2 CHAPTER 1 abnormal psychology: an overview learning objectives. 1.1. How do we define abnormality and classify mental disorders?
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2 CHAPTER 1 abnormal psychology: an overviewlearning objectives1.1How do we de˜ne abnormality and classify mental disorders? 1.2What are the advantages and disadvantages of classi˜cation? 1.3How common are mental disorders? Which disorders are most prevalent? 1.4Why do we need a research-based approach in abnormal psychology?1.5How do we gather information about mental disorders? 1.6What kinds of research designs are used to conduct research in abnormal psychology? Abnormal psychology is concerned with understanding the nature, causes, and treatment of mental disorders. The topics and problems within the field of abnormal psychology surround us every day. You have only to pick up a newspaper, flip through a magazine, surf the web, or sit through a movie to be exposed to some of the issues that clinicians and researchers deal with on a day-to-day basis. Almost weekly some celebrity is in the news because of a drug or alcohol problem, an eating disorder, or some other psychological difficulty. Countless books provide personal accounts of struggles with schizo-phrenia, depression, phobias, and panic attacks. Films and TV shows portray aspects of abnormal behavior with varying degrees of accuracy. And then there are the tragic news stories of mothers who kill their children, in which problems with depression, schizophre-nia, or postpartum difficulties seem to be implicated.Abnormal psychology can also be found much closer to home. Walk around any college campus, and you will see fly -ers about peer support groups for people with eating disorders, depression, and a variety of other disturbances. You may even know someone who has experienced a clinical problem. It may be a cousin with a cocaine habit, a roommate with bulimia, or a grandparent who is developing Alzheimer™s disease. It may be a coworker of your mother™s who is hospitalized for depression, a neighbor who is afraid to leave the house, or someone at your gym who works out intensely despite being worrisomely thin. It may even be the disheveled street person in the aluminum foil hat who shouts, fiLeave me alone!fl to voices only he can hear. The issues of abnormal psychology capture our inter -est, demand our attention, and trigger our concern. They also compel us to ask questions. To illustrate further, let™s consider two clinical cases.Monique Monique is a 24-year-old law student. She is attractive, neatly dressed, and clearly very bright. If you were to meet her, you would think that she had few problems in her life; but Monique has been drinking alcohol since she was 14, and she smokes marijuana every day. Although she describes herself as fijust a social drinker,fl she drinks four or five glasses of wine when she goes out with friends and also drinks a couple of glasses of wine a night when she is alone in her apartment in the evening. She frequently misses early-morning classes because she feels too hung over to get out of bed. On several occasions her drinking has caused her to black out. Although she denies having any prob -lems with alcohol, Monique admits that her friends and family have become very concerned about her and have suggested that she seek help. Monique, however, says, fiI don™t think I am an alco -holic because I never drink in the mornings.fl The previous week she decided to stop smoking marijuana entirely because she was concerned that she might have a drug problem. However, she found it impossible to stop and is now smoking regularly again. John John comes from a family with no history of mental illness. He had a normal birth and seemed to develop normally when he was a child. However, when he was 21, John began to hear voices and started to believe that there was a conspiracy against him. Since that time, he has been on various different anti -psychotic medications. Although these have helped a little, he still has symptoms of psychosis. Now aged 46, John has been unable to work since he became ill. He has also been hospitalized many times. John lives in sheltered accommodation, although he main -tains contact with his parents and his older brother. Perhaps you found yourself asking questions as you read about Monique and John. For example, because Monique doesn™t drink in the mornings, you might have wondered whether she could really have a serious alcohol problem. She does. This is a question that concerns the criteria that must be met before some -one receives a particular diagnosis. Or perhaps you wondered whether other people in Monique™s family likewise have drinking problems. They do. This is a question about what we call family aggregation Šthat is, whether a disorder runs in families. You may also have been curious about what is wrong with John and why he is hearing voices. Questions about the age of onset of his symptoms as well as predisposing factors may also have occurred to you. John has schizophrenia, a disorder that often strikes in late adolescence or early adulthood. Also, as 1M01_BUTC4286_16_SE_C01.indd 210/06/13 1:20 PM

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abnormal psychology: an overview CHAPTER 1 3John™s case illustrates, it is not unusual for someone who develops schizophrenia to develop perfectly normally before suddenly be -coming ill. You can read more about John™s case and treatment in Valmaggia and colleagues (2008). These cases, which describe real people, give some indication of just how profoundly lives can be derailed because of mental disor -ders. It is hard to read about difficulties such as these without feeling compassion for the people who are struggling. Still, in addition to compassion, clinicians and researchers who want to help people like Monique and John must have other attributes and skills. If we are to understand mental disorders, we must learn to ask the kinds of ques -tions that will enable us to help the patients and families who have mental disorders. These questions are at the very heart of a research- based approach that looks to use scientific inquiry and careful obser – vation to understand abnormal psychology. Asking questions is an important aspect of being a psycholo -gist. Psychology is a fascinating field, and abnormal psychology is one of the most interesting areas of psychology (although we are undoubtedly biased). Psychologists are trained to ask questions and to conduct research. Though not all people who are trained in abnormal psychology (this field is sometimes called psy -chopathology) conduct research, they still rely heavily on their scientific skills and ability both to ask questions and to put infor-mation together in coherent and logical ways. For example, when a clinician first sees a new client or patient, he or she asks many questions to try and understand the issues or problems related to that person. The clinician will also rely on current research to choose the most effective treatment. The best treatments of 20, 10, or even 5 years ago are not invariably the best treatments of today. Knowledge accumulates and advances are made. And re -search is the engine that drives all of these developments. In this chapter, we will outline the field of abnormal psy -chology and the varied training and activities of the people who work within its demands. First we describe the ways in which ab -normal behavior is defined and classified so that researchers and mental health professionals can communicate with each other about the people they see. Some of the issues here are probably more complex and controversial than you might expect. We also outline basic information about the extent of behavioral abnor-malities in the population at large.You will notice that a large section of this chapter is devoted to research. We make every effort to convey how abnormal behav -ior is studied. Research is at the heart of progress and knowledge in abnormal psychology. The more you know and understand about how research is conducted, the more educated and aware you will be about what research findings do and do not mean. What Do We Mean by Abnormality? It may come as a surprise to you that there is still no universal agreement about what is meant by abnormality or disorder . This is not to say we do not have definitions; we do. However, a truly satisfactory definition will probably always remain elusive (Lilienfeld & Landfield, 2008; Stein et al., 2010) even though there is a great deal of general agreement about which conditions are disorders and which are not (Spitzer, 1999). Why does the definition of a mental disorder present so many challenges? A major problem is that there is no one behavior that makes someone abnormal. However, there are some clear elements or indicators of abnormality (Lilienfeld & Marino, 1999; Stein et al., 2010). No single indicator is sufficient in and of itself to define or determine abnormality. Nonetheless, the more that someone has difficulties in the following areas, the more likely he or she is to have some form of mental disorder.1. Su˜ering: If people su˜er or experience psychological pain we are inclined to consider this as indicative of abnormality. Depressed people clearly su˜er, as do people with anxiety dis – orders. But what of the patient who is manic and whose mood is one of elation? He or she may not be su˜ering. In fact, many such patients dislike taking medications because they do not want to lose their manic fihighs.fl You may have a test tomor -row and be su˜ering with worry. But we would hardly label your su˜ering abnormal. Although su˜ering is an element of abnormality in many cases, it is neither a su˚cient condition (all that is needed) nor even a necessary condition (a feature that all cases of abnormality must show) for us to consider something as abnormal.2. Maladaptiveness: Maladaptive behavior is often an indica -tor of abnormality. ˛e person with anorexia may restrict her intake of food to the point where she becomes so emaciated Fergie has spoken about her past struggles with substance abuse, specifically crystal meth.M01_BUTC4286_16_SE_C01.indd 310/06/13 1:20 PM

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4 CHAPTER 1 abnormal psychology: an overviewthat she needs to be hospitalized. ˛e person with depression may withdraw from friends and family and may be unable to work for weeks or months. Maladaptive behavior interferes with our well-being and with our ability to enjoy our work and our relationships. However, not all disorders involve mal -adaptive behavior. Consider the con artist and the contract killer, both of whom have antisocial personality disorder. ˛e ˝rst may be able glibly to talk people out of their life savings, the second to take someone™s life in return for payment. Is this behavior maladaptive? Not for them, because it is the way in which they make their respective livings. We consider them abnormal, however, because their behavior is maladap -tive for and toward society. 3. Statistical Deviancy: ˛e word abnormal literally means fiaway from the normal.fl But simply considering statistical -ly rare behavior to be abnormal does not provide us with a solution to our problem of de˝ning abnormality. Genius is statistically rare, as is perfect pitch. However, we do not con -sider people with such uncommon talents to be abnormal in any way. Also, just because something is statistically common doesn™t make it normal. ˛e common cold is certainly very common, but it is regarded as an illness nonetheless. On the other hand, intellectual disability (which is statis -tically rare and represents a deviation from normal) is con -sidered to re˙ect abnormality. ˛is tells us that in de˝ning abnormality we make value judgments. If something is statis -tically rare and undesirable (as is severely diminished intellec -tual functioning), we are more likely to consider it abnormal than something that is statistically rare and highly desirable (such as genius) or something that is undesirable but statisti-cally common (such as rudeness). 4. Violation of the Standards of Society: All cultures have rules. Some of these are formalized as laws. Others form the norms and moral standards that we are taught to follow. Although many social rules are arbitrary to some extent, when people fail to follow the conventional social and moral rules of their cultural group we may consider their behavior abnormal. For example, driving a car or watching television would be considered highly abnormal for the Amish of Pennsylvania. However, both of these activities re˙ect normal everyday be -havior for most other Pennsylvania residents. Of course, much depends on the magnitude of the viola -tion and on how commonly the rule is violated by others. As illustrated in the example above, a behavior is most likely to be viewed as abnormal when it violates the standards of society and is statistically deviant or rare. In contrast, most of us have parked illegally at some point. ˛is failure to follow the rules is so statistically common that we tend not to think of it as ab -normal. Yet when a mother drowns her children there is instant recognition that this is abnormal behavior. 5. Social Discomfort: When someone violates a social rule, those around him or her may experience a sense of discom -fort or unease. Imagine that you are sitting in an almost empty movie theater. ˛ere are rows and rows of unoccupied seats. ˛en someone comes in and sits down right next to you. How do you feel? In a similar vein, how do you feel when someone you met only 4 minutes ago begins to chat about her suicide attempt? Unless you are a therapist working in a crisis intervention center, you would probably consider this an example of abnormal behavior. 6. Irrationality and Unpredictability: As we have already noted, we expect people to behave in certain ways. Although a little unconventionality may add some spice to life, there is a point at which we are likely to consider a given unorthodox behav -ior abnormal. If a person sitting next to you suddenly began to scream and yell obscenities at nothing, you would probably regard that behavior as abnormal. It would be unpredictable, and it would make no sense to you. ˛e disordered speech and the disorganized behavior of patients with schizophrenia are often irrational. Such behaviors are also a hallmark of the manic phases of bipolar disorder. Perhaps the most impor -tant factor, however, is our evaluation of whether the person can control his or her behavior. Few of us would consider a roommate who began to recite speeches from King Lear to be abnormal if we knew that he was playing Lear in the next cam -pus Shakespeare productionŠor even if he was a dramatic person given to extravagant outbursts. On the other hand, if we discovered our roommate lying on the ˙oor, ˙ailing wildly, and reciting Shakespeare, we might consider calling for assis -tance if this was entirely out of character and we knew of no reason why he should be behaving in such a manner. 7. Dangerousness: It seems quite reasonable to think that some -one who is a danger to him- or herself or to another person must be psychologically abnormal. Indeed, therapists are re -quired to hospitalize suicidal clients or contact the police (as well as the person who is the target of the threat) if they have a client who makes an explicit threat to harm another person. As with most accomplished athletes, Venus and Serena Williams™ physical ability is abnormal in a literal and statistical sense. Their behavior, however, would not be labeled as being abnormal by psychologists. Why not?M01_BUTC4286_16_SE_C01.indd 410/06/13 1:20 PM

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abnormal psychology: an overview CHAPTER 1 5How important is dangerousness to the definition of mental illness? If we are a risk to ourselves or to others, does this mean we are mentally ill?Tattoos, which were once regarded as highly deviant, are now quite commonplace and considered fashionable by many.But, as with all of the other elements of abnormality, if we rely only on dangerousness as our sole feature of abnormality, we will run into problems. Is a soldier in combat mentally ill? What about someone who is an extremely bad driver? Both of these people may be a danger to others. Yet we would not consider them to be mentally ill. Why not? And why is some -one who engages in extreme sports or who has a dangerous hobby (such as free diving, race car driving, or keeping poi -sonous snakes as pets) not immediately regarded as mentally ill? Just because we may be a danger to ourselves or to others does not mean we are mentally ill. Conversely, we cannot as -sume that someone diagnosed with a mental disorder must be dangerous. Although mentally ill people do commit serious crimes, serious crimes are also committed every day by people who have no signs of mental disorder. Indeed, research sug -gests that in people with mental illness, dangerousness is more the exception than it is the rule (Corrigan & Watson, 2005). One final point bears repeating. Decisions about abnormal behavior always involve social judgments and are based on the values and expectations of society at large. This means that cul-ture plays a role in determining what is and is not abnormal. For example, in the United States, people do not believe that it is acceptable to murder a woman who has a premarital or an extra-marital relationship. However, karo-kari (a form of honor killing where a woman is murdered by a male relative because she is considered to have brought disgrace onto her family) is considered justifiable by many people in Pakistan (Patel & Gadit, 2008).In addition, because society is constantly shifting and becom-ing more or less tolerant of certain behaviors, what is considered abnormal or deviant in one decade may not be considered abnor-mal or deviant a decade or two later. At one time, homosexuality was classified as a mental disorder. But this is no longer the case. A generation ago, pierced noses and navels were regarded as highly deviant and prompted questions about a person™s mental health. Now, however, such adornments are commonplace, considered fashionable by many, and attract little attention. What other behaviors can you think of that are now considered normal but were regarded as deviant in the past?As you think about these issues, consider the person described in The World Around Us box on page 6. Is he a courageous man of profound moral commitment? Or is his behavior abnormal and indicative of a mental disorder? Do others share your view about him?The DSM-5 and the Definition of Mental Disorder In the United States, the accepted standard for defining various types of mental disorders is the American Psychiatric Associa -tion™s Diagnostic and Statistical Manual of Mental Disorders . This manual, commonly referred to as the DSM, is revised and updated from time to time. The current version, called DSM-5, was published in 2013. Its revision has been a topic of much debate and controversy. In the box on page 7 we explain more about the DSM and discuss why a revision was necessary. M01_BUTC4286_16_SE_C01.indd 510/06/13 1:20 PM

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6 CHAPTER 1 abnormal psychology: an overviewthe WORLD around usExtreme Generosity or Pathological Behavior? Zell Kravinsky was a brilliant student who grew up in a working-class neighborhood in Philadelphia. He won prizes at school, and at the age of 12, he began investing in the stock market. Despite his abilities, his Russian immigrant parents were, in the words of a family friend, fisteadfast in denying him any praise.fl Kravinsky eventually completed two Ph.D. degrees and indulged his growing interest in real estate. By the time he was 45 years old, he was married with children. His assets amounted to almost $45 million.Although Kravinsky had a talent for making money, he found it difficult to spend it. He drove an old car, did not give his children pocket money, and lived with his family in a modest home. As his fortune grew, however, he began to talk to his friends about his plans to give all of his assets to charity. His philanthropy began in earnest when he and his wife gave two gifts, totaling $6.2 million, to the Centers for Disease Control Foundation. They also donated an apartment building to a school for the disabled in Philadelphia. The following year the Kravinskys gave real estate gifts worth approximately $30 million to Ohio State University. Kravinsky™s motivation for his donations was to help others. According to one of his friends, fiHe gave away the money because he had it and there were people who needed it. But it changed his way of looking at himself. He decided the purpose of his life was to give away things.fl After he had put some money aside in trust for his wife and his children, Kravinsky™s personal assets were reduced to a house (on which he had a substantial mortgage), two minivans, and around $80,000 in stocks and cash. He had essentially given away his entire fortune. Kravinsky™s donations did not end when his financial assets be-came depleted. He began to be preoccupied with the idea of nondirected organ donations, in which an altruistic person gives an organ to a total stranger. When he learned that he could live quite normally with only one kidney, Kravinsky decided that the personal costs of giving away one of his kidneys were minimal compared to the benefits received by the kidney recipient. His wife, however, did not share his view. Although she had consented to bequeathing substantial sums of money to worth-while charities, when it came to her husband offering his kidney, she could not support him.For Kravinsky, however, the burden of refusing to help alleviate the suffering of someone in need was almost unbearable, even if it meant sacrificing his very own organs. He called the Albert Einstein Medical Center and spoke to a transplant coordinator. He met with a surgeon and then with a psychiatrist. Kravinsky told the psychiatrist that his wife did not support his desire to donate one of his kidneys. When the psychiatrist told him that he was doing something he did not have to do, Kravinsky™s response was that he did need to make this sacrifice: fiYou™re missing the whole point. It™s as much a necessity as food, water, and air.flThree months later, Kravinsky left his home in the early hours of the morning, drove to the hospital, and donated his right kidney. He informed his wife after the surgery was over. In spite of the turmoil that his kidney donation created within his family, Kravinsky™s mind turned back to philanthropy almost immedi- ately. fiI lay there in the hospital, and I thought about all my other good organs. When I do something good, I feel that I can do more. I burn to do more. It™s a heady feeling.fl By the time he was discharged, he was wondering about giving away his one remaining kidney.After the operation, Kravinsky experienced a loss of direction. He had come to view his life as a continuing donation. However, now that his financial assets and his kidney were gone, what could he provide to the less fortunate? Sometimes he imagines offering his entire body for donation. fiMy organs could save several people if I gave my whole body away.fl He acknowledges that he feels un- able to hurt his family through the sacrifice of his life.Several years after the kidney donation, Kravinsky still remains committed to giving away as much as possible. However, his actions have caused a tremendous strain in his marriage. In an effort to maintain a harmonious relationship with his wife, he is now involved in real estate and has recently bought his family a larger home. (Taken from Parker, 2004.)Is Zell Kravinsky™s behavior abnormal, or is he a man with profound moral conviction and courage?M01_BUTC4286_16_SE_C01.indd 610/06/13 1:20 PM

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8 CHAPTER 1 abnormal psychology: an overviewWhat Are the Disadvantages of Classification? Of course, there are a number of disadvantages in the usage of a discrete classification system. Classification, by its very nature, provides information in a shorthand form. However, using any form of shorthand inevitably leads to a loss of infor-mation. If we know the specific history, personality traits, idiosyncrasies, and familial relations of a person with a partic -ular type of disorder (e.g., from reading a case summary), we naturally have much more information than if we were simply told the individual™s diagnosis (e.g., schizophrenia). In other words, as we simplify through classification, we inevitably lose an array of personal details about the actual person who has the disorder. Moreover, although things are improving, there can still be some stigma (or disgrace) associated with having a psychiatric diagnosis. Even today, people are generally far more comfort-able disclosing that they have a physical illness such as diabetes than they are in admitting to any mental disorder. This is in part due to the fear (real or imagined) that speaking candidly about having a psychological disorder will result in unwanted social or occupational consequences or frank discrimination. Be honest. Have you ever described someone as finuts,fl ficrazy,fl or fia psychofl? Now think of the hurt that people with mental disor-ders experience when they hear such words. In a recent study, 96 percent of patients with schizophrenia reported that stigma was a routine part of their lives (Jenkins & Carpenter-Song, 2008). In spite of the large amount of information that is now available about mental health issues, the level of knowledge about mental illness (sometimes referred to as mental health lit-eracy) is often very poor (Thornicroft et al., 2007).Related to stigma is the problem of stereotyping . Stereo -types are automatic beliefs concerning other people that are based on minimal (often trivial) information (e.g., people who wear glasses are more intelligent; New Yorkers are rude; every -one in the South has a gun). Because we may have heard about certain behaviors that can accompany mental disorders, we may automatically and incorrectly infer that these behaviors will also be present in any person we meet who has a psychiatric diagnosis. This is reflected in the comment, fiPeople like you don™t go back to work,fl in the case example of James McNulty. James McNulty I have lived with bipolar disorder for more than 35 yearsŠall of my adult life. The first 15 years were relatively conventional, at least on the surface. I graduated from an Ivy League university, started my own business, and began a career in local politics. I was married, the father of two sons. I experienced mood swings during these years, and as I got older the swings worsened. Eventually, I became so ill that I was unable to work, my marriage ended, I lost my business, and I became homeless.At this point I had my most powerful experience with stigma. I was 38 years old. I had recently been discharged after a psychiatric hospitalization for a suicide attempt, I had no place to live, my savings were exhausted, and my only possession was a 4-year-old car. I contacted the mental health authorities in the state where I then lived and asked for assistance in dealing with my mental illness. I was told that to qualify for assistance I would need to sell my car and spend down the proceeds. I asked how I was supposed to get to work when I recovered enough to find a job. I was told, fiDon™t worry about going back to work. People like you don™t go back to work.fl (McNulty, 2004) Take a moment to consider honestly your own attitudes toward people with mental disorders. What assumptions do you tend to make? Do you view people with mental illness as less competent, more irresponsible, more dangerous, and more unpredictable? Research has shown that such attitudes are not uncommon (see A. C. Watson et al., 2004). Can you recall movies, novels, or advertisements that maintain such stereotypes? What are some ways in which you can challenge the false assumptions that are so common in the media? Do you think reality TV shows such as Hoarders, Obsessed, or My Strange Addiction have a helpful or harmful impact on societal attitudes?Finally, stigma can be perpetuated by the problem of labeling. A person™s self-concept may be directly affected by being given a diagnosis of schizophrenia, depression, or some other form of mental illness. How might you react if you were told something like this? Furthermore, once a group of symp-toms is given a name and identified by means of a diagnosis, this diagnostic label can be hard to shake even if the person later makes a full recovery.It is important to keep in mind, however, that diagnostic classification systems do not classify people. Rather, they clas-sify the disorders that people have. When we note that someone has an illness, we should take care not to define him or her by that illness. Respectful and appropriate language should instead be used. At one time, it was quite common for mental health professionals to describe a given patient as fia schizophrenicfl or fia manic-depressive.fl Now, however, it is widely acknowledged that it is more accurate (not to mention more considerate) to say, fia person with schizophrenia,fl or fia person with manic depression.fl Simply put, the person is not the diagnosis.How Can We Reduce Prejudicial Attitudes Toward the Mentally Ill? For a long time, it was thought that educating people that mental illnesses were firealfl brain disorders might be the solution. Sadly, however, this does not seem to be the case. Although there have been impressive increases in the propor -tion of people who now understand that mental disorders have neurobiological causes, this increased awareness has not resulted in decreases in stigma. In a recent study, Pescosolido and colleagues (2010) asked people in the community to read a vignette (brief description) about a person who showed symptoms of mental illness. Some people read a vignette about M01_BUTC4286_16_SE_C01.indd 810/06/13 1:20 PM

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abnormal psychology: an overview CHAPTER 1 9a person who had schizophrenia. Others read a vignette about someone with clinical depression or alcohol dependence. Importantly, no diagnostic labels were used to describe these people. The vignettes simply provided descriptive information. Nonetheless, the majority of the people who were surveyed in this study expressed an unwillingness to work with the person described in the vignette. They also did not want to have to socialize with them and did not want them to marry into their family. Moreover, the level of rejection that was shown was just as high as it was in a similar survey that was done 10 years earlier. Over that same 10-year period, however, many more people embraced a neurobiological understand -ing about the causes of mental illness. So what this study tells us is that just because people understand that mental illness is caused by problems in the brain doesn™t mean that they are any less prejudiced toward those with mental illness. This is a disappointing conclusion for everyone who hoped that more scientific research into the biology of mental illness would lead to the elimination of stigma.Stigma does seem to be reduced by having more contact with people in the stigmatized group (Couture & Penn, 2003). However, there may be barriers to this. Simply imagining interacting with a person who has a mental disorder can lead to distress and also to unpleasant physical reactions. In an interesting study, Graves and colleagues (2005) asked college students enrolled in a psychology course to imagine interact-ing with a person whose image was shown to them on a slide. As the slide was being presented, subjects were given some scripted biographical information that described the person. In some scripts, the target person was described as having been diagnosed with schizophrenia, although it was also mentioned that he or she was fidoing much better now.fl In other trials, the biographical description made no mention of any men-tal illness when the person on the slide was being described. the WORLD around usMad, Sick, Head Nuh Good: Mental Illness and Stigma in JamaicaEvidence suggests that negative reactions to the mentally ill may be a fairly widespread phenomenon. Using focus groups, Arthur and colleagues (2010) asked commu -nity residents in Jamaica about the concept of stigma. Some participants came from rural communities, others from more urban areas. Regardless of their gender, level of education, or where they lived, most participants described highly prejudicial attitudes toward the mentally ill. One middle-class male partici – pant said, fiWe treat them as in a sense second class citizens, we stay far away from them, ostracize them, we just treat them badfl (see Arthur et al., 2010, p. 263). Fear of the mentally ill was also commonly expressed. A rural-dwelling middle-class man described a specific situation in the following way, fiThere is a mad lady on the road named [. . .]. Even the police are afraid of her because she throws stones at them. She is very, very terriblefl (p. 261). Moreover, even when more kindly at – titudes were expressed, fear was still a common response. One person put it simply, fiYou are fearful even though you may be sympatheticfl (p. 262).The Jamaicans in this study also made a distinction between mental illness (a term used to denote less severe conditions) and madness, which was used to describe more severe prob-lems. Madness was invariably regarded as being a permanent condition (fionce yuh mad yuh madfl or fionce yuh gone yuh gonefl). Moreover, homelessness was almost always taken to indicate madness. In short, the results of this study suggest that stereotyping, labeling, and stigma toward the mentally ill are not restricted to industrialized countries. Although we might wish that it were otherwise, prejudicial attitudes are common. This highlights the need for antistigma campaigns in Jamaica, as well as everywhere else in the world.Are attitudes toward the mentally ill in Jamaica more be-nign than they are in more industrialized countries?M01_BUTC4286_16_SE_C01.indd 910/06/13 1:20 PM

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