; Perry, R.; and Magnusson, J. An attributional
analysis of reactions to stigma. Journal of Personality and
Social Psychology, 55:738-748, 1988.
Phelan, J.C. Genetic bases of mental illness—a cure for
stigma? Trends in Neurosciences, 25:430—431, 2002.
Acknowledgments
Phelan, J.C; Link, B.G.; Stueve, A.; and Pescosolido, B.A.
Public conceptions of mental illness in 1950 and 1996:
What is mental illness and is it to be feared? Journal of
Health and Social Behavior, 41:188-207, 2000.
Ralph, R. Recovery. Psychiatric Rehabilitation
4:480-517,2000.
This article was made possible in part by National
Institute of Mental Health grant MH-62198, which supports the Chicago Consortium for Stigma Research. Many
thanks to the anonymous reviewers who provided feedback on earlier drafts of this article.
Skills,
Read, J., and Law, A. The relationship of causal beliefs
and contact with users of mental health services to attitudes to the 'mentally ill.' International Journal of Social
Psychiatry, 45:216-229, 1999.
The Authors
Patrick W. Corrigan, Psy.D., is Professor of Psychiatry,
and Amy C. Watson, Ph.D., is Assistant Professor of
Psychiatry, Northwestern University, Evanston, IL.
Watson, A.C., and Corrigan, P.W. Changing public
stigma: A targeted approach. In: Corrigan, P.W., ed. A
479