3.1. Prior and Projected Contact with Mental Illness
Overall, most participants reported some form of prior contact with someone with a mental health problem; with only one in five reporting no prior contact. However, contact came in multiple forms: roughly half the sample reported a close friend with a mental health problem (Table 3
), which is broadly comparable with national average in 2017 [39
]. Expanding our understanding of forms of contact, interviews revealed participants as engaging with mental health and ill-health in multiple ways. These ranged from mediated contact through media sources (TV, movies, newspapers, social media and plays), to in-person experiences, predominantly with close family and friends.
Focusing on the more symbolic forms of contact, participants showed an aversion to sharing personal objects with someone perceived as having a mental health problem, often centring on the sensitive points of personhood. For example, P.31 describes avoiding contact through objects that have links with the head:
“I would say anything that has connections, or some sort of links with the head, … pillow, crash helmet … I think it is a feeling of how dangerous can it be to pass on to me… how dangerous can it be if I talk to this person too much for a long time, how can I be somehow contaminated by his ideas or somehow influenced by something that I don’t know”. (P. 31)
Similarly, P.12 expresses concerns over: “their computer, I mean that is kinda a reflection of the kind of person they are, and like probably their condition influences what they do.” By avoiding sharing a computer, she maintains her distance from the perceived personal characteristics and behaviours of someone with a mental health problem.
A self-protective element may be involved in distancing behaviours and prohibitions of contact. For instance, P.9 also expresses concerns about sharing a computer: “I don’t want to share clothes, or a computer maybe. I think my computer has so much on me in it ... you don’t know what they’ll do”. Here, by avoiding a shared computer, she symbolically minimizes a perceived risk; a risk of exposing herself. A self-protective element may also take on group dimensions, with participants moving flexibly between first and third person pronouns: “they have fear that it’s going to pass them. They dont want to be like them. I think I just want to be in the normal group, and not the not-normal group.” (P.34). By minimising close forms of contact, P34, aligned herself with an in-group; the ‘normal’ group, and distanced herself from Othered out-group.
3.2. Experiential Aspects of Contact with Mental Illness
Overall, across all conditions, sharing a mug with classmate was generally considered to present some degree of risk. In the common cold condition, this risk was primarily considered to present a germ-based form of infection risk.
“If you’ve seen somebody with a cold sneeze onto something, … then obviously there would be germs on there” (p. 3)
“For the cold, I think I would have answered very differently if I had to use a spoon that someone else had used. Because with the mug, you would have had to place your lips exactly on the spot where the other people put it.” (p. 23)
Diverging from how the participants experienced contact with someone with a mental illness, as described in Section 3.1
, students with a common cold were not represented using a group-based language, the possessions of someone with a common cold were not anthropomorphized to reflect undesirable personality characteristics; perceived risks of contact were localised to specific points of shared contact. In contrast, participants typically constructed mental illness as different and abnormal, or in other words, as ‘Other’. Indeed, whilst across all conditions participants expressed a sense of having violated a social norm by drinking from a classmate’s mug: when the classmate was perceived as having a mental illness, this social norm took on new meanings:
“You don’t know what to do now, in that situation, it’s basically like ‘ahhh’. I feel like I could feel the difference in kinda that feeling. It was different categories. It was really something that is like like ‘oh’, they are more different, like psychologically” (P. 19)
P.19 felt he had crossed a boundary and had entered a different ‘psychological’ category, an experience that resisted labelling, drawing instead on ‘non-words’ to convey his anxiety around contact. In more extreme accounts, a concern about sharing with someone perceived as psychologically different drew on a language of abnormality. For instance, P.34 states: “they don’t think as normal people … I want to stay away from this person”.
Imagining contact with mental illness elicited a range of appraisals, the affective components of which sometimes involved experiences of disgust and fear. In the most extreme accounts, the perceived threat posed by contact with mental illness engaged a visceral response:
“Is there emotions ‘I just want to escape’? I just want to get away, I just want to stop thinking this. I feel sickness in my stomach. This is strong, I feel I want to eugh [pretends to vomit]. This is a strong emotion … disgust, yeah. Extremely disgust!” (P. 9)
However, not all participants experienced this form of appraisal. Indeed, there were also expressions of compassion: “My emotions were different just because I was imagining sitting with someone that had gone through something … and hoping they were okay.” (P.13). However, there was a fine line between compassion and pity: “I was a bit freaked out because they might [pause]. I don’t want to say they are crazy, but like [pause]. Well I felt bad for them in both cases” (P.10). P.10 makes sense of mental health problems through an image of the Other as ‘crazy’, something discrediting, which elicits sadness and fear. Drawing participants’ descriptions together suggests that an idea of difference associated with mental illness engaged an embodied form of appraisal, ranging from being uncomfortable to a concerted desire to flee, and from compassion to pity.
Within a unified appraisal of mental illness, differentiation in the degree of affective arousal elicited by contact with mental illness was found between disorder labels. Specifically, schizophrenia was found to elicit more HCNV emotions [F(1, 35) = 5.264, p
= 0.028, ηp2
= 0.141], and fewer LCPV emotions [F(1,35) = 17.513, p
= <0.001, ηp2
= 0.361] than depression (Table 4
). Additionally, schizophrenia engaged greater activation at the levator labii superioris relative to depression [F(1,35) = 4.53, p
= 0.04, ηp2
= 0.118] (Table 4
). No individual differences were found according to DS or PCMI. As differentiation was only found in the emotion groups elicited by a unified image of mental illness (fear, disgust, compassion), appraisal of contact seems to be negotiated by disorder label, whilst remaining constrained within overarching beliefs about mental illness. Furthermore, as differentiation was found in facial activation at the levator labii superioris—an index of disgust-related affect—this suggests that the body is involved in appraising contact with mental illness, and appraisal may involve an affective process, which could be outside conscious awareness.
An examination of participant narratives provides some insight into the different levels of arousal found between depression and schizophrenia. Overall, participants divided forms of mental illness according their perceived unpredictability, familiarity, comprehensibility, symptomology and cause.
In general, schizophrenia was perceived as the prototypical violent Other. For example, as P.21 describes: “in schizophrenia there is an—[pause]—like a bit unknown about, not unknown, unpredictability—[pause]—and that is frightening”. Indeed, participants felt their only contact with schizophrenia was through the media (TV, movies and newspapers) and was felt to be ‘invisible’ (P.10) in student communications. As P.41 explains: “I don’t really know people with [schizophrenia] … they’re a bit everywhere in the movies, books, as crazy, as wanting to kill” (P.41). In this low state of perceived in-person contact, schizophrenia retained an image as different and violent. However, whilst considered invisible in their immediate environment, its media representation rendered it immediately available in their imagination.
In contrast, depression was felt to be more familiar and understandable. As P.20 explains: “maybe because I know people with this problem… I’ve never been really depressed but sometimes I’m a little bit low, so I can understand them better, and I think I feel close to them [pause], closer to them.” Depression was predominantly considered to be a disorder of feeling ‘low’ and ‘emotional’, a symptomology the participants felt they could understand and with which they could empathize, contrasting with the image of schizophrenia as incomprehensible. As P.37 explains, firstly in relation to schizophrenia: “they have things going on that I can’t comprehend or see, so I’m not gonna press or cause any extra difficulty … I feel I just understood the depression more”. Here, an image of schizophrenia as incomprehensible is linked to behavioural restriction, limiting the scope for intimate interpersonal contact.
Descriptions of compassion towards depression were often matched by descriptions of intimate prior contact. For example, P.21 argues her responses to the vignettes to be contingent upon having close friend with depression: “I don’t have any close friends with schizophrenia, but I do have a close friend with depression… I had more like compassion, because I was thinking of my friend” (P.21). Conversely, only two participants reported having in-person contact with schizophrenia. Triangulating this with PCMI suggests a high overall self-reported prior contact to be skewed towards perceived contact with people experiencing depression not schizophrenia. However, one must be cautious about interpreting the positive effects of prior contact, as participants’ descriptions of compassion also often expressed pity. For example, as P.26 describes: “depression, you imagine them as a victim … and you want to feel compassionate”. She highlights how expressions of compassion are considered socially desirable, and links this to image of victimhood; arguably an elicitor of pity. Furthermore, it is important not to overstate the perceived differences between depression and schizophrenia. Indeed, the differences were relative not absolute:
“If they are in depression, I’m afraid they will do something aggressive, especially in private room. Just speak to someone in depression, she just start crying or screaming or lots of negative complaints” (P. 9)
“People with depression, or being prone to be sad or over-upset by small things, their emotions are quite volatile …. Something like this could easily upset them.” (P. 27)
Expressing an image of depression as a proclivity for sadness and volatility, some participants engaged in a unified appraisal of mental illness as Other, contact with whom is risky. Moreover, for some, this perceived Otherness involved fears of contamination:
“People with depression, or being in prone to be sad or have sad attitudes, or negative attitudes, I feel they transfer part of that to myself, and I don’t feel comfortable. I don’t despise them, but it makes me feel a bit upset or angry, because I feel how all that negative feeling is taking, transferring on to me” (P. 15)
Here, P.15 expresses a belief that negative attitudes—a symptom she considers constitutive of depression—have the capacity to permeate. In response, she experiences anger towards this person. However, for others the anger was self-focused: “with depression, I felt more sorry, more angry at myself for doing it. Thinking this could have upset them”. Expressing an implicit belief that depression renders a person vulnerable, she describes anger towards herself for potentially upsetting them.
3.3. Triangulating the Data
Hitherto, as shown, contact with mental illness was experienced as ‘risky’, a risk differentially experienced by disorder label. The perceived risk elicited appraisals of disgust and fear; and images of mental illness as unpredictable, violent, unfamiliar. To understand why this ‘risk’ may have been maintained despite the length and intimacy of contact prior to the study, we will now layer the image of mental illness against participant normativity. Specifically, we propose appraisals that maintain distance between the Self and mental illness, reflect a desire for self-regulation and self-control, a desire potentially rendering the Self impervious to ‘risk’.
Participants engaged in a belief in health as an emergent and regulated process, rather than as a static or given state. Purposely, participants considered infection to be something that should be actively managed. For example, “I was worried for my own health … I’m like that, I back up my immune system” (P.14). P.14 does not see his immune system as an independent functioning process. Rather, he emphasizes its self-controllable aspects, considering it an object in need of nurture. This self-perception was opposed to participants’ perception of mental illness, which was constructed as a failure in self-control. As P.31 explains:
“They would attach a degree of contagiousness to it. It’s the fear of losing control… or not knowing what you are doing. It’s dangerous, so better to seal it off” (P. 31)
This participant describes a belief that an idea of contagion is embedded in public beliefs around contact with mental ill-health, linking it to a protective mechanism. That is, he suggests the public ‘seal off’ the perceived threat of ‘losing control’ by limiting contact with mental ill-health.
Not all participants were explicit about the connection between contagion and a failure in self-control. For others, the construction of mental illness as contagious was more subtle, through prohibitions around shared personhood (as previously described), or through its association with sexually transmitted diseases. For example, P.17 states: “after depression and schizophrenia I was expecting more like HIV, or something like this.” By engaging with mental illness through the same framework as HIV, she expresses the shared social meanings they hold in the public imagination. An association charged with emotion for P. 36.
“Mental like, the people not like us, abnormals… normal is like, we can talk really … we think like human things, don’t imagine things, … they crazy, they abnormal, they take drugs, maybe like have HIV, or hepatitis A B C D. I do care, because I can be addicted to it” (P. 36)
P.36 fluidly moves between a concept of abnormality and craziness, to sexually transmitted infections and addiction. She positions herself as “normal”, distinguishing herself from that which she sees as crazy. However, simultaneously, she suggests an identification with this abnormality, through her perceived ability to be ‘addicted’, though to what she leaves unclear. What we see is a construction of contact with mental illness as a threat to thinking ‘human things’; arguably a presenting a perceived risk of ‘losing the Self’.