Psychiatric stigma: medicalization, motivations, and motivated cognition

© 2014 Dr. Erlend Pedersen KvaaleUnderstanding and reducing stigma is vital for facilitating recovery from mental disorders. Anti-stigma campaigns have often portrayed mental disorders as medical illnesses with biological and genetic (biogenetic) causes, hoping that this would reduce the tendency to blame sufferers for their problems. However, critics have cautioned that medicalizing mental disorders could backfire, increasing other facets of stigma (e.g., negative stereotyping, separation, and social rejection). A rapidly growing literature has attempted to test these propositions by examining how biogenetic causal beliefs about mental disorders influence stigma, but the findings have typically been mixed. Further, because biogenetic explanations for mental disorders appear to convey both stigmatizing and de-stigmatizing meanings, these explanations may be interpreted in different ways by different people, perhaps in line with an underlying motivation to accept or reject sufferers. In this thesis, I aimed to shed new light on the complex relationship between medicalization and stigma by (1) conducting the first meta-analytic review of the literature on how biogenetic explanations relate to and affect stigma, and (2) testing the proposition that the same motives that drive stigmatization shape how individuals interpret biogenetic explanations for mental disorders. The meta-analytic review confirmed that biogenetic explanations typically confer mixed blessings, reducing the tendency to blame people with mental disorders for their problems, but increasing endorsement of the negative stereotypes that sufferers are dangerous and have poor prognoses. However, the meta-analytic findings were equivocal with respect to how biogenetic explanations influence social rejection, with evidence of a positive correlation but no evidence of any causal effect of biogenetic explanations on rejection. Further, in two studies employing undergraduate student samples, the findings suggested that motivation to maintain collective security and cohesion (indexed by Right Wing Authoritarianism) and motivation to compete for group dominance (indexed by Social Dominance Orientation) predict key facets of stigma (blame, perceived dangerousness, and social rejection). The findings also suggested that these motivational orientations influence the interpretation of biogenetic explanations for mental disorders in complex ways that tend to reinforce stigmatizing attitudes. I conclude that disseminating biogenetic explanations for mental disorders is unlikely to reduce stigma, and could in fact reinforce stigmatization among individuals who are motivated to stigmatize