Shame, Blame and Contamination: Mental Illness Stigma and the Family
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Illinois Institute of Technology
Home page: http://www.iit.edu/human-sciences/faculty/patrick_corrigan.shtml
University of Illinois at Chicago
Home page: http://www.uic.edu/jaddams/college/faculty_staff/faculty/watson.html
Field period: 03/26/2004 - 04/08/2004
Family members of relatives with mental illness and/or substance abuse report they are frequently harmed by this kind of stigma. There has not, however, been a population-based survey that assesses how members of the general public actually view family members. Hence, we examined ways that family roles and types of psychiatric disorders influence family stigma. A nationally representative sample (N=968) was recruited as part of Time-Experiments for the Social Sciences. We used a vignette design describing a person with a health condition (schizophrenia, drug dependence, or emphysema) and a family member. We found that family stigma related to mental illnesses like schizophrenia is not highly endorsed. Family stigma related to substance dependence, however, is worse than other health conditions. Additional analyses showed that family role predicted stigma with parents being blamed for onset and offset of a relative's disorder, and children viewed as contaminated by the health condition.Hypotheses:
a. Family with a member labeled with mental illness will be judged more harshly than those labeled with some other disability.
b. Family stigma will vary with the role of the person -- e.g., parent, sibling, child -- who is stigmatized.
850 participants in the TESS internet sample were presented a brief paragraph describing a family member and his or her relative in this general format:
NAME-1 is the FAMILY ROLE BY GENDER of NAME-2, a 30 year old man with HEALTH CONDITION. NAME-2 lives with his family in an apartment and works as a clerk at a nearby store. NAME-2 has been hospitalized several times because of his illness. The illness has disrupted his life significantly.
NAME-1 represented the family member; NAME-2 was the relative with the health condition. FAMILY ROLE and GENDER were crossed to yield 8 possible relationships consistent with our hypotheses: mother/father, wife/husband, sister/brother, and daughter/son.
NAME-2 was described as having one of three health conditions. Two of these were mental health conditions -- schizophrenia and drug dependence - shown in previous research to yield significant stigmatizing reactions (Link et al., 1997; Phelan et al., 2001). The third health condition was emphysema, selected because research subjects generally view people with this kind of condition as responsible for their illness (Weiner, Perry, & Magnusson, 1988).
Attitudes about NAME-2, the person with the health condition. The 7 items in this set are taken from the short form of the Attribution Questionnaire version 2 (AQ-2) and represent the factors embedded in the two models of mental illness stigma outlined above: blame, pity, anger, help, danger, fear, and avoidance.
Attitudes about NAME-1, the family member. Seven individual items were selected based on a literature review on family stigma and a pilot qualitative study completed with 8 family members in focus group fashion for this purpose.
How Does Family Stigma Vary by Health Condition?
The results of a oneway MANOVA with the seven items of the family scale were significant. Subsequent oneway ANOVAs showed that all seven items differed significantly. Post hoc Tukey's test examined the differences between pairs of health conditions. Results suggest that families of drug dependent people are viewed in the most stigmatizing manner; i.e., more responsible for onset and offset of the disorder, more likely to be contaminated, more ashamed of afflicted family member, and less competent in their family role. Families of people with drug dependence and schizophrenia were viewed as more pitiable than those with emphysema.
How Does Family Stigma Vary with Family Role?
Results of a 4X3 (family role by health condition) MANOVA with the seven family stigma items as dependent variables yielded significant main effects for family role as well as a significant interaction. Subsequent 4X3 ANOVAs were then conducted for the seven family stigma items individually. Signficant main effects for family role were found for onset blame, contamination, offset blame, and withholding pity. Results showed that parents and spouses are viewed to be more responsible for the onset of the person's schizophrenia, drug dependence,and emphysema then children and siblings.
Several interesting trends emerge. First, the public does not seem to highly endorse family stigma of mental illness or substance abuse. Family stigma of people with mental illnesses like schizophrenia was less harmful. We chose emphysema as a physical health condition because of the perception that people suffering with this disorder are more blameworthy because of a past smoking history. And in fact, the primary stigma related to blame was more highly endorsed for emphysema than schizophrenia. However, no difference was found in blaming family members for emphysema compared to schizophrenia. Combined with our earlier findings, these results suggest that families with a relative who abuses substances are viewed in a stigmatizing manner by the public while those with a person with mental illness are not.
A third goal of this study was to determine whether family stigma varies by role. Results clearly suggest yes, but the specific difference depends on the type of stigma. For example, results showed adults in a family with an immediate relationship with the person -- parents and spouses -- are more likely to be viewed as responsible for the health condition.
Corrigan, P.W., Watson, A.C., & Miller, F.E. The impact of mental illness and substance abuse stigma on family members. Click here for the manuscript
Corrigan, P. W., and A. C. Watson. 2007. "The stigma of psychiatric disorders and the gender, ethnicity, and education of the perceiver." Community mental health journal 43:439-458. Click here for the manuscript
Corrigan, P.W., A. C. Watson, and F. E. Miller. 2006. Blame, shame, and contamination: The impact of mental illness and drug dependence stigma of family members. Journal of Family Psychology. 20: 239-246.