Effects of Labeling on Public Attitudes Towards People with Mental Disorders - Dissertation Example

? Attitude towards People with Schizophrenia Lecturer Contents Contents 2 3 0 Introduction 4 1 Introduction to the Problem 4 1.2 Background to the Study 5 1.3 Problem Statement 7 1.4 Research Questions and Purpose of the Study 8 1.5 Significance of the Study 9 2.0 Literature review 9 2.1 Overview on schizophrenia 9 2.2 Attitudes towards people with schizophrenia 10 2.3 Imagined Contact and Attitude towards schizophrenia 12 2.4 Perspective-taking and attitude towards schizophrenia 15 3.0 Methodology 18 3.1 Research design and data collection 18 3.2 Selection of Participants 19 3.3 Instrumentation and procedures 20 3.4 Ethical Considerations 21 References 23 Abstract Previous research has demonstrated that negative attitudes towards people with schizophrenia are widespread. This research study aims to investigate whether the imagining intergroup contact and perspective taking as suggested by various authors are effective techniques through which stigma against people with schizophrenia can be reduced. The study further investigates whether the two techniques lead to greater intentions to engage in contact in the future as compared to control condition. The paper in essence argues that that these conditions are important techniques for reducing prejudice, since positive interactions and attitudes towards highly stigmatized group leads to improvement to intergroup relations and reduction of intergroup prejudice. 1.0 Introduction 1.1 Introduction to the Problem Social stigma against those considered as ‘abnormal’ has been in existence since time immemorial. Many of these are often mainly aimed towards people who are mentally challenged with those with schizophrenia representing quite a significant percentage of the stigmatised group. There is consensus in psychology research that most of the social stigma are often mainly because of the how people think and behave towards those considered as ‘abnormal’ (Angermayer and Matschinger, 2003; Link and Phelan, 2001; Angermayer and Dietrich, 2006). Smith, et al (2011:46) in their analysis of perceptions of people towards schizophrenia acknowledge that while previous studies have provided much insight on attitudes and perceptions towards schizophrenia, there is still great lacking in the area enough to help change people’s attitudes towards schizophrenia. As such, the behaviours, perceptions and attitudes that the public has towards people with schizophrenia represents an area of study that requires more research and insight. This is especially important as stigmatised individuals are usually vulnerable in their social environments as they become saddled and labelled with toxic social identities that interfere with their normal lives (Smith, et al, 2011:45). Stigma against people with schizophrenia has an even more significant impact to the individual as the stigma is often motivated by ignorance and fear and the schizophrenia person has less power to determine their lives. Hence this study seeks to examine the attitudes towards people with schizophrenia focusing on ways to reduce the negative outcome through imagined contact and perspective taking techniques. 1.2 Background to the Study Schizophrenia is a long term persistent and severe mental disorder often characterised by delusions, hallucinations and changes in behaviour. This condition which affects both men and women has been noted to affect approximately 0.5-1% of the population in a given area (Leiderman, et al, 2011:281). For instance, in the UK, a National Survey of Psychiatric Morbidity in showed that five out of a thousand people in the country experienced a chronic form of schizophrenia either in terms of manic depression or schizophrenia (NHS, 2010). Schizophrenia has attracted attention from both researchers and practitioners since some of its symptoms such as hallucination and delusions can be difficult to comprehend. While patients with schizophrenia are rarely violent, the few that are tend to be bizarre attracting a great deal of high profile public attention, hence giving the impression that such acts occur frequently (NHS, 2010; Leiderman, et al, 2011:281). This has resulted to misunderstanding of schizophrenia with people holding misconceptions about the illness such as split personality and violence, while others being highly distrustful and afraid of schizophrenic patients. However, in reality, violent crime can be associated more with alcohol and drug abuse than it can be associated with schizophrenia. It is those who suffer from schizophrenia who are rather more likely to be victims of violent crimes than perpetrators (NHS, 2010). Research shows that stigmatization and discrimination against those with schizophrenia impacts every aspect of the lives of such patients hence reducing the chances of recovery (Berge, Ranney, 2005). Such stigma also reduces chances of employment, social relationships (Crisp and Turner, 2009), and increases feelings of isolation, depression and low self esteem (West, et al, 2011). Various studies argue that majority of population, for instance in Britain, believes that people with schizophrenia are dangerous to other members of society (West et al., 2011; Leiderman, et al, 2011). Empirical research suggests that initial expectations can have a powerful impact on people’s perceptions of and behaviour toward people with schizophrenia (Graves, Cassisi, & Penn, 2005). Stereotyped expectations may influence socialization process and the acquisition of abnormal behaviour (West et al., 2011). Schizophrenia is often chronic in most cases hence highly impacting the functional life of an individual with the ailment. However, there are various issues that impact the outcome of such illness, with different interventions enabling the patient to have higher chances of recovery while living and interacting with people in the community. Studies show that about 5% to 22% of the patients diagnosed schizophrenia recover from the first spell of such disease without any recurrence of the symptoms (Leiderman, et al, 2011:281, Wiersma, et al, 1998), while about 40% of those with the ailment can have a functional and sustained recovery after more than one attack (Harrison, et al, 2001). This though occurs in an environment with positive attitude towards schizophrenia and where care is provided. Often knowledge or lack of knowledge shapes the behaviour and attitude towards those with schizophrenia. Smith, et al (2011:46) in their analysis of perceptions of people towards schizophrenia acknowledge that while previous studies have provided much insight on attitudes and perceptions towards schizophrenia, there is still great lacking in the area enough to help change people’s attitudes towards schizophrenia. Researchers on intergroup relations have highlighted the evidence that imagined contact and perspective taking may be effective tool to improve attitudes toward people with mental illness and reduce negative outcomes such as labelling and stereotyping (Galinsky and Ku 2004; Shih et al.,2009; Stathi and Crisp 2008). However, this area in research is narrow hence requiring more research and insight. This is especially important as stigmatised individuals are usually vulnerable in their social environments as they become saddled and labelled with toxic social identities that interfere with their normal lives (Smith, et al, 2011:45). Hence this study will specifically focus on analysing whether imagined contact and perspective-taking techniques do indeed reduce stigma and negative perceptions against those with schizophrenia. 1.3 Problem Statement A number of research studies have brought to attention the devastating effects that stigmatisation and discrimination against people with schizophrenia has such patients. More importantly, it has been noted that besides negatively impacting social relationships (Crisp and Turner, 2009), and increasing feelings of isolation, depression and low self esteem (West, et al, 2011), stigmatisation reduces the chances of recovery for the patients hence depriving them of the chance to live normal lives (Berge and Ranney, 2005). Even worse, saddling and labelling people with schizophrenia with toxic social identities that interfere with their normal lives (Smith, et al, 2011:45), greatly accelerates feelings of depression. Various researches have, therefore, highlighted the significance improving public attitude towards people with schizophrenia. Most notable, a number of research emphasized the use of imagined contact and perspective-taking as important tools in reducing stereotypical and discriminatory behaviour against people with schizophrenia (Galinsky and Ku 2004; Shih et al., 2009; Stathi and Crisp, 2008). Indeed Pettigrew and Tropp (2005) suggest that imagined contact is associated with reduced prejudice as it encourages actual social contact, while Galinsky and Moskowitz (2000) notes that perspective taking encourages empathy. While these methods of reducing negative perceptions towards schizophrenia patients make sense, the stigmas have still continued to persist. This research hence seeks to investigate whether indeed imagined contact and perspective-taking helps in reducing negative attitudes towards people with schizophrenia and whether the two techniques lead to greater intentions to engage in contact in the future compared to control condition. 1.4 Research Questions and Purpose of the Study The purpose of this study as noted in previous sections is to examine attitudes towards people with schizophrenia and whether indeed imagined contact and perspective-taking helps in reducing negative attitudes towards people with schizophrenia. The goal of the research is to not only validate indeed imagined contact and perspective-taking as effective tools in reducing negative attitudes towards schizophrenia, but also to extend research efforts in this arena beyond solution suggestions to the problems, but also ensuring that such research recommendations and solutions do indeed make a difference. Hence, the study examined the following research questions: 1. What are the attitudes towards people with schizophrenia? 2. Does imagine contact and perspective taking techniques reduce prejudice in people with schizophrenia? 3. Do the two techniques lead to greater intentions to engage in contact in the future compare to control condition 1.5 Significance of the Study The impact of prejudice and discrimination against people with schizophrenia has become an important topic both for researchers and practitioners within the field of psychology. This research study has implication for various researchers and practitioners in dealing with perceptions and attitudes with regard to schizophrenia patients. Most specifically, the significant contribution that this research has is that it enables greater understanding as to the impact and effectiveness of imagined contact and perspective-taking techniques in reducing prejudice and stigmatization of patients with schizophrenia. While various research studies have suggested these solutions, none have closely analysed their effectiveness and reliability in reducing negative perception outcomes. Furthermore, the study acts a vehicle in further research and discussion on the application of various tools in reducing negative perceptions towards people with the schizophrenia in society. Hence, this research brings in an application aspect into the study giving fresh insight in the research area. 2.0 Literature review 2.1 Overview on schizophrenia As noted above schizophrenia is a long term persistent mental health condition which is characterised by a number of symptoms as hallucinations, catatonia, behavioural change and delusions. This kind of disorder is often severe and considered to be chronic where it severely impairs an individual’s functionality. The disorder affects about 0.5-1% within a given population (Leiderman, et al, 2011:281), with the statistics in the UK showing that five out of a thousand people have experienced schizophrenia (NHS, 2010). The exact cause of schizophrenia is not known, with a majority of practitioners believing that it is caused by a combination of environmental and genetic factors (NHS, 2010). Irrespective of what the causes are, schizophrenia is more than a mental health condition. Langdon, Colheart, and Ward (2006:134) describe it as a social disorder to lack of capacity to socially perceive and recognise various cues, gestures, mental states or even facial effects. This view is supported by Wible (2012) who notes that a disruption in core system responsible for social cognition and moment to moment social communication is a major characteristic of a schizophrenic syndrome. Though remediation of social cognition in people with schizophrenia can done medically to help them have more social cognition and improve their socio-occupational life, more effectiveness can only be attained if the schizophrenia people are surrounded by more positive and accepting people (Langdon, Colheart and Ward, 2006). Indeed one of the reasons for the relapsing and long recovery of schizophrenia patients has mainly been due stigmatisation and prejudice that they face from other people which greatly accelerates low self esteem, depression, anxiety, and social isolation (Smith, et al, 2011:45). In essence therefore, understanding and improving the attitude that people have towards schizophrenia patients is essential in helping such people recover and live full lives. 2.2 Attitudes towards people with schizophrenia As noted above, schizophrenia is a complex mental illness that impacts grossly a person social life and can be devastating to both the individual and their family members especially due to stigmatisation and the negative attitude that people have towards schizophrenic individuals. Smith et al (2011) notes that stigma against schizophrenic persons can be inform of prejudice where people simply do not the schizophrenic person, Stereotype where people may view them as dangerous or discrimination where others feel that they need to be separated from society. Such negative views are often common in reference to schizophrenia. Some of the commonly held misperceptions by the public include schizophrenia individuals are violet and have multiple personality disorders, while this may not be true. In fact, research shows that schizophrenic individuals are more likely to be victims of violence than the perpetrators (NHS, 2010). Other researchers in their analysis of people’s perception have found that people deem schizophrenic individuals as less intelligent (Angermayer and Matschinger, 2003; Yager and Ehmann, 2006) hence less capable of social functioning. Therefore, a teacher or employer who is privy to the medical reports of a person with schizophrenia may consciously or unconsciously discriminate against such a person deeming them less intellectually capable. The very nature of prejudice or discrimination against the people with schizophrenia, which involves a great deal of social marginalisation and social distancing, poses a great challenge in gaining insight not only from the perspective of a schizophrenic person but also on which techniques are most effective in lowering negative attitude towards schizophrenia (Yager and Ehmann, 2006; Esterberg, et al., 2008, p. 86; Griffiths, et al., 2006; Gaebel, Baumann, Witte, & Zaeske, 2002). Most notably, negative attitude, behaviours and perceptions towards people with schizophrenia often stem from pity, ignorance of fear, of which most are ignited by the media (Angermayer and Matsinger, 2003; NHS, 2010). For instance, Economou, et al (2009) in their survey of the main sources of information on schizophrenia and possible attitudinal impact, noted that television was the main source of information with less than 33% of the respondents in the study actually understanding the causal factors of the illness. On the other hand 81.3% believed that people with schizophrenia had split personality disorder, 74.6% believed that they were dangerous and need to be separated from society while 83.2% believed that they had no intellectual capacity to work. On the other hand, Rosenfarb, Bellack, and Aziz (2006) found a positive correlation between negative family attitude and higher burden of care for the people with schizophrenia. Such negative attitudes towards people with schizophrenia impact negatively the individual’s recovery who may potentially relapse. This is especially so where family members have a negative attitude. 2.3 Imagined Contact and Attitude towards schizophrenia As noted above, research has consistently shown that persons with mental health conditions have been a strongly prejudiced group (Smith, et al, 2011; Angermayer and Matschinger, 2003; Yager and Ehmann, 2006). Negative attitude against those with schizophrenia has a bad effect on the people as such negative attitudes and perceptions act as a barrier to the participation and integration of people with schizophrenia in social life. Based on research by social psychologists, one of the key strategies by which such attitudes can be improved against prejudiced groups through imagined contact. Pettigrew and Tropp (2005) suggest that since imagined intergroup contact involves mental simulation of social interaction with an out-group group, it also encourages people to engage in actual contact with prejudiced people, thus it reduces stereotyping. This ideology was derived from the contact hypothesis which suggests that getting people from different groups to interact enhances positive attitudes and cooperation between the groups (Harwood, et al, 2011; Vezzali and Capozza, 2011:140). Indeed, Pettigrew and Tropp (2006) in their meta-analysis concluded that contact was a powerful technique in overcoming prejudice in society and enhancing intergroup relations. While imagined contact is not actual contact, but rather a mental stimulation of contact, researchers have found this mental contact to also play a key role in reducing prejudice tendencies before a person gets into contact. Brambilla, Ravenna and Hewstone (2012) in their experimental research found that imagining intergroup contact lowers hostility tendencies towards prejudiced and stereotyped groups. The research found that imagined contact enhances competent perception and warmth towards the out-groups. This implies that imagined contact can promote positive perceptions and attitudes towards groups such as schizophrenic individuals who are viewed negatively by society as violent with multiple personality disorders and little intelligence. Brambilla, Ravenna and Hewstone’s findings have been supported by other authors. For instance, Pagotto, e al (2012) notes that imagined contact between two different groups reduces barriers between the groups enhancing cooperation and inherently fostering trust towards the out-group. Furthermore, such imagined contact also reduces intergroup anxiety fostering a more relaxed environment of interaction (West, Holmes and Hewstone, 2011:407; Frye, Lord, & Brady, 2012). In Stathi and Crisp (2008) experimental investigation of ethnic groups in the UK and Mexico to understand under what conditions imagined contact is most effective, the research concluded that positive projections of imagined contact to prejudiced groups was more stronger when the intergroup interaction focused on the personal self rather than the social self, as the social self is most likely to be influenced by other in-group individuals. This is clearly argued by West, Holmes and Hewstone (2011) who acknowledge that imagined contact can only have positive effect in intergroup attitudes and relations where the imagined contact cultivated is positive. Where such contact is negated, the consequences of an intergroup contact may have negative outcomes and consequences. Hence, in using imagined contact as a tool to reduce prejudice against people with schizophrenia, it is important that the quality of imagined contact be taken into consideration with a core focus on reducing prejudice tendencies and misconceptions concerning schizophrenic individuals. Therefore, from the wide range of research on imagined contact, it is generally agreed that encouraging different people to mentally stimulate a positive encounter with a person with schizophrenia develops a positive attitude hence reducing stigmatization of schizophrenia. Furthermore, it enhances projection of positive attributes of people with schizophrenia while reducing intergroup anxiety (Crisp and Turner, 2009; Hall, Crisp, & Mein-woei, 2009). Though imagined contact as a way of reducing stigmatization of various outgroups has received a lot of attention lately, few researchers have focused on how imagined contact would impact contact with person with schizophrenia (Leiderman, et al, 2009; West, Holmes, and Hewstone, 2011; Vezzali and Capozza, 2011; Turner and Crisp, 2010). This area of research is still young and requires more informed research in order to truly validate whether such imagined contact has an impact on intentions to engage in contact in the future. None of the researches have so far looked at this aspect of future intentions. This research study hence seeks to fill this gap in research. 2.4 Perspective-taking and attitude towards schizophrenia Another key strategy that has been explored in research as a way of reducing prejudice is perspective taking. This involves one putting themselves in the shoes of others to understand what they go through and what they feel and further actively considers others view point to understand where they are coming from (Weyant, 2007). Galinsky and Moskowitz (2000) suggest that the act of perspective taking results in merging of self and the out-group, resulting in increased prosaically behaviour. Since most people often have a positive self concept, perspective taking them would most like reduce prejudice and stereotyping as a person would not want others to discriminate them if they were in a similar state. Galinsky and Moskowitz’s findings have been supported by Shih, Wang, Bucher, and Stotzer (2009) who in their research showed that perspective taking has a positive impact in changing people’s view towards those who are viewed as the outgroups. This they noted reduced discrimination and prejudice not only on the group but also among individual members of the group. A search through literature noted the linking of perspective taking to altruism, empathy, moral development (Cialdini, Brown, Lewis, Luce, & Neuberg, 1997) and pro-social behaviour (Galinksy and Ku, 2004). Most of the research in social psychology have focused on the significance of perspective taking in reducing biases in social thought and conflict hence fostering cooperation among different intergroup that may be conflicting (Galinksy and Moskowitz, 2000; Shih, Wang, Bucher, and Stotzer, 2009; Dimdins, Montgomery, & Austers, 2005). For instance Galinksy, Wang and Ku (2008) in their experimental research found that taking the perspective of a professor enhance the analytical ability and thinking of a person hence increasing academic performance. This was unlike taking the perspective of a cheerleader. The research acknowledged that while one can take the perspective of an individual without necessarily liking them, they are often able to note both the positive and negative traits of the out-group, and hence be able to change their perspectives concerning the out-groups. The tendency of a person to think positively of themselves as better than others often result to ascription of positive descriptors (Galinksy, 2002). Hence, the impact of perspective taking mainly has a stronger impact on reducing stigma if the individual has a higher self esteem and views themselves highly. When people have positive views concerning themselves, then their self concept will be transferred to the prejudiced group. However, where an individual has low self esteem or have a negative self concept about themselves, Galinksy and Ku (2004) in their research note that they most likely would not have any impact on stigma and prejudice as they would even more hate to think themselves as member of the out-group. A wide range of research in perspective-taking has mainly focused promoting positive relationships among different conflicting groups such as racial differences (Galinksy, Wang and Ku (2008; Galinksy and Ku, 2004). Few research studies have focused on schizophrenia. For instance, Langdon, Coltheart and Ward (2006) in investigating perspective taking in schizophrenia, note that while schizophrenia patients have a difficulty in developing empathetic perspective taking that would allow them to appreciate other people’s beliefs, other normal individuals were quite capable of taking the perspectives of the individuals with schizophrenia. This view was further supported by a subsequent research by Langdon and Ward (2009) in which it was noted that taking the perspective of those suffering from schizophrenia raised more awareness of the illness hence reducing the negative attitude towards people with schizophrenia as well as psychological defence mechanisms that make the people with schizophrenia deny that they are sick. However, the level of research on how perspective-taking helps in reducing negative attitudes towards schizophrenia has been low. Currently there is no research which has investigated how both imagine contact and perspective taking techniques can reduce prejudice in people with schizophrenia, and whether the two techniques lead to greater intentions to engage in contact in the future compare to control condition. This research paper seeks to fill this gap in knowledge. 3.0 Methodology 3.1 Research design and data collection This research study used a quantitative non experimental research design to examine the imagined contact and perspective-taking helps in reducing negative attitudes towards people with schizophrenia and whether the two techniques lead to greater intentions to engage in contact in the future compared to control condition. In this research approach, a one way ANOVA was used to examine whether the was significant differences in the mean scores of the attitudes scores between the three conditions as examined from three groups of participants. The main aim of a one analysis of variance approach is mainly to understand whether two groups have any connections, and what the relationship between such groups are in order to understand a phenomenon or the relationship between two or more variables (Fraenkel and Wallen, 2003, p.339). Since the key objective of this research is to determine whether imagined contact and perspective-taking impact attitude of other people towards schizophrenia, then ANOVA would provide the appropriate tool in examining whether indeed the attitudes of participants who have taken part in the imagined contact exercise, the perspective taking exercise, and the control condition differ significantly. In completing the research, this study hence seeks to examine the research questions: 1. What are the attitudes towards people with schizophrenia? 2. Does imagine contact and perspective taking techniques reduce prejudice in people with schizophrenia? 3. Do the two techniques lead to greater intentions to engage in contact in the future compare to control condition These three research questions are developed into two key hypotheses that the research study will be aiming to test: H1: Imagined contact and perspective-taking techniques do reduce prejudice in people with schizophrenia H2: The two techniques lead to greater intentions to engage in contact in the future compare to control condition In this research, data will be collected through survey questionnaires from the participants. The use of survey questionnaires is collecting data in this study not only because of the large number of participants in the study which may be too high for any data gathering instrument to handle, but also help in standardising the response from the participants in a coherent manner (Saunders, Lewis, & Thornhill, 2003) 3.2 Selection of Participants In completing the study, a primary research survey was done on 90 targeted participants from the University of Greenwich, Greenwich campus to test the above hypothesis. The participants were selected randomly selected. Kline (1998:12) notes that in order to reduce the sampling errors in any investigation, it is imperative to use a wider population sample, with a random sample selection ensuring a more unbiased sample selection that is representative of the targeted population. For this reason, ninety participants aged 18-40 were targeted with this population being equally divided between males and female participants. These participants were randomly placed in three groups each with 30 participants and each participating one of the conditions under study: perspective taking, control and imagine contact condition. The fact that the participants are drawn from a higher institution of learning implies that the population is more educated and hence more inclined to provide well informed answers to questionnaires and the imaginary tasks, and they can also express themselves easily in terms of their perceptions of people with schizophrenia (Smith, et al, 2011). 3.3 Instrumentation and procedures In this research, the key instruments used were a survey questionnaire and imaginary task pad developed by the author. These were designed to measure attitudes and perceptions concerning people with schizophrenia. The survey questionnaire was a six item questionnaire about schizophrenia and social interaction with a person with schizophrenia. Questions concerning participant’s emotions towards schizophrenia, description of persons with schizophrenia, intergroup anxiety on meeting a person with schizophrenia in the future, degree of stereotyping against schizophrenia, and future contacts were covered. All this was on a seven point Likert scale with the participants asked to evaluate their general impression of people with schizophrenia on a scale of 0 to 100. Furthermore, they were also asked if they are related to a person with schizophrenia. Participants were randomly selected on Greenwich campus, University of Greenwich, and asked they wish to participate in this study. Following informed consent which informed the aim of the study and the timeframe it would take (15 minutes), as well as the participants choice to withdraw from their participation, all respondents completed the self administered questionnaire and demographic data. This questionnaire determined the dependent measures such as intergroup anxiety, stereotyping, intentions for the future contact. In the imaginary task, the participants were mainly divided into three groups of individuals with each group receiving a different set of instructions depending on the condition they were assigned. In the imagined contact condition, participants were asked to imagine positive relaxed interaction with a person with schizophrenia for the first time. As for, perspective taking condition, participants were asked to imagine themselves in the place of a person with schizophrenia. In control condition, participants were asked to imagine walking in the outdoors. After timing the participants for one minute in order to reinforce the impact of manipulation, participants were asked to describe in detail and write down what they imagined previously. Upon completion of both the imaginary task and the survey questions, the participants were debriefed again on the purpose of study and what exactly was measured in the study. Any concerns were addressed and contacts provided for future concerns. Afterward participants were thanked for their participation. 3.4 Ethical Considerations In carrying out this research, a number of ethical considerations were taken into account. First and foremost, the confidentiality of the respondents in the research survey was upheld with the main experimental procedures described and explained to the participants before they took part in the research. Each of the participants chose to take part in the research voluntarily. Furthermore the participants had the right to withdraw at anytime from the study including withdrawing their data. The participant information was not revealed to ay third parties and the information collected was destroyed upon completion of data analysis. 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