|
Irina MACSINGA* |
|
West University of Timisoara, Timisoara, Romania |
Abstract
Stereotypes of mental illness related to dangerousness, handicap and lack of control lead to negative emotional reactions and discriminatory behavior. While there is a growing literature on mental illness perception among adults, less is known about how adolescents view mentally ill people. This study investigated adolescents’ lay perspective on the causes, manifestations and efficiency of treatments (role played by society and hospitals) of mental illnesses. A total of 251 participants completed a 60-item questionnaire derived from the questions used in Furnham’s study (1988). Factor analysis provided a solution with twelve basic factors. The results of research regarding the themes that appear in people’s discourse about mentally ill, have the potential to influence a variety of decisions, ranging from financial policies to employment policies.
Keywords: lay theory, adolescents, mental illness, lack of control
Introduction
Implicit versus explicit theories
In time, the idea that people differ in terms of the way they structure reality, according to their own beliefs and expectations, has been explained theoretically and analyzed empirically in numerous studies. The assumptions concerning the significance and re-significance of existence are deeply rooted in psychology. The field of social cognition is one of the most important fields of research that has provided essential contributions to the understanding of this idea. If, in the beginning, the social-cognitive approaches focused their efforts on the analysis of cognitive structures and of processes involved in social judgment and behavior, later on, a great part of research in this field was equally interested in the meanings resulting from the representation of social stimuli on an individual level (Mischel, 1973; Bandura, 1986).
One of the variables moderating the person-situation relationship is precisely the way the person gives meaning to situational stimuli. The concept of moderating variable was introduced in the trait theories in order to highlight the fact that the effects of a particular disposition are usually moderated by other variables such as the situational characteristics. When carrying out observation on the interactions between the effects of dispositions and conditions, the number of moderating variables that predicted behavior proved much higher. The current research is based on this assumption that people’s response in a certain situation depends on the way they interpret the situation.
Starting with Kelly’s studies (1955), who introduce the man as scientist metaphor in explaining the way personality is formed, numerous studies have proven the impact of implicit theories functioning as belief systems that people have developed on various subjects related to attitudes, behaviors and emotions. According to Kelly’s metaphor, just as a scientific model’s assumptions direct the interpretation of scientific results, the “naive” model’s implicit beliefs influence the way of processing and understanding information about oneself and others.
Usually, research draws the distinction between three types of theories: popular theories which refer to ideas shared by a particular group on a particular category of reality; non-scientific or implicit theories of a personal, idiosyncratic and informal nature and scientific theories as a result of empirical research.
Some researchers have argued and stated the importance for the scientific world to know the non-scientific perspective on a phenomenon, perspective known as implicit theory. It is defined as a system of individual beliefs which are not formed and developed on the basis of academic research or validated empirical studies, and which are of a non-scientific and informal nature. These theories are “constructions made by people, mental schemes formed as a result of various experiences, concerning a certain category of reality” (Sternberg, 1990, p.54).
Numerous studies have proven the role played by implicit beliefs or cognitions in self-knowledge, motivation, performance or coping strategies. Regarding this aspect, one of the models relevant to the educational context is the socio-cognitive model of motivation and performance (Dweck, 1986; Dweck & Leggett, 1988). This model’s central assumption is that people differ in terms of the beliefs regarding the fundamental nature of abilities. Abilities, viewed as instrumental aspects of personality, can be seen as fixed, rigid, unchangeable entities (entity beliefs), or as aspects that are flexible, malleable and changeable through effort (incremental beliefs). Generally, incremental beliefs lead to the activation of resolutive strategies, when facing a problem situation, and to adaptive responses, whereas entity beliefs lead to less adaptive responses. The first type of beliefs mentioned is of an adaptive nature because it enables cognitive, attentional and motivational mobilization. Perceiving ability as malleable, as having the potential to change, is positively associated with the effort and persistence in tasks that are increasingly difficult (Cury, Elliott, DaFonseca, & Moller, 2006); complementarily, perceiving ability as something fixed is associated with a decrease in effort along with an increase in task complexity and reduced persistence (Ommudsen, Haugen, & Lund, 2005).
Lately, Molden and Dweck (2006) have shown that people’s implicit theories build a reference framework for information processing, causality assignment, understanding behaviors, representing social events and making predictions about behavior. In this context, Dweck et al. (1995, p. 268), state that:
“we do not see implicit theories as rigidly determining people’s behavior. Instead, we see them as creating a framework and then fostering judgments and reactions that are consistent with that framework”.
Therefore, people’s beliefs, regarding a certain phenomenon or aspect of reality, function as self-fulfilling prophesies: they will determine the nature of expectations which, in turn, will orient behavior.
Mental health literacy
Link and colleagues (1999) suggested that, if mental disorder continues to be linked in people’s minds to fear of violence, to lability and unpredictability of behavior, then in the times ahead, mentally ill people will come across serious difficulties with integration, and will become the target of social rejection. As a result of this social stigma, these people will become much more reluctant to seek specialized help. Recent studies confirm this situation, showing that public opinion still develops an attitude of low tolerance of mental illness, as well as an attitude of relative mistrust in the efficiency of certain treatments of mental illness (Angermeyer & Matschinger, 1997, in Furnham and Chen, 2004).
In a review concerning public beliefs and attitude towards the mentally ill, Dietrich and colleagues (2004, 2006) summarized the main research results as follows:
– the majority of the public does not recognize particular mental illnesses;
– when explaining the causes attributed to mental illness, psychosocial stress is one of the causes most often mentioned;
– most people believe that mentally ill persons needed specialized help, perceiving them as unpredictable and dangerous; a tendency of social distancing from these persons is also noticeable;
– the tendency towards social rejection is stronger with regard to drugs and alcohol abuse and less pronounced in the case of depression and anxiety;
– studies reveal the existence of a significant link between the respondent’s degree of familiarity with mental illness and the degree of acceptance of mentally ill persons;
– research regarding people’s attitude towards mental illness is mainly of a descriptive nature and is mainly focused on schizophrenia and depression, other mental disorders being rather neglected;
– very little is still known about the link between the attitudes towards mentally ill persons and the behavior manifested towards these persons;
– studies show the existence of intercultural variations as far as beliefs and attitudes towards mental illness are concerned.
Another review, by Jorm and Oh (2009, p.184), on the topic of social distance towards the mentally ill, shows that:
– generally, people expresses a tendency of greater social distance towards the mentally ill compared to the distance towards persons suffering from minor disorders and those with physical disabilities;
– the greatest social distance is towards substance abuse, followed by schizophrenia and depressive and anxious disorders;
– greater social distance is observed towards men suffering from mental illness compared to mentally ill women;
– labeling a person as mentally ill or as suffering of a specific mental disorder increases the social distance, but the effect is different according to the degree of the respondent’s familiarity with mental illness;
– the belief that mental illness is caused by brain damage is associated with a greater social distance, as opposed to the belief that mental disorder is caused by a biochemical imbalance, for which studies do not show association with social distance;
– research has not reached conclusive results with regard to the fact that belief in genetic causes would increase social distance, whereas belief in psychosocial causes would decrease this distance;
– social distance can be reduced by planned interventions, with effects lasting for at least a few months.
These attitudes are mostly determined by quantitatively and qualitatively poor knowledge that the public generally has about mental disorders. In this context, identifying the implicit representations of mental illness is not only an important research topic, but also a necessity.
Conceptualizing and evaluating the concept of mental illness has often been the target of academic controversy, especially the idea that mental illness is genetically predetermined and, therefore, leads to behavior that is stable in time and resistant to change. The implications of this concept in everyday life have led the debate on this topic to reach beyond the academic forum’s boundaries and become a subject of public interest. The common person is relatively familiar with this subject. This familiarity does not derive from a solid basis of accurate knowledge, but more likely from its frequent use within the social space//n-ar fi mai bine “social field?” As a result, people are potentially capable of developing their own theory about mental health. As far as people’s ability to develop their own perspective on mental illness is concerned, Jorm et. al (1997) introduced the term mental health literacy in the literature, defined as ‘knowledge and beliefs about mental disorders which aid their recognition, management or prevention’.
Furnham (2008, p. 528) shows that: “a good mental health literacy allows access to an understanding and use of information which aids treatment of those who have disorders, by the means of more efficient help-seeking and pro-active behavior. Being literate about mental health occurs when the beliefs about the form, cause and treatment correspond to expert knowledge.”
Furhnam and Cheng (2000, p.228), reviewing the main articles on this subject, show that scientific research on non-scientific, implicit theories tends to focus on the concept of mental illness (alcoholism, anorexia, depression, delinquency, addictions, phobias, schizophrenia), on therapeutic interventions (types of psychotherapy, efficiency and prognosis, etc.) and on psychological problems (psychosomatic illness, difficulties and vulnerabilities, cognitive or sexual related problems).
There are at least five reasons an implicit theory on mental illness may be considered valuable:
- the nature of beliefs about mental health can influence the process of self-evaluation within this construct, in the sense of developing one’s own reference framework for making interpersonal comparisons. For instance, if a person thinks that being mentally ill means not being capable of emotional control, then emotional control becomes the reference framework in which the person makes comparisons between himself/herself and others, in order to evaluate his/her own mental health.
- implicit theories about mental illness and its means of evaluation may have significant effects on educational and social level. The perception of mental illness underlies future attitudes and beliefs, which, in turn, influence social behaviors of approach or rejection. Moreover, the way the population’s perception on mental illness is built is closely related to the degree of trust in the efficiency of different forms of therapy.
- in an implicit theory on mental illness, certain aspects, which respondents associate with this concept, may come up, which do not appear in the formal theories about mental illness, and, as a result, may not be highlighted in the explicit specific measurements of this concept. It is very important for a therapist or counselor working with adolescents to have a set of information regarding the etiology, manifestations and solutions perceived by the specific age group. The quality of the therapeutic relationship and of the therapeutic procedures may be influenced by this kind of informal knowledge.
- implicit theories, as a set of personal beliefs, hold an important place in attributing meaning to various social actions, either as an actor or an observer of behaviors manifested in different circumstances.
- an implicit theory can be a valuable starting point in developing a scientific hypothesis, in approximately the same way intuition or common sense can give rise to scientific hypotheses or theories. Thus, researchers can develop future theories, can test new hypotheses or can build new assessment instruments, taking into account the meanings given to this term in the implicit, non-scientific theories. Moreover, implicit beliefs can change academic theories, drawing attention to semantic changes suffered by the concept or to nuances that the social factor has given this notion. Complementarily, knowing the perspective that people have on the concept of mental health, researchers can not only understand the meanings given, but can also change them, if these contribute to a discriminatory social behavior. In this respect, the validity of personal perspectives should not be judged relative to the norms of scientific theories, but rather to practical utility, in everyday life.
Knowing the implicit theories on mental illness would make answers to the following questions possible: (a) What is the function of these theories on a personal level? What would the implications of these beliefs be?; (b) Are these perspectives stable in time? Do they undergo changes, along with the changes occurring in the evolution of the society (economic, cultural, social)?; (c) What aspects of people’s lives are influenced by these theories?; (d) What are the connections between these theories and the field of social behaviors?
Mental health literacy of young people
While there is a growing literature on mental illness stigma and on strategies for reducing stigma among adults, less is known about how adolescents view persons with mental illness. Young people’s perspective on this phenomenon is important not only because they are the future adults, but mainly because, according to public health reports and research carried out in this field (Kessler, Berglund, Demler, Jin & Walters, 2005), a prevalence of mental health issues was noticed among youngsters and adolescents. Furthermore, their decision to turn to a specialist is tributary to the way they structure their perception of mental illness, of its etiology, manifestations and consequences on a personal and social level. In this context, Hanrahan (2008, p.6964) shows that:
an increasing number of children and adolescents are receiving mental health services and until now no practical resource on the stigma of mental illness among adolescents and children was available for the clinicians who work with these young people.
Corrigan and colleagues (2005), in a study on how adolescents perceive the stigma of mental illness showed that adolescents view substance abuse more harshly than the other disorders; blame and dangerousness were important aspects leading to discrimination, and contact with mentally ill persons led to more discrimination. The personal perspective on the concept of mental illness, which lies at the basis of the attitude towards this reality, is materialized in relation to certain factors, among which, most significant is the culture to which the person belongs. Furnham and Chen (2004), two of the most prolific researchers on this subject, indicate that, in the 80s and 90s, this research-based idea was gaining increasingly more ground: that culture affects the way people perceive the mental illness and the way they assign causality. (Chang, 1985, 1988; Fernando, 1988; Furnham & Kuiken, 1991; Furnham & Malik, 1994).
In 2006, Kelly, Jorm and Rodgers carried out a study in Australia, using a sample of 1,137 students in the 8th, 9th and 10th grades. Among other things, the study reached the following conclusions (Jorm & Kelly, 2007, p.83): 54% of the participants were capable of correctly identifying depression, girls more often than boys; none of them identified conduct disorders correctly; the most common professional support invoked was the school counselor (84% for depression), but when asked whom they would personally prefer to get in contact with regarding a mental health issue, family and friends were most often preferred; friends were the first option for 49% of the female subjects, and family – for 30% of these respondents; family was the first option for 52% of the male respondents and friends for 27%; generally, their attitude towards medication was positive; among the cures in the case of depression, the first places were held by conversation with a friend (87%), reading (self-help books) (84%), avoiding drugs and alcohol consumption (76%) and physical exercises (66%).
The current study sets out to explore Romanian adolescents’ implicit theory regarding the concept of mental illness and to identify the major themes which appear in the adolescents’ discourse relating to this concept. Within the Romanian cultural space, such a process is necessary. Many parents who encounter difficulties in the relationship with their own teenager child wish to turn to a counselor or psychotherapist, aware of the fact that they do not have the necessary knowledge to solve the problem. Trying to understand adolescents’ beliefs regarding a certain phenomenon or aspect of reality is absolutely necessary for parents seeking answers as well as for specialists interested specializing in therapy with adolescents.
Therefore, the present study investigated the response patterns of adolescents, when asked about causes, beliefs and cures for mental-illness. The questions are derived from a popular instrument described below and the analysis will focus on exploring how such responses are structured.
Method
Participants
A total of 251 participants completed the questionnaire (73.3% female). Their ages ranged from 16 to 18, with an average age of 16.8 years. All the participants were students attending social sciences educational programs in 4 high schools in Timisoara. We decided for social sciences students because, by the specific of their curricula, they should have the highest level of knowledge in the mental-illness field and are interested in continuing education in this field (The Psychological Counseling and Career Orientation Center’s Rapport, West University of Timisoara, 2008). Out of the entire sample, 104 (41.5%) of these young people claimed to have friends or relatives who suffered from mental illness. Regarding the participants themselves, all of them said they did not have a personal medical history of mental illness and 53 (21%) claimed to have read books on psychology, all of them invoking Freud when asked to give examples of psychologists they knew.
Measures
The questionnaire used in this study was derived from the questions used in Furnham’s research (1988) conducted in Britain and Japan. The items were designed to assess three different sections. The first section had 21 questions on people’s beliefs about those who suffer from mental illness. The second section consisted of 16 questions on causal explanations of mental illness, and the third consisted of 23 questions about the way people perceive the role of hospitals and society in treating mental illness. The last part of the questionnaire consisted of demographic features concerning participants’ age, gender, knowledge about mental illnesses and the participants and their friends’ medical history of mental illness. The participants answered the questionnaire’s items on a Likert scale of 6 points, ranging from 1 (strong agreement) to 6 (strong disagreement). The original English questionnaire was translated into Romanian and than back-translated. The questionnaire took about 20 minutes to complete and the majority of the participants showed a fair amount of interest in the subject. Before participants completed the questionnaire, they answered the following question: “What does the term mental illness mean to you?”
Procedure
All participants were directly contacted by the researcher and they filled out the questionnaire at school, with the parents and high-school management’s approval. Participants were asked to fill out the questionnaire in their spare time and all questionnaires were returned personally. After the testing session, participants were debriefed.
Results
When participants were asked what the expression mental illness meant to them, 34% of them associated this term with the word crazy, and 10% of them – with the term mentally handicapped. The answers given by the subjects also revealed the following: associations of the term mental illness with negative affect, two of which more predominant – sadness (4%) and fear (3.8%). Also, 6.4% of the subjects mentioned depression in their verbal associations with the term mental illness, whereas 4.4% mentioned the term schizophrenia. Participants also made associations with mental illness symptoms, such as hallucinations (2.2%) and nervous tics (1.2%). Regarding the most frequent verbal associations referring to psycho-behavioral characteristics, lack of self control appeared in 12% of associations made by participants, followed by dangerousness (6%) and self-isolation/communication problems (5.2%).
Data analysis
All answers collected on beliefs, causes and cures of mental illness were included in a single exploratory analysis. Data was analyzed using exploratory factor analysis with oblique rotation (because we expected factors to correlate). The number of factors for the optimal solution was selected using the Kaiser criterion (eigenvalue > 1). Items were eliminated in more stages, as follows:
- Items with a mean score outside the [2-5] interval were eliminated. Based on this criterion, items Q7, Q43, Q46, Q51, Q54, Q55 (mean scores < 2), Q2, Q15, Q37 (mean scores > 5) respectively, were eliminated.
- A number of factorial analyses were carried out. Items with a loading < 30 on all factors (Q3, Q6, Q8, Q9, Q11, Q16, Q21, Q29, Q45, Q47, Q49, Q50, Q58, Q53) were eliminated.
- Items forming a single factor were eliminated : Q1, Q4, Q28
In the final solution (presented in Table 1), factor analysis yielded twelve factors with an eigenvalue greater than 1.00. The twelve factors explain 63.35% of item variance.
The first factor, accounting for 11.3% of the item variance, was named Early Trauma and Rejection. As shown in Table 2, all items with a high loading on this factor concerned mental illness in relation to rejective and abusive behavior of parents and friends.
The second factor, labeled Social Distance from mentally ill people, accounted for 9.3% of the variance. All items with a high loading on this factor concerned the distance between mental hospitals and the community, in general, and the intimate space, in particular (Q59) and Q60).
The third factor, accounting for 6.5% of the variance, was named Function of hospitals. As one can notice from Table 2, items with a great loading on this factor (Q41 and Q42) refer to mental hospitals as places for poor, disadvantaged and unfortunate people.
The fourth factor, named Treatment of mental illness, accounted for 5.3% of the variance. Table 2 indicates that the content of the items that greatly load on this factor (Q52 and Q57) is centered on the idea that respecting mentally ill people’s rights is the way to treat them.
The fifth factor, accounting for 4.6% of the variance, was named Congenital nature of mental illness. Table 2 shows that all items with a great loading on this factor refer to associating mental illness with inheriting it from parents or close relatives.
The sixth factor, named Bio-organic chemistry, accounted for 4.4% of the variance. The two items that load on this factor share the fact that both invoke aspects linked to body chemistry (chemical imbalance) as causes for mental illness.
Table 1. Solution of exploratory factor analysis
| Item |
Factor |
|||||||||||
|
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
12 |
|
|
Q24 |
.74 |
|
|
|
|
|
|
|
|
|
|
|
|
Q25 |
.64 |
|
|
|
|
|
|
|
|
|
|
|
|
Q22 |
.47 |
|
|
|
|
|
|
|
|
|
|
|
|
Q59 |
|
.77 |
|
|
|
|
|
|
|
|
|
|
|
Q60 |
|
.68 |
|
|
|
|
|
|
|
|
|
|
|
Q18 |
|
.33 |
|
|
|
|
|
|
|
|
|
-.32 |
|
Q38 |
|
.31 |
|
|
|
|
|
|
|
|
|
|
|
Q41 |
|
|
.80 |
|
|
|
|
|
|
|
|
|
|
Q42 |
|
|
.80 |
|
|
|
|
|
|
|
|
|
|
Q39 |
|
|
.40 |
|
|
|
|
|
|
|
|
|
|
Q52 |
|
|
|
.83 |
|
|
|
|
|
|
|
|
|
Q57 |
|
|
|
.68 |
|
|
|
|
|
|
|
|
|
Q40 |
|
|
|
.41 |
|
|
|
|
|
|
-.37 |
|
|
Q56 |
|
|
|
.36 |
|
|
|
|
|
|
|
|
|
Q23 |
|
|
|
|
.-73 |
|
|
|
|
|
|
|
|
Q34 |
|
|
|
|
.-67 |
|
|
|
|
|
|
|
|
Q32 |
|
|
|
|
|
-.59 |
|
|
|
|
|
|
|
Q35 |
|
|
|
|
|
-.42 |
|
|
|
|
|
|
|
Q14 |
|
|
|
|
|
|
.57 |
|
|
|
|
|
|
Q20 |
|
|
|
|
|
|
.41 |
|
|
|
|
|
|
Q48 |
|
|
|
.33 |
|
|
|
|
|
|
|
|
|
Q44 |
|
|
|
|
|
|
|
.57 |
|
|
|
|
|
Q10 |
|
|
|
|
|
|
|
.49 |
|
|
|
|
|
Q5 |
|
|
|
|
|
|
|
.35 |
|
|
|
|
|
Q33 |
|
|
|
|
|
|
|
|
.49 |
|
|
|
|
Q19 |
|
|
|
|
|
|
|
|
.42 |
|
|
|
|
Q36 |
|
|
|
|
|
|
|
|
|
-.58 |
|
|
|
Q30 |
|
|
|
|
|
|
|
|
|
-.43 |
|
|
|
Q31 |
|
|
|
|
|
|
|
|
|
-.39 |
|
|
|
Q27 |
|
|
|
|
|
|
|
|
|
|
-.47 |
|
|
Q17 |
|
|
|
|
|
|
|
|
|
|
-.40 |
|
|
Q26 |
|
|
|
|
|
|
|
|
|
|
-.39 |
|
|
Q12 |
|
|
|
|
|
|
|
|
|
|
|
.49 |
|
Q13 |
|
|
|
|
|
|
|
|
|
|
|
-.49 |
Table 2. Means and factor loadings from the factor analysis
| Factor |
|
1. Early trauma and rejection (Eigenvalue = 3.85; Var = 11.3% ; alpha = .69) |
| Q24 Sexual and/or physical abuse as children is the cause of mental illness |
| Q25 Having parents who are inconsistent in their behavior leads one to become mentally ill |
| Q22 Strong rejection by family or friends at an early age causes one to become mentally ill |
| 2. Social distance Eigenvalue = 3.18; Var = 9.3%; alpha = .65 |
| Q59 Mentally ill patients’ rehabilitation facilities should be far from their community |
| Q60 I prefer not to live near any mental illness rehabilitation facilities |
| Q18 I will choose not to be friends with people suffering from mental illness |
| Q38 Society has the right to protect its people from mentally ill persons |
| 3. Function of hospitals Eigenvalue = 2.20; Var = 6.5%; alpha = .68 |
| Q41 Whatever the aim of a mental hospital, it often ends up becoming a dumping ground for the poor and the disadvantaged |
| Q42 Mental hospitals sometimes end up simply providing shelter for the poor and other unfortunates. |
| Q39 Mental hospitals are used to keep persons away from society and have little interest in cure. |
| 4. Treatment Eigenvalue = 1.80; Var = 5.3%; alpha = .66 |
| Q52 The best way to treat mentally ill persons is to respect their right to lead their own lives |
| Q57 The best way to treat mentally ill persons is to respect their liberty and right to lead their own lives |
| Q40 Producing a more comfortable and less stressful society is the best way to treat mentally ill persons |
| Q56 A one-to-one relationship with a skilled therapist is the best way to treat mentally ill persons
Q48 The most effective way to help mentally ill persons is to create a society which is truly fit for them to live in |
| 5.Congenital nature of mental illness Eigenvalue = 1.59; Var = 4.6 %; alpha = .62 |
| Q23 Mental illness is caused by having blood relatives who are mentally ill |
| Q34 Mental illness is caused by having a parent or both parents mentally ill |
| 6.Bio-Organic chemistry Eigenvalue = 1.50, Var = 4.4% alpha = .44 |
| Q32 Mental illness is caused by a low birth weight |
| Q35 Mental illness is caused by having a chemical imbalance in the body |
| 7. Supportive issue Eigenvalue = 1.41; Var = 4.1% alpha = .43 |
| Q14 Mentally ill persons have the right to be treated sympathetically |
| Q20 Mental illness can be treated by seeking help from God or other spirits |
| 8. Isolation Eigenvalue = 1.30 Var = 3.8% alpha = .56 |
| Q44 The function of a hospital is to rid society of those who threaten it |
| Q10 Once individuals have been diagnosed as mentally ill, they should spend the rest of their lives in an institution |
| Q5 The term psychopath is the best way to describe a mentally ill person |
Table 2. (continued) Means and factor loadings from the factor analysis
|
9. Supernatural control Eigenvalue = 1.24 Var = 3.6% ; alpha = .40 |
| Q33 Brain damage resulting from a serious accident is the cause of mental illness |
| Q19 Mental illness may not be an illness because the patient may be controlled by evil spirits |
| 10. Social messages Eigenvalue = 1.20 Var = 3.5% alpha = .58 |
| Q36 Too much social pressure on people to behave properly causes people to become mentally ill |
| Q30 Stressful events in life, such as losing one’s job, can lead to mental illness |
| Q31 Mental illness is caused by patients’ parents having emotional extremes and sending them contradictory messages |
| 11. Situational attribution Eigenvalue = 1.15 Var = 3.3% alpha = .43 |
| Q27 The cause of mental illness is the “sick” society which we live in |
| Q17 People who suffer from mental illnesses are mostly from the lower socio-economic class |
| Q26 Mental illness is caused by learning strange and bizarre behaviors from others |
| 12. Behavior Eigenvalue = 1.10 Var = 3.2% alpha = .37 |
| Q12 It is possible to treat mentally ill people through surgery |
| Q13 Many mentally ill people commit outrageous acts in public places |
The seventh factor was named Supportive issue and accounts for 4.2% of the variance. As shown in Table 2, the two items concerned the mentally ill persons in relation to compassion and to help from God.
The eighth factor, accounting for 3.8% of the variance, was named Isolation. Items with a high loading on this factor concerned isolating the mentally ill people in an institution, because they are viewed as dangerous.
The ninth factor, named Supernatural control of mental illness, accounted for 3.6% of the variance. Table 2 shows that all items with a great loading on this factor refer to the idea that mentally ill people may be controlled by evil spirits.
The tenth factor, accounting for 3.5% of the variance, was named Social messages. The content of the items with a high loading on this factor refers to social factors influences like social pressure or parental incentives as an explanation for the appearance of mental illness.
The 11th factor named Situational attribution accounted for 3.3% of the variance. As shown in Table 2, all items with a high loading on this factor refer to viewing mental illness causes in relation with a sick society or learned behavioral patterns.
The 12th factor, accounting for 3.2% of the variance is named Behavior. From the analysis of Table 2, we can see that there are only 2 items (Q12 and Q13) that load on this last factor, and their content refers to the possibility that mental illness be operable and to the belief that mentally ill people commit outrageous acts in public places.
Discussion and conclusions
The aim of the study was to explore Romanian adolescents’ implicit theory regarding the concept of mental illness, in order to identify the major themes which appear in the adolescents’ discourse relating to this concept. The factor analysis revealed a structure with twelve factors.
We first examined the associations with the expression mental illness (the item given before filling out the questionnaire). The analysis shows that the word crazy was the most accessible semantic content that the group activated in relation to the inductive expression. The association that respondents make between the two contents highlights an implicit belief deeply rooted in popular mentality that has the potential of forming the nucleus of a stereotype. It is interesting that, although the word crazy within the Romanian space of communication is often non-verbally confirmed by a gesture that points to the head, therefore at the way one thinks and judges, the investigated adolescents are more likely to associate mental illness with aspects pertaining to emotion and less to that of cognition, mentioning affects such as sadness or fear. The fact that, of all emotions, they choose sadness is not at all accidental, because it is correlated to an association that often appears in their answers (i.e., depression). Adolescents are also familiar with aspects in the field of mental illness symptomatology, hallucinations holding the first place in the group’s associations. Also in the context of spontaneous associations with mental illness, adolescents link this expression to three aspects: reduced self control, dangerousness and communication problems. Thus, the typical example of the mentally ill person as seen by this group would be „a sad, crazy person, with hallucinations, who cannot control or express himself/herself, and who is dangerous”.
The results of the factorial analysis indicate that respondents link mental illness to childhood trauma and early rejective behavior. A possible explanation of this result may be given by the nature of psychological literature they read; it is worth mentioning again that, when asked to give the name of a well-known psychologist, all our respondents invoked Freud. When adolescents in this group come into contact with psychological literature it is mostly of psychoanalytical nature. It is therefore possible that the content of this literature has led to explanations that emphasize childhood trauma, abuse or rejections by significant others. Another plausible explanation is the fact that our sample consisted of adolescents, a period of introspection and values structuring, of outlining one’s identity, a process in which the analysis of one’s relationship with parents and significant others plays a crucial role.
Other themes which appear in the adolescents’ discourse relating to the concept of mental illness are: distance from community, mental hospitals as places for poor or unfortunate people; respect for the mentally ill people’s rights, compassion for mentally ill people, the possibility that mentally ill are controlled by evil spirits and the possibility to treat mental illness by surgery. Media messages focused on the idea of increasing tolerance towards mentally ill people can explain the theme of respect for the rights and liberty of mentally ill people.
Understanding mental health literacy as public knowledge and beliefs about mental disorders (Jorm, 2000) represents a subject of academic as well as general public interest. The results of research carried on this topic can influence a variety of decisions, ranging from financial to employment policies Also, these results are important for developing public programs for educating teenagers, which would transform the nucleus of negative beliefs regarding the causes and manifestations of mental illnesses. By developing programs that would function in Romanian schools, with the aim of reducing the social stigma associated with mental illness, teenagers’ attitudes can be influenced at an age when these values are developed and behaviorally expressed. Moreover, knowing the specifics of these themes within a particular culture is extremely useful in educational planning and in public information interventions.
AKNOWLEDGMENTS
This work was supported by CNCSIS – UEFISCSU No. 941/2009, PNII – IDEI ID 1076/2008
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