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The Public Perception Dangerousness Sociology Essay

Paper Type: Free Essay Subject: Sociology
Wordcount: 5522 words Published: 1st Jan 2015

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Mental illnesses affect…so these are not uncommon illness that only affect a small minority of people. It has been suggested that 77% of people know someone will a mental illness. The public perception of people who suffer from mental illnesses are that they are dangerous and ‘mad’ has become linked in people’s minds with ‘bad’ and ‘dangerous’. Even though the majority of people know someone with a mental illness, paradoxically, little accurate information is known about mental illness and how they can affect the sufferer and potentially those around them. People’s knowledge, attitudes and behaviour can be affected by media portrayals of the mentally ill and these often negative portrayals have been argued to increase stigma. The media over emphasise the link between the mentally ill and violent behaviour above all else, and this is not only giving mentally ill people an unjustified label of ‘dangerous’ but this labelling is also dangerous to the person. Stigma can lead to bigger problems which can have significant knock on effects for an already vulnerable group of people. Stigma can have serious consequences. The public perception needs to change in order for mentally ill people to be treated fairly. The reality is that mentally ill people are no more dangerous (and potentially less dangerous) than the general public and are more at risk of harming themselves than others. The general public needs to be educated correctly about mental illness so this perception can change. Recent research suggests that stereotypes of dangerousness are actually increasing 8 and that the stigma of mental illness remains a powerfully detrimental feature of the lives of people living with a mental illness.9-13 Knowledge and understanding can help to reduce the stigma associated with mental illness and by understanding the ways in which vulnerable members of society can be supported, the few that may harm others can then be identified and helped also.

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Mental illnesses can be as common as physical illnesses as they affect around 300 people out of every 1,000 every year in the UK (Mind). Among people under 65, nearly half of all ill health is mental illness (LSE). Mental illnesses cover a wide range of disorders and symptoms and an individual can suffer from more than one illness at a time. The American Psychiatric Association (APA) devised a classification system, known as the Diagnostic and Statistical Manual (DSM) which has been used to classify symptoms since 1933 and is currently in its fourth edition with a fifth due to be published in 2013 (DSM-IV-TR:APA 2000). The DSM describes three main groupings (with subcategories) of mental disorder that describe symptoms and behaviour which are: psychosis (cognitive), neurosis (mainly affective) and personality disorder (mainly affective). The classification system is multi-axial which allows the individuals mental state to be evaluated on five different axes. In order to make a diagnosis, psychiatrists (mental health doctors) look for groupings of certain symptoms which have been present for a defined period of time; for example, to diagnose depression they look for symptoms such as low mood and a lack of interest or pleasure in usual activities for a period of more than two weeks. Because diagnoses are based on grouping symptoms together, there is a lot of overlap between different conditions; for example, a change in sleeping pattern is a feature of both depression and anxiety.

. To clinically diagnose a mental illness there are a set of diagnostic labels that can be ascribed to people with common mental experiences. This is the ‘medical model’ of mental health which assumes problems are the result of physiological abnormalities. The type of treatment given is determined by the presence or absence of various signs or symptoms. This assumes that people with mental health problems are experiencing a state divorced from that of ‘normal’ individuals: a mental illness. This provides a dichotomous diagnosis of either mentally ill or not. Whether a person is diagnosed with an illness will determine whether they receive treatment and help. Proponents of this ‘medical model’ have argued that a reliable diagnosis that is consistent between countries ensures that any individual presenting with a set of problems will receive the same diagnosis across the world, which should then mean they receive the same treatment and research that informs treatment focuses on the same condition wherever it is conducted. Making a diagnosis helps to assess what treatment a person needs and can help predict how a condition is likely to develop. However, there are different ways of understanding mental health problems. The ‘medical model’ approach sees them as illnesses and they are therefore diagnosed and treated by a doctor. However, a lot of people (including some doctors) disagree with using a purely medical model and psychological and social factors are likely to play a role.

Despite the development of clear criteria for each disorder, making a diagnosis is not a clear-cut process and levels of diagnostic agreement may be low. In an assessment of individuals diagnosed using the DSM-III (APA, 1987), Chen et al (1996) examined changes in diagnoses among individuals initially diagnosed with schizophrenia who were hospitalised at least four times over a seven year period. 22% were subsequently given different diagnoses. Nathan and Langenbucher (2003) found that there was a higher rate of diagnostic consistency in the DSM-IV for some conditions such as substance abuse, there were no gains in others such as personality disorders and schizophrenia. Barnes (2008) found systematic differences in the diagnosis of schizophrenia across different ethnic groups in all the psychiatric hospitals in one US state. The DSM being in its 5th edition (due for publication in May 2013) highlights the difficulty in diagnosing and how the diagnostic criteria can change over time as well as ‘new’ mental illnesses being discovered.

Public perception – dangerousness

When a person receives a diagnosis of a mental illness this may help the individual as they can put a name to what is wrong, however, that diagnosis can also become a label and this can be dangerous to the individual. Instead of the person being seen as a person they can become a ‘schizophrenic’ (for example). The public perception of mental illness can then colour how the ‘schizophrenic’ is treated within society, regardless of whether these perceptions are based on fact.

The public perception of the mentally ill is that they can be dangerous and violent. ‘Mad’ has become synonymous with ‘bad’ and ‘dangerous’. As there is little formally taught on mental disorders within the education system, 6. it can be argued that people learn about mental illnesses either through personal contact with people with such conditions or from the media. 4,5. In 2003 it was found that 77% of people knew someone with a mental illness, however the evidence suggests that members of the general public paradoxically have remarkably little factual knowledge about mental illnesses 165. A person’s knowledge attitudes and behaviour towards people with a mental illness can also be influenced by the media (by being the main source of information). 8. The majority of information present in the public domain tends to emphasise the danger of violence from mentally ill people almost to the exclusion of all other aspects and the belief that individuals with a mental illness are dangerous is one of the most common misconceptions among the general public (Arboleda-Florenz, 2003; Pescosolido et al., 1999).


Some studies have suggested a clear association between mental illnesses and violence (Hodgins, Mednick, Brennan, Schulsinger, & Engberg, 1996; Nestor, 2002; Swanson, Holzer, Ganju, & Jono, 1990), however the contribution of people with mental illnesses to overall rates of violence is small, and is greatly exaggerated in the minds of the general public (Institute of Medicine, 2006). It has been argued that the majority of people who are violent do not suffer from mental illnesses (American Psychiatric Association, 1994) and only a small proportion of the violence in our society can be attributed to persons who are mentally ill (Mulvey, 1994). A longitudinal study of American’s attitudes on mental health between 1950 and 1996 found, “the proportion of Americans who describe mental illness in terms consistent with violent or dangerous behavior nearly doubled” and the majority of Americans believe that people with mental illnesses pose a threat for violence towards others (Pescosolido, et al., 1996, Pescosolido et al., 1999). Some types of mental disorder can confer a higher likelihood of a person behaving violently, and other conditions do not however the assumption of dangerousness is applied to the whole category of people with any type of mental illness, whether or not it is justified by the evidence. The public has been misinformed about the link between mental illness and violence by the media and this can lead to a mentally ill person being labelled as ‘dangerous’ and this label becoming dangerous to the individual in many areas of their life.

Perceptions of dangerousness vary, and literature and the media influence these perceptions. The most common perception of dangerousness is in the form of one person presenting a danger to others. More often than not, however, dangerousness presents in the form of people being a danger to themselves, through suicide or deliberate self-harm. Public perceptions of dangerousness can impact on different groups of people, particularly people with mental health problems and people from minority ethnic groups. The effects of such stigmatisation can be extremely negative, and in some cases has even led people from these groups to become victims of violent crime.


As a group, mentally ill people are no more violent than any other group. In fact, people with mental illnesses are far more likely to be the victims of violence than to be violent themselves. Current research shows that people with major mental illness are 2.5 times more likely to be the victims of violence than other members of society. It is estimated that one in every four persons with mental illness will experience violent victimization every year, a rate that is eleven times higher than the rate of violent victimization experienced by the general population. Mental illness plays no part in the majority of violent crimes committed in our society. The assumption that any and every mental illness carries with it an almost certain potential for violence has been proven wrong in many studies.

The facts demonstrate how exaggerated and unfair this view is. Figures from 2007-08 show that about 1.2 million people were treated by secondary mental health services in England and Wales in one year. [20], [21], [22] More than 110,000 people were admitted to hospital for a mental health problem,[23], [24], [25] and close to 34,000 people spent some time as formally detained inpatients. [26], [27], [28] In this same period, there were 662 homicides in England and Wales, [29] of which little more than 10 per cent would have involved people known to have a mental illness.

There is research that challenges the perceived link between mental disorder and violent behaviours. It has been found that the rates of homicides committed by mentally disordered people is remaining much the same however the number of homicides carried out by people without a mental disorder is increasing (Appleby, 1999; Taylor and Gunn, 1999). Studies have found that 10% of people convicted of homicide in the UK were found to have had symptoms of mental health problems at the time of the offence. [5] [6] It has been estimated that about one in six of the adult population will have a significant mental health problem at any one time (so in the UK that would be around seven million of the population of 43,000,000), [7], [8]  and research has shown that there between fifty and seventy homicides a year that involve people known to have a mental health problem at the time of the murder, [9]. This suggests that the data does not support the exaggerated media coverage about the perceived dangerousness that people with mental health problems pose to the community. It has been argued that the majority of violent crimes and homicides are committed by people who do not have mental health problems and 95% of homicides are committed by people who have not been diagnosed with a mental health problem.[10] The number of homicides committed by people diagnosed with mental health problems has stayed at a fairly constant level since the 1990s. [11] A Home Office report [33] that researched the number of homicides committed by people with mental health problems found that of the total number of homicides committed in the nine- year period covered by the study, a total of 510 (10 per cent of the total) were committed by someone who had been in contact with mental health services in the 12 months before committing the homicide. A total of 550 individuals were found to have had symptoms of mental illness at the time of the offence. Symptoms included hypomania, depression, delusions, hallucinations and other psychotic symptoms. Among the people found to have a mental illness, 289 were diagnosed as psychotic. Of these, 226 were diagnosed with schizophrenia. Mentally ill perpetrators have lower rate of previous convictions for violence than those who are not mentally ill at the time of the offence (Monahan, et al. 2001)

The MacArthur Foundation’s Community Violence Risk Study was set up to compare the rates of violence by former mental patients and other members of the community. [32] The study found that people with a diagnosis of a major mental illness but with no history of substance abuse, were involved in much less violence than those with a history of substance abuse. It was also found that

Instances of violence was higher among people who have symptoms of substance abuse in both mental health patients and non-patients. According to the British Crime Survey, 47% of the victims of violent crimes believed that their offender was under the influence of alcohol and about 17 per cent believed that the offender was under the influence of drugs. [13] Another survey suggested that about 30 per cent of victims believed that the offender attacked them because they were under the influence of drugs or alcohol. In contrast, only one per cent of victims believed that the violent incident happened because the offender had a mental illness. [14]

It has been suggested that people with mental health problems are actually more dangerous to themselves than they are to others. It was suggested that one in four people with a severe mental illness had been a victim of crime in one year. [16]. The fear of random unprovoked attacks on strangers by people with mental health problems is unjustified. This has been highlighted by a US finding that patients with psychosis who are living in the community are 14 times more likely to be the victims of a violent crime than to be arrested for such a crime. [12] It has also been found that 90% of people who commit suicide in the UK have a mental disorder.[15] and over 60% of people who commit suicide are thought to have been experiencing a depressive illness at the time, however it is important to note that the majority of people with a mental disorder will never attempt suicide. [37] A UK study found that about 10 per cent of people with no mental disorder have had suicidal thoughts at some time in their life, [38] and about 2 per cent have attempted suicide. The study showed that rates were much higher among people with mental disorders. As expected, the researchers found that people who had experienced a depressive episode had high rates of suicidal thoughts. About 52 per cent of those with depression had a lifetime prevalence of suicidal thoughts, and 25 per cent had attempted suicide at some stage in their life. People with obsessive-compulsive disorder had the highest rate of suicidal thoughts, with a 64% lifetime prevalence.

People with psychiatric disabilities are far more likely to be victims than perpetrators of violent crime (Appleby, et al., 2001). People with severe mental illnesses, schizophrenia, bipolar disorder or psychosis, are 2 ½ times more likely to be attacked, raped or mugged than the general population (Hiday, et al.,1999).”


There is a common misconception that people with mental health problems are likely to behave in a violent way and this view is repeatedly promoted by the media. As the media are the public’s primary source of information about mental illnesses [1-3], depictions of those suffering from these disorders contribute significantly to the stigma associated with mental illness. This contribution makes the negativity of media depictions [1,4-8]. The media frequently draws links between mental illness and crime, particularly violent crime such as homicide. [41] In one survey, homicide and crime were the most common stories covered in relation to mental health. [42] The sources most frequently used in reporting on mental health were the police and the courts. One journalist said that “there is no sexiness in mental health unless someone has committed a terrible crime.” [43] People who have personal experience of mental illness are rarely quoted in the media: one survey showed that they were quoted in only six per cent of articles covering topics relating to mental health. [44]. The mass media’s power to impact public perception and the degree to which people are exposed to media representations makes the mass media one of the most significant influences in developed societies.

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The majority of news accounts portray people with mental illness as dangerous (Wahl, 1995) and the majority of news stories on mental illness focus on negative characteristics related to people with the disorder and violent behaviour with very few stories highlighting positive aspects such as the recovery of people with mental illnesses (Wahl, et al., 2002). In a study from New Zealand it was found that more than 50% of all news items depicted the mentally ill as dangerous. 10 and it was concluded that ‘print media portrayals are negative, exaggerated and do not reflect the reality of most people with mental illness. 10,12. Fewer than 5% of news stories were from the person’s own viewpoint and only 1% quoted the person in their own words and it was argued that own voices were largely absent from media depictions of mental illness. 13. It is also uncommon to see a person who has been diagnosed with schizophrenia discussing the condition in his or her own words on television. 58. A UK study compared mental health and physical health items published in nine national papers. It was found that 64% of mental illness stories were negative compared to 46% of physical illness. It was also found that negative medical articles suggested bad doctors, whereas negative mental articles tended to describe bad patients.15. A similar study also found that nearly 50% of all tabloid stories used pejorative terms such as ‘looney’ or ‘nutter’ when describing the mentally ill. 16. All too often, the media use sensational language that tends to perpetuate myths and stereotypes regarding mental illness, promote fear in the community and promote incorrect assumptions. Provocative mainstream newspaper headlines such as “Terror, mentally ill threaten Games” (Headline, Toronto Sun, 5 November, 2008 (Toronto)), and “Knife maniac freed to kill. Mental patient ran amok in the park.” (Front page headline, Daily Mail, 26 February, 2005 (England)), and “Violent, mad. So Docs set him free. New ‘Community Care’ scandal.” (The Sun, 26 February, 2005 (England)) transforms a health issue into a public safety issue and capitalizes on the fear of violence and irrationality that lack of understanding about mental illness can cause. A further study analysed 3000 newspaper stories about mental illnesses and it was found that the majority of stories focussed on dangerousness and violence above all else. Many were front page stories (39%) and far less often treatment (14%) and recovery (4%) were mentioned. This tendency to highlight violence above all other aspects of mental health was described as ‘structural discrimination’ 17. Newspaper coverage of mental illness tends to be short of accurate and detailed content, emphasises violence over all other aspects of mental illness and reinforces prejudices against people with mental illness. There is ‘ample evidence for a distorted presentation of mentally ill people in newspapers’ 26. Published studies of newspaper stories dealing with mental illness [5,21,22] do not report accounts

or explanations provided by those with a mental disorder. This means that readers are informed about mental illnesses through stories from lay persons or professionals who have interacted with a sufferer.

The media do not make it clear to the public, however, that only a minority of those afflicted with MDs commit severe crimes and that the percentage of general violence associated with MD is low, indeed not above 14% (Angermeyer & Schulze, 2001; Arboleda-Florez, 1998; Monaham, 1997). need to protect the afflicted from self-destruction (Rowe, Tilbury, Rapley, & O’Ferrall, 2003). Selective coverage by journalists of attacks by persons with schizophrenia reinforces the connection between violence and schizophrenia that labels the entire MD population as dangerous and unpredictable (Angermeyer & Matschinger, 1996; Philo, 1997; Wahl, 1995, 2004).


Most programmes see their remit as focussing firmly on entertainment rather than education. 57. News and features emphasise the newsworthy rather than the worthy. It has been found that 60% of characters in prime time television portrayed as having a mental illness are depicted were shown to be involved in crime or violence and are r as being the most dangerous of all demographic groups (Mental Health American, 1999). Glasgow Media Group analysed output for national and local television, the press and magazines, including all content from factual through to cartoons.27. Those which reported harm to others were most common at 66% followed by treatment/recovery at 18%, harm to self at 12%. The authors said “the bulk of media content situates mental illness in a context of violence and harm…such representations can clearly affect audiences” 27. A content analysis of prime-time television in the US concluded that mentally ill characters were nearly ten times more violent than the general population of television characters and 10 to 20 times more violent than the mentally ill in the US population. 28. Stereotypes and labeling of these disorders even in children’s films and television programs, especially in animated caricatures, point to the trend toward stigmatization (Lawson & Fouts, 2004; Wahl, 2003b; Wilson, Nairn, Coverdale, & Panapa, 2000). Very common in television dramas or films are depictions of persons afflicted with MD as violent and unpredictable, as victims, or as incapable of holding down a job (Bryne, 1998; Diefenbach, 1997; Hillert et al., 1999; Hyler, Gabbard, & Schneider, 1991; Kerson, Kerson, & Kerson, 2000; Signorielli, 1989; Wilson et al., 1999). Selective coverage by journalists of attacks by persons with schizophrenia reinforces the connection between violence and schizophrenia that labels the entire MD population as dangerous and unpredictable, leads to negative attitudes, and distances the public from them (Angermeyer & Matschinger, 1996; Philo, 1997; Wahl, 2004; Wahl & Lefkowits, 1989).

It seems that media representations do matter and do play an active part in shaping and sustaining what mental illnesses mean in our cultures.36.

Although many studies have examined the public’s perceptions of mental illness and related stigmas, in fact, only a minority of the studies reviewed were oriented to the study of the influence of the mental health message in the mass media on public perceptions. Unusual, then, is the empirical study conducted by the Glasgow group who examined the perceptions and attitudes toward persons with MD in response to exposure to different genres in different mass media (Philo, 1999). The study found that not only news stories in newspapers and magazines, but also fictional stories in genres such as soap operas, films, and dramas, clearly have a very strong influence on the beliefs and attitudes of viewers and readers toward the mentally ill. The majority connected MDs to violence, expressed fear of those afflicted, and cited the mass media as the source of their beliefs.

A 1996 Health Canada review of scientific articles found that the strongest predictor of violence and criminal behaviour is not major mental illness, but past history of violence and criminality. Factors such as age, gender, substance abuse and educational level are significantly greater contributors to violence than mental disorders. The conditions which increase the risk of violence are the same whether a person has a mental illness or not. Mistaken and negative depictions perpetuate the public’s damning image of people with mental illness and perpetuate continued intolerance and oppression. Such distorted and negative associations are woven so deeply into the fabric of the public consciousness that sensationalism need no longer occur for the public to equate mental illness with violence. Studies have shown that exposure to even just one single shocking media image of violent mental illness seemed to increase the expectation that those labeled as mentally ill are particularly likely to do physical harm to others and to make the media consumer more fearful of such individuals. A report by Mind, a U.K. mental healthy charity, asserts that negative media coverage has a direct and harmful impact on the lives of people with mental illness. Mind surveyed 515 people suffering from a range of disorders about their feelings regarding media coverage of mental illness. Half of the respondents said that the media coverage had a negative effect on their own mental health, and 34% said this led directly to an increase in their depression and anxiety. A total of 22% of the participants said they felt more withdrawn and isolated as a result of negative media coverage, and 8% said that such press coverage made them feel suicidal. Almost 25% of respondents said that they noticed hostile behaviour from their neighbours due to negative newspaper and television reports. A further 11% said they required additional support from mental health services due to negative press coverage, and almost 25% of all respondents said that they had changed their minds about applying for jobs or volunteer positions due to negative media coverage.

Considerable research has concluded that the media are the public’s most significant source of information about mental illness (Coverdale et al., 2002 [citing Borinstein, 1992; Kalafatelis & Dowden, 1997; Philo, 1994]). Fiske (1987, cited in Rose, 1998) argues that television is the most powerful medium for framing public consciousness. Cutcliffe and Hannigan (2001) further state that rarely does a week go by without a reference to mental illness in the mass media. One study found that media representations of mental illness are so powerful that they can override people’s own personal experiences in relation to how they view mental illness (Philo, 1996, cited in Rose, 1998). On television and in film, as well as in news reporting, there is an emphasis on people with mental illness as “other” or separate from the general fabric of society. They are often portrayed as unemployed, homeless, and without family or friends, roots or history.

Stigma – Consequences

Recent research suggests that stereotypes of dangerousness are actually on the increase8 and that the stigma of mental illness remains a powerfully detrimental feature of the lives of people with such conditions.9-13 Despite an apparent improvement in public understanding the nature and causes of mental illness, mental disorders (especially psychosis) are linked with perceptions of violence. As such, public’s perceptions are not entirely out of line with objective assessments of risk. Unfortunately, perceptions of violence are a significant component to the stigma associated with mental illness which likely adds to the devaluation and discrimination that many persons who are diagnosed‐‐yet are not violent‐‐experience.

Public stigma refers to the general public’s discriminatory response to people with mental illnesses (Corrigan & Kleinlein, 2005). When considering stigma, this is typically the type of stigma that is discussed. Public stigma affects the person with a mental illness and the person’s friends, family members, and mental health professionals (Corrigan & Kleinlein, 2005). Public stigma can cause individuals with mental illnesses to lose or be unable to obtain gainful employment and adequate housing (Corrigan, 2004; DHHS, 1999; Wahl, 1999) and their interactions with the criminal justice system (Corrigan & Kleinlein, 2005).

Self-stigma is the internalization of public stigma regarding mental illness (Corrigan, 2004; Corrigan, 2007; Corrigan & Wassell, 2008). According to Corrigan (2007), self-stigma “leads to automatic thoughts and negative emotional reactions; prominent among these are shame, low self-esteem, and diminished self-efficacy” (p. 32). In other words, people with mental illnesses may believe that they are less appreciated and respected because of their disorder, and this may lead to demoralization and diminished self-worth and self-efficacy (Corrigan, 2004). These emotional reactions may exacerbate mental health problems.

Stigma and social rejection, in turn, limits social opportunities, such as jobs, housing, and social networks for persons with mental illness, that to some extent, serve as protective factors in reducing stress, and thereby reducing the risk of violence. While the proportion of persons with mental illness who are at risk of violence/criminal behavior is modest, in the aggregate, the risk translates into appreciable increases in the numbers of persons with mental illness who end up in the criminal justice system. Prejudice against those with mental illness increases social isolation and is a source of harassment and discrimination in employment, housing and insurance (Byrne, 1999; Corrigan et al, 1999). Having a mental illness adversely affects situations as diverse as prisoners being granted parole (Miller & Metzner, 1994) and patients being offered suitable organs for transplant (Corley et al, 1998). Stigma means that people are reluctant to present with psychiatric problems to primary care and often default from specialist services (Van, 1996; White, 1998). This might partly be a response to negative attitudes expressed by general practitioners (Lawrie et al, 1996, 1998) and hospital medical and nursing staff (Fleming & Szmukler, 1992). Not surprisingly, this discrimination adversely affects social behaviour and damages self-confidence (Gilbert, 2000). S

Wahl says, “People with mental illnesses are also readers and viewers of those images; they are shamed by them and they’re embarrassed by them. They’re aware that they are depicted in negative ways and it damages their self-esteem, it damages their confidence, and it increases their likelihood that they won’t tell anyone about their illnesses. So they’re not going to seek treatment.” Wahl argues that negative images in the mass media influence not only the general public, but also health care professionals. He points out that although practitioners are trained; they are subjected to and influenced by the same misconceptions and negative imagery as the public. This influence can lead health care practitioners to approach, and thus potentially treat, mentally ill patients with the same negative attitudes portrayed by the media and accepted by the general public. Stigma due to negative media coverage impedes recovery, triggers discrimination and prejudice, and creates barriers to see


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