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The Stigmatising Implications of Presenting Schizophrenia as a Genetic Disease

Abstract

This study aimed to investigate the hypothesis that belief in a genetic aetiology of schizophrenia will increase the stigma associated with the disorder. Levels of five potentially stigmatising attitudes were compared in two groups of participants who had read a vignette describing an individual who has schizophrenia. In one group the disorder was explained as being caused by ‘genetic’ factors, and in the other by ‘environmental’ factors. This study found that three of the five potentially stigmatising attitudes measured were increased when participants read a vignette with a genetic causation rather than an environmental causation. Firstly, genetic attributions increased levels of associative stigma towards close relatives (p < 0.001). Secondly, participants viewed recovery as less likely when genetic factors were implicated as causative (p < 0.001). Finally, there was also an increased perception of the character’s “dangerousness” when the condition was explained by genetic factors (p < 0.05). Contrary to previous research was the finding that perceived aetiology had no effect on participant’s desire for social distance from an affected individual. Neither did perceived aetiology influence beliefs about moral accountability. The implications of these findings suggest that genetic counsellors and other health professionals, who are providing genetic information to those affected by schizophrenia should be aware of the possibility that a genetic explanation of schizophrenia could increase potentially stigmatising attitudes towards their clients and their clients’ families. It is also possible that individuals with a diagnosis of schizophrenia may themselves form deterministic interpretations of the genetic information they receive and subsequently be less likely to adopt behavioural advice or adhere to treatment. Counsellors and health professionals should strive to present information in a balanced manner, ensuring recipients understand the multi-factorial causes of the disease.

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Correspondence to Kathryn Thirlaway.

Appendices

Appendix 1

Participant Instructions

I would be grateful if you would take a few minutes to take part in my research into how much people know about schizophrenia, and how they feel about people with the condition. All that is involved is a short questionnaire. However, in order that everyone taking part in this study has at least a minimal knowledge of schizophrenia, a short statement giving an example of somebody with the condition is outlined below for you to read before you complete the questionnaire.

Vignette 1 (Experiential Causes)

Simon is a 30-year-old man who has completed a degree at university. Up until a year ago, life was pretty ok for Simon. However, following the unexpected death of his wife, things began to change1. He began to think that people around him were making disapproving comments and talking behind his back. Simon was convinced that people were spying on him and that they could hear what he was thinking. Simon lost his drive to participate in his usual work and family activities and retreated to his home, eventually spending most of his day in his room. Simon became so preoccupied with what he was thinking that he skipped meals and stopped bathing regularly. At night, when everyone else was sleeping, he was walking back and forth in his room. Simon was also hearing voices even though no-one else was around. These voices told him what to do and what to think. He has been living this way since his wife died, 6 months ago2.

Vignette 2 (Genetic Causation)

The genetic vignette was identical to the experiential vignette apart from the sentences in bold in the experiential were replaced by the following sentences:

  1. 1.

    However, things began to change last year.

  2. 2.

    Doctors believe that Simon’s illness occurred due to a genetic predisposition towards schizophrenia within his family. He has been living this way for 6 months.

Appendix 2: Attitudes Questionnaire

Response categories are illustrated here for the first question only. They were identical for all subsequent questions. Question numbers are provided here to enable the make-up of each attitude scale to be illustrated, they were not present in the study instrument. Desire for social distance was measured by questions: 1, 7, 12, 16, 18, 20, 32 and 37. Associative stigma towards close family members was measured by questions: 3, 5, 8, 15, 21, 24, 31 and 36. The perceived potential for recovery was measured by questions: 2, 9, 25, 27 and 29. The perceived accountability of an affected individual was measured by questions: 6, 10, 13, 17, 23, 28, 33 and 35. Assumption of dangerousness was measured by questions: 4, 11, 14, 19, 22, 26, 30 and 34.

  1. 1.

    I would be happy to sit next to Simon on the bus

    □ Strongly agree □ Agree □ Don’t know □ Disagree □ Strongly disagree

  2. 2.

    Attending a support group for people with mental health problems would be likely to help Simon to recover.

  3. 3.

    Simon’s younger brother is at a high risk of developing Schizophrenia.

  4. 4.

    Simon should be detained in a hospital to ensure the public’s safety.

  5. 5.

    If my partner had a sister with Simon’s problems it would make me more wary of having children with them.

  6. 6.

    I think that Simon has some degree of control over whether or not to obey the voices he hears when they tell him what to do.

  7. 7.

    I would definitely never marry somebody with these problems.

  8. 8.

    I would be comfortable with a close relative marrying Simon’s brother/sister.

  9. 9.

    I don’t think Simon could ever be completely ‘cured’, although he could probably find ways to manage his symptoms.

  10. 10.

    If Simon neglected his children when he began experiencing symptoms then I would begin to lose sympathy for him.

  11. 11.

    I think it’s quite unlikely that Simon has aggressive thoughts.

  12. 12.

    I would feel uncomfortable inviting Simon along to a friend’s party.

  13. 13.

    If Simon obeyed voices that told him to steal from somebody, it would be unfair to treat him as if he had purposefully done something wrong.

  14. 14.

    There is no reason why Simon should not be trusted around vulnerable people, such as children.

  15. 15.

    I would feel uncomfortable being close friends with Simon’s sister.

  16. 16.

    I would be very concerned if a close relative told me they were planning to marry and start a family with Simon.

  17. 17.

    The law should apply to Simon in the same way that it applies to everybody else

  18. 18.

    I would happily share a flat with Simon.

  19. 19.

    I don’t think it’s very likely that Simon would act in an violent way towards anybody else

  20. 20.

    I wouldn’t mind if a friend invited Simon along on a holiday we had booked together.

  21. 21.

    I would never date a sibling of Simon’s.

  22. 22.

    I would feel unsafe if I were left alone with Simon.

  23. 23.

    Simon cannot use having Schizophrenia as an excuse for wrongdoings. His symptoms do not prevent him from knowing what is right from what is wrong.

  24. 24.

    It is unlikely that a child of Simon’s would develop the same problems as him.

  25. 25.

    Simon will always be ‘schizophrenic’. Even if his symptoms disappear they could come back at any time.

  26. 26.

    Simon is at risk of harming himself.

  27. 27.

    I think that Simon’s problems would pass with time, even with minimal intervention from others.

  28. 28.

    I don’t think it would be right to hold Simon entirely responsible if he were to cause somebody offence.

  29. 29.

    I don’t think that a ‘talking’ therapy (such as psychotherapy) would significantly improve Simon’s symptoms.

  30. 30.

    Simon is no more likely to become verbally abusive to others than anybody else.

  31. 31.

    If my partner told me that their father had problems just like Simon, this would not worry me.

  32. 32.

    I would feel a little uncomfortable if a friend introduced Simon into our social circle.

  33. 33.

    There is no way that Simon can control his paranoid thoughts.

  34. 34.

    It is highly likely that Simon will commit a crime.

  35. 35.

    If I knew Simon, and he threatened to harm me I wouldn’t feel anger towards him, as he is not responsible for his behaviour.

  36. 36.

    I would happily move into a flat with Simon’s younger brother.

  37. 37.

    If a close friend told me that her and Simon were in love I imagine I would be happy for her

    Have you ever known anybody with schizophrenia?

    □ Yes □ No

Thank you for spending the time to complete this questionnaire.

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Bennett, L., Thirlaway, K. & Murray, A.J. The Stigmatising Implications of Presenting Schizophrenia as a Genetic Disease. J Genet Counsel 17, 550–559 (2008). https://doi.org/10.1007/s10897-008-9178-8

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Keywords

  • Schizophrenia
  • Stigma
  • Geneticisation