2. ATTITUDE
DEFINTION:
• Gordon Allport, 1935, Handbook of social
psychology
“ a mental and neural state of readiness organized
through experience, exerting a directive or
dynamic influence upon the individual’s response
to all objects and situations with which it is
related”
• Derived from the Greek word “ aptus” : fit and
ready for action
4. Kinds of attitudes:
According to S.H. Britt
1. General attitudes
2. Specific attitudes
According to Allport
1. Social attitudes- similarity
uniformity
co-operation
competition
2. Specific persons
3. Specific groups
5. Development of attitude:
• Not inborn but learnt out of experiences in
society
• Conditioning
• Observational learning– modelling
• Parents
• Mass media
• Sociocultural factors
• Religion
6. Personality variables assc. with attitude
• Authoritarianism
- Low authoritarianism and positive correlation
between accepting attitudes towards mentally ill
• Aggression
-less aggression– more positive attitude
• Self insight
- More empathic understanding of persons who
are disabled
• Anxiety
- High level of anxiety – positively correlated with
rejection
• Self concept
- Positive self concept– more accepting
7. • Ego strength
- Strong ego strength– positive attitude
Intelligence level: higher
Sex: females
Age: late childhood and adulthood
Socioeconomic status: higher income groups
8. Changes in attitudes can be brought about by the
following:
• Communication
• Mutual contact
• Individual influence
• Group decision
9. PREJUDICE
• Derived form the Latin word “prejudicum”–
pronouncing a judgement without going into the
evidence
DEFN:
A prejudice is an unfavourable attitude, a pre
disposition to perceive, act , think, and feel in
ways that are against rather than from another
person or group
10. Development of prejudices:
1. Psychological factors
• Motive or self regard
• Self defence
• Mal- adjustment
• Frustrated needs
• Abnormality
• Conditioning
2. Social factors
• Social distance
• Social taboos
• Cultural differences
• Social conditions and phenomena
11. Other factors:
• Historical
• Physical
• Geographical
• Political
• Economic
Baseless conclusions
Unfavourable feelings towards others
Generally based on past factors
12. Prejudice against the mentally ill:
• “mad” label is used to dehumanise and justify
discrimination
• Middle ages– female schizophrenics were
labelled witches and burned at the stake
• Hitler, Stalin
• Bedlam hospital like asylums still exist in some
places in the world
• Low funding for research into most mental
illnesses and poor resourcing for care and
therapy
13. • Victims of prejudice – poverty, low self esteem,
depressed aspirations, physical and verbal abuse
• Brutal conditions of existence
• Much of the intolerance due to the general
ignorance of the condition– ‘fear of the
unknown’
• Segregation leading to social taboo
• “Inter group conflict”
• Media intensifies the problems of
discrimination– lunatic, nutter, loony, mad, crazy
14. STIGMA
ORIGIN AND DEFINTION:
• word stigma - Greek origin
• brand or scar burned or cut into the body,
signifying that the bearer was a slave, or criminal
or otherwise set apart from the general society
• Webster’s Dictionary - “something that detracts
from the character or reputation of person/group
etc., a mark, sign, etc.”
• Stigma is defined in terms of the co–occurrence
of its components: labeling, stereotyping,
separation, status loss and discrimination
15. Four components:
1. Labelling people with a condition
2. Stereotyping people with that condition
3. Creating a division – ‘us’ and ‘them’
4. Discriminating against people based on
their label
16. Fear and exclusion: persons with severe mental
illness should be feared and therefore be kept
out of most communities
Authoritarianism : persons with severe mental
illness are irresponsible, so life decisions should
be made by others
Benevolence: persons with severe mental illness
are childlike and need to be cared for
17. Stigma related to chronic health conditions such as
HIV/AIDS
Leprosy
TB
Mental illness
Epilepsy
18. Types of mental disorders that carry the heaviest
stigma:
• Disorders assc. In the popular mind with violence
and or illegal activity– schizophrenia, substance
abuse disorders
• Disorders in which the pts. Behaviour in public
may embarrass family members— dementia,
borderline personality disorders, autistic
spectrum disorders in children
• Disorders treated with medications that cause
weight gain or other visible side effects
19. Types of stigma experiences
• Violence
– Those with no previous contact held that
schizophrenic patients were found more
dangerous than those who had previous
contact
– public fears nurtured by selective reporting by
the media
– no unambiguous evidence of an increase of
violent acts committed by severely mentally ill
people in general and people suffering from
schizophrenia in particular in recent years
20. • Employment
– 50% would never/occasionally employ the
currently mentally ill, compared with 56% of
other employers who were judged to be
usually/ always biased against employing the
currently ill
• Marriage and heredity
– Emphasis on genetic /biological causes has the
potential to decrease stigma
• Media discrimination
– Projects a horrifying, feared image of
psychiatry
21. Cultural factors in stigma
• Islamic society there existed traditions that
equated evil spirits with madness and insanity
• morality and interpersonal obligations and duties -
integral to Chinese society-- factor contributing to
the general social stigma affecting insanity
• ancient India - spiritual/ moral/ religious person,
as well as lay indigenous folk and Ayurvedic
practitioners handled much of the psychiatric
patients
22. In the Indian perspective ….
Stigma is associated with following factors:
- Karma & Evil spirit
- God’s will
- Bad deeds/ fate
- Witchcraft
- Psycho-social Stressors ( tension)
23. Patients when compared to general population feel
that psychiatric patients are viewed as…..
• Less intelligent
• Less trustworthy
• Taken less seriously
• Personal failure
• Think less of
24. • Peak stigma experiences were most during the
acute phase of the illness (93%).
Common stigma experiences were….
• Ridiculing by others, more in rural
• Worry that others might talk about illness
• Difficulty in getting marriage proposals
25. Double stigmatization:
• Women with schizophrenia and broken marriages
in India are disabled and stigmatized not only by
the illness, but also by the social attitudes to
marital separation and divorce
• Concerns centered on their children’s future &
burden to their ageing parents
26. Impact of stigma
• Mental illness is considered untreatable and
treatment used in mental health services is seen
as inefficient and dangerous
• Mental hospitals are viewed with horror and staff
working with psychiatric services are portrayed as
being mentally abnormal, incompetent, corrupt,
or evil
• Stigmatization does not stop at the person who
has a mental illness: it spreads to the family and
remains present across generations
27. • It is the stigma, and the feelings of guilt and
shame, or the defensive denial, that go with it that
makes people with psychiatric symptoms reluctant
to seek treatment, or even to accept that their
symptoms exist
• Anyone who has suffered from a mental illness is
liable to be discriminated against even if they have
made a full recovery
• When there is intense competition for resources,
as there frequently is, any new funds tend to go to
services for the kinds of patients the public regard
as most deserving - Funding and recruitment are
determined by the attitudes of the people in
charge
28. • Stigma keeps legislatures from giving enough
funding for the appropriate care of mental illness;
it keeps insurance companies from giving enough
coverage for mental illness; it keeps neighbors
from allowing ex mentally ill persons from living in
their community; and keeps employers giving
mentally ill persons an adequate chance
• Lack of public awareness of the advancements
made in psychiatry in the past 25 years
29. Family and stigma:
• Family feels blamed and responsible for having
brought on the illness
• Couples get divorced
• Financial burden on the family
30. Indian studies
• Dube (1970), points out that a great deal of
misconception, superstition and ignorance exists
in respect of mental disease. Mental illnesses are
viewed as a visitation of the evil spirits of a
goddess of curse
• Neki (1966), who carried out a research project at
Amritsar, reported that a sizeable section of the
public fears tends to strongly reject the mentally ill
• Prabhu- educated lay persons viewed the mentally
ill as aggressive, violent and dangerous
31. • Verghese and Baig (1974) - Vellore, India --
majority of the people have positive attitudes
towards mental diseases ; higher education and
higher income. But two-thirds were against a
marital alliance with a family where there is a
positive history of mental illness
• Thara and srinivasan - Marriage, fear of rejection
from neighbor and the need to hide the fact from
others . Female gender of patient and younger age
of the caregiver and patient were related to higher
stigma A supernatural cause was named by only
12% of the families and as the only cause by only
5%
32. From the Indian experience the stigma and
discrimination experience arises from
(i) strong emphasis on heredity as the cause of
illness
(ii) chronicity as a feature of the illness
(iii) fear of violence and unpredictable behavior
(iv) need for lifelong care
33. Myths & Misconceptions:
• Mental hospitals are dangerous places
• Mental hospitals are funny places worth visiting
for fun
• Mental health hospitals should be located away
from living areas
• Mental health professionals are themselves
queers
• Mental health professional is a non medical man
34. Myths related to ECT:
• ECT is painful, barbaric inhuman treatment
• Fear conscious shocks
• Memory permanently wiped out
35. Psychiatrists experience stigma
• Relationship with friends, family, colleagues and
medical colleagues
• Lack of appreciation for their clinical work even
among medical specialties
• Stereotypical negative public images of psychiatry
• Lack of resources for their job resulting from an
inequitable distribution of healthcare funds
36. Do Psychiatrists cause stigma…?
• Careless use of diagnostic labels can be harmful
• Propensity of medication Side effects (EPS, Wt.
gain)
• Government’s support for use of medications with
more side effects
• Poor involvement of psychiatrists in anti stigma
interventions
37. Interventions
• Community
Corrigan et al (2001) : three strategies for
changing stigmatizing attitudes –
– education (which replaces myths about mental
illness with accurate conceptions)
– contact (which challenges public attitudes
about mental illness through direct
interactions with persons who have these
disorders)
– protest (which seeks to suppress stigmatizing
attitudes about mental illness)
In India, National mental health program stresses
not only a multisectoral involvement by the
way of co-operation between health,
education and social welfare sectors but also
the participation of the community
38. Education:
• Town meeting
• Portfolio of radio, television
& printed materials
• Expansion of delivery of communications
through training & technical assistance
39. • School
– School student’s attitudes changed when the
information was given by the affected patients
themselves along with psychiatrist than when
the information was provided by the
psychiatrist and social worker
– necessary that students have the opportunity
to get in contact with a person affected by
psychiatric illness
• Family
– education alone is ineffective
– It has become increasingly clear over recent
years that providing training programs in family
work for staff is not sufficient to guarantee its
integration into routine clinical services
40. • Professional
– identify and challenge psychiatrist’s own
prejudices and attempt to modify our clinical
practice
Change of labels:
• ECT – electro- stimulatory therapy
• “Psychophobic”– an individual who continues
to hold prejudicial attitudes about mental
illness regardless of rational contrary evidence
• “mentally ill”– mental illness
41. Do use respectful language such as:
• - Person who has schizophrenia
• - Person with a psychiatric disability
• - Person with bipolar disorder
Integration of Mental health into Primary health
centers lead to
• Diagnosis & treatment of 40% of people
attending PHC
• Improvement in disability, Quality of life
42. • Anti discriminatory laws specific to mental illness
• Legislation to modify the media portrayal of
mental illness– media should encourage inclusion
rather than exclusion
• Compulsory training for healthcare professionals
on mental health issues in order to prevent
unintentional discrimination
43. • International campaigns
– The American Psychiatric Association (1997)
– The Royal College of Psychiatrists’ has
embarked on a five year long campaign
(Changing Minds) to combat the stigmatization
of people with mental illnesses
– The World Psychiatric Association (WPA) has
made the fight against stigma and
discrimination against schizophrenia one of its
institutional projects and given it high priority
– SANE Australia : lobby for better education,
more research funding, and more accessible
treatment opportunities for people with
mental illness
44. What psychiatrists can do…?
• Evaluate our own attitudes & try to increase our
tolerance to treat mental illness
• Carefully watch for discrimination in health
services
• To be active in fighting battles to make mentally ill
patients realize their rights
• Change our focus of attention from pure clinical
work to community service to make life of people
tolerable
45. CONCLUSION:
• Despite general improvement in knowledge about
mental illness, mental disorder continues to
receive a great amount of prejudice,
discrimination, and stigma from the public
• Programmes to fight stigma needs to be tailored
to culture
• Anti stigma interventions should continue more
effectively for improving knowledge among
society & better treatment of mentally ill
