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Depression
Why Is Stigma Toward Schizophrenia Getting Worse?
A new study finds schizophrenia stigma is increasing. How can we turn it around?
Posted December 12, 2022 Reviewed by Devon Frye
Key points
- In contrast to depression-related stigma, research finds that the stigma toward schizophrenia has been getting worse over the last three decades.
- Stigma toward schizophrenia may be linked to the increasing acceptance of biological explanations for it, rather than psychosocial ones.
- Reversing the trend will involve looking carefully at media representations of psychosis, and widespread beliefs about causation.
In the 1990s, mental health awareness organizations like the National Alliance for Mental Illness held high hope that the stigma toward schizophrenia and other serious mental illnesses would soon end. Once people understood that schizophrenia is a brain disease, perhaps due to faulty neurotransmission or bad wiring, we’d no longer blame people with schizophrenia for their illness, they reasoned. We'd see it as a disease, just like cancer or diabetes.
Sadly, the stigma towards schizophrenia isn’t getting better. A 30-year longitudinal study published in November in the journal European Psychiatry actually found that it’s getting worse. The exact reason for this negative turn remains unknown.
A Long-Term Study
The study, started by Matthias Angermeyer and now led by Georg Schomerus, a psychiatrist at the University of Leipzig Medical Center, began in 1990. At that time, they interviewed over 2,000 people and assessed their attitudes toward schizophrenia.
Did thinking about schizophrenia evoke negative emotions for them? Were they inclined to distance themselves from people with schizophrenia? How likely were they to welcome a person with schizophrenia as a coworker or roommate?
Schomerus and colleagues repeated the same interview in 2001, 2011, and 2020. In total, they interviewed over 10,000 people during the three decades.
What they found was that by nearly all measures, stigma got worse. People were less likely in 2020 to accept someone with schizophrenia as a roommate or co-worker than in 1990. They also felt more negative emotions toward schizophrenia, such as fear and uneasiness, and less desire to help.
One hopeful sign is that at least regarding depression, stigma seems to have improved. Today, knowing that someone has depression is less likely to evoke negative emotions or a desire for social distance than it was 30 years ago.
Schomerus’ results are consistent with similar trends found in the United States by Bernice Pescosolido and colleagues, who studied changing public attitudes toward depression and schizophrenia from 1996-2018.
An Urgent Puzzle
The study raises two critical questions. Why is stigma toward schizophrenia increasing? And why do attitudes towards schizophrenia and depression differ?
Several studies over the last decade, such as here and here, have shown that acceptance of biological explanations for schizophrenia actually increases some forms of stigma rather than decreases them. While biological explanations tend to decrease blame, they tend to increase the perception that people with serious mental illnesses are unpredictable and dangerous. They also tend to reduce expectations of recovery.
Intriguingly, the greatest increase in stigma toward schizophrenia occurred from 1990 to 2001, the so-called “decade of the brain.” This was a time in which biological explanations for mental illness became widespread in popular media.
What About Depression?
If biological explanations for schizophrenia increase stigma, why hasn't stigma toward depression also gone up? Most of us are familiar with the idea that depression comes from a chemical imbalance in the brain, even if that idea has come under fire in recent months.
Schomerus and colleagues hypothesize that while biological explanations alone might have increased stigma toward depression, other factors have pushed stigma in the opposite direction.
One factor is that rates of depression are far higher now than in 1990. Many of us either have been diagnosed with major depressive disorder or know someone very close to us who has. Perhaps as depression has become more common, it seems less mysterious and more relatable.
Moreover, Schomerus points out, people now are more likely to see depression as continuous with other sorts of low mood such as burnout and stress, which are easy to relate to.
Reversing the Trend
How can we reframe schizophrenia to alleviate stigma?
One starting point is to look carefully at media representations of schizophrenia, which are often associated with violence. More realistic and representative portrayals of schizophrenia could help curb this misunderstanding.
We may also need to reconsider public beliefs about causation. Psychologists Eleanor Longden and John Read, in a summary of research linking biogenic explanations to stigma, emphasize the need for greater appreciation of psychosocial factors in serious mental illness. Seeing psychosis as a coherent response to a crisis rather than a fixed brain disease, they argue, helps us see “people with problems,” rather than “patients with illnesses.”
Our causal use of disease language—a language replete with “chemical imbalances,” “brain dysfunctions,” and “neural circuit defects”—is a profound moral issue. It’s quite possible that the language once meant to lessen stigma is actually making it worse.
