How do Americans perceive mental illness?

New IU-Columbia study finds general knowledge has increased, but stigmatization remains high

By Susan Williams

Between 1957 and 1996, the percentage of Americans who indicated they would seek informal support to deal with an anticipated nervous breakdown increased by more than 400 percent. And when compared to our fellow America ns in 1957 and 1976, we are significantly more likely to consult a mental health professional and to accept prescription medications and/or psychotherapies.

Even if stated somewhat unscientifically, that’s the emerging message from a 1996 national survey, the General Social Survey (GSS) Americans’ Views of Mental Health and Illness at Century’s End: Continuity and Change, conducted by researchers at th e Indiana Consortium of Mental Health Services Research at Indiana University and the Joseph P. Mailman School of Public Health at Columbia University and funded by the National Science Foundation.

The mental health module of the GSS, supported through additional grants from the MacArthur Foundation and the National Institute of Mental Health and the National Science Foundation is considered the foremost survey on attitudes toward mental health and illness. Its data is often referenced and its researchers consulted by scholars, policy makers and congressional leaders.

The 1996 GSS explored ground around basic questions of definition, tolerance and personal experience in an effort to map Americans’ knowledge and attitudes of mental health and illness, including drug and alcohol dependencies. Survey results, compared to those of three earlier studies—the 1950 The Dilemmas of Mental Illness Survey (DMIS) and the 1957 and 1976 Americans View Their Mental Health Surveys (AVTMHS), indicate both remarkable progress and distressing regression. They also provide f ood for thought among policy makers.

“The two most interesting sets of findings are paradoxical,” said Bernice A. Pescosolido, Chancellor’s Professor in sociology at IU Bloomington and co-author of the study. “Americans appear to be more sophisticated about what mental illness is, what cause s it and what to do about it. At the same time, however, their reaction to individuals with mental health problems is dismaying. They report high levels of stigma and a high level of willingness to use legal means to coerce individuals into treatment.”

Two steps forward

The level of Americans’ sophistication can be measured in increased knowledge of mental health and illness. We’re more likely today to know what it is, suggests the GSS. For example, in the 1950s, we often mentioned serious behaviors indicative of either psychoses or anxiety/depression when asked to define mental illness. But by the 1990s, we had broadened our definition to include less severe problems—mild anxiety and mood disorders. We also have become more definitive of the differences between a “nervo us breakdown” and a mental illness—the former corresponds more closely to neurotic and mood disorders, we say, while the latter indicates serious psychotic and socially deviant behaviors.

Maybe our knowledge of mental health and illness has increased in part because we are more intimately familiar with it. In 1957, one of five Americans reported having personal fears of an impending breakdown, but by 1996, this number had increased to near ly one in three. And a relatively large number of Americans had first-hand knowledge of persons suffering from mental health problems in 1996, with more than half reporting they knew someone who had been hospitalized. An even greater number indicated know ing others who have received out-patient mental health services.

We are also increasingly inclined to attribute mental health problems to combinations of stress, genetics and chemical imbalance, rather than to poor upbringing or bad character, especially in the case of disorders such as depression and schizophrenia. < p> If we are more able to define, recognize and understand mental illness, we are also more likely to know where to go for help. And we are optimistic about the effectiveness of treatment. Between 1957 and 1996, the percentage of Americans who indicated they would seek informal support to deal with an anticipated nervous breakdown increased by more than 400 percent. And when compared to our fellow Americans in 1957 and 1976, we are significantly more likely to consult a mental health professional and to acc ept prescription medications and/or psychotherapies. And most encouraging, in overwhelming numbers we believe today that if treated, mental health problems will improve. We don’t think they get better on their own.

One step back

Of course, with the good comes Pescosolido’s paradoxical bad. Despite all of our increased knowledge and understanding of mental health and illness, Americans have not risen to a greater level of acceptance for those with mental health problems. Nearly 75 percent of us prefer to avoid contact with those suffering from alcohol or drug dependent illness. While more tolerant of traditional forms of mental illness, such as depression or schizophrenia, a good number of us still prefer to maintain our social di stance. Nearly half of us would avoid someone with schizophrenia, and almost 40 percent of us would stay away from someone suffering from major depression. Even more alarming, we’d rather not work with someone dealing with depression, schizophrenia, alcoh ol or drug dependence—a full 67.4 percent of us say so.

Perhaps that unwillingness is related to our tendency to see mental illness as a indicator of financial competence and the ability to make decisions regarding mental health care. While 70 percent of us believe that people with depression are able or somew hat able to manage money, only 64 percent believe they can make decisions regarding their health care. The numbers plummet from there. We are nearly uniform in our acceptance of using a legal means to force mentally ill who may be at risk to themselves in to hospitalization— nearly 88 percent—and even more of us support coercion if they are a risk to others—93 percent.

Bringing up the possibility of harm to oneself or to others leads to what may have been the most stigmatizing of our attitudes in 1996. Despite evidence that people with mental illness are no more likely to exhibit violent behavior than those in the popul ation at large, Americans today perceive the opposite. Between 1950 and 1996, the number of us who associated mental illness with violent or dangerous behavior toward self or others nearly doubled. Researchers speculate that this misperception may be the result of rare but highly publicized and all too real incidents of violence by mentally ill persons. Consider the “Son of Sam” murders, for example, the assassination of John Lennon and the Unibomber’s deadly mail bombs.

“We can’t be too quick about blaming the media for negative images of mental illness, though,” Pescosolido said, “We also have to give the media credit for getting information out there from scientific studies about what causes mental illness and what kin ds of treatments are out there to help.”

The path from here

"We need to understand the roots of stigma, and once we begin to understand why these results are so dismaying, we must work on policies to try and change public attitudes,” said Pescosolido.

According to the GSS, forging a path toward breaking down the stigma that may keep people with mental illness from seeking treatment may mean developing a well-articulated national mental health policy. This is something the United States has lacked since the Reagan administration decentralized federal health care in the mid-1980s.

There is also clear support among us for more government spending on mental health care. Just over 46 percent of us believe the government should spend more money, while nearly 37 percent support the amount now being spent. Only 10.5 percent of us would p refer the government spend less.

And we believe strongly that the government should have at least some responsibility to provide mental health care, with around 74 percent of us voicing probable or definite support. In light of this finding, it’s interesting to note that most of us—nearl y 75 percent—believe that the affected individual and insurance still hold primary responsibility for payment of mental health care. More research may be needed for clarification.