Emotional Reactions to People with
Mental Illness:
Results from Population Studies
Matthias C. Angermeyer
Center for Public Mental Health
Gösing am Wagram
Austria
“…Social psychologists have focused upon
thoughts (cognition) rather than feelings (affect). …
However, the reactions of a host majority acting
with prejudice in rejecting a minority group usually
involve not just negative thoughts but also
emotionally laden attitudes involving anxiety, anger,
resentment, hostility, distaste or disgust…In fact,
prejudice may more strongly predict discrimination
than do stereotypes…Interestingly,…there is almost
nothing published about emotional reactions to
people with mental illness apart from that which
describes a fear of violence …”
(Thornicroft & Kassam 2008, 189ff)
Systematic Review of Population Studies on Public Beliefs
About Mental Disorders and Attitudes Towards the Mentally Ill
• Inclusion criteria: - Population studies using random sampling
- All languages
• Time period covered: 1948 – 2008
• Countries included: 62
• Number of publications: 369
• Number of studies: 261 (137 national, 124 local/regional)
Publications on Population Studies on Public Beliefs About
Mental Disorder and Attitudes Towards People With Mental
Illness (N=369)
110
100
90
80
70
60
50
40
30
20
10
0
46- 49- 52- 55- 58- 61- 64- 67- 70- 73- 76- 79- 82- 85- 88- 91- 94- 97- 00- 03- 0648 51 54 57 60 63 66 69 72 75 78 81 84 87 90 93 96 99 02 05 08
Years
Studies on Public Beliefs about Mental Disorders and Attitudes
Towards the Mentally Ill (n=261)
1-9
10+
Publications on Population Studies Including Measures
of Emotional Reactions
N
%
of all studies (n=261)
Perspective of the Stigmatizer
● Positive feelings
● Anxiety
● Anger
15
19
15
5.7
7.3
5.7
Perspective of the Stigmatized
● Shame
● Embarrassment
7
18
2.7
6.9
Total
45
17.2
Components of Modern Conceptualizations of Stigma
Link & Phelan 2004
Corrigan & Watson 2002
Thornicroft 2006
Stereotype
Ignorance
Prejudice
Prejudice
Labelling
Stereotyping
Separating
Emotional Reactions
Status loss + Discrimination
Dependence of Stigma on
Power
Discrimination
Discrimination
Components of Modern Conceptualizations of Stigma
Link & Phelan 2004
Corrigan & Watson 2002
Thornicroft 2006
Stereotype
Ignorance
Labelling
Stereotyping
Separating
Emotional Reactions
Status loss + Discrimination
Dependence of Stigma on
Power
„Prejudice also yields
emotional responses
(e.g. anger or fear) to
stigmatized groups“
„The reactions of a host
majority acting with
prejudice… involve not just
negative thoughts but also
emotionally laden
attitudes…“
Prejudice
Prejudice
Discrimination
Discrimination
The Role of Emotions Seen From the Vantage
Point of the Stigmatizer
• In personal encounters, the way others respond emotionally tells the
stigmatised person how he or she is being perceived.
Example:
Example:“ “AAperson
personwho
whofeels
feelssome
somecombination
combinationofofpity
pityand
andanxiety
anxietyin
the
presence
of aofperson
withwith
mental
illness
might
modulate
his his
or her
in the
presence
a person
mental
illness
might
modulate
or
voice,
speaking
softlysoftly
and in
aninunnaturally
calmcalm
tone,tone,
signalling
to the
her voice,
speaking
and
an unnaturally
signalling
person
with mental
illness that
he that
or she
from a
to the person
with mental
illness
he is
orbeing
she isapproached
being approached
standpoint
of differentness.”
(Link et (Link
al. 2004)
from a standpoint
of differentness.”
et al. 2004)
• Emotional responses may shape subsequent behaviour toward the
stigmatised person.
Example:AAperson
personwho
whoreacts
reactswith
withfear
fearmight
mightfeel
feelaastronger
strongerdesire
desirefor
Example:
for social
distance
avoid
contact
people
mental
illness.
social
distance
and and
avoid
contact
with with
people
with with
mental
illness.
The Role of Emotions Seen From the Vantage
Point of the Stigmatized
• In interpersonal interaction, how the stigmatised individual responds
emotionally may confirm misconceptions held by others.
Example:
Example:InIninterpersonal
interpersonalencounters,
encounters,aaperson
personashamed
ashamedofofher
her
mental
mentalillness
illnessmight
mightkeep
keepher
herillness
illnessaasecret.
secret.Preoccupation
Preoccupationwith
withhis
his
ororher
herundisclosed
undisclosedstatus
statusas
asmentally
mentallyillillperson
personmay
maylead
leadtotoanxiety,
anxiety,
which
whichininturn
turnleads
leadstotosocial
socialawkwardness.
awkwardness.This
Thismay
maylet
letothers
othersfeel
feel
uncomfortable
uncomfortableand
andconfirm
confirmtheir
theirperception
perceptionthat
thatpeople
peoplewith
withmental
mental
illness
illnessare
arestrange
strangeand
andhard
hardtototalk
talkto.
to.
• Emotional responses may shape subsequent behaviour of the
stigmatised person.
Example:
Example:Shame
Shameand
andanxiety
anxietymight
mightlet
letpeople
peoplewith
withmental
mentalillness
illnessavoid
contact
with mental
health professionals,
resulting
in delayed
help
avoid contact
with mental
health professionals,
resulting
in delayed
seeking
or discontinuation
of treatment.
help seeking
or discontinuation
of treatment.
• How prevalent are the various emotional reactions to
people with mental disorder?
• Are there differences between mental disorders as
concerns the public’s emotional reactions?
• How important are emotional reactions as compared with
stereotypes?
• Does familiarity with mental illness work through
modification of emotional reactions?
• How prevalent are the various emotional reactions to
people with mental disorder?
• Are there differences between mental disorders?
• How important are emotional reactions as compared to
stereotypes?
• Does familiarity with mental illness work through
modification of emotional reactions?
Emotional Reactions to People With Schizophrenia
Population Study in Germany, 2001
%
100
90
80
70
60
50
40
30
20
10
0
ty
Pi
D
ire
s
e
to
lp
he
as
e
n
U
ss
e
in
i ty
r
u
ec
s
In
ar
e
F
Em
y
th
a
p
ck
La
Positive Emotions
of
g
in
d
an
st
r
de
n
u
Fear
n
io
t
i ta
Irr
er
g
An
Anger
R
le
cu
i
id
Emotional Reactions to People With Schizophrenia
Population Study in Bratislava, 2003
%
100
90
80
70
60
50
40
30
20
10
0
D
ire
s
e
to
lp
he
ty
Pi
i ty
r
u
ec
s
In
U
as
e
n
ss
e
in
Em
y
th
a
p
ar
e
F
n
io
t
i ta
Irr
ck
La
Positive Emotions
Fear
of
g
in
d
an
st
r
de
n
u
er
g
An
Anger
R
le
cu
i
id
Emotional Reactions to People With Schizophrenia
Population Study in Novosibirsk, 2002
%
100
90
80
70
60
50
40
30
20
10
0
ty
Pi
D
ire
s
e
to
lp
he
as
e
n
U
ss
e
in
i ty
r
u
ec
s
In
ck
La
Positive Emotions
ar
e
F
n
io
t
i ta
Irr
of
g
in
d
an
st
r
de
n
u
Fear
Em
y
th
a
p
er
g
An
Anger
R
le
cu
i
id
Emotional Reactions to People With Schizophrenia
Population Study in Ulaanbaatar, 2002
%
100
90
80
70
60
50
40
30
20
10
0
ty
Pi
D
ire
s
e
to
lp
he
as
e
n
ss
e
in
ar
e
F
U
Positive Emotions
g
i ty
in
r
d
u
c
n
ta
se
s
n
r
I
de
n
u
of
ck
La
n
io
t
i ta
Irr
Fear
Em
y
th
a
p
er
g
An
Anger
R
le
cu
i
id
Emotional Reactions to People With Major Depression
Population Study in Germany, 2001
%
100
90
80
70
60
50
40
30
20
10
0
D
ire
s
e
to
lp
he
ty
Pi
Em
y
th
a
p
U
as
e
n
ss
e
in
i ty
r
u
ec
s
In
ar
e
F
ck
La
Positive Emotions
of
g
in
d
an
st
r
de
n
u
Fear
n
io
t
i ta
Irr
er
g
An
Anger
R
le
cu
i
id
Emotional Reactions to People With Major Depression
Population Study in Germany, 2001
%
100
90
80
70
60
50
40
30
20
10
0
D
ire
s
e
to
lp
he
ty
Pi
Em
y
th
a
p
U
as
e
n
ss
e
in
i ty
r
u
ec
s
In
ar
e
F
ck
La
Positive Emotions
of
g
in
d
an
st
r
de
n
u
Fear
n
io
t
i ta
Irr
er
g
An
Anger
R
le
cu
i
id
Emotional Reactions to People With Major Depression
Population Study in Bratislava, 2003
%
100
90
80
70
60
50
40
30
20
10
0
D
ire
s
e
to
lp
he
ty
Pi
Em
y
th
a
p
i ty
r
u
ec
s
In
as
e
n
ss
e
in
ar
e
F
n
io
t
i ta
Irr
U
ck
La
Positive Emotions
Fear
of
g
in
d
an
st
r
de
n
u
er
g
An
Anger
R
le
cu
i
id
Emotional Reactions to People With Major Depression
Population Study in Novosibirsk, 2002
%
100
90
80
70
60
50
40
30
20
10
0
ty
Pi
D
ire
s
e
to
lp
he
as
e
n
U
ss
e
in
i ty
r
u
ec
s
In
n
io
t
i ta
Irr
ck
La
Positive Emotions
of
g
in
d
an
st
r
de
n
u
Em
Fear
y
th
a
p
ar
e
F
er
g
An
Anger
R
le
cu
i
id
Emotional Reactions to People With Major Depression
Population Study in Ulaanbaatar, 2002
%
100
90
80
70
60
50
40
30
20
10
0
ty
Pi
D
ire
s
e
to
lp
he
as
e
n
U
ss
e
in
i ty
r
u
ec
s
In
ar
e
F
ck
La
Positive Emotions
of
g
in
d
an
st
r
de
n
u
Em
Fear
y
th
a
p
n
io
t
i ta
Irr
er
g
An
Anger
R
le
cu
i
id
Emotional Reactions to People With Schizophrenia
Population Studies in the Western Part of Germany, 1990 and 2001
Positive emotions
Fear
Anger
Score
Score
Score
0,3
0,3
0,3
0,2
0,2
0,2
0,1
0,1
0,1
0
0
0
-0,1
-0,1
-0,1
-0,2
-0,2
-0,2
-0,3
-0,3
-0,3
1990
2001
1990
2001
1990
2001
Emotional Reactions to People With Major Depression
Population Studies in the Western Part of Germany, 1990 and 2001
Positive emotions
Fear
Anger
Score
Score
Score
0,3
0,3
0,3
0,2
0,2
0,2
0,1
0,1
0,1
0
0
0
-0,1
-0,1
-0,1
-0,2
-0,2
-0,2
-0,3
-0,3
-0,3
1990
2001
1990
2001
1990
2001
Emotional Reactions to People With Schizophrenia
Population Studies in the Eastern Part of Germany, 1993 and 2001
Positive emotions
Fear
Anger
Score
Score
Score
0,3
0,3
0,3
0,2
0,2
0,2
0,1
0,1
0,1
0
0
0
-0,1
-0,1
-0,1
-0,2
-0,2
-0,2
-0,3
-0,3
-0,3
1993
2001
1993
2001
1993
2001
Emotional Reactions to People With Major Depression
Population Studies in the Eastern Part of Germany, 1993 and 2001
Positive emotions
Fear
Anger
Score
Score
Score
0,3
0,3
0,3
0,2
0,2
0,2
0,1
0,1
0,1
0
0
0
-0,1
-0,1
-0,1
-0,2
-0,2
-0,2
-0,3
-0,3
-0,3
1993
2001
1993
2001
1993
2001
• How prevalent are the various emotional reactions to
people with mental disorder?
• Are there differences between mental disorders as
concerns the public’s emotional reactions?
• How important are emotional reactions as compared to
stereotypes?
• Does familiarity with mental illness work through
modification of emotional reactions?
Emotional Reactions to People With Schizophrenia, Major
Depression and Alcohol Dependence
Population Studies in the Western Part of Germany, 1990
Positive emotions
Fear
Anger
Score
Score
Score
0,3
0,3
0,3
0,2
0,2
0,2
0,1
0,1
0,1
0
0
0
-0,1
-0,1
-0,1
-0,2
-0,2
-0,2
-0,3
-0,3
-0,3
Schizophrenia
Major Depression
Alcohol Dependence
Emotional Reactions to People With Schizophrenia, Major
Depression and Alcoholism
Population Studies in the Western Part of Germany, 1990
Positive emotions
Fear
Anger
Score
Score
Score
0,3
0,3
0,3
0,2
0,2
0,2
0,1
0,1
0,1
0
0
0
-0,1
-0,1
-0,1
-0,2
-0,2
-0,2
-0,3
-0,3
-0,3
Schizophrenia
Major Depression
Alcoholism
Emotional Reactions to People With Schizophrenia, Major
Depression and Alcoholism
Population Studies in the Western Part of Germany, 1990
Positive emotions
Fear
Anger
Score
Score
Score
0,3
0,3
0,3
0,2
0,2
0,2
0,1
0,1
0,1
0
0
0
-0,1
-0,1
-0,1
-0,2
-0,2
-0,2
-0,3
-0,3
-0,3
Schizophrenia
Major Depression
Alcoholism
Emotional Reactions to People With Schizophrenia, Major
Depression and Alcohol Dependence
Population Studies in the Western Part of Germany, 1990
Positive emotions
Fear
Anger
Score
Score
Score
0,3
0,3
0,3
0,2
0,2
0,2
0,1
0,1
0,1
0
0
0
-0,1
-0,1
-0,1
-0,2
-0,2
-0,2
-0,3
-0,3
-0,3
Schizophrenia
Major Depression
Alcohol Dependence
Emotional Reactions to People With Schizophrenia, Major
Depression and Alcoholism
Population Studies in the Western Part of Germany, 1990
Positive emotions
Fear
Anger
Score
Score
Score
0,3
0,3
0,3
0,2
0,2
0,2
0,1
0,1
0,1
0
0
0
-0,1
-0,1
-0,1
-0,2
-0,2
-0,2
-0,3
-0,3
-0,3
Schizophrenia
Major Depression
Alcoholism
• How prevalent are the various emotional reactions to
people with mental disorder?
• Are there differences between mental disorders?
• How important are emotional reactions as compared to
stereotypes?
• Does familiarity with mental illness work through
modification of emotional reactions?
Regression of Desire For Social Distance Towards People With
Schizophrenia on Socio-Demographic Characteristics, Stereotypes
and Emotional Reactions.
Population Study in Germany, 2001.
Model 1
B
Age
p
Model 2
B
p
Model 3
B
p
Model 4
B
p
.021
.007
.022
.003
.029
.000
.028
.000
Gender
-.302
.236
-.253
.279
-.225
.334
-.181
.420
Educational attainment
-.319
.049
-.100
.509
.108
.468
-.073
.616
Dangerous
1.019
.000
.680
.000
Unpredictable
1.403
.000
1.036
.000
.394
.699
.011
.351
Lack of willpower
Fear
1.781
.000
1.072
.000
Positive emotions
-2.154
.000
-1.819
.000
.181
.100
.211
.061
Anger
Adj. R²
.005
.165
.209
.270
Regression of Desire For Social Distance Towards People With
Schizophrenia on Socio-Demographic Characteristics, Stereotypes
and Emotional Reactions.
Population Study in Germany, 2001.
Model 1
B
Age
p
Model 2
B
p
Model 3
B
p
Model 4
B
p
.021
.007
.022
.003
.029
.000
.028
.000
Gender
-.302
.236
-.253
.279
-.225
.334
-.181
.420
Educational attainment
-.319
.049
-.100
.509
.108
.468
-.073
.616
Dangerous
1.019
.000
.680
.000
Unpredictable
1.403
.000
1.036
.000
.394
.699
.011
.351
Lack of willpower
Fear
1.781
.000
1.072
.000
Positive emotions
-2.154
.000
-1.819
.000
.181
.100
.211
.061
Anger
Adj. R²
.005
.165
.209
.270
Regression of Desire for Social Distance Towards People With
Schizophrenia on Socio-Demographic Characteristics, Stereotypes
and Emotional Reactions.
Population Study in Germany, 2001.
Model 1
B
Age
p
Model 2
B
p
Model 3
B
p
Model 4
B
p
.021
.007
.022
.003
.029
.000
.028
.000
Gender
-.302
.236
-.253
.279
-.225
.334
-.181
.420
Educational attainment
-.319
.049
-.100
.509
.108
.468
-.073
.616
Dangerous
1.019
.000
.680
.000
Unpredictable
1.403
.000
1.036
.000
.394
.699
.011
.351
Lack of willpower
Fear
1.781
.000
1.072
.000
Positive emotions
-2.154
.000
-1.819
.000
.181
.100
.211
.061
Anger
Adj. R²
.005
.165
.209
.270
Regression of Desire for Social Distance Towards People with
Schizophrenia on Socio-Demographic Characteristics, Stereotypes
and Emotional Reactions.
Population Study in Germany, 2001.
Model 1
B
Age
p
Model 2
B
p
Model 3
B
p
Model 4
B
p
.021
.007
.022
.003
.029
.000
.028
.000
Gender
-.302
.236
-.253
.279
-.225
.334
-.181
.420
Educational attainment
-.319
.049
-.100
.509
.108
.468
-.073
.616
Dangerous
1.019
.000
.680
.000
Unpredictable
1.403
.000
1.036
.000
.394
.699
.011
.351
Lack of willpower
Fear
1.781
.000
1.072
.000
Positive emotions
-2.154
.000
-1.819
.000
.181
.100
.211
.061
Anger
Adj. R²
.005
.165
.209
.270
• How prevalent are the various emotional reactions to
people with mental disorder?
• Are there differences between mental disorders?
• How important are emotional reactions as compared to
stereotypes?
• Does familiarity with mental illness work through
modification of emotional reactions?
Familiarity with Mental Illness and Desire for Social Distance
Systematic Review of Population-Based Studies on Public Beliefs
About Mental Disorders and Attitudes Towards the Mentally Ill
30
20
10
0
Positive associations
No associations
Negative associations
Association Between Familiarity, Emotional Reactions and
Social Distance Towards People With Schizophrenia
Population Study in Germany, 2001
Fear
0.22
Familiarity
0.22
Positive
emotions
-2.09
Anger
-1.60
Sum of indirect effects –1.61
Social distance
Association Between Familiarity, Emotional Reactions and
Social Distance Towards People With Major Depression
Population Study in Germany, 2001
Fear
0.15
Familiarity
0.25
Positive
emotions
-1.75
Anger
-1.31
Sum of indirect effects –1.22
Social distance
Summary
• Positive emotional responses to people with mental illness are most
prevalent, followed by fear and anger.
• This pattern appears relatively stable across different cultures.
• There are differences in the public’s emotional reactions to the
various types of mental disorder.
• Emotional reactions have a substantial effect on the desire for social
distance.
• The association between familiarity with mental disorder and the
desire for social distance is to a considerable extent mediated through
emotions.
Conclusion
• As compared to stereotypes and behavioural intentions, the public’s
emotional reactions to people with mental disorders are relatively
under-researched.
• Our findings suggest that more research on the public’s emotional
reactions may allow to better understand the complexities of the
stigma surrounding mental illness.
• Interventions aimed at reducing the stigma of mental illness may
benefit from paying more attention to emotions.