The stigma of mental illness: Explanatory models and methods for change

For people with mental illness, diminished quality of life and loss of personal goals does not result solely from the symptoms, distress, and disabilities caused by their psychiatric disorder. Quality of life and personal goals are also hindered by people who embrace the stigma that accompanies mental illness and mental health care. This paper reviews evidence of the impact of mental illness stigma and strategies for seeking to ease its impact. To achieve these goals, we (a) describe the ways in which stigma harm people with mental illness, (b) summarize models that explain the development and maintenance of these stigmatizing effects, and (c) review strategies that have been shown to decrease the impact of stigma. Concerns about stigma are on the political agendas of many mental health advocacy groups. It has recently also become the focus of extensive research. Our goal in this paper is to balance the practical concerns raised by mental health advocates against data that support or contradicts specific assertions.     

Infants’ reasoning about ambiguous motion events: The role of spatiotemporal and dispositional status information

Two experiments investigate whether 7-month-olds reason about the origin of motion events by considering two sources of causally relevant information: spatiotemporal cues and dispositional status information derived from the identification of an object as either animate (with the enduring causal property of self-initiated motion) or inanimate (requiring an external cause of motion). Infants were shown a ball, a human hand, and an animal engaged in a motion event. While dispositional status information remained constant, spatiotemporal relations varied across conditions. Based on looking time data, we conclude that infants attend flexibly to both types of information. Without spatiotemporal cues, infants rely on dispositional status information. When two objects provide dispositional cues to motion origin, but only one also provides corresponding spatiotemporal information, infants attribute the motion to the object providing both types of information. Given an ambiguous motion event with two dispositional motion originators but no additional spatiotemporal cues, infants may prefer either of the two.     

Uncovering deterministic causal structures: a Boolean approach

While standard procedures of causal reasoning as procedures analyzing causal Bayesian networks are custom-built for (non-deterministic) probabilistic structures, this paper introduces a Boolean procedure that uncovers deterministic causal structures. Contrary to existing Boolean methodologies, the procedure advanced here successfully analyzes structures of arbitrary complexity. It roughly involves three parts: first, deterministic dependencies are identified in the data; second, these dependencies are suitably minimalized in order to eliminate redundancies; and third, one or—in case of ambiguities—more than one causal structure is assigned to the minimalized deterministic dependencies.     

Children’s developing understanding of the relation between variable causal efficacy and mechanistic complexity

Two experiments investigated 3–4-year-olds’ ability to infer the causal mechanisms for a pair of lights. In both experiments the exterior of the two lights appeared identical. In Experiment 1, one light displayed a stable activation pattern of a single color while the other light displayed a variable pattern of activation by cycling through a series of different colors (i.e., a more varied effect). Children were asked to judge which light had a more complex internal structure. Four-year-olds were more likely to match the light with the more variable effect with a more complex internal mechanism and the light with the more stable effect with a less complex mechanism. Three-year-olds’ responses were at chance. Experiment 2 replicated this finding when the activation patterns of the two lights were described verbally but never demonstrated. Taken together, these results suggest that 4-year-olds appreciate that the variability of an object’s causal efficacy is related to the complexity of its internal mechanistic structure.     

Event completion: event based inferences distort memory in a matter of seconds

We present novel evidence that implicit causal inferences distort memory for events only seconds after viewing. Adults watched videos of someone launching (or throwing) an object. However, the videos omitted the moment of contact (or release). Subjects falsely reported seeing the moment of contact when it was implied by subsequent footage but did not do so when the contact was not implied. Causal implications were disrupted either by replacing the resulting flight of the ball with irrelevant video or by scrambling event segments. Subjects in the different causal implication conditions did not differ on false alarms for other moments of the event, nor did they differ in general recognition accuracy. These results suggest that as people perceive events, they generate rapid conceptual interpretations that can have a powerful effect on how events are remembered.     

Just world beliefs, causal beliefs, and acquaintance: Associations with stigma toward eating disorders and obesity

The current study investigated the relationship between just world beliefs and stigmatizing attitudes toward eating disorders and obesity. Further, the associations between stigma and causal beliefs, and between stigma and acquaintance with these conditions, were examined. Participants (n = 447) read four vignettes describing an individual with anorexia nervosa, bulimia nervosa, binge eating disorder, or obesity. After each vignette, participants completed questionnaires assessing stigmatizing attitudes, just world beliefs, causal beliefs, and acquaintance with the condition depicted in the vignette. Stronger just world beliefs were associated with greater stigma toward all three eating disorders, as well as obesity (rs ranging from −.11 to −.18). More stigmatizing attitudes were associated with greater attribution of individual responsibility for the development of the disorder. However, participants with personal experience or who knew someone with the depicted problem did not have lower stigma scores than those who did not. The current study suggests that justification ideologies such as just world beliefs and controllability beliefs may underlie the stigmatization of eating disorders and obesity. These findings provide support for stigma reduction efforts aimed at targeting justification ideologies and altering causal beliefs.     

Bridging the gap: Causality-at-a-distance in children's categorization and inferences about internal properties

Previous research has shown that preschoolers extend labels and internal properties of objects based on those objects’ causal properties, even when the causal properties conflict with the objects’ perceptual appearance [Nazzi, T., & Gopnik, A. (2000). A shift in children's use of perceptual and causal cues to categorization. Developmental Science, 3, 389–396; Sobel, D. M., Yoachim, C. M., Gopnik, A., Meltzoff, A. N., & Blumenthal, E. J. (2007). The blicket within: Preschoolers’ inferences about insides and causes. Journal of Cognition and Development, 8, 159–182]. These studies, however, only presented causal relations that acted on contact. In two studies, contact causality was replaced by distance causality. In contrast to the contact causality case, 4- and 5-year-olds extended labels to objects with similar perceptual properties over objects with similar causal properties when those properties acted at a distance. When children were asked to make inferences about object's internal properties, they were more likely to make causal responses, with 5-year-olds doing so to a greater extent than 4-year-olds. In a second study, 4-year-olds registered causal properties that acted at a distance and used them to make inferences when no perceptual conflict was present. These results support a hypothesis that young children develop an understanding of the specific mechanisms that link causal relations.     

The illness perception questionnaire: A new method for assessing the cognitive representation of illness

Abstract

The Illness Perception Questionnaire (IPQ) is a new method for assessing cognitive representations of illness. The IPQ is a theoretically derived measure comprising five scales that provides information about the five components that have been found to underlie the cognitive representation of illness. The five scales assess identity - the symptoms the patient associates with the illness, cause - personal ideas about aetiology, time-line - the perceived duration of the illness, consequences - expected effects and outcome and cure control - how one controls or recovers from the illness. The IPQ has a specific number of core items but allows the user to add items for particular patient groups or health threats. Data is presented supporting the reliability and validity of the IPQ scales in different chronic illness populations.     

Children's Judgments of Certainty and Uncertainty on a Problem Where the Possible Solutions Differ in Likelihood

In this study the author examined why children and adults think they need to eat. Preschoolers through adults were provided with physiological, social, psychological, and routine causes for eating breakfast, lunch, snack, and dinner, and were asked to either agree or disagree with the causal responses provided. A 4 Reason × 4 Meal repeated measures analysis of variance revealed significant main effects for meals and reasons, as well as significant Meal × Reason and Meal × Reason × Grade interactions. The effect sizes ranged from 0.1 to 0.7. Across all age groups, participants acknowledged physiological needs and desires (fulfilling hunger and needs to stay healthy) and routine (e.g., it is dinner time) as the primary causes for eating breakfast, lunch, and dinner. However, for snack physiological needs were the primary reason. Second-grade students onward spontaneously produced biological justifications such as the need for energy and nutrition as important reasons for food consumption. These results lend support to the developmental model that children's and adults’ understanding of eating changes in middle childhood.     

The development of causal categorization

Two experiments examined the impact of causal relations between features on categorization in 5- to 6-year-old children and adults. Participants learned artificial categories containing instances with causally related features and noncausal features. They then selected the most likely category member from a series of novel test pairs. Classification patterns and logistic regression were used to diagnose the presence of independent effects of causal coherence, causal status, and relational centrality. Adult classification was driven primarily by coherence when causal links were deterministic (Experiment 1) but showed additional influences of causal status when links were probabilistic (Experiment 2). Children's classification was based primarily on causal coherence in both cases. There was no effect of relational centrality in either age group. These results suggest that the generative model (Rehder, 2003a) provides a good account of causal categorization in children as well as adults.     

Causal conjunction fallacies: The roles of causal strength and mental resources

In two experiments we tested the prediction derived from Tversky and Kahneman's (1983) work on the causal conjunction fallacy that the strength of the causal connection between constituent events directly affects the magnitude of the causal conjunction fallacy. We also explored whether any effects of perceived causal strength were due to graded output from heuristic Type 1 reasoning processes or the result of analytic Type 2 reasoning processes. As predicted, Experiment 1 demonstrated that fallacy rates were higher for strongly than for weakly related conjunctions. Weakly related conjunctions in turn attracted higher rates of fallacious responding than did unrelated conjunctions. Experiment 2 showed that a concurrent memory load increased rates of fallacious responding for strongly related but not for weakly related conjunctions. We interpret these results as showing that manipulations of the strength of the perceived causal relationship between the conjuncts result in graded output from heuristic reasoning process and that additional mental resources are required to suppress strong heuristic output.     

When intuitions are helpful: Prior beliefs can support reasoning in the bat-and-ball problem

Intuitions are often considered suboptimal because they can bias people's thinking. The bat-and-ball problem is a celebrated example of this potentially detrimental aspect of intuitions since it elicits a very appealing and prepotent intuitive but incorrect response. We propose to show that certain kinds of intuitions (i.e., prior beliefs) can help people to reason better on this task. In two experiments, participants answered either a classic congruent version of the bat-and-ball problem in which the intuitively cued response fitted with prior knowledge (i.e., was believable) or a modified incongruent version in which the intuitively cued response conflicted with prior knowledge (i.e., was unbelievable). Results indicate that participants who solved the modified unbelievable version performed better than participants who solved the classic believable version. Our data highlight that prior beliefs, even in the bat-and-ball problem, can accidentally make people perform better, probably because they encourage them to adopt a more effortful processing strategy.     

Enabling conditions and children’s understanding of pretense

Two experiments examined whether preschoolers’ difficulties on tasks that required relating pretending and knowledge (e.g., Lillard, A. S. (1993a). Young children’s conceptualization of pretense: Action or mental representational state? Child Development, 64, 372-386) were due to children’s inability to appreciate the causal mechanism behind enabling conditions. In Experiment 1, 4-year-olds were told about a character who knew about one kind of animal and did not know about another. The character acted in a manner consistent with both animals. Children were asked whether the character was pretending to be the animal of which he was ignorant. The character’s knowledge was either represented in a generic manner (as a picture) or in a manner that suggested a particular enabling condition relation that children found accessible (as a battery, which most 4-year-olds recognize is critical for making toys work). Children were more successful at relating knowledge and pretending in the battery condition. This improvement in performance extended to another task in which children had to identify the enabling condition relation between knowledge and identification, in which there were reduced demands on the inhibitory mechanisms necessary for success. Experiment 2 found that the results in Experiment 1 were not due to demands of the procedure used in Experiment 1. These results are discussed in the context of recent theories of theory of mind that focus on the importance of causal relations among mental states.     

The development of possibility judgment within and across domains

The ability to differentiate possible events from impossible ones is an invaluable skill when reasoning about claims that transcend the perceptual evidence at hand, yet preschool-aged children do not readily make this differentiation when reasoning about physically extraordinary events [Shtulman, A., &; Carey, S. (2007). Improbable or impossible? How children reason about the possibility of extraordinary claims. Child Development, 78, 1015–1032]. The present study sought to determine whether this failure stems from deficits in domain-specific knowledge or deficits in the domain-general procedure by which possibility judgments are made. Participants (48 children aged 4-9 years olds and 16 adults) were asked to judge the possibility of three types of extraordinary events – physical, psychological, and biological – and to justify their judgments of impossibility. Developmental changes in the ability to differentiate improbable events from impossible events were qualitatively similar across domains. Moreover, participants’ propensity to judge improbable events possible was significantly correlated with the quality of their justifications, both within and across domains. These findings suggest that modal development involves a domain-general change in how modal claims are evaluated.     

Learning the form of causal relationships using hierarchical bayesian models

People learn quickly when reasoning about causal relationships, making inferences from limited data and avoiding spurious inferences. Efficient learning depends on abstract knowledge, which is often domain or context specific, and much of it must be learned. While such knowledge effects are well documented, little is known about exactly how we acquire knowledge that constrains learning. This work focuses on knowledge of the functional form of causal relationships; there are many kinds of relationships that can apply between causes and their effects, and knowledge of the form such a relationship takes is important in order to quickly identify the real causes of an observed effect. We developed a hierarchical Bayesian model of the acquisition of knowledge of the functional form of causal relationships and tested it in five experimental studies, considering disjunctive and conjunctive relationships, failure rates, and cross-domain effects. The Bayesian model accurately predicted human judgments and outperformed several alternative models.     

Quality of Life in Patients with Recurrent Vasovagal or Unexplained Syncope: Influence of Sex, Syncope Type and Illness Representations

Health-related quality of life (QoL) is reduced in patients with recurrent vasovagal (VVS) or unexplained (US) syncope. Little is known regarding these patients’ QoL as pertains to their capacity to attain their life goals. Factors influencing QoL, such as sex, syncope type and illness representations have not been studied. Our objective is to examine the relationship between illness representations and QoL, as well as possible sex and syncope type differences. One hundred and four patients undergoing tilt-table testing (TTT) for recurrent syncope were interviewed one month before TTT, using questionnaires. Data were analysed using ANCOVAs, a-priori Helmert contrasts for illness representations, and regressions. Patients with US had a poor QoL compared to those with VVS [F(1, 91) = 10.46; p < 0.01], particularly in men (p < 0.01). Patients with higher perceived syncope severity showed an impoverished QoL relative to those with less severe perceptions [F(1, 91) = 5.47; p < 0.05]. A hierarchical regression revealed that illness representations mediate the impact of lifetime number of syncope on QoL. In conclusion, QoL is reduced in these patients, and is influenced by illness representations. Helping patients change their perceptions about their syncope may be an efficient way to promote QoL.     

Two causal theories of counterfactual conditionals

Bayes nets are formal representations of causal systems that many psychologists have claimed as plausible mental representations. One purported advantage of Bayes nets is that they may provide a theory of counterfactual conditionals, such as If Calvin had been at the party, Miriam would have left early. This article compares two proposed Bayes net theories as models of people's understanding of counterfactuals. Experiments 1-3 show that neither theory makes correct predictions about backtracking counterfactuals (in which the event of the if-clause occurs after the event of the then-clause), and Experiment 4 shows the same is true of forward counterfactuals. An amended version of one of the approaches, however, can provide a more accurate account of these data.     

Impact of genetic testing on causal models of heart disease and arthritis: An analogue study

Abstract

An analogue study investigated the impact of genetic testing on perceptions of disease. Using a 2 × 2 design, participants (n = 212) imagined receiving the information that they were at increased risk for either heart disease or arthritis. The type of risk information was either genetic or unspecified. Presentation of genetic risk information resulted in the condition being perceived as less preventable. Causal models of disease where investigated using principal components analysis. When hem disease was the stimulus condition, attributions to genes and chance were positively associated following unspecified risk information, and negatively associated following genetic risk information. When arthritis was the stimulus condition, presentation of genetic risk information was associated with attributions to genes becoming separated from the other attributions. One explanation for this is that providing genetic risk information may decrease perceptions of a sense of randomness or uncertainty in disease causation. The extent to which these effects occur in clinical populations. and their behavioural consequences. needs to be established.