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Mental Disorders Stigma in the Media: Review of Studies on Productions, Content, and Influences

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Journal of Health Communication:
International Perspectives
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Mental Disorders Stigma in the Media:
Review of Studies on Production,
Content, and Influences
a
Anat Klin & Dafna Lemish
b
a
School of Public Health, Haifa University and Department of
Communication, Western Galilee Academic College , Haifa, Israel
b
Department of Communication , Tel Aviv University , Ramat Aviv,
Tel Aviv, Israel
Published online: 25 Jul 2008.
To cite this article: Anat Klin & Dafna Lemish (2008) Mental Disorders Stigma in the Media: Review
of Studies on Production, Content, and Influences, Journal of Health Communication: International
Perspectives, 13:5, 434-449, DOI: 10.1080/10810730802198813
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Journal of Health Communication, 13:434–449, 2008
Copyright # Taylor & Francis Group, LLC
ISSN: 1081-0730 print/1087-0415 online
DOI: 10.1080/10810730802198813
Mental Disorders Stigma in the Media: Review
of Studies on Production, Content, and Influences
ANAT KLIN
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School of Public Health, Haifa University and Department of
Communication, Western Galilee Academic College, Haifa, Israel
DAFNA LEMISH
Department of Communication, Tel Aviv University, Ramat Aviv,
Tel Aviv, Israel
This article analyzes two decades of research regarding the mass media’s role in
shaping, perpetuating, and reducing the stigma of mental illness. It concentrates
on three broad areas common in media inquiry: production, representation, and
audiences.
The analysis reveals that descriptions of mental illness and the mentally ill
are distorted due to inaccuracies, exaggerations, or misinformation. The ill are
presented not only as peculiar and different, but also as dangerous. Thus, the media
perpetuate misconceptions and stigma. Especially prominent is the absence of
agreed-upon definitions of ‘‘mental illness,’’ as well as the lack of research on the
inter-relationships in audience studies between portrayals in the media and social
perceptions. The analysis concludes with suggestions for further research on mass
media’s inter-relationships with mental illness.
Negative social attitudes toward those suffering from psychiatric disorders that
derive from misperceptions and stigmas are a key mental health and social problem
(Corrigan & Penn, 1999). These attitudes interfere with the social integration of
those who suffer from mental disorders (MDs); violate their civic rights, self-image,
and family life; and could be a cause for employment and housing discrimination.
One of the explanations for the low percentage of persons suffering from MD
who seek professional assistance is fear of stigmas and their negative consequences,
and the fear of being the target of disparaging laughter (Arboleda-Florez, 2002;
Brown & Bradely, 2002; Crisp, Gelder, Rix, Meltzer, & Ravlands, 2000; Hayward &
Bright, 1997; Link et al., 1999; Miller & Major, 2000).
The mass media are an important source of information about mental health
and have an important role in cultivating perceptions and stigma (Wahl, 2004).
Assuming that a negative framing of MDs in the media (Sieff, 2003) contributes
to misperceptions and myths associated with and hostile attitudes toward the
The authors thank Professor Itzhak Levav from the research unit, Mental Health Services
of the Israeli Ministry of Health, for his enthusiastic support and important psychiatric
insights; and to Dr. Peter Lemish for his excellent editorial contributions. Thanks also to
the Western Galilee Academic College for the financial support.
Address correspondence to Dr. Anat Klin, Haifa University, P.O. Box 7430, Haifa 31074,
Israel. E-mail: [email protected]
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mentally ill and their caregivers, then positive framing may well influence development of positive perceptions, reduce stigma, and contribute to a change in public
attitudes. This is all the more important today given growing support for policies
that integrate the mentally ill into the community. This policy shift involves changing
the mental health care model from the institutionalization of individuals suffering
from mental disorders to a community care approach, one that involves their integration into the community while using its health care system (World Health Organization [WHO], 2001). The success of such a process requires an enlightened public.
This article analyzes studies of three broad areas common in media inquiry—
production, representation, and audience reception (see McQuail, 2006) of MDs.
All three areas focus on media involvement and their impact in fostering, perpetuating, or in reducing MDs stigma. Production studies focus on the nature of the influence exerted by governments, professional organizations, and business interests on
those responsible for producing mental health related messages. Representation
studies involve analysis of media messages themselves—analysis of the portrayals
of MDs, the mentally ill, and those of their caregivers. Audience studies involve
the analysis of perceptions, attitudes, and behavior of different media audiences in
response to media messages about MDs and the mentally ill. The article concludes
with suggestions for additional research that may advance our understanding
of the roles the media play in regard to the mentally ill.
Stigma and Mental Disorders
Between 20–25% of the population of every country in the world suffer from an MD
or a neuropsychiatric disorder during their lifetime (WHO, 2001). In countries where
citizens are exposed to repeated traumatic stress (e.g., wars or terrorism), these security situations have additional impact and consequences for mental health. Often residents of such societies are forced to confront post-traumatic disorders many years
after the traumatic incident (Neriya et al., 1998; U.S. Department of Health=Human
Services, 2002). Even though conventional treatments of MDs are efficient and not
expensive, only 20–35% of those afflicted seek professional assistance (Brown &
Bradley, 2002; Wedding & Boyd, 1999). Prejudice and fear of stigma are among
the principal factors for the fact that many people who suffer with MD do not seek
or postpone seeking assistance (Jorm, 2000; Lipczynska, 2005; Philo & Secker, 1999).
Thus, stigmatization harms attempts to reduce the suicide rate (Philo, 1996), because
a direct connection has been proven to exist between depression and suicide (Beautrais, 2000; Wilkinson, 1994).
The primary conclusions of these studies support the view that mental illness
continues to be stigmatized and that large portions of communities hold highly
prejudiced and hostile attitudes toward people with MDs (Bagley & King, 2005;
Dahaf Survey, 1997).
The common perception is that those afflicted with MDs (not just those who
suffer from schizophrenia but also those with severe depression) are dangerous;
developmentally disabled, of low intelligence, have communication disorders, or
all of these; are dysfunctional; and do not contribute as workers as they lack desire
or are lazy (Arboleda-Florez, 2002; Crisp et al., 2000). Even some psychiatrists hold
negative attitudes of those afflicted with MDs—possibly even more negative than
those held by the public at large (Chaplin, 2000; Sartorius, 2002). Labeling
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attitudes of those who suffer from MDs also have been found also among some
policymakers (Gureje & Alem, 2000; Sartorius, 1999).
Labeling attitudes directed toward professionals causes persons who suffer from
depression to feel embarrassed to seek their advice, primarily for fear that they will
be perceived to be imbalanced or neurotic (Priest et al., 1996). In this regard, the
public image of psychiatrists is less positive than that associated with other doctors
as they often are considered to be cruel. In addition, images associated with psychotherapists, psychologists, and psychiatrists as being crazed, lacking in understanding of the patient, and involved in unethical sexual behavior are detrimental,
especially in instilling trust in those in need of their assistance (Von Sydow &
Reimer, 1998).
There is limited evidence in the literature in regard to the source of stigma. Some
claim that the tendency to label (stigmatization) is actually a survival strategy since it
involves identifying and expelling scapegoats (Gilman, 1988, 1995; Haghighat, 2000;
Shakespeare, 1994; Stangor & Crandall, 2000; Wedding & Boyd, 1999).
Serving as a central source of information, the mass media not only reflect public attitudes and values in relation to disabilities and illnesses, but also take part in
shaping them, both unintentionally by means of news coverage and entertainment
shows, as well as intentionally, through advertising and information campaigns
(Hafferty & Foster, 1994; Klin, 2001). Further, the media serve as socializing agents
who influence both by cultivating the construction and perpetuation of perceptions
(Gerbner, Gross, Morgan, Signorelli, & Shanahan, 2002) and learned behaviors
(Bandura, 2002).
Framing (Entman, 1993; Goffman, 1986), or the ways in which references to the
mentally ill are constructed, organized, presented, and interpreted in the media, has a
decisive impact on the way in which the public thinks about them (Sieff, 2003). Similarly, the frequency and prominence of the mentally ill in the media impacts attitudes
toward them and the social agenda regarding mental health issues, as argued by
advocates of the theory of agenda setting (Dearing & Rogers, 1996; McCombs,
1994, 1997).
Methodological Note
In order to complete a thorough review of the existing literature in the field, 325 articles and books published between 1985 and 2005 were collected from key databases
(e.g., Sociological Abstracts, Medline, Psychinfo) by means of keyword searches
(e.g., mental health, mental illness, psychiatric disorders, mental disorders, stigma,
prejudice, media, television, newspaper, magazines, Internet, World Wide Web).
This produced a research corpus that included empirical studies, theoretical essays,
and reviews. News items, editorials, articles regarding eating disorders, and nonEnglish articles were excluded. Due to many replications of similar studies by the
same authors, or other researchers who found similar results, we have chosen to
highlight in this review about 100 items of the corpus as illustrations of the available
literature.
Production Studies of Messages of Mental Disorders
Production studies examine processes through which reporters, editors, and producers of news and entertainment programs produce messages related to mental health
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topics. Such studies might examine the sources of information provided producers,
their personal attitudes, and their influence on the messages that they create
(Glasgow University Media Group, 1976; Schudson, 1989) in relation to mental
health subjects. This area of research is also interested in the nature of the influence
exerted by governments, professional organizations, and business interests on those
responsible for producing various media; how pharmaceutical companies influence
magazine editors through paying for advertising; how journalists relate to their
sources and decide on what counts as a good story; and how health groups use
the web to distribute information.
Very few production studies are present in the research corpus. For example, an
isolated study found that print news editors’ attitudes toward persons with MD are
more positive that those held by the public-at-large. This having been said, they too
rejected employing them in media institutions (Greirson & Scot, 1995). This research
did not examine, however, the influence on newspaper coverage of the journalists
who hold such positive attitudes.
Taking a broader view, production studies could assist us to understand if
additional factors—such as pressures for profits resulting in sensationalized products—contribute to the distorted images and stereotypes of MDs presented in the
mass media. Another study (Stuart, 2003) describes attempts to provide reporters
with accurate background by assisting them in the preparation of positive accounts
about MDs, but it did not take into account or examine other sources of information
that could influence the coverage of MDs, or analyze how journalists relate to their
sources, including health pressure groups, and how they decide on what counts as a
good story. Another limited case study examined production values that lead the
producers to determine the story plot of a popular soap opera (Henderson, 1996).
Studies of Mental Disorder Representations
Representation studies involve analysis of the content and form of media messages.
Most of representation studies in the research corpus seek ideological biases or the
discursive dominance of particular themes and constructions that result in what is
perceived as being distorted coverage. Some studies are concerned with whether messages are likely to promote or damage health. For example, how a medical soap
opera portrays the mentally ill and their health care providers, how murderers are
depicted in the press, what messages about personal versus societal responsibility
for health are conveyed in the advice columns of magazines, how the press portray
mentally ill males in comparison with females, and which political analyses of the
problems of health care systems receive more coverage.
Representation studies demonstrate, on the one hand, that MDs most frequently
are described in the broadcast media and films among all forms of disability; on the
other hand, the amount of coverage devoted to them in print media is less than that
of physical disabilities (Byrd & Elliot, 1998). And, generally, negative stereotyping of
MD images is more frequent than those of physical disability (Seale, 2004, p. 109).
Distortion of Images of the Mentally Ill. A primary claim made by many
researchers who conducted content analysis studies is that the negative framing of
MDs in different genres of the media contributes to perpetuation of the public’s
negative attitudes toward those afflicted (Sieff, 2003).
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Content analysis studies suggest that news reports often are sensationalized,
including dramatic descriptions of violent attacks and murders committed intentionally by persons with MDs. For example, the criminal may be presented as suspected
of psychosis, paranoia, depression, or schizophrenia (Hillert et al., 1999; Wahl,
2003a).
News coverage focuses on description of legal cases that center on a violent sub
group (Angermeyer & Schulze, 2001). Different from other MDs in which the print
news media stress the motive, in the case of depression, in particular, they emphsasize the need to protect the afflicted from self-destruction (Rowe, Tilbury, Rapley, &
O’Ferrall, 2003). Selective coverage by journalists of attacks by persons with schizophrenia reinforces the connection between violence and schizophrenia that labels the
entire MD population as dangerous and unpredictable (Angermeyer & Matschinger,
1996; Philo, 1997; Wahl, 1995, 2004). Distorted descriptions of the connection
of schizophrenics to violence were found even in drug advertisements in medical
journals (McKay, 2000).
Indeed, MD are among the causes for the rise in violence among children and
youth (Colon-de-Marti & Marti-Calzamilia, 2000). The media do not make it clear
to the public, however, that only a minority of those afflicted with MDs commit
severe crimes and that the percentage of general violence associated with MD is
low, indeed not above 14% (Angermeyer & Schulze, 2001; Arboleda-Florez, 1998;
Monaham, 1997).
Stereotypes and labeling of these disorders even in children’s films and television
programs, especially in animated caricatures, point to the trend toward stigmatization (Lawson & Fouts, 2004; Wahl, 2003b; Wilson, Nairn, Coverdale, & Panapa,
2000). Very common in television dramas or films are depictions of persons afflicted
with MD as violent and unpredictable, as victims, or as incapable of holding down a
job (Bryne, 1998; Diefenbach, 1997; Hillert et al., 1999; Hyler, Gabbard, &
Schneider, 1991; Kerson, Kerson, & Kerson, 2000; Signorielli, 1989; Wilson et al.,
1999). What is prominent in television programs is not only the connection of
violence with people afflicted with MDs, but also the tendency to place responsibility
for scandals and tragedies associated with them on the policy that supports deinstitutionalization and community-based services (Rose, 1998).
Gender Bias. Another type of mass media distortion of MDs is evident in the
sexist stance applied to them. Content analysis of women’s magazines points to
portrayals that lessened the severity of women’s mental problems, in comparison
with those of others, especially their partners, and of ignoring solutions that will heal
them. Prominent is the focus on ‘‘stress’’ and fear of open spaces (agoraphobia) as
female mental disabilities, while ignoring more severe MDs such as schizophrenia
and bipolar disorder (Beal & Gardner, 2000). Men were over-represented as having
mental illness and as exemplars of health problems in popular magazines and in
discussions about psychoses, personality disorders, and childhood problems. In
contrast, women were over-represented with problems and models of sexual dysfunction, neuroses, and so on (Doherty & Young, 1978).
Gender bias, too was found in direct-to-consumer advertising of antidepressants
that frames depression as a female condition. In doing so, it perpetuates the
stereotype of females as biologically depressive (Grow, Park, & Han, 2006).
Discrimination of women is apparent, too, in the higher proportion of male
experts portrayed in the mass media as involved in the mental health field than is
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the case in reality. Women in the field—in contrast to men—are described as their
failures as women: in lacking femininity and professional power (Von Sydow &
Reimer, 1998). Gender bias even was found in advertisements for psychotropic
medications in medical journals. Here, in the majority of cases, a male psychiatrist
is portrayed as he actively observes a passive female client, even though many
psychiatrists are women (Metzl, 2004).
Distortion of Images of Professionals and Health Care Services. Films not only
stigmatize MDs, but also male psychiatrists. They are portrayed as crazed (Walter,
1989), weird jesters, evildoers, sexually depraved, lustful, oppressive, and vindictive.
In comparison, female psychiatrists are portrayed as persons deprived of love and
satisfaction (Gabbard & Gabbard, 1992). Psychotherapists are presented in films
and other media as people who abuse their power and violate the privacy of others
(Von Sydow & Reimer, 1998). Researchers point, too, to the contribution of psychotropic drugs advertisements to the distorted images of the psychiatrists by emphasizing the psychiatrists’ power over patients’ subservient status and their control of
patients by means of these drugs (Metzl, 2004). In addition, Berlin (1991) found that
television news focuses solely on failures of psychiatric rehabilitation.
Distortion of the Causes of Mental Disorders and Their Treatments. Biases
in descriptions of causes of MDs and their treatment also have been documented.
Conrad (2001) found that in coverage of the discovery of the genes associated with
schizophrenia and manic depression there was a marked tendency to genetic determinism and overoptimism in regard to the genetic causes of MDs and their cure.
He claimed that such descriptions could foster a public perception of genetic research
as involved in a moral problem because of its comparison with eugenics.
Prozac—the most famous antidepressant drug of the class (SSRIs—selective
serotonin reuptake inhibitors) is another such example of distortion. This class of
antidepressants has become a model of cosmetic psychopharmacology, due in part
to the cultivating power of the mass media (Montagne, 2001). The press proclaimed
Prozac to be a miracle drug for treating depression, despite the fact that the SSRI
class of drugs has not proven to be much more effective in alleviating the symptoms
of depression than the preceding generation of drugs (Montagne, p. 1268). Such
coverage is problematic as it can cultivate unjustified expectations and hopes among
those afflicted. The rise in sales of Prozac may be considered to be evidence of the
enormous impact of the mass media in fostering perceptions regarding the influence,
advantages, and safety of antidepressant medicines. The pharmaceutical industry
used a marketing strategy that exploited the cultural image of the scientist who discovers biological causes of disease and scientific ways of healing (Sayce, 2000).
An additional distortion was found in descriptions of post-partum depression
and related mood disturbances. This distortion adopts the biomedical model of
emotional disorders following childbirth and fails to provide accurate information
regarding psychological aspects of this period. Further, there is contradictory information regarding the phenomenon’s definition and its frequency, onset, duration,
causes, symptoms, and treatment (Martinez, Johnston-Robledo, Ulsh, & Chrisler,
2000). Similarly, direct-to-consumer advertising of antidepressants frames depression narrowly within a biomedical model of causation and privileges benefits over
risks (Grow et al., 2006).
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Studies of the Impact of Messages on Mental Disorders on Audiences
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The studies that examined audience responses to depictions of MDs can be divided
into two groups: studies that look for unintentional media influences, and those that
look for intentional influences, following interventional antistigma media campaigns. The unintentional effects of the media can be divided into those that effect
the public and those that effect policymakers; studies following unintentional effects
on the public trace negative effects, while studies of intentional effects focus on
antistigma interventions.
Unintentional Media Influences. Most studies that report on misperceptions and
negative attitudes of those afflicted with MD do not provide data about the sources
of such perceptions (Crisp et al., 2000; Jorm, 2000). Overall, one of the primary
sources is relatives or friends of the afflicted; however, the mass media and
principally television may well have a decisive role in providing information to the
public-at-large (Jorm, 2000; Sayce, 2000; Wahl, 2004).
Although the images of MDs in the mass media are not synonymous with public
attitudes, the idea of moral contamination—that arises from the mass media—is
prominent in findings of public opinion studies (Sayce, 2000), and it is more
widespread among the young than among adults (Bolton, 2000).
Media images are considered to be primary contributors to all mental illness
stigmas, to negative attitudes toward people with MDs, and to the perception that
such persons are dangerous and should be kept at a distance from the community
by means of hospitalization (Glasson, 1996; Wahl, 1999). In particular, stereotypes
add to, reinforce, and foster beliefs and prejudices as well as perpetuate the image
of the schizophrenic as a violent person (McKay, 2000). Selective coverage by journalists of attacks by persons with schizophrenia reinforces the connection between
violence and schizophrenia that labels the entire MD population as dangerous
and unpredictable, leads to negative attitudes, and distances the public from
them (Angermeyer & Matschinger, 1996; Philo, 1997; Wahl, 2004; Wahl &
Lefkowits, 1989).
The focus on legal cases in news coverage and descriptions that center on a
violent subgroup do influence public attitudes toward the mentally ill and undermine
attempts of mental health advocates to deny the connection between MDs and
violence in their attempts to reduce the stigma associated with these diseases
(Angermeyer & Schulze, 2001). In addition, depictions of persons afflicted with
MDs in television dramas or films as violent and unpredictable, as victims, or as
incapable of holding down a job contribute to negative stereotypes (Byrne, 1998;
Diefenbach, 1997; Hillert et al., 1999; Hyler et al., 1991; Kerson et al., 2000;
Signorielli, 1989; Wilson et al., 1999).
Mass media also were found to be among the primary contributors to both
knowledge about, as well as the negative attitudes of medical students toward the
use of electric shock treatment for persons with MDs and its perception as being
cruel and painful, as a cause of brain damage, and its use solely as punishment
for persons with MD who are violent or uncooperative (Andrade & Rao, 1996).
Rose (1998), who reported a study of U.K. television’s treatment of MD and
community care, argued that the fear of and hostility toward mentally ill people
fueled by media imagery has a significant effect on policies of community care.
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Although many studies have examined the public’s perceptions of mental illness
and related stigmas, in fact, only a minority of the studies reviewed were oriented to
the study of the influence of the mental health message in the mass media on public
perceptions. Unusual, then, is the empirical study conducted by the Glasgow group
who examined the perceptions and attitudes toward persons with MD in response to
exposure to different genres in different mass media (Philo, 1999). The study found
that not only news stories in newspapers and magazines, but also fictional stories in
genres such as soap operas, films, and dramas, clearly have a very strong influence
on the beliefs and attitudes of viewers and readers toward the mentally ill. The
majority connected MDs to violence, expressed fear of those afflicted, and cited
the mass media as the source of their beliefs.
Intentional Media Influences. Just as the mass media perpetuate stereotypes of
MD, they also are capable of promoting mental health and contributing to the social
struggle against mental illness stigma. This can be accomplished through promoting
information campaigns, by exposing and opposing cases of prejudices, and by initiating public discussion (Salter & Byrne, 2000). Attempts to provide reporters with
accurate background by assisting them in the preparation of positive accounts about
MDs have met with limited success along with the rise in the number of positive stories about MDs and increase in their length, however, there was also a rise in the
number and length of negative stories, especially in regard to schizophrenia (Heater,
2003). Similarly, the long-term influences of such interventions are not clear, since
only the immediate influences were examined during an intervention that took place
over a 16-month period.
Having extensive knowledge regarding MDs does not necessarily lead to greater
openness to those afflicted with these disorders (Link et al., 1999). Further, even if
there is success in changing attitudes toward persons afflicted with MDs, as well
as in changing laws and policies, it is impossible to assume that this will necessarily
result in a change in behavior toward them. Repper and colleagues (1997) claimed
that the most effective education of the public involves integration of educational
messages with approaches that bring the afflicted with MD in contact with the community and their acceptance by it. Thus, for example, while a documentary film did
lead to a decrease in viewers’ perception of schizophrenics as guilty for their disease,
it did not change their perception regarding their inherent risk or their willingness to
be in contact with them (Penn, Chamberline, & Mueser, 2003). The involvement of
celebrities who actually had experienced MD—in campaigns against stigmas and discrimination—raised interest in and awareness of those afflicted and improved the
publics’ attitudes toward them when accompanied by community education
campaigns (Vaughan & Hansen, 2004).
While information campaigns did produce limited influence, they also led to
decreased fear of persons with MDs and increased willingness to engage in social
contact with them (Wolff et al., 1999). Another study found that an information
campaign with high school pupils led to increased readiness to seek professional
assistance (Battaglia, Coverdale, & Bushony, 1990; Esters, Cooker, & Ittenbach,
1998). The print media was found to be effective in reducing mental illness
stigma and in promoting the acceptance of the mentally ill in the community
(Hickling, 1992). Radio broadcasts were found to be the most efficient and inexpensive way to transmit messages about mental health to large population groups, while
the print media were efficient but more expensive (Austin & Husted, 1998). Some
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scholars argue that information campaigns are not effective among minorities or
educated population (Jorm, 2000) groups and therefore intervention should focus
on specific target groups, such as high school pupils and clinical workers (Corrigan
& Penn, 1999).
Some claim that in order for a campaign related to MDs to have an effect, it is
not sufficient to present facts; rather, initiatives that arouse strong feelings or humor
should be integrated in order to prevent boredom and to provide a compelling counter response to fear of a ‘‘crazed murderer’’ or to humor aimed at ‘‘crazy persons’’
(Wahl, 1995). This having been said, we need to acknowledge that some studies have
found that there is a connection between active psychosis and an increase in risk of
violence. Thus, we cannot claim that those afflicted with MDs are not more violent
than anyone else. Accordingly, a more promising approach to earning the public’s
trust is transmission of a clear message that those afflicted with MDs are only
responsible for a small percentage of violent crimes (Sayce, 2000).
While many studies have examined public perceptions of MD and prejudices
associated with them, very few have studied the perceptions of those assisted by mental health services. Unusual, then, is the recent study by Bagley and King (2005) that
found that only a minority among those who use these services seek actively to
oppose these stigmas. This suggests that the effects of campaigns against stigmas
need to be examined among the mentally ill as well.
The expanding use of new media in the medical profession has lead to an interest
in their potential role in attitude change regarding MDs as well. A review analyzing
63 studies concerning telepsychiatry examined, among others, ethical and legal
themes and patients’ and caregivers’ satisfaction with the new communication technologies. The researchers claimed that only few of these studies can be considered
methodologically reliable (Monnier, Knapp, & Frueh, 2003), for example, a study
that focused on the impact of new media such as the videophone or the telemedicine
system on the relationship between physician and patients with anxiety and
depression as well as on the therapeutic potential of this technology. It found that
this technology was rejected and resisted in a determined way by the psychiatrists
because of the limited interaction with patients involved (May et al., 2001). Another
study examined the role of virtual reality for treating people with specific phobias,
pointing to its therapeutic potential (Davidson & Smith, 2003). In addition, two dissertations dealt with on-line mental health services: Efern-Fernnando (2003) stressed
that Internet service insures confidentially in providing on-line information about
mental illness services, while Slavich (2004) discussed the potential advantages of
counseling and treatment services on the websites. While both studies indicate the
potential advantages of the new media for persons who express fear of stigma, they
too did not examine their impact on reducing mental illness stigmas.
An initial effort in this area is a review that examined four Internet sites
developed especially to support patients who suffer from stigmas and to provide
information to their relatives as well as to educate the public regarding MDs
(Lipczynska, 2005). The review examined their quality in relation to the assistance
provided to the afflicted; the information on their rights and on the policies influence
them; the presence or absence of online support; and the presence or absence of
campaigns demolishing popular myths about mental illness. The review concluded
that although all of the sites provide answers for the people involved with sufferers—from their friends and relatives to employers—only two combine online support with an awareness of public policy and the rights of individuals.
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One prominent deficiency of many audience studies is that they rely on college
students as their research subjects, as is often the case, and, as a result, it is not
possible to generalize about the entire population. Furthermore, very few studies
of persons afflicted with MDs have attempted to understand how they themselves
perceive their images in the mass media. Such studies have great importance since
more than 40% of the schizophrenics in one study reported that they had been
harmed frequently by such messages (Dickerson, Sommerville, Origoni, Ringel, &
Parente, 2002).
An additional methodological disadvantage is that the few studies that examined
the influences on people exposed to media messages did not document their attitudes
prior to the exposure. Similarly, most studies are of only one medium and focused
solely on its contents, types of coverage, or its short-term influence.
Summary and Future Research Directions
Although the public perception in relation to what is thought to be an MD has changed over time and now also includes depression and anxiety (Phelan, Link, Stueve, &
Pescosolido, 2000), most of the studies described above do not focus on a specific
MD, such as schizophrenia, nor do they define what is considered to be an MD in
media representations. Therefore, it is not possible to make comparisons between
studies or to generalize from them.
In addition, most of the studies described above focused on representations and
images of MDs and those afflicted in the mass media. Content analyses of the messages revealed different sets of distortions: exaggerated, distorted, or inaccurate
information in the presentation of MDs; descriptions of the mentally ill as violent
and dangerous portrayals of the nature of MDs and their causes; as well as descriptions of mental health services and caregivers. These consistent findings support the
claim that the images used by the mass media may be contributing to the perpetuation of stigmas of mental illness, the mentally ill, mental health services, and caregivers. One of the early representation studies that was conducted by Signorielli
(1989) concluded that these images are ‘‘likely to contribute to . . . ignorance and
neglect, . . . perpetuate unwarranted views about mental illness, . . . and frustrate
efforts at health education and integration of those who recovered from mental
illness’’ (1989, p. 330).
Prominently absent is research that examined the representation of subjects
relating to policies and preferences for budget allocations, coverage of policies
regarding integration of the mentally ill into society, as well as studies that focus
on coverage of new technologies including new drugs. Also absent are representation
studies about the appearance of persons with MDs in commercials, an action that
violates professional ethical codes that seek to prevent potential harm to persons
with disabilities, including those with MDs (Elfent-Lafler, 2003).
In comparison with the many representation studies that deal with images of
MDs and those afflicted in the conventional mass media, there is an absence
of studies that focus on MDs’ images in the ‘‘new’’ mass media and especially the
Internet, as well as studies that focus on the impact of new mass media on perceptions and stigmas of mental illness and the mentally ill. This could be attributed
to, among other things, methodological difficulties, including the need to develop
new sampling and analyzing methods. Internet studies also pose the new challenge
of the blurring of the boundary between sender and receiver, producer and audience.
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A. Klin and D. Lemish
Our literature search has found very few production studies in the research
corpus. The relationships between mass media descriptions and public perceptions,
although informed by studies about the mass media’s role in cultivating social
perceptions in other fields, remains theoretical and speculative at this stage. This
may well be the most important gap in the existing literature and is a result of
the fact that very few studies were conducted on the influence of the mass media
on the public’s perceptions, although many studies have examined the public’s
perceptions of mental illness and related stigmas.
Most insightful are studies that include an analysis of the process of image
production, the messages contained in these images, and their effects on a variety
of audiences. In doing so, they illustrate the assumed relationship between
production to creation of misinformation and stigma or the relationships between
production of media interventions and their effects on reducing stigma (Philo,
1996; Philo, 1999; Philo & Secker, 1999).
Clearly, in order to maximize the use of mass media with the goal of reducing
stigmatization, we should enrich our knowledge on the topic. To this end, it is
important, initially, to define explicitly what is included in the term mental disorder.
This will allow researchers to make relevant comparisons between different studies.
Furthermore, systematic studies should be conducted on different media simultaneously, while examining the contents and framing of the subject of mental health
and their long-term influence, even after a period in which there is a lack of exposure.
The variety of genres of mass media, too, should be examined as well as the channels
that have specific influence on particular audiences, under certain circumstances,
such as children and adolescents or the mentally ill themselves.
The importance of research on MDs lies in its potential contribution to
understanding the mechanisms that create and reinforce mental illness stigmas as
well as their contribution to their reduction. Reduction of stigmas will encourage
the ill to request assistance that may ease their suffering, assist their integration
into society, prevent harm to their self-image and family life, and prevent economic
damage to health and employment systems. Similarly, a thorough and consistent
discussion of mental health policy issues may influence decision makers in the
allocation of appropriate resources.
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