Public Conceptions of Mental Illness in 1950 and 1996: What Is Mental Illness and Is It to be Feared? Author(s): Jo C.

Phelan, Bruce G. Link, Ann Stueve and Bernice A. Pescosolido Source: Journal of Health and Social Behavior, Vol. 41, No. 2 (Jun., 2000), pp. 188-207 Published by: American Sociological Association Stable URL: . Accessed: 25/02/2014 15:13
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Public Conceptions ofMental Illnessin 1950 and 1996: What is MentalIllnessand Is It to be Feared?*
Columbia University

ColumbiaUniversity and NewYork StatePsychiatric Institute

Columbia University

Indiana University Journal ofHealthand Social Behavior Vol 41 (June)188-207

In the 1950s, thepublic definedmentalillness in muchnarrower and more termsthandid psychiatry, extreme and fearfuland rejecting attitudes toward people with mental illnesses were common.Several indicatorssuggest that definitions of mentalillnessmayhave broadenedand thatrejection and negativestereotypes mayhave decreasedsince thattime. lack ofcomparaHowever, ble data overtime usfrom prevents drawing firmconclusions on thesequestions. To addressthis theMentalHealthModule of the1996 GeneralSocial problem, the meaningof mentalillness thatwas Surveyrepeateda questionregarding firstasked ofa nationally representative sample in 1950.A comparison of 1950 and 1996 results showsthatconceptions illnesshave broadened someofmental whatoverthistime disperiod to includea greater proportion ofnon-psychotic thatmentally ill people are violentor frightening orders,but that perceptions substantially increased,ratherthan decreased. This increase was limitedto who viewed mental illness in termsof psychosis.Among such respondents the whodescribed illpersonas beingviolent respondents, proportion a mentally increasedby nearly2 1/2timesbetween1950 and 1996. Wediscuss thepossithatthere has been a real movetoward bility acceptanceofmany formsofmental illnessas something thatcan happento one of "us,"butthat people with psy" whoare more chosisremain a "them werehalfa century fearedthanthey ago. In the 1950s, social scientists began to address questions concerning howthelaypubmentalillness and how they lic understood reacted to peoplewho suffered from suchilllearned was notheartening. nesses.Whatthey that, notonlywas thepubEarlystudies found uninillnesslargely lic's orientation to mental thinking of psychiatric formed by thecurrent

*We wish to acknowledge the contribution of Dr. MentalHealthModule of the 1996 GeneralSocial Shirley Star, whosethoughtful, painstaking andorig- Survey was funded Foundation. by the MacArthur inal analysis of publicconceptions of mental illness Partial bya Senior support for Dr.Linkwas provided the NationalAlliancefor inspired thepresent paper. We thank Patrick Bova of Investigator Awardfrom theNational Opinion and Major Depression. Research Center, whofacilitat-Research on Schizophrenia Division of to:JoC. Phelan, correspondence ed ouraccessto Star's original data, coding materials, Address L. MailmanSchool and unpublished and we thankthe Sociomedical Sciences,Joseph manuscripts, reviewers of twoversions of thismanu- ofPublicHealth, Columbia University, 600 W 168th anonymous NY 10032. who providedmany helpfulinsights. The Street, NewYork, script,


This content downloaded from on Tue, 25 Feb 2014 15:13:49 PM All use subject to JSTOR Terms and Conditions

Thesefindings werediscouraging to mental Regarding publicconceptualizations ofmental professionals and researchers forseverillness. house"(Star1957:3).changes in public beliefs and attitudes. Yarrow.47. (1981) found I'd haveto go to 1957 and 1976 not onlyin reports bluntly putit: "I don'tthink of actual holdmyhand help-seeking to tellme I was crazy. however. tility. ence ofa non-problematic sort"(Star1952:7). treatment As we enter the new millennium. an increase between et al. peopleweremorelikely of rangeof negative adjectives suchas "danger. found Nunnally (1961). they This content downloaded from 205. didn't haveanymoresensethan to go to a increased reflects.""bad. studying that there is less stigma attached to these probthat most lemsandtheir communities in Saskatchewan.butpublicconceptions weresuffused psychiatrist theyoughtto be put in a nut withnegative stereotypes.173. for example.253 on Tue. fear. Edgerton. it was because According to some authors. anxiety Not surprisingly. Theyimplied that persons identiequate mentalillnesswithpsychosisand to little ill fied as mentally might suffer extreme rejeckindsof emotional. in mental health terms and of problems array andCumming two Cumming (1957).many that might benefit them.""cold. concludedthat al reasons.andmaybe tripled. Regier et al. that to applya broad (Veroff. "an emotional or character differ. Dohrenwend and Chin-Shong1967. Regardless in terms treatment. own that the today." included characteristics mental illness that they nowdefine a broader such as dangerousness and unpredictability.000 Americans. tactwithsomeonewho had been mentally and thatthe researchers' efforts to change There is also more direct evidence for thoseattitudes weremetwith andhos.based on interviews health Theyimplied that publiceducation with over 3. Clausen." of of profesthat the rate utilization suggest "insane"or "neurotic" thanto an "average" has at leastdousionalmental health services person(p. with few peopleknowing anyone a psychiatrist orwhothey sulted thought might Brockman andD'arcy 1978. KulkaandDouvan 1981." "worthless. and rejection. or view other behavioral.. Meyer chiatrists enjoyedlittlepublic endorsement." "dirty. inusingtheir found that many Americans." twenty suggesting that utilization at least in part. Linket al..Bentz.1993. Crocetti andLemkau1963.thedata and "ignorant" to a personlabeledas (Manderscheid "weak. Similarly. presence of ulation surveys self-reported help-seeking umented. If ness for self-referral. peoplewouldfailto seek mental health terms as. were conducted. extreme terms rejected. Star (1952. toward and devalued people with mentalillnesses haps dramaticallysince these earlystudies The clearestchangeis that (Star 1952. 1999). 1964. and Bernard. It is difficult to imagpeoplepreferred to avoid close personal con.Nunnally (1961) found haveshown a fairly cleartrend illness" the public evaluated who treat toward professionals increased identification ofthevignettes mental disorders morenegatively as instances significantly and of mental illness(Cumming thanthosewho treat Star Cumming1957.and Siassi 1974. physicaldisorders. Crocetti. thattheidea of consulting (1957) found psy. witha description ofa person criteria meeting The public's negativeorientations toward for a particular and is disorder psychiatric to theprofession. there are reasons to believe that orientations mental illness was defined in suchnarrow and mental illness mayhavechanged-perthat thepublicfeared. 1955) between the1950sand bled. Kesslerand Zhao 1999) or in terms of service facility-based records utilization ous. Dohrenwend. and Kherlopian 1969. 1955). lay definitions that was a severalstudies Robbins fear ofstigma (1955) found the"Starvignettes" employing serious concern for wives of psychiatric (Star1955) in which a respondent is presented patients.and Regarding of mentalillness.inesuchdramatic inutilization inthe increases ill absenceof suchchanges. These trends indirectly suggest wordsto describe their of the understanding about public has come to thinkdifferently term "mental illness. Spiro. whohadcon. 25 Feb 2014 15:13:49 PM All use subject to JSTOR Terms and Conditions . Star(1952. found treatment. regarding mental illnesshad produced therewas a strong for people to efforts tendency effect. many more people now seek mentalhealth ofthesourceof these Gove 1982).PUBLIC CONCEPTIONS OF MENTAL ILLNESS 189 theday.Kolb 1962. 46). anybody but also in hypothetical "readiandtalktome for dollars an hour." and Henderson 1998).asked how likelyit is thatthe personhas a mental illnessalso extended that "mental als whotreated it. Whether measured ofpoptheir was welldocnegative attitudes. Andthey implied that personality problemsin non-mental health tionand stigmatization. As one respondent Veroff be helped bya psychiatrist.

By repeating disclosures of mental selves. negativeimages as an indicator we look at mentions of violence and Cumming 1957. Dohrenwend Specifically. negative images and and Miller 1969.g.there illness dents'reactions.thatwould be directly and their willingness health gatheredin earlier research. and Lemkau 1963. Our question havevaried they forthe issue of stig. Dohrenwend and Chin-Shong1967. theevidence indicate ed by the same organization: of the1950swould the National menthat wasignorant about .Gove(1982) interviews (Gove 1982. 1974. have con. Meyer 1964. This wouldcause problems inthevastmajority theresult ofcases that] of mental illrability overtimeifconceptions thestigma bymental patients] [experienced a set of ness were assessed by presenting tobe transitory anddoesnotappear appears to pose a severe problem. Rootman willingness to seek such University withand a greater also found andinterpret-Star1952.Theseauthors The Mental Health Module of the 1996 ed as evidence for reduced stigma an the betweenrespondents' GeneralSocial Survey(GSS) presented increasing congruence to addressthislimitation by colfor opportunity endorsement of mentalhealthtreatment of mental illness data on conceptions crisis lecting someoneelse facingan unmanageable to those comparable to seek elicits definitions evidence Whiletheincrease of to mental vice utilization is unquestionable. This content downloaded from 205. the public Center (NORC). or behaviorsthat match current symptoms are indications thatsubstantial diagnosticgroupingsand elicitingresponThus. in ser. ducted at different in thepopulations havesam. 1969. since the 1950s ofmental illness andeffectiveness have changedsignificantly rynature Association 1952. Crocetti definitions ofmental andwe use these 1970. However. (P 290).asksaboutrespondents' ofmental pled and-particularly conceptions ma-in thequestions haveaskedofstudy illnessand is notwell suitedto assess social they subjects (Belson 1957.. Sincethen there has beena excluded 1996 responses to be coded in a consistent effort focused on mental massive education manner.253 on Tue.1 moredirect from clusionsthatcan be drawn Stigma has typicallybeen measured in are termsof social distance(Owen. Eisnerand evidence andattitudes on beliefs empirical con." mayhavetaken Because our is notfirm.chiatric nomenclature werenotproblematic. 25 Feb 2014 15:13:49 PM All use subject to JSTOR Terms and Conditions . 1959.The con. and other potentially frightening and unpredictability. Blizzard stereotypes are an integral Bentz. Bentz et al.had a verynegative image of interview schedules is sampleofStar's original persons identifiedas mentallyill.1955). forexample: states. Star's (1952. Padilla.McFaul 1981) or of negativeimages and limited of thestudies by incomparability timepoints. Purdue tal health professional and Lafare 1965. 1974).. Edgerton.Finally. of stigma. theextent therespondent than illnessfrom rather which changesin conceptions and attitudes presenting tohimorher. Elinson. Crocetti et al. Cumming characteris1966. Nunnally 1961. in 1955) open-endedquestion asking responreviewsof studiesconducted cludedfrom illness the 1950sand 1960s that bothsocial distance dentsto definetheconceptof mental for thispurandnegative stereotypes regarding peoplewith was chosenas theone bestsuited use face-to-face didStar's study mental illnessesabatedoverthattimeperiod pose.Butthe widely used "Star vignettes. 1999.190 JOURNALOF HEALTH AND SOCIAL BEHAVIOR 1961. to view emotional or Lemkauand Crocetti tendency botha greater as something that a men. Link et al. in similarmethodology WilliamStyron) Mike Wallaceand author comparisons fear of wouldbe possibleto makedirect a diminishing recent years also suggest andattitudes overtime. (American Psychiatric hasbecomefairly visible[with oftreatment of compa1994).Notonly representative with a nationally etal.Crocetti liketheGSS. partof individuals' and D'arcy 1978.47. Brockman illness. and Bentz tics such as instability Dohrenwend et al. These studies stereotypes(Star 1952.MacLean 1969. inpublicorientations tomental changes as is thecase withthemore place sincethe1950s.Diagnostic categoriesand criteria thegenerally transitoillness:furthermore. butitwas also conductsample. 1962. journalist questionsfroman earlierstudythatused a it and sampling frame. Olmstedand behavioral problems might be able to help Durham 1976. A random Opinion Research tal illness..ofbeliefs some researchers stigma. help.Voluntary problems by public figures(e. distance.Olmstedand Durham 1976). Edgerton is notmeasured 1969. and archivedat NORC. allowingthe 1950 and them. Phillips 1964. and Perkins 1967. inpsythem changes account for thisincrease is notclear. Whilesocialdistance directly.173.

non-psychotic) disorders2 and whether random there has been a lessening of fearful of respondents within the imagery and quotasampling interselected blocks. 1974.529 adults(age 21 or older)by et al.253 on Tue. and race/ethnicity have all symptoms/ manifestations (see below). we anamore broadlyinclusiveand less stereotyped lyzewas askedofa random of710 sub-sample of mentalillness.47. we sampling assess whether definitions have broadened at NORC at the time.5 been shown to be associated withconceptions ofmental attitudes toward illness. answers 1957.speaking livpersons18 yearsof age or over4 orders thewholegestalt ill. The response ratewas 76. askedin 1950and 1996: "Of course.Linketal. 25 Feb 2014 15:13:49 PM All use subject to JSTOR Terms and Conditions . .Specifically.1 ordoes this create frightening. does theinclusion of less seriousdis. . Star 1952.we assess whether Starused a modified apparent TheStarsurvey. fearful non-responsesand non-codable responses shouldalso decline. In thispaper. and Pennay1993). resulting in a nitions of mental illnessbroaden to includea them remain archived morediverse setofproblems. of mental illnessfeedback to soften negative conducted byNORC (Davis and Smith1996). Excluding if definitionsbroaden over time.The question possible respondents. tolerance greater fora broader overall concept The GSS. the folpart byincreased tus particularly education andbyincreased lowingprompts were used: (1) "How would a person whois mentally-ill?" urbanicity. population overthelasthalf 653 foranalysisof syndromes/problem cateofthetwentieth Socioeconomic century. However. areasampleof U. JacobFeldman. buta randomly selected one-tenth of at NORC. test. Kiecolt 1988. youdescribe (2) This content downloaded from 205. sampleof352 for study. Freeman1961. Cumming and Cumming The dependent to thefollowing and Chin-Shong1967.' changes of and attitudes toward mentalillnessare in whatdoes that meanto you?"If respondents' mediated socioeconomic sta. residents.answers wereunclearor incomplete. 1955. a descriptions illness. (Abrahamson from measuresare derived 1995. Lege. thecurrent By this thinking. peoplewith mental illness and general tolerance Dependent Variables and Carter1986.3 Face-to-face surrounding mental illness.discarded. Most of the attitudes tied to psychosisand thatattitudes toward originalinterview scheduleswere eventually ill peopleimprove mentally whenpublicdefi.whatabouttheones we call since 1950. a further can be asked: drome/problem question anda sampleof335 categories Are positivechangesin attitudes limitedto foranalysisof symptoms/manifestations (see withnon-psychotic or does below). Phelanet al.S. broadening two percent. Parra1985.S. We therefore mental or nervous illness . The 1996 GeneralSocial Survey."rendering it moreacceptableand less theUnitedStates.. conceptions and Excluding non-responses is thesociodemographic transfor-non-codable explanation in a sampleof results responses mation oftheU. to samplingstatistician includea greater proportion of less serious recalls thatthe sample entailedmulti-stage selection downthrough theblocklevel (i. goriesand a sample of 622 foranalysisof urbanresidence. 1987.e.If thisprovesto resulted ina sampleof337 for imagery analysis ofsynbe thecase. We have changesin publicorientations toward mental probability documentation of the illness are reflected in people's self-stated located littlewritten ofmental method. When you hear changedmarkedly test thehypothesis that in conceptions someonesay thata personis 'mentally-ill. status. 1999).ing in non-institutional of"mental change within arrangements ness. everyone illnessand Westbrook. Dohrenwend open-ended question.Crocetti with3.PUBLIC CONCEPTIONS OF MENTAL ILLNESS 191 ofdangerousness perceptions havebeenshown METHODS to be an important factor underlying thedesire for socialdistance from ill. persons disorders. ducted Gove 1982) that fear andnegative are NORC in May and June of 1950.Sampleand Procedure peoplewith mental ness (Linketal. attitudes toward as well? used a full probability peoplewith psychosis sample of EnglishThatis. and the hearsa good deal aboutphysical distribution of each of these variableshas disease.butnow. We also assess the randomly 1 1/2 association between thesetwovariables.173.viewsof approximately hours wereconingthenotion (Star1952.Interviews 1 1/2 of approximately that elicitdistinct reactions? subgroups hours were conductedface-to-face between ifthere has been movement toward MarchandMayof 1996.

g. In all. code.g.comes back partially dressed") ings. mood/anxiety problems) correspondquite Mentions of bizarre behavior (e." mentioned symptoms indicating breakswith der."person "livesinhisownworld." that affect notonly "depressed").pulsivebehavior." "lifeis getting "reaccategories awayfrom them.To address our lem.stance problems.The "deranged." "psychological problem").Statistical Manual of Mental Disorders al terms suchas "nuts." was coded whentherespondent tions "mental orbrain disorPsychosis disproportionate. public responsesbut the coding process as "emotional comfrom the Star withdrawal (e.. down. "not normal ofmen. "look derelict-clothes in rags"). Violence includedmentions of violent sex self. ness.(e." illquestions regarding conceptions Social deviancewas coded when responof mental references to abnornessandstigma. difficulty making tions.These are wide rangeof problems moregeneral ofsyndromes ortypes included categories no references to psychosis butwere of problems thatrespondents associatewith not clear enough to classifyfurther ( of oneself(e. subSymptoms/manifestations.nal or delinquent mentions ofmental behavior. (e." talillness as described byrespondents.""borderline gory." homicidal or impulses."does not have the capacity to function norcidal tendencies. was subtyped as withDSM-definedmentaldisorders." and (2) behavior. Mental psychosis iftherespondent violent also mentioned includes both oneor deficiency/cognitive impairment more of the violentbehaviors or tendencies clear-cut indications ofmental retardation and indicated underviolentsymptoms/manifestaothermanifestations (e.g. like?"(3) "What doesa person likethis do that This category was codedifa respondent mentellsyouhe is mentally-ill?" (4) "How does a tionedanxiety or depressive symptoms (e." "out of his mind"were also coded as psy.g. withcopingand functioning unstable.. as defined by the Diagnostic and characteristic ofpsychosis anduse ofcolloqui.g. mental retardecisions)that maynotindicate Anxiety/mood problems combines Star's dation. twovariables werecoded:(1) dentsmade non-specific behavior(e. cerned socialchange might social ups and downs.. uncontrolled." "one who is notable to do forhimself.g. "wanders closelyto broadpsychiatric diagnostic groupofffordays. to code ifrespondents referred to an "emotional probcoding categoriesand definitions responsesto both surveys. personlike thisact?" Because we were con. personis neurosis. 25 Feb 2014 15:13:49 PM All use subject to JSTOR Terms and Conditions . "slow in thinking.mally in everyday life").Social deviance includesmanifestacodes of neurasthenic other tions of antisocialpersonality disorder original and neurosis. all open-ended questions inability to function or take andGSS surveys werecodedbythesameindi. "can't cope withreality viduals thesameprocedures.. sexualdeviations." or (American Psychiatric Association 1994)..mal or strange andmanifestations specific symptoms in withsociety.." "cannot reason. ic forms ofbehavior or experience therespon. tendencies sui. up to three categories nervousbreakand codingcriteria areas follows. we (e.192 JOURNALOF HEALTH AND SOCIAL BEHAVIOR "Whatdo you think a mentally-ill and acutenervestorms or tensions. irrational. extreme or labileemotions (e. there are 97 symptom/manifesta-Mental deficiency/cognitive impairment tions codes. and crimident as beingindicative ill.himis aboutas important as another. well. or physical book is archived at NORC.g.g...47." "angry"). If a respondentdescribed "unbalanced in his thinking-one decisionfor behavior withmorethanone cate. public")." "crazy. as well as cognitively symptoms/manifestations: extreme/excessive. Star's using malaiseorcollapse. violence againstproperty. inreality." analysis. unpre. mentions of abnormalappearance These are specif." Two of these categories(psychosisand notcompletely reality (e. Also includedare more specific broader or problem syndromes categories in thesymptoms ofdeviant which andmanifestations canbe mentions behavior (e. "stayto themselves"). "difficulty fitting into "strange")..g.g.In addition..g.Up to three symptoms werecoded refers with toproblems thinking andreasoning for In thepresent eachrespondent."appear worriedor anxious all the time. on thefollowing report "can'thandlemoney")." consistent "chemiwerecoded.g.other three less directly categories correspond chosis."urinates grouped.based difficulties and violent. crimes. mental illness..g.. ofviolence." "imaginary friends").173. andunspecified forms Othernon-psychotic problemsincludesa and syndromes that Syndromes/problem categories. This content downloaded from 205. and we used her andfunction"). The cal imbalance."couldnotmakegooddecisions for himdictable.253 on Tue..

Education. in terms of sevencategories.. (4) cities between 10. andwe usedthesecategories for the non-white. intheStarsurvey. The lowest and highestcategories "abnormal" or "strange" thatdo not werecoded. othernon-psychotic is a het. Most striking $500 to $10. degrees tions were discussedwith the firstauthor. was was codedindependently bytwo of three measured in persons self-report.89 for frightening 2. (2) townsunder2.7 in 1950 to 18. in the Star survey.000to $75. analyses involving ed a third variable: education was a somewhat of (1) less than high andthere higher proportion school. 25 Feb 2014 15:13:49 PM All use subject to JSTOR Terms and Conditions . townsand villagesbetween areas between1.93 for violent .respectively.1990 Censuses. master's in psychology. income.analyses that erogeneous does notcorrespond ed a variable in which Star values were category clearly withanyparticular psychiatric diagno. from ranging no Table 1 reports charactersociodemographic formal to completion of college. and (1) rural 1 and 2 and GSS cateinterview (1950 or 1996).family and community size. community and place of residence kappa.000or over. ranging We used thesecategories noted.000and249.First. intheStarsurvey.173. Each verba. Kappa valuesare was measured 0 whenraters agree no morethanwould be categoriesare for places within Standard Statistical Areas (SMSAs): (10) expected is Metropolitan by chanceand 1 whenagreement In thisstudy.(Star) and $750 and $100. interms sured ofninecategories. (4) collegedegree.and women in 1996. from centageof non-white rose from respondents ranging is under In theGSS.999.Census1997). irrational). the Starand comparing from less thanhighschoolto GSS samples.96 for psychosis. in terms of 21 categories. trained to code all theopen. indicating divisions. and (1) farm.47.(4) metropolitan district Module.under1.53 to correct for inflation (U.750 and $13. psychosis.unchanged but GSS values were dividedby 6.95 four categories . presence relevant to our central unincorporated areas. several sociodemographic mediatechangesin conhypothesized The Starsurvey raceas white or might categorized andattitudes ceptions overtime.S. Coders'ques. was mea.(7) central or absenceof the fourratings most between 50.The other questions: Kappa was and (5) their are forplaces outside SMSAs: .000. and . unstable.000 and extreme/excessive.999.500.000 and 49.severaldifferences shouldbe egories. it 10.999.000.based on respondent of fivecategories: (5) metropolitan disended material from the Mental Health terms over 1.1 in 1996. For involving bothtimepoints. This content downloaded from 205.500 and 9.000. educationalattainment. We also measure area (Star categories variablesthat we gories1 and2).e. lowerin 1996 a smallnumforanalysesrestricted to one timepoint. disorders we usedthemidpoints ofthecatcategorythat also includes descriptions of egories. we creatgory.berof 18 to 20 yearoldswhomStarexcluded).253 on Tue. itwas measured in terms of fivecat. citiesover250. behavior $3.For analysesinvolving both time reliability. kappaswerecomputed central foragreement between thetworaters as to the (8) their cities unincorporated areas. (9) their suburbs.Mean age was slightly graduate education. we creat. large metropolitan district (comprising Star variables categories4 and 5 and GSS categories5 Independent through 10).Similarly.In the size was based on Census Reliability was assessedusingCohen's(1960) GSS.(2) highschool. (3) for dangerousness.(3) somecollege.000.PUBLIC CONCEPTIONS OF MENTAL ILLNESS 193 substance-related but is a broader bothsurveys. (2) smallcity/town (Starcategory The primary variable is yearof 3 and GSS categories independent 3 and 4).000andover.499. an additional we created variable:(3) points. Bureauofthe SiS.000.a measure of agreement corrected for data forrespondents' in terms of tencategories.500to 50. Six chanceexpected agreement. and (1) opencountry uncontrolled. timresponse Community size.330 to anypsychiatric obviously correspond cate. The perFamily income. (2) unincorporated within larger civil excellent 2. symptoms excluding violence (i.(6) their suburbs. Codingofdependent variables.The codershad clinicaltraining and trict (3) citiesof2.only37 percent ofthesample $1. in levelsof formal education in was measured rang.000.theincrease hada high ingfrom under For 1950.000 (GSS). perfect. was measured GSS as well. Larger differencesare observed for race.For (partly becausetheGSS included bothtimepoints.In isticsfor bothsamples as wellas the1950and schooling theGSS.unpredictable.

000or over 7 $10.0 Male 177 51. thepercentage ofrespondents Census.9 156 26.8 5 0.1 $10.9 99 16. cAgedistributions amongpersons in respondents withdatafrom thecorresponding schooldiploma.0 64.9 40 61 55 to 64 13. substantially.3percent 1996.andthepercentage ofrespondents living procedures and the fact that the sampling in rural included a combination ofprobability areasdecreasing from over30 percent method to less than tenpercent.7 sented theU.000or over 76 12.000-4. Sociodemographic Characteristicsof the Star and GSS Samples and United States Censusesfor1950 and 1990 Star(N = 352) (1950) Census (1950) GSS (N = 658) (1996) Census (1990) N N % % % % Gender Female 170 49.500 $3.0 46 7.8 12 35.000-49.8 64 18.2 71. and doubled to $5.3b 78.persons with less than a highschooleducation.5 539 81.0 34 $5. for community No censuscomparisons aregiven. identical in whichrespon.999 10.9 Non-white 37 10.S.999 $75. 25 years ofage or older.9 MedianIncome $2.999 135 39.8 18.1 Age 25 to 54C 227 73.000 12.000-29.9 5 0.173. size is basedon self-reported theGSS.194 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR TABLE 1.3 52 Smallcity ortown 15.6 Ruralarea 110 31.3 370 56.1 Education Less than highschool 218 63. cations.4 in 1996. medianreal incomemorethan NORC sample and Census including nearly percentages of women.2 51.47.500 forStar and metropolitan districts increasing from justover $3.253 on Tue.7 430 68.whites. the proportion of respondents livingin large witha medianvalue of $2.itcan be seenthat bothsurveys reprewhohad graduated from collegerosefrom 8.0 72.0 15.8 2. withthe forinflation.The correspondence is particfrom $2.7 174 College 26. The size of thecommunities dentslived also increased with The largest is forfamily discrepancy income.5 342 Highschool 52.9 44.3 13.000-2. aAdjusted usingtheConsumer theStarsurvey. Medianincomerose reasonably well.1 $3.3 89.743-between1950and 1996. the overall corresponthecharacteristics to Censusdatais parComparing ofthesurvey denceoftheStarsurvey This content downloaded from 205.000-74.073 $37.095a to (Adjusted $5.000-9.7 24. Similarly.8 $1.Even after adjusting ularly impressive fortheStarsurvey.502.0 50.999 171 28.0 83 12.9 79. 25 Feb 2014 15:13:49 PM All use subject to JSTOR Terms and Conditions .073 forthe Census.1 10.0 288 43.999 119 2.8 30 8.8 Race/ethnicity White 310 89.4 Family income 44 Less than$1.5 $30.743 1950dollars) size Community Largemetropolitan district 185 515 53.7 119 18.3 $50.3 13.6 41 65+ 13. as compared to 85.2 MeanAge 44. itis basedon censusclassifibFor size ofplace.8 45 6. and quota sampling.502 $36.3 to 1996dollars PriceIndex.999 120 20. Giventhe scarcity of in surviving half in 1950 to more thanthree-quarters of theStarsampling documentation 1996.7 60 9.0 34 Some college 9.500to $37. population atthetime ofsurvey in 1950 to 26.0 97 14.

andwe cannot saywith certainty led thecoders to enter 1950and 1996.The largest are forgen. contrast. and references problems increased from 7. percentages response was codedwithsyndromes ofmental given yearsumto morethan100 percent. that referred topsychosis decreased overrepresented (56. tions andeach char.9%+ 34. 51% in mentions) theCensus). By thesix-year the 1950 to 34.01).3%*** 15.1%*** Psychosis Anxiety/depression Social deviance Mentaldeficiency/cognitive impairment Other non-psychotic + p <.1 percent(p < . is whether and to knowwhatspecificsymptoms Ourfirst question publicconcep. ofsocial deviance. somewhat choticsyndromes all increasedsubstantially. and other Table 2 indicatesthat the percentage of deficiency/cognitive impairment TABLE 2.8 in 1950 to 30.7 in 1950 to was conducted same yearas theCensus.andthosewith less education are from 37. find are limitedexclusively to psyNevertheless. While these discrepancies mightin lems also decreased-from48.deficiency/cognitive increased impairment sociodemographic characteristics. syndromes each syndrome frequency with which was rep.7 percentin in 1996 (p < . because. ChangesinDefinitions ofMentalIllness it is of and othernon-psychotic syndromes.7% intheGSS vs. yearofinterview acteristic to othernon-psychotic willbe assessed.Thisdecrease is notquitesignifconducted six yearsafter thenearest Census.7% 48. in thepotenRESULTS Because ofthelargeincreases of mental tially heterogeneous categories deficiency/cognitive impairment.05) andthat discrepancies mentioned (allowingformultiple der and educational Womenare syndromes attainment. the GSS samplecharacteristicsdescriptions are reasonably from 25.001). we so thatthecorrespondence between thelatter slightly that thepercentage of respondents whose two cannot be expected to be as close.tionsincludereference cation).7% 7.the 1996 GSS was 34. social devianceincreased 7. 10. ofpsychosis in their description of a mentally Whereas theStarsurvey in the ill person did decrease-from 40.8 percent between 6.3 percent reflect difference between part descriptions thatincludedbehavior administration of the Census and the GSS.5 percent (p < . social deviance. codes.5 percent (p < . icantat the .PUBLIC CONCEPTIONS OF MENTAL ILLNESS 195 who included behavior ticularly reassuring and providesclear evi.6 in consistent withthose of the chosis dropped thepercentage ofall the Census.2% intheGSS vs.1 percent to 20. mental deficienwomen andpeoplewith socioeconomic indicative higher impairment. relative from to to olderpeople.Analyzing theseresults differently (notshown in Table2).Because up to three which categories which symptoms in a syndrome if a particular were coded per respondent.173.001).253 on Tue.1996(p < .5%*** 13.1% 6.respondents indicative dence of the high quality of the overrepresented Both surveys rarysocial surveys. and othernon-psystatus are often in contempo.1% GSS 1996 (N = 653) 34. References to mental and interac.interest tions of mental illness have broadenedto manifestations forthose may be accounting We cannot answer thisquestion preincludea greater proportion of non-psychoticincreases.1 percent All of our coreresults will be adjustedfor 15.8% The percentage intheCensushaveless than to anxiety/mood proba highschooledu.8%*** 20.5 in 1950 to 19. there are Table 2 reports the cisely and problems.001). ***p < .from to 13.4 in 1996 (p < .001).47.9 in 1996.6 ofrespondents whosedescripunderrepresented (14.05 level. the age of 25 The percentage of respondents to referring overrepresent people between and 54. For example.multiplesymptom codes and multiplesynresented in descriptions of mentalillness in drome codes.5% 7.001 (two-tailed tests) This content downloaded from 205. 25 Feb 2014 15:13:49 PM All use subject to JSTOR Terms and Conditions . 24.for many respondents. Diagnostic Categories with Which Respondents' Descriptions of Mental Illness Corresponded Star 1950 (N = 337) 40.

thelargest of definitions indicative code that seemsclearly a symptom on publicones.It is notclearto whatextent increasedin frequency these this indicatesan increasedcorrespondence whoseanswers werecodedas indicating deficiency/cognithree Formental of syndromes.1% of thetotalsample tendencies. of increasingly drome code of mental deficiency/cognitive disorders. chiatricdiagnosticcategories(e. the symptoms/manifestachotic syndromes.whichhas seen a proliferation Amongrespondents impairment. (extreme/excessive. Forother non-psy.7% to 6%)..syndrome/behavior from eachof The tableshowsthat violent psychosis. 2. shows increase nota decrease buta significant from (increasing The percentage of under from 2.47.2% (N = 335) .2%) and disordered. (increasing predictable. peo. and uncontrolled.9%).23 (N = 335) 6. ChangesinPerceptions Characteristics in social devianceand other and Other Frightening The increases seem to be largely syndromes non-psychotic is whether Our secondquestion perceptions accounted for by symptoms/manifestations and relatedcharacteristics withpsychiatric diag. 25 Feb 2014 15:13:49 PM All use subject to JSTOR Terms and Conditions .05. and incompetent codes indicating category lessthan1% to2.indicating unor excessive. functional from 0 to 2.3% ofthetotalsample)in tent deftraditionally broader psychiatric with 1996. symptom/manifestation frightening characother potentially in 1950 to 8.g.31* (N = 622) 12. as "violent wereclassified whosedescriptions ofrespondents Percent psychosis" tests) *p < . ** p < . the symptom/manifestation behav.1%).8% (N = 337) GSS 1996 %* 12. or irrational).On theone hand. by eight werementioned breadth perse ofthepublic's comprehension thegreater ple (2. Also showingsizable increaseswere initions and is also consistent with thegeneral and functional thrust of incompetence symptoms of changesto theDSM overtheyears.tion codes indicatingviolent behavior or was sociallydeviant increased themost codes ior (increasing from 2.of dangerousness whose correspondence have and instability nostic categories is ambiguous.8% in 1996). with syndrome respondents to thisquestion: symptom/manifestathat relevant deviance. Characteristics ofViolenceand otherFrightening TABLE 3.7% overtheperiod study. diverse eachofthesesymptoms was menimpairment.8%). (extreme from teristics (increasing abnormal. unspecified (increasing abnormal. unstable.4% of the totalsample).253 on Tue. followedby impaired problemsand a symptom non-psychotic from0 to 3. Among like unpredictability three Table 3 reports typesof data codes of social decreased.4%** (N = 653) symptoms/manifestations mentioning violent Percent ofrespondents characteristics ofother frightening ofmentions Mean number irrational) unpredictable. social mental deficiency/cognitive of devianceor impaired retardation/lack of intellectual symptoms On theother judgment).hand. uncontrolled.or both.4%) and functional we cannotbe certain (increasing impairment.173. Among 1950 responses good deal ofthechange mentalretardation: is toward descriptions a syndrome of that psythatwerecoded as indicating do notcorrespond directly to specific impairment. unstable. thefunctional impairment contributedimpairment (increasing whether deficiency code. Perceptions Star 1950 7. followed by disor.01 (two-tailed This content downloaded from 205.196 JOURNALOF HEALTH AND SOCIAL BEHAVIOR judgment of to 8. tioned (less than1% ofthetotal byoneperson ofDangerousness sample)in 1950and23 people(3. witha syn.7%) in 1996.1 (N = 622) . between conceptions publicandpsychiatric of psychiatric increase illnessor the influence was fora mental tiveimpairment. of perceiveddangerousness the mostwere irrational these indicators tionsthatincreased 0 to 5. unspecified dered.this number current illnessis moreconsisimageofmental roseto 51 people(8. theothernonthe findings relating to our to themental To summarize illWhatwe wereable to first ofmental question: Publicdefinitions psychotic code. that nesshaveindeedbroadened beyond psychosis do is examinethe types of symptoms among respondents to some degree.

25 Feb 2014 15:13:49 PM All use subject to JSTOR Terms and Conditions .7 whilethe of psychosis to 12.In a logistic regression predicting includenon-psychotic conditions) have fewer mentions of violencefrom mentions of psyillnessthando chosis.9 types suggests thetwomust havechanged.7percent in 1950to 31 perdefine mental illness more broadly (i. of violenceis confined to those at the same timenegative broadened stereo. Percentof Respondents Violence 35- 30- 25- 20- 15- 10- 5- 3 0does notinclude Descniption psychosis 1950 includes Description psychosis 1996 ofpsychosis byyearofinterview) was in theFigure(descriptions presented Note:The interaction at the .31 in ationbetweendescriptions of psychosisand of dangerousness increased substan1996 (p < . First. Second.05 level(two-tailed test).01). age mentioning violencemorethandoubled. amongthosewhosedescriptions are Illnessand Perceptions ofDangerousness classified as indicating thepercentpsychosis. and was foundto be significant regression testedin a logistic This content downloaded from 205.PUBLIC CONCEPTIONS OF MENTAL ILLNESS 197 respondents mentioning violentbehavioror important findings.Thus.e. negative stereotypes of mental yearof interview. thatassociation theunexpected increase in The fact that definitions have perceptions understudy.those interms whodescribe mental illness are morelikelyto includevioin 1996 (p < .8 tially over the period under study. whichcontains is confirmed two definitions of mental illnessovertimecannot Whose Descriptionof Mental Illness Includes Perceptions of FIGURE 1.2 percent in 1950 ods.05).chosis. description of a mentally the .47. thisassocimeannumber ofmentions ofother frightening behaviors increased from .173. andtheir interaction.8 percentage whomentioned violencedecreased in 1950 to 2 percent in 1996.05). Our third questionis whether people who increasing from 12. in Figure1.23 in 1950to .. tionbetween This Given these itis clearthat broadened results. from 3 percent Relation Between Definitions ofMental However.253 on Tue. itmore those whodefine narrowly andwhether the interaction termwas statistically signifihas changedoverthe period cant(p < .4 percent in 1996 (p < respondents percent their ill person.Among whodidnotmention psychosis in in 1950 to 12. centin 1996. forbothtimeperitendencies increased from 7. The percentage of responses mentions indicating violent psychosis increased from 6.who think illnessin terms of mental of psyhaveincreased that theassocia.05).1 percent lenceintheir descriptions.

separately forthetwosurveys.01) weresignificantly Mean education was 1. conceptions andattibefore playsomeroleinshaping for ofpsychosis.Themagnitude ofthis marginally tomentions was marginally related ofviolence association was increased slightly bytheinclusion of race and genderand thenmorethan (p = .6 percentamong whites.and of violence(first in Figure1) presented tionsof psychosisand violencewitheduca. level.Less educated (p = . When aresomewhat mentions of psychosis were entered mayhave intothe ple. race. er educational and white tomentions attainment mentions were somewhatmore significantly associatedwithfewer althoughnon-whites ofpsychosis income was marto mention violence(p = .064) and non-white As Table4 shows.198 JOURNALOF HEALTH AND SOCIAL BEHAVIOR mediatea reduction in negative stereotypes. inthe1996sammore prevalent respondent would mentionviolence. inTable4). Thiswas con. withlower incomes among .comparedto mentions 32. community we addtwoadditional steps tothe (using t-tests).Finally. size to the equations in three successive Sociodemographic Characteristics. we assess thepossiblecontributionlyincome.056).whilecontrolling for factors sociodemographic size andchanges.01). tudes. Thus. did.078).Wheneach sociodethosewho mentioned None of the mographic variablewas enteredalone with psychosis. blocks. educational they attainment andfamily andcommunity income.Nextwe entered terms forinteractions Definitions ofMentalIllness. andPerceptions betweenyear of interview and each of the ofDangerousness sociodemographic variables. familyincome.we addedmentions ofviolence andthen was significantly graphicfactors relatedto a term fortheinteraction of mentions of psymentions of psychosis or violenceat the .ginallyassociatedwithfewer mentions (p < Although This content downloaded from 205. size totheequation who mentioned and 1. and gender(using chi.47. andcommunity size that synthesize ofdemographic tothechanges theStarand GSS codingschemes. with ofpsychosis percentmentioned likely fewofthese associations weresta.102) to men. racialcomeducational attainment. highvariables was significantlyyearofinterview sociodemographic (notshown racewere related ofviolence atthe.42 for those addition ofcommunity had psychosis.consistent withprevious results and supports firmed bylogistic regressions predicting men.theidea that sociodemographic characteristics tionof violencefrom yearof survey. Because the U. one or moreof thesevariables in contheadjusted equation.05 in the finalmodel).Familyincome non-white respondents mentioning psychosis was also marginally related morefrequently than whites (p < (p = . Mentionsof psychosisand violence on yearof interview regressed only.Amongnon-white respondents. 1950 and 1996. transformations in mental-illness we havereport. and urbanicity.association between of pyschosis perceptions tions.8 timesthe odds thata 1950 position. odds ratioincreased to playeda rolein thechangesobserved and attitudes.076) respondents psychosis .253 on Tue. thepattern of findings is becausethere was no reduction. In theGSS.without the broadening To evaluatethisquesof defini. in theseequations. and because women personwere 1.05) andrace(p < halvedandreduced to non-significance bythe related to mentions of inclusion ofeducation andfamily income. We first examined the bivariate associa.ables. wouldhaveincreased evenmorethan werefirst violence We thenadded race and gender. Lowerfamily income between 1950and 1996.05 chosisandyearofinterview.173.tistically significant.3. of men. noneof thesociodemo. Finally.significantly tionsofpsychosis.3 variable that was significantly associated college).05 level. with 45. there was a marginal (p < mentioned (p = . appearsthat perceptions of further conceptions evaluatethe increased ed. 25 Feb 2014 15:13:49 PM All use subject to JSTOR Terms and Conditions . population has andafter controlling mention in 1996 would changedsubstantially The odds thata respondent since 1950 withregard mention violencein describing a mentally ill to income. Recall thatthese variables for famianalyses employ education.series of regressions predicting mentions of squaretests). education (p < . Afterthe sociodemographic variIn theStarsurvey. tion. age. The .ceptions a seriesof logistic we performed regrestionsof mental illnessthatoccurred between tion.10) decrease in mentions of psychosis moreoften. Race was the only sociodemographic whodidnot(1 = highschooldegree. (p < . violence.61 forthose little onthecoefficient for ofinterimpact year psychosis 2 = some view.S.

146) -.265+ (. None of the interactions mentioning violence less often. Several factors.193) -.192) -.illness.017 (. factorswas significantlyand rejecting. ness peopledefined and mentions year of interview werefearful terms.e.017 (.05). size reduced None community in the 1950s painteda bleak Researchers thestatisofthese however. onlyrace was marginally .156 (.001) and thatthe (p < .andviolence.097) 15.10) with mentions ofviolence.01 (two-tailed in parentheses arestandard Note:Numbers errors.107 (. status and thatdefinitions changing demographic profiles didnot ened evenmorein the absenceof increasing appearto playa noteworthy role in increased that perceptions racial diversity. none of the and extreme Moreover.101 (.021) -. 25 Feb 2014 15:13:49 PM All use subject to JSTOR Terms and Conditions .47.119 (.253 on Tue.435* (. ofmental illnesschanged indicated latesof conceptions 4 (without inFigure congraphically overthistime period. mentions trolsforsociodemographic factors). increased of womenin theGSS sampleplayeda rolein rolein increasWhatdoesplayan important ofdefinitions ofmental ing perceptions themodest broadening of violence is the changing illness any relationship between 1950and 1996.32* 3 -.164) -.69+ Chi-square 1 df tests).In summary.142) -. reduced thesize of thecoefficient the subsequent addition interview somewhat.433* (.05.. 1 = 1996) Race/ethnicity 1 = white) (0 = non-white.156 (.and empiricalfindings This content downloaded from 205.140) 3 -. Gender (0 = male. in subseto quentstepsshown illnessweremediated definitions of mental in columns 5 and 6). +p < . some degreeby increasesin socioeconomic unlikethe situation of mental fordefinitions might have broad. changed additions.noris there of psychosis betweenmentions thatthe sociodemographic corre.237+ (.18** 5 4 -. Log-odds that and Sociodemographic Factors. it of education and family incomeincreased of DISCUSSION value. There is no indication of violence between 1950 and urbanization or a greater proportion 1996. 10. Thus.017 (. **p < . mentions are significantly associatedwith between 1950and 1996 mentions increased significantly of violence(p < .076) 15. indication 5 and6 confirm as Columns that.173.05). and attitudes in the final model.021) -. *p < .When increased associatedwithmentions of mentalhealthproblems disclosure variableswas greater each of the sociodemographic enteredalone with year of interview (not by public figures.168) -.118 (.188) -.the interactions yearof interview betweensociodemographics in and year of interview significant (notshown torswas statistically was significant (not itappears that broadened shownin Table 5 and not included tables). and neither community associated withmentions of associated was significantly (p < .10).10. The additionof race and gender twoaremorestrongly in 1996 than associated foryearof in 1950 (p < .(1 = female) Family income Education size Community 2. Description Refersto Psychosis)from Year of Interview N = 904 1 Year (0 = 1950.136 (.076) -.498** (.144) 2 -. of violence. of violence of psychosis As shownin Table 5.21* 6 size nor gender shownin Table 5). including sociodemographic utilization ofmental health services. Noneof and sociodemographic fac.and theaddition beyondits original itagainslightly. Logistic Regressions Predicting Definitions of Mental Illness (i.PUBLIC CONCEPTIONS OF MENTAL ILLNESS 199 TABLE 4. between whites psychosis.142) -. illofpublicorientations toward mental of the association between picture tical significance mental illnessin narrow of violence.

499) 1.017 (.123) . "Popular Thinking in theirdescriptions of mentalillMentalHealth")and 1996 (theGeneral Social psychosis ness. Kessleret results.fitintoa picture ofnormalization or increased son by analyzingresponsesto an identical acceptability of mentalillness.483+ (. in the data give us confiin thepercentage who Several strengths increase ofrespondents the andto dencein thevalidity referred to non-specific socialdeviance ofthefindings.173. but do they aremuch to include tualization of mentalillness has broadened ifthey morelikely This as part oftheir description. 1 = 1996) (.634) 108.05.284) -.54* 3 1 5 df +P < .308) -. ** P <. Log-odds that Description ReferstoViolence)from Year ofInterview and Sociodemographic Factors.278) -.480*** (.Americans arenowless likely to describe Mental HealthModule). 10. We wereable to makesucha compari. has bothadvantages and ness is now conceivedof as something less question potentially alienandless extreme thanitwas in 1950. thesame ofpsychosis played tionalstereotype ill.094 (.169) 5 . somewhat suchthat dominated peo. 25 Feb 2014 15:13:49 PM All use subject to JSTOR Terms and Conditions .037 (.045 (.280 (.028 (. conceptions: alignment of respondents mentioning anxiety anyparticular percentage sociodemographic groups.246) -.233) -. First.001 (two-tailed tests) in parentheses Note:Numbers arestandard errors.35 6 2 .230) 3 . whatextent thisbroadening norwerementions ofviolence withpsychiatric The itedto.200 JOURNAL OF HEALTH AND SOCIAL BEHAVIOR TABLE 5. regarding public conceptions the significant increasein mensuggest thatthissituation mayhave changed tions of dangerousness in respondents' com.19*** 8 and attitudes.253 on Tue.616* (0 = 1950.285 (.47.039 (.785* (.671* (.S.123) 4 .027 (. Yetwe didfind sample and face-to-face a smaller interviews of aboutthesamelength.035) -.. It is notclearto sociodemographic of the U.01* 10.179) 2.479+ (.262) Race/ethnicity 1 = white) (0 = non-white. Gender (0 = male.055 (.660* (.248) -.descriptions significantly.033) -. extent composition limreflects a closer population. and therewas a large strengths and limitations of our analysis.e. 1 = female) Family income Education size Community Mentions psychosis x year Mentions psychosis 6.534+ (.132) . 1994) decreased.036) . theimplications of these or mood problems (very commondisorders Beforediscussing data.006 (.015 (.psychosis Ourresults suggest thepublic's when askedaboutmental illness.122 (.important clue to thisincongruity is found question askedin thesamemanner of dangerousness only ally representative samplesin 1950 (Shirley the factthatmentions in theField of increasedamong respondents who include Star'sstudy.027 (.thesame codingschemewas used by ill. *** P < .288) -.or evensignificantly morefrequent in.392 (.310) -. Because itaskspeopleto speak disadvantages.285) -.490* (.we would like to consider some according to epidemiological al.the same coders.304) -. This content downloaded from 205.121 (.296) -. * P < .questionwas repeated at bothtime ofmental verbatim partin respondents' descriptions ness in 1996 thanit did in 1950.99*** 7 6 -. mental overall.033) -.567) -.179) 1.233) -.430** (. LogisticRegressions Predicting Perceptions ofViolence(i.A potentially in of nation.580* (. However.264) -.047 (.The findings points.dangerousness psychosis ple's descriptions of mental illnessto a lesser changewas notattributable to changesin the in 1996 thanin 1950. but no study has directly of mentalillness nearlydouover this time blingbetween1950 and 1996 is difficult pared public beliefs andattitudes to period.008 (. Survey's that concep.01.305) 102.The use of an open-ended thussupport theidea that.027 (.nationalprobability that non-psychotic").133) . and analysis ofthetwosurveys orproblems that do notfit anyofthe administration behaviors both surveys used a ("other were verycomparable: diagnostic-related syndrome groupings thetradi.10.33+ Chi-square 9. N = 866 1 Year .

PUBLIC CONCEPTIONS OF MENTAL ILLNESS 201 "off thecuff. 25 Feb 2014 15:13:49 PM All use subject to JSTOR Terms and Conditions . ments. Arguing against of thistypeof question relieson raters' however.and stigma. al indications that thepreceding were of the present is reasonably findings vignettes to testthegeneralizability of thesefindcededby anyother aboutmental questions thatthe ingstoother ofstigma. 1984). is the factthatperjudg. variablesat eithertime point.Notably.perceptions ofdangerousness and other frightson withnon-clinical problems and worries.possibility illness acceptance description ofmenticularvignette receivedsignifi. cocainedependence. eningcharacteristics.253 on Tue. reliability related the rating categories we examined was high. described stereotypes by illnessand in negative in the open-ended toa discussion oftheimplications respondents question. 33%) tobe vioOne methodological between the lentas theperson with majordepressive disordifference twosurveys is a potential sourceof bias. the and we believe thattheyrepresent notan important sourceofbias.173.47.the social desirability bias thathas if it were couldbe a problem Confounding been shownto influence expressed attitudes something about the type of person who towardmentally ill people when measured describes mental illnessin terms of psychosis with fixed-response surveyitems(Link and thatleads to mentions of violencerather than Cullen 1983). validity offered that ofviolence survey. byrespondents tendency taneous to mention there for thevalidity violence. in the is vignette evidenceforconstruct experiment component of the 1996 Moreover. thereis the possibility influenced the type of syndromes distance or direct vignette queries(as opposedto spondescribed and/or their mentions) concerning dangerousness. Regarding the best the diagnosis availabledatapertaining to historical typesof syndromes mentioned. the person described with pattern graphic characteristics with definitions of symptoms of schizophrenia was perceived as mental illnessandperceptions ofviolence. Overall. The der. However.Disclosureof mentalillnessby public increase all the figures an effort to destigmatize to theopen-ended for response question may reflect thanan indication that 1996 respondents. 1999).features ofmental illness(Jones tionsincluding thelikelihood theproblem et Wenowturn assessedwitha chi-square test. changes was notsignificantlyinpublic definitions andconceptions ofmental assignedin thevignette associatedwiththe syndromes and stigma.Nor did thepar. majordepression. which raisesquestions ofreliability and ceptionsof dangerousness were not signifitheinter-rater of cantly to anyof thesociodemographic validity. from illness(Link et al. degree.itwouldbe very ill. One notable limitation is that questionanalyzedhere was precededin the we haveonly GSS study by a Star-type vignette describing one typeof measureof negative perceptions either schizophrenia. alco. lence. are severwe believeevidence However. desirour question was notpre." we believethistypeof question to respondents whodescribed mental illnessin has the potentialto circumvent. This content downloaded from 205. in whichdescriptions bythefact perceptions of different psyweremorecommon thosewhodefined chiatric wererandomly among disorders assignedto mental illnessinterms ofpsychosis andbythe respondents (eliminating the possibilityof of(modest) associations ofsociodemo. personswithmental In the Starsurvey.hasnotincreased. and although that perceived dangerdescribed is a mental illness andthelikelihood ousnessis strongly related to social distance that theperson described might be dangerous. theseare core Although The vignette ofthestigma was followed bya seriesofques. theanalysis the psychosis conceptitself. measures suchas social ness. ofincreased ofdanthoughroughly40 percentof respondents Ourfinding perceptions received a vignettedescribing substance gerousnesswas unexpected and appears at of decreased sixoftheentire men.A farther is that definitions illness concern whether suchas broadened ofmental asking could or greater or affordability of treatthevignette be dangerous subject might availability thetendency to mention violencein ment. On theother hand.talhealth influence their tomention services maybe due to other cantly tendency factors. even oftheresults.Linketal. the factthatthe mentalillnessrather However. only sample stigOne tioned alcohol or drug problemsin their ma. Thus. mentioned namely spontaneously hol dependence.1987. Rather inmentions ofviolence was restricted that than reflectincrease goalhasbeenrealized. nearly twiceas likely (61% vs.Also.odds withother indications dependence. How can thesefactsbe reconciled? of mental is that of mental illness. ora per. to some terms ofpsychosis argues against sucha bias.thispossibility. Increased utilization respondents vio.confounding).

Overall. apparent trends inthe thathas leftbehindthe most seriously illfindings ofempirical studies mayreflect either those withpsychosis-who are viewedwith methodological differences between studies or greater fear than they werehalfa century ago. veryreal impacton thepersonal.less serious The danger is in obscurseems unlikely. ofdangerousness haveincreased. seen as something thatis partof nearly of respondents one-third increasingly spontaneously lifethatcan happento anyone. 25 Feb 2014 15:13:49 PM All use subject to JSTOR Terms and Conditions . fearedin others.An obviousquestionis whythisnegative trum Research results a stereotype has not decreased or remained disorders. psychotic syndromes andtheir divergence more than Whileitremains time. problems functioning-are a halftimes since1950toa point in 1996. 1989. Phelan.1999). theexpression of changing sociallyappropri.173."whilepeoplewith psychosis underscored by notingLink et alia's (1987. and Increased of mental health services economic ofpeoplewhohaveor utilization opportunities is primarilyfor non-psychotic problems.psychotic personhas becomestronger inoneself society than it was in the time when tobe concealed thing whenitoccurs first or one's family(Link et al. and non-psychoticsonwith psychotic Thus. suggesting buthas actually decrease in social distancehave generally steady. 1987. thestrong asso. A second possibility is thatotherdimen.ofsocialdistance referred to earlier thepublicdesires from a perstigma tinction between a mental illness.Perhapspeople with less a seriousset-back forpeople withpsychosis.increased perof dangerousness are likely to havea we see thatthoseindicators reflect ceptions disorders.Rabkin1974).while maybe violent. socialdistance attitudes whichappear (Linketal.overthepasthalfcentury.253 on Tue.tivestereotypes of etal. some.buta move and Cocozza 1978). Steadman greater acceptance in theGSS (the views of mentalillness. 1974. increased. This because it improves ceptions the lives of people with disorders." 1999) finding in determining Ifwye re-examine theindicators ofdecreased nessarea keyfactor thedegree in lightof thisdis. forms ofmental of thisresult can be severe disorder do increasing.Mentionsof dangerousness unclear whether thesocial doubledbetween1950 and 1996 in descrip. Results ofresearch on attitudes distinction.The practical importance lybelongto "us. thisis notin itself a sionsof stigma haveabatedeventhough per. beenfor moodrather than schizophrenia-spec. social. beenmadein terms ofnormalization Thus. it represents progress.acceptance in oursociety. negative This content downloaded from 205. 1989). and non.47.202 JOURNALOF HEALTH AND SOCIAL BEHAVIOR ingtrue attitude change. psychosis.climate forpeoplewithnon-psychotic mental tionsinvolving whereasmentions illnesses has improved. in our psychosisremainsalien. prob. however. whatourresults show fornon-psychoticclearly of dangerousness decreased is that theclimate has notimproved for thatsuch Perceptions syndromes. but not those involving ateattitudes psychosis. anxiety. the less severe.If it is truethatsome mental illnesses. also improved. non-psychoticillnesses. Perhapsit is the case thatless people withpsychosis. mentally withthe dramatic in our results. that.ifwe look at lic acceptance of less severementalillnesses changing orientations toward less severe mentopeople tal illnesses. However. have gained (Rabkin1974).peoplearedangerous increased twoand nearly lems coping. Signorelli 1989.toward illness" betweendescriptions of psychotic a generalconceptof "mental over mayalso obscure thisdistinction. A third possibility is that gainshaveindeed to havehadvery different livesandtrajectories andpub. who have previously experienced psychosis Notable instances of public disclosurehave (Linketal. given in perceptions differences between of thetwo ciation and ingstark perceived dangerousness tiersof mental illness. stigmatized. as something volunteered the idea thatpsychotic persons The stereotype of theviolent thatone can be somewhat open about.Ithas beenclearly negaarecon. attibutthat these we mayfalsely conclude that gainsdo notgeneralize Sucha possibility ill peoplehave with is consistent tudestoward severely psychosis.and something to be existence stereotypes. thatperceptions of dangerousremain "them. severeproblems depression. Two particularly salientpossibilities are the askedrespondents about"mentally ofthemediaand ofde-institutionalizaa label thatis apparently increasingly applied effects illnesses that to thosewith documented non-psychotic (Crocetti tion.Thesefacts (including dangerousness) in which there has been people withmentalillnessesabound in the sistent with a scenario a realmovetoward andless media(Wahl1995. researchers pointed outand lamented the of suchnegative This is Bromet and Link 1998). significantly ill" people.bad thing.

current whoreported frequent.we 1.001 and p < . idea thatincreased perceptions from to mentally thelivesofpeoplewith ness result exposure mengreater themostserious as frightening. Two involuntary thenewspaper or of watching here:First.Ironically.PUBLIC CONCEPTIONS OF MENTAL ILLNESS 203 ill people are dangerous.507 describe hypothetical conducted Americans byLinketal. of dangerous. they werenotwell ill perless likely to perceive mentally cantly changesin cultural concepsuited to track sons as dangerous(p < . somethinghas is thatexposureto mentally ill occurred tionalization in ourculture overthepasthalfcenpsychosisand tury people who oftenexperience that has increased theconnection between and behavein bizarre psychosisand violence in the public mind. second. 1999 foranalysesusing or talking weresignifigestures thevignettes). Thus. alpha= . each media rolein strengthening thestereotype ofthedancaveatsare important (Phelanand Link 1998). By referring This content downloaded from 205. 25 Feb 2014 15:13:49 PM All use subject to JSTOR Terms and Conditions . able to mimic De-institutionalization is a secondpotential stronger thantheywere46 is important tions in media exposure at the present that we recognize that the III error"-get.changethem.stereotype of a "type has becomestronger. the less seriousmentalillnesses. it has had this A positive salient life. in the 1996 someveryimportant that massive cultural change. ple-would provide indirect and advocacy is required to of dangerous." thatfear and now its influence our findings suggest in television at themostserious mental viewingmay not be and stigma variations directed respects.tionsthatmentally onlysurvey thereis some evidencethat the werenotsig. We variable was measured witha single gerouspsychotic exposure of the measures emphasize that theseanalyses question.NOTES dataon contact and perceptions ness from a nationwidesurvey of 1.identify ofthese unfortunate theprecise source dangerousnessparticularly evidenceforthe stereotypes.47. While that mentally theterm reasonforincreased perceptions illness"is now less likely to "mental ill people. One consequence attempt research to explainwhythe has psychotic person effects of changes in exposureto negative stereotype ofa dangerous at varia. contact with mentally negative the including tions about the individual. In particular.effect aspectofurban ourbestefforts to achieveexactdespite tion betweencommunity size and perceived ly theopposite is required to Research result. (1994). (Schwartz in 1950.173.253 on Tue.ed to reflect reasoning. sured with two single items) would regard has a "mental likelihood that theindividual themas more dangerous(measuredwith a of thesevignettes.05. associa.2. andrejection.becomestronger mediamessages overtime bylooking itwas in 1950.In theabsenceof such efforts. The "Starvignettes" criteria for various psyindividuals meeting thatmembers of the examined thepossibility as defined bythepsychichiatric disorders. and the reliability again. were tionsovertimebecause thevignettes dataavaillimited respectively). respondents in the1996GSS Mental werealso included ly seeingpeople in publicwho seemedto be HealthModule (see Link et al. However.77). maybe an instance of tingthe right answerto the wrongquestion increased acceptance Despitethepossible and Carpenter whichmay 1999). abletous provided as disorders to non-psychotic on increased of de-institutionalization percep.mentions ofdangerousness of reading "dangerousto self or others"criterion for nificantly related to thefrequency may have playeda commitment television.For than today time now. illnesses are. forwhichthesedata wereavail. moreimpersonal contact or publicwhoreport and ask respondents quesill people(meaatric profession. Current like anyother. 1999 and ill or seeinghomeless peoplemaking mentally to themselves Pescosolidoet al. itremains a chalandthat and theparticulars of themediaexposure are arefar from decisive to assess the lenge forfuture unknown.thevery no support for theinfluence notrepeated verbatim. able).particularly thosewithpsychosis. bring ofAmericans thepicture of to theminds are dangerous. however.a person with psychosis.however. indeed increasingly be viewed as "illnesses television was notpartof ourculture is ubiquitous. effects of stigma of dangersize was unrelated to perceptions at bothtime ousness Usingmoredirect points. adaptillness. often appeardisheveled and incomprehensible thatsomething ways has become a Whatever is. ill people who are perceived by willcontinue tobe complicated talillnesses thatcommunity theinjurious Our data indicate. Contrary psychiatric definitions." Versions tothis seven-item scale.

or ability findno evidence that willingness categories of psychosis and antisocial/ This content downloaded from 205.Thus. of andcommunity tions of violence.In both cases.204 JOURNALOF HEALTH AND SOCIAL BEHAVIOR less severe or serious. and for symptoms/manifesta. able.all associations characteristics violencewerenotelevated amongresponbetween respondent and usable responses werenon-significant dentswhosedescriptions werecategorized and extremely weak. of respondents who mention percentage inmentions reflect theincrease of butrather therespondent's suchsymptoms. andthetwosetsof orhadrefused call at a dwelling results do not differin any important unit.8% for syndrome respondents and 12. However. 1.that many foreach variable mention andsocially deviant both psychosis thanothers.age. es in theGSS werenotrefusals to answer.. We wereconcerned thatmentions tions.for sympForsynintheperor foreither. The GSS included those18 to 20 years old.g. notable thosewe report. thepercentage increases ultimate is probably as quality in 1950to 9. type. 1950 in a slightly smaller between increase syndrome/problem category. forthe of sociodemographic therewas no tendency we characteristics. we attempted to terms ofdeviant behavior which (a category determine whether some kindsof responalso includesantisocial behavior and subtoprovide dents wereless likely usabledata stance respondents might abuse). and 1996.ifwe compute thepercentin any do notdiffer menandthoseresults age of all symptoms/manifestations dents.Thus.1% forsymptoms). As notedpreviously. thanmanysamplesused by good or better for therep. all analyses respondent (mean= 1. whom we have includedin the diagnostic categories were coded per results reported here. we refer to whatwe istics. education.g.173. there older. the 7. Specifically. of the 51 percent centageof diagnosescoded thatindicate drome/problem category.253 on Tue. ofthesubstantial lence might be more frequentamong ofmissing data proportion illnessin for these corevariables who describe mental (7. Fordescriptions of violent psyresponse(e. refusalrates in the early yearsof survey research weresubstantially respects. diagnostic up to three socialscientists Evidence today.However. mentions size. Thismeant that there wereno callbacks for they describe psychosis rather than whether were potential respondents whowerenotathome leastin terms as indicatingsocially deviant behavior. However. violent respects from tionedin a givenyearthatindicate 5.37 were re-runexcludingthose 22 responforStar). consequently. theassociation at leastpartially account for variable(usable vs. theserelationships we logistically andthat might regresseda dichotomous behavior.7 analysis. family income. Moreover..In the GSS. somewhat fewer sympper whereasStaronlysampledpersons21 or toms/manifestations were mentioned respondent (mean= 2. were22 (3. dent.However. from the are omitted lower thanthey are now.we believe are public perceptions that psy. all analyses on thefirst runwith bothmeasures.6. here. "hopefully they're getting thissamekindofadjustment results help") that was not codable for choses. "I don't violent and frightening between symptoms likethat") than reported 1950and 1996is evengreater know-I don'tknowanyone ora in Table 3. missing data) on genof psychosis between mentions and mender. thisincrease toms/manifestations. Rather. In subsequent analysespresented chosis is a more extreme deviation from assess conceptionsof mental illness in describes normal psychological functioning. festations couldbe coded foreach respon4. oftheStarsample is providresentativeness andup to three symptoms/manicategories ed inTable 1. and slightly and 20.3 in 1996 (p < .. terms of whether therespondent 3.48 forGSS vs.47.09) thanin the Star In oursample.54).3%) GSS respondents more betweenthe ages of 18 survey(mean = 2.However. inability to answer the question (e. Because 9. Mostofthemissing ornon-usable or frightening rather thanthe responssymptoms. If suicidaltendencies ofthesample from 5.05 probability of vio69 percent wereofthistype. is stillsignificant at the non-usable wereofthisnon-codviolent psychoses responses level. we do notmeanthat to describe"mentalillness" (and consethey are notseriousor that they are necesin our analyses)is sysquently inclusion characterto theill person tematically related to respondent sarily less distressing than is psychosis.8. race.05). 25 Feb 2014 15:13:49 PM All use subject to JSTOR Terms and Conditions .

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Herresearch interests include social stigma. Herresearch focuses on social issuesin health. theimpact ofthe"genetics revolution" on thestigma ofmental illness.PUBLICCONCEPTIONS OF MENTAL ILLNESS 207 Jo C. His research interests include theimpact of labeling and stigma on people withmental theroleof social factors causesof disease. andhealing. Phelan is Assistant Professor ofPublicHealthat Columbia University. Pescosolidois Chancellor's Professor of Sociologyat IndianaUniversity and Director of the IndianaConsortium MentalHealthServicesResearch. and social inequalities in health andmortality.publicconandphysical illnesses.173. howsocialnetworks connect individuals communities andto institutional structures. attitudes and beliefs relating to social inequality and itslegitimation. BerniceA. This content downloaded from 205. 25 Feb 2014 15:13:49 PM All use subject to JSTOR Terms and Conditions . as fundamental ofmental andtherelationship between mental ceptions illness. methodological issuesinevaluation ofHIV infection research. on therelationship mental illness andviolence. high-risk populations. Ann Stueveis Associate Professor ofClinicalPublicHealthat Columbia Herresearch focuses University. of PublicHealthat ColumbiaUniversity and a Research Bruce G. Link is Professor Scientist at theNew YorkStatePsychiatric Institute.47. ofmental conceptions illness.253 on Tue. illnessandviolence. for inparticular totheir illness. thedevelopment ofproblem behaviors between childduring andtheprevention in hoodandadolescence.