Attitudes regarding interpersonal relationships with persons with mental illness and mental retardation

Journal of Rehabilitation, Jan-March, 2004 by Phyllis A. Gordon, Jennifer Chiriboga Tantillo, David Feldman, Kristin Perrone

Historically, persons with disabilities have been confronted with not only the physical and mental impediments of their disability, but also with the accompanying social stigma and negative social attitudes. A persistent negative attitude and social rejection of people with disabilities is evident throughout history and across cultures. Ancient Roman and Greek cultures viewed persons with physical disabilities as burdens on society and as less than human (Rubin & Roessler, 1995). People with mental illness were viewed as either immoral souls punished by God, or as being possessed by demonic spirits requiring exorcisms and other religious interventions (Deutsch, 1949). Individuals with mental retardation were mocked, teased and used for social amusement (Kanner, 1964).

Negative attitudes and a high degree of social distance towards people with disabilities has been well documented. Research has shown, however, that the degree of social rejection and social stigma varies with specific disabilities, creating a well-defined hierarchical order (Strohmer, Grand, & Purcell, 1984). In studies examining the hierarchical attitudes towards disabling conditions, mental retardation and mental illness have consistently been cited as the least socially accepted (Lyons & Hayes, 1993; Jones, Gottfried, & Owens, 1965; Karnilowicz, Sparrow, & Shinkfield, 1994).

Negative social responses to persons with mental retardation and mental illness have persisted across generations despite improved care, legislative support, and a more sophisticated medical understanding of the causes and origins of these disabilities. During a time of heightened social awareness, social tolerance in the sixties and seventies began to slowly evolve. Social activists reacted to the "dehumanizing conditions and the absence of individual dignity" evident in institutions serving persons with disabilities, and called for institutional reform and accountability (Scheerenberger, 1987, p. 221). The Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963 furthered the rights of persons with mental retardation and mental illness, resulting in the institutional release of thousands of individuals (Scheerenberger, 1987). With the passage of five major legislative titles under the American with Disabilities Act, growing social awareness and continued efforts towards social progress continued through the 1990's (Rubin & Roessler, 1995). More recently, public service groups have attempted to increase public acceptance of disabilities such as mental illness through educational media campaigns (Martin, Pescosolido, & Tuch, 2000). By building awareness, the hope has been to increase social acceptance and decrease prejudice towards persons with differing abilities.

Social Rejection and Social Distance

Unfortunately, efforts to reduce negative stereotypes toward disabilities do not appear to have been substantially successful. Link and Phelan (1999) examined national survey data collected in 1996 to assess public conceptions of mental illness. Their findings support both a greater public knowledge of mental illness and an understanding of causal etiology. However, cultural misconceptions attached to mental illness also appear to exist, confounding an already meager understanding of accompanying characteristics and behaviors. Data showed that a significant attribution for increased violence in social interactions was attached to all of the mental disorders listed in the study. In addition, the more violent a mental disorder was perceived, the greater social distance desired by the respondents.

Similarly, a high degree of social rejection of persons with mental illness was also found in a study that compared reactions to the behaviors of individuals labeled as mentally ill and those labeled as physically ill (Socall & Holtgraves, 1992). Findings confirmed more willingness to interact with an individual labeled as physically ill than with a similar individual labeled as mentally ill. Desired social distance also increased with severity of symptoms. Negative social stereotypes about mental illness over-rode observed behaviors, leading to an increase in social distance. Public attitudes toward persons with mental illness were also compared using a public survey completed in the 1950's and the Mental Health Module of the 1996 General Social Survey (Phelan, Link, Stueve, & Pescosolido, 2000). Findings suggest that although the public has developed a realization that mental illness is something that can happen to anyone, the perception of persons with mental illness as violent and dangerous actually increased more than twofold.

Likewise, studies examining mental retardation have also illustrated a significantly negative social attitude. Mental retardation, described as "the most socially invisible of all people with disabilities" (Smith & Anton, 1997, p. 398) creates similar negative social attitudes. Measuring the social attitudes of high school students, Kamilowicz and associates (1994) compared attitudes about interacting with nondisabled peers, physically disabled peers, and mentally disabled peers and found students less willing to interact with persons with mental disabilities. In comparing twelve disabilities, Lyons and Hayes (1993) found that occupational therapy students reported a hierarchical preference citing mental illness and mental retardation as least preferred disabilities. Corrigan, River, Lundin and others (2000) also found "differential discrimination" among disabilities when examining social attributions towards persons with mental health disabilities. Persons with mental retardation were rated as least stable while persons with specific mental illnesses were rated as least controllable. The implications of these negative social attitudes toward persons with mental retardation and mental illness are significant. These social misperceptions and stereotypes of persons with mental disorders as instable, unpredictable and dangerous appear to have serious consequences in the willingness of the nondisabled to interact and pursue interpersonal relationships (Lyons & Hayes, 1993).