Reframing mental illness: The role of essentialism on perceived treatment efficacy and stigmatization

Abstract

People believe that treatments for illnesses are effective when they target the cause of the illness. Prior work suggests that biological essentialist explanations of mental illness lead people to prefer medications or other pharmacological treatments. However, prior work has not distinguished between biological and essentialist explanations. In three studies (total n = 517), we presented adults with vignettes about an individual with an artificial mental illness and manipulated the descriptions to emphasize or de-emphasize essentialist characteristics. Critically, none of the vignettes made reference to a biological basis for the disorder. Participants rated their willingness to interact with the person described in the vignettes and how effective they believed drug treatment and talk therapy would be on the mental illness. Across the three studies, describing mental illness with an essentialist framing led participants to think drug treatments would be more effective, but there was no effect for stigma or perceived effectiveness of talk therapy. This effect appears to be mediated by how much participants essentialized individuals with the disorder. The first framing that participants encountered seemed to shape their reasoning for the remainder of the study, even if they saw conflicting framing later on. The framing manipulation had similar effects for individuals with and without a mental illness. Results suggest that it is important to consider how mental illness is framed to the general public as it might impact people’s treatment preferences.

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References

  1. Ahn, W. K., Flanagan, E. H., Marsh, J. K., & Sanislow, C. A. (2006). Beliefs about essences and the reality of mental disorders. Psychological Science, 17(9), 759–766.

    PubMed  PubMed Central  Article  Google Scholar 

  2. Balkcom, E. R., Alogna, V. K., Curtin, E. R., Halberstadt, J. B., & Bering, J. M. (2019). Aversion to organs donated by suicide victims: The role of psychological essentialism. Cognition, 192, 104037. https://doi.org/10.1016/j.cognition.2019.104037

    Article  PubMed  Google Scholar 

  3. Breheny, M. (2007). Genetic attribution for schizophrenia, depression, and skin cancer: Impact on social distance. New Zealand Journal of Psychology, 36(3), 154.

    Google Scholar 

  4. Dar-Nimrod, I., & Heine, S. J. (2011). Genetic essentialism: On the deceptive determinism of DNA. Psychological Bulletin, 137(5), 800.

    PubMed  PubMed Central  Article  Google Scholar 

  5. Foster-Hanson, E., Leslie, S. J., & Rhodes, M. (2019). Speaking of kinds: How generic language shapes the development of category representations. PsyArXiv. 10.31234/osf.io/28qf7

  6. Gelman, S. A. (2003). The essential child: Origins of essentialism in everyday thought. Oxford, England: Oxford University Press.

    Google Scholar 

  7. Gelman, S. A. (2004). Psychological essentialism in children. Trends in Cognitive Sciences, 8(9), 404-409.

    PubMed  Article  Google Scholar 

  8. Gelman, S. A., & Bloom, P. (2000). Young children are sensitive to how an object was created when deciding what to name it. Cognition, 76(2), 91–103.

    PubMed  Article  Google Scholar 

  9. Goldstein, B., & Rosselli, F. (2003). Etiological paradigms of depression: The relationship between perceived causes, empowerment, treatment preferences, and stigma. Journal of Mental Health, 12(6), 551–563.

    Article  Google Scholar 

  10. Haslam, N., & Ernst, D. (2002). Essentialist beliefs about mental disorders. Journal of Social and Clinical Psychology, 21(6), 628–644.

    Article  Google Scholar 

  11. Haslam, N., & Kvaale, E. P. (2015). Biogenetic explanations of mental disorder: The mixed blessings model. Current Directions in Psychological Science, 24(5), 399–404.

    Article  Google Scholar 

  12. Haslam, N., & Levy, S. R. (2006). Essentialist beliefs about homosexuality: Structure and implications for prejudice. Personality and Social Psychology Bulletin, 32(4), 471–485.

    PubMed  Article  Google Scholar 

  13. Haslam, N., Rothschild, L., & Ernst, D. (2000). Essentialist beliefs about social categories. British Journal of Social Psychology, 39(1), 113–127.

    PubMed  Article  Google Scholar 

  14. Haslam, N., Rothschild, L., & Ernst, D. (2002). Are essentialist beliefs associated with prejudice? British Journal of Social Psychology, 41(1), 87–100.

    PubMed  Article  Google Scholar 

  15. Howell, A. J., Weikum, B. A., & Dyck, H. L. (2011). Psychological essentialism and its association with stigmatization. Personality and Individual Differences, 50(1), 95–100.

    Article  Google Scholar 

  16. Howell, A. J., Ulan, J. A., & Powell, R. A. (2014). Essentialist beliefs, stigmatizing attitudes, and low empathy predict greater endorsement of noun labels applied to people with mental disorders. Personality and Individual Differences, 66, 33–38.

    Article  Google Scholar 

  17. Kemp, J. J., Lickel, J. J., & Deacon, B. J. (2014). Effects of a chemical imbalance causal explanation on individuals’ perceptions of their depressive symptoms. Behaviour Research and Therapy, 56, 47–52.

    PubMed  Article  Google Scholar 

  18. Kim, N. S., & LoSavio, S. T. (2009). Causal explanations affect judgments of the need for psychological treatment. Judgment and Decision Making, 4(1), 82.

    Google Scholar 

  19. Kocsis, J. H., Leon, A. C., Markowitz, J. C., Manber, R., Arnow, B., Klein, D. N., & Thase, M. E. (2009). Patient preference as a moderator of outcome for chronic forms of major depressive disorder treated with nefazodone, cognitive behavioral analysis system of psychotherapy, or their combination. The Journal of Clinical Psychiatry, 70, 354–361.

    PubMed  Article  Google Scholar 

  20. Lebowitz, M. S., & Ahn, W. K. (2014). Effects of biological explanations for mental disorders on clinicians’ empathy. Proceedings of the National Academy of Sciences, 111(50), 17786–17790.

    Article  Google Scholar 

  21. Lebowitz, M. S., & Appelbaum, P. S. (2017). Beneficial and detrimental effects of genetic explanations for addiction. International Journal of Social Psychiatry, 63(8), 717–723.

    PubMed  Article  Google Scholar 

  22. Lebowitz, M. S., Ahn, W. K., & Nolen-Hoeksema, S. (2013). Fixable or fate? Perceptions of the biology of depression. Journal of Consulting and Clinical Psychology, 81(3), 518.

    PubMed  PubMed Central  Article  Google Scholar 

  23. Lebowitz, M. S., Pyun, J. J., & Ahn, W. K. (2014). Biological explanations of generalized anxiety disorder: Effects on beliefs about prognosis and responsibility. Psychiatric Services, 65(4), 498–503.

    PubMed  Article  Google Scholar 

  24. Lebowitz, M. S., Rosenthal, J. E., & Ahn, W. K. (2016). Effects of biological versus psychosocial explanations on stigmatization of children with ADHD. Journal of Attention Disorders, 20(3), 240–250.

    PubMed  Article  Google Scholar 

  25. Link, B. G., & Phelan, J. C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27(1), 363–385.

    Article  Google Scholar 

  26. Link, B. G., Phelan, J. C., Bresnahan, M., Stueve, A., & Pescosolido, B. A. (1999). Public conceptions of mental illness: Labels, causes, dangerousness, and social distance. American Journal of Public Health, 89(9), 1328–1333.

    PubMed  PubMed Central  Article  Google Scholar 

  27. Link, B. G., Yang, L. H., Phelan, J. C., & Collins, P. Y. (2004). Measuring mental illness stigma. Schizophrenia Bulletin, 30(3), 511–541.

    PubMed  Article  Google Scholar 

  28. Loughman, A., & Haslam, N. (2018). Neuroscientific explanations and the stigma of mental disorder: A meta-analytic study. Cognitive Research: Principles and Implications, 3(1), 43.

    Google Scholar 

  29. Marsh, J. K., & Romano, A. L. (2016). Lay judgments of mental health treatment options: The mind versus body problem. MDM Policy & Practice, 1(1), 2381468316669361. https://doi.org/10.1177/2381468316669361

    Article  Google Scholar 

  30. Marsh, J. K., & Shanks, L. L. (2014). Thinking you can catch mental illness: How beliefs about membership attainment and category structure influence interactions with mental health category members. Memory & Cognition, 42(7), 1011–1025.

    Article  Google Scholar 

  31. Medin, D. L., & Ortony, A. (1989). Psychological essentialism. In S. Vosniadou & A. Ortony (Eds.), Similarity and Analogical Reasoning (pp. 179 -195). New York: Cambridge University Press.

    Google Scholar 

  32. Morandini, J. S., Blaszczynski, A., Ross, M. W., Costa, D. S., & Dar-Nimrod, I. (2015).Essentialist beliefs, sexual identity uncertainty, internalized homonegativity and psychological well-being in gay men. Journal of Counseling Psychology, 62(3), 413.

    PubMed  Article  Google Scholar 

  33. Morandini, J. S., Blaszczynski, A., Costa, D. S., Godwin, A., & Dar-Nimrod, I. (2017). Born this way: Sexual orientation beliefs and their correlates in lesbian and bisexual women. Journal of Counseling Psychology, 64(5), 560.

    PubMed  Article  Google Scholar 

  34. Morton, T. A., & Postmes, T. (2009). When differences become essential: Minority essentialism in response to majority treatment. Personality and Social Psychology Bulletin, 35(5), 656–668.

    PubMed  Article  Google Scholar 

  35. National Institute of Mental Health. (2017). Mental illness. Retrieved from https://www.National Institute of Mental Health.nih.gov/health/statistics/mental-illness.shtml

  36. Phelan, J. C. (2002). Genetic bases of mental illness—A cure for stigma? Trends in Neurosciences, 25(8), 430–431.

    PubMed  Article  Google Scholar 

  37. Phelan, J. C., Yang, L. H., & Cruz-Rojas, R. (2006). Effects of attributing serious mental illnesses to genetic causes on orientations to treatment. Psychiatric Services, 57(3), 382–387.

    PubMed  Article  Google Scholar 

  38. Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, & Computers, 36(4), 717–731.

    Article  Google Scholar 

  39. Raue, P. J., Schulberg, H. C., Heo, M., Klimstra, S., & Bruce, M. L. (2009). Patients’ depression treatment preferences and initiation, adherence, and outcome: A randomized primary care study. Psychiatric Services, 60(3), 337–343.

    PubMed  Article  Google Scholar 

  40. Reynolds, W. M. (1982). Development of reliable and valid short forms of the Marlowe–Crowne Social Desirability Scale. Journal of Clinical Psychology, 38(1), 119–125.

    Article  Google Scholar 

  41. Rhodes, M., Leslie, S-J., & Tworek, C. M. (2012). Cultural transmission of social essentialism. Proceedings of the National Academy of Sciences of the United States of America, 109, 13526–13531. https://doi.org/10.1073/pnas.1208951109

    Article  PubMed  PubMed Central  Google Scholar 

  42. Roberts, S. O., & Gelman, S. A. (2015). Do children see in black and white? Children’s and adults’ categorizations of multiracial individuals. Child Development, 86(6), 1830–1847.

    PubMed  PubMed Central  Article  Google Scholar 

  43. Roberts, S. O., Ho, A. K., Rhodes, M., & Gelman, S. A. (2017). Making boundaries great again: Essentialism and support for boundary-enhancing initiatives. Personality and Social Psychology Bulletin, 43(12), 1643–1658.

    PubMed  Article  Google Scholar 

  44. Rüsch, N., Angermeyer, M. C., & Corrigan, P. W. (2005). Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. European Psychiatry, 20(8), 529–539.

    PubMed  Article  Google Scholar 

  45. Schroder, H. S., Dawood, S., Yalch, M. M., Donnellan, M. B., & Moser, J. S. (2015). The role of implicit theories in mental health symptoms, emotion regulation, and hypothetical treatment choices in college students. Cognitive Therapy and Research, 39(2), 120–139. https://doi.org/10.1007/s10608-014-9652-6

    Article  Google Scholar 

  46. Segal, S. P., Kotler, P. L., & Holschuh, J. (1991). Attitudes of sheltered care residents toward others with mental illness. Psychiatric Services, 42(11), 1138–1143.

    Article  Google Scholar 

  47. Taylor, M. G., Rhodes, M., & Gelman, S. A. (2009). Boys will be boys: Cows will be cows: Children’s essentialist reasoning about gender categories and animal species. Child Development, 80, 461–481.

    PubMed  PubMed Central  Article  Google Scholar 

  48. Walker, I., & Read, J. (2002). The differential effectiveness of psychosocial and biogenetic causal explanations in reducing negative attitudes toward “mental illness”. Psychiatry: Interpersonal and Biological Processes, 65(4), 313–325.

    Article  Google Scholar 

  49. Waxman, S., Medin, D., & Ross, N. (2007). Folk biological reasoning from a cross-cultural developmental perspective: Early essentialist notions are shaped by cultural beliefs. Developmental Psychology, 43(2), 294.

    PubMed  Article  Google Scholar 

  50. Yopchick, J. E., & Kim, N. S. (2009). The influence of causal information on judgments of treatment efficacy. Memory & Cognition, 37(1), 29–41.

    Article  Google Scholar 

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Appendices

Appendix 1

Vignettes

Base descriptions

Terry has a mental disorder called Fortioris. People with this disorder display an intense fear of gaining weight. In addition, they lack remorse when they hurt others. They display repetitive motor mannerisms such as repeatedly slapping their hands together. They often act as if they are “on the go,” constantly moving around.

Terry has a mental disorder called Obstatia. People with this disorder are very impulsive and will often do things without thinking them through. They also lose a significant amount of weight without dieting. They lose interest and pleasure in all activities. They also have a lot of muscle tension.

Terry has a mental disorder called Nollentism. People with this disorder find hidden and threatening meanings in nonthreatening conversations. They have reduced feelings for others. They often interrupt others when they are speaking. They exercise more than most people.

Terry has a mental disorder called Mirania. People with this disorder are in a depressed mood most of the day. They rarely need to sleep. They have difficulty concentrating. They also believe their friends and peers are disloyal, even when there is no reason to believe that they are.

Manipulations

Essentialism-consistent framing: This disorder has discrete boundaries, so that people either have the disorder or they don’t. It has been in the Diagnostic Manual since the first manual was made, and psychologists around the worlds agree on its existence. The disorder is very uniform, so people with the disorder are highly similar to one another.

Essentialism-inconsistent framing: This disorder exists on a continuum, because the disorder can have varying levels of severity. Psychologists debate its existence, and it seems to be present in some cultures but not others. The disorder is very diverse, so that people with the disorder may be very different from each other.

Control framing: Patients with this disorder often start to exhibit symptoms during adolescence. It is usually diagnosed by a psychologist. Experts have yet to determine what percentage of the population has this disorder.

Appendix 2

Essentialist Beliefs Scale

  1. 1.

    Some categories do not allow their members to belong to other categories. For example, a triangle cannot also be a square. On the other hand, some categories do not limit which other categories their members can belong to. For example, a square is also a rectangle.

    Rate the extent to which you believe members of this category (people with [Mirania/Fortioris/Obstatia/Nollentism]) are excluded from being part of other categories.

  2. 2.

    Some categories have necessary features or characteristics; without these characteristics someone cannot be a category member. For example, all triangles must have three sides. Other categories have many similarities, but no features or characteristics are necessary for membership. For example, there are similarities but no necessary features to define something as art.

    Rate the extent to which this category (people with [Mirania/Fortioris/Obstatia/Nollentism]) has the necessary features (features that members need to have in order to belong to the category).

  3. 3.

    Some categories have an underlying reality; although their members have similarities and differences on the surface, underneath they are basically the same. For example, a butterfly and a caterpillar may look different on the surface, but underneath they are the same species. Other categories also have similarities and differences on the surface, but do not correspond to an underlying reality. For example, butterflies and moths may look similar on the surface, but are not the same species.

    Rate the extent to which this category (people with [Mirania/Fortioris/Obstatia/Nollentism]) has an underlying reality.

  4. 4.

    Some categories have always existed and their characteristics have not changed much throughout history. For example, rocks have always existed. Other categories are less stable and may not have always existed. For example, computers are a relatively new category.

    Rate the extent to which this category (people with [Mirania/Fortioris/Obstatia/Nollentism]) has been stable across time.

  5. 5.

    Membership in some categories is easy to change. For example, water can turn into ice. For other categories it is difficult for category members to become nonmembers. For example, silver cannot turn into gold.

    Rate the extent to which it easy for members of this category (people with [Mirania/Fortioris/Obstatia/Nollentism]) to change their membership.

  6. 6.

    Some categories, like rubies, are more natural than others, whereas others, like plastic, are more artificial.

    Rate the extent to which this category (people with [Mirania/Fortioris/Obstatia/Nollentism]) is natural or artificial.

  7. 7.

    Some categories allow people to make many judgements about their members. Knowing that something belongs to the category tells us a lot about that category member. For example, knowing that something is a living thing can tell you a lot about it. For other categories, knowledge of membership is not very informative. For example, knowing something is a blue thing doesn’t tell you very much about it.

    Rate the extent to which the category (people with [Mirania/Fortioris/Obstatia/Nollentism]) is informative about the characteristics of its members.

  8. 8.

    Some categories contain members who are very similar to one another; they have many things in common. For example, cars are highly similar to one another. Other categories contain members who differ greatly from one another, and don’t share many characteristics. For example, different foods may be very different from one another.

    Rate the extent to which members of this category (people with [Mirania/Fortioris/Obstatia/Nollentism]) are diverse or similar.

  9. 9.

    Some categories have sharper boundaries than others. For some, membership is clear-cut, definite, and of an either–or variety; things either belong to the category or they do not. For example, the category of bicycles has clear-cut boundaries. For others, membership is more fuzzy; members belong to the category in varying degrees. For example, the category of big things has no clear boundaries. Rate the extent to which this category (people with [Mirania/Fortioris/Obstatia/Nollentism]) has clear-cut or fuzzy boundaries.

Appendix 3

Reynolds (1982) Social Desirability Scale Short Form C

  1. 1.

    It is sometimes hard for me to go on with my work if I am not encouraged.

  2. 2.

    I sometimes feel resentful when I don’t get my way.

  3. 3.

    On a few occasions, I have given up doing something because I thought too little of my ability.

  4. 4.

    There have been times when I felt like rebelling against people in authority even though I knew they were right.

  5. 5.

    No matter who I’m talking to, I’m always a good listener.

  6. 6.

    There have been occasions when I took advantage of someone.

  7. 7.

    I’m always willing to admit it when I make a mistake.

  8. 8.

    I sometimes try to get even rather than forgive and forget.

  9. 9.

    I am always courteous, even to people who are disagreeable.

  10. 10.

    I have never been irked when people expressed ideas very different from my own.

  11. 11.

    There have been times when I was quite jealous of the good fortune of others.

  12. 12.

    I am sometimes irritated by people who ask favors of me.

  13. 13.

    I have never deliberately said something that hurt someone’s feelings.

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Peters, D., Menendez, D. & Rosengren, K. Reframing mental illness: The role of essentialism on perceived treatment efficacy and stigmatization. Mem Cogn (2020). https://doi.org/10.3758/s13421-020-01061-1

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Keywords

  • Essentialism
  • Social cognition
  • Perceive Treatment Effectiveness
  • Stigma
  • mental illness