Not bigoted, just keeping our distance

25th February 2005 at 00:00
It's undeniable that attitudes towards people who are "different" have improved over the years. But by how much? One major effect of campaigns to combat racism and prejudice towards the mentally ill and the disabled is that most people now know what to say if they're approached by an opinion pollster; they know that in these politically correct times they should not admit to any prejudices. This presents a problem for researchers.

One solution has been the widespread use of the concept of "social distance" in market research. This is related to "attitude", but is a more subtle and perhaps more accurate measure of what the public really think.

It measures people's willingness to engage in relationships of varying intimacy with others. So an example of a question which probes social distance could be: "Would you allow someone with a history of psychosis, but who is now recovered, to babysit your children?" A team of Swiss psychiatrists recently used this technique to probe attitudes to psychosis.

The surprising result was that the more educated they were about mental illness, the more social distance people put between themselves and those with psychosis.

This runs against the central tenet of anti-stigma campaigns: that it is ignorance which produces negative attitudes. It also highlights the role of education. What can teachers do? Is it not a key role of education to eliminate irrational prejudice?

The term stigma comes from the ancient Greeks, who burnt "deviants" to advertise that they were blemished and to be avoided, especially in public places.

According to Erving Goffman, who pioneered the sociological study of stigma, people designated as "normals" believe that the stigmatised are not fully human. They construct a belief system in which the stigmatised are dangerous and use words such as "moron", "loony" or "cripple" to reinforce these beliefs.

To combat this negative public perception, it is important to emphasise the fundamental humanity of the psychotic and their common experience with the rest of us. For example, do we all not experience a psychotic phenomenon when we dream? A new language is needed to describe psychotic states.

But there is a problem. This approach clouds the fact that sometimes those suffering from psychosis have little in common with other people. We can try too hard to find similarities that simply aren't there.

This problem is highlighted by inaccurate portrayals of psychosis in film and television. Take the depiction of pianist David Helfgott's life in the film Shine, for example. Academic psychiatrists have found this to be at odds with other versions, notably that offered by Helfgott's sister, Margaret.

The inaccuracy of such portrayals - or at least the fact that they do not address what psychiatrists feel needs destigmatising - means they cannot ease real prejudices. Teachers might find it useful to get their students to critically assess whether the aim of destigmatisation is served by inaccurate fictional accounts. It would be interesting, for example, to juxtapose a viewing of a film about mental illness such as A Beautiful Mind (pictured) with a visit to a psychiatric hospital. If we don't teach our students how to assess what is thrown at them in the popular media then we leave them unprepared for the lifelong learning they will need to undertake once they leave school.

Professor Raj Persaud is a consultant psychiatrist at the Bethlem Royal and Maudsley hospitals in London. His latest book is The Motivated Mind (Bantam Press, pound;12.99). Email:

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