Revisiting stigma: Exposure to Tourette in an ordinary setting increases stigmatization

Highlights

• Stigma towards Gilles de la Tourette Syndrome (GTS) is understudied.

• People with GTS are being stigmatized due to distorted media representation.

• Exposure to a person with GTS behaving in mannerly fashion elicit stigmatization.

Abstract

Stigma toward people with mental disorders is frequently studied yet less is known about prejudice toward persons with tic disorders, especially sufferers of Gilles de la Tourette Syndrome (GTS). We examined stigmatizing attributions concerning a GTS patient in an online study with participants randomly assigned to one of two video clip conditions: the experimental group saw to a person with Tourette syndrome; the control group watched a nature scenic footage. Results revealed that participants in the experimental condition exhibited higher scores on a stigma questionnaire. Clinicians should be aware that GTS patients are prone to being stigmatized by general public.

Introduction

Stigma toward people with mental disorders is common among the general public in the Western world (Corrigan and Watson, 2002) and its societal repercussions have not diminished since the pioneering work of Erving Goffman (Goffman, 1963). Moreover, stigmatizing views span from lay people all the way to highly-trained mental health professionals from various disciplines (Corrigan and Watson, 2002). According to Corrigan and Watson (2002, p. 16), public stigma consists of three key elements: 1. Stereotypical negative beliefs about a group (e.g., dangerousness, incompetence, character weakness); 2. Prejudiced agreement with a belief and/or negative emotional reaction (e.g., anger, fear, disgust); and 3. Discriminating behavioral responses to the targets of prejudice (e.g., avoidance, employment and housing discrimination, reluctance to help). People with chronic illnesses tend to anticipate stigma from their families, friends, coworkers and healthcare professional. This anticipated stigma was found to have detrimental effects of targets’ quality of life (Earnshaw and Quinn, 2011).

The extant literature mainly focuses on two major groups of people with mental disorders that are routinely being stigmatized. The first group are people with psychotic disorders specifically schizophrenia, and the second are people with mood disorders primarily bipolar disorders (Livingston and Boyd, 2010). However, one set of disorders that received less empirical attention, but renders high stigmatization, are tic disorders, or particularly, people with Gilles de la Tourette Syndrome (GTS).

GTS is a neuropsychiatric disorder exhibited by motor and vocal tics, and it is classified under Tic disorders in the DSM-5. The syndrome is mainly characterized by multiple motor, and at least one vocal/phonic, tic (Robertson, 2015). The prevalence of GTS is very low in comparison to the frequency of psychotic disorders and mood disorders. Estimated prevalence of GTS is ranging from 0.3% to 0.9% for children (Scharf et al., 2015), and 0.03% to 0.08% among adults (Knight et al., 2012). In other words, the chance of a person from the general public to encounter face-to-face a person with GTS is negligible in comparison to chances of meeting a person with psychotic disorders or mood disorder. Yet, there is very high stigmatization toward GTS group as it attracts the media's attention. Habitually, GTS is presented in the media as a “cursing disease” (Davis et al., 2004).

One recent review documented that children and adolescents exhibited unfavorable attitudes toward their peers with GTS. Youth with GTS also reported some forms of devaluation from others as a response to their condition. Moreover, parents of youth with GTS expressed guilt in relation to their children's condition along with a sense of social alienation resulting from the disorder (Malli et al., 2016).

A synthesis of qualitative literature identified several themes that encompass the experience of people with tic disorders that included negative experiences in organizations (i.e., school, social, and workplace environments), and negative impact on interpersonal relationships and personal identity (Smith et al., 2015).

A significant role in the understanding of social and cultural issues related to stigma is the influence of popular media (Smith et al., 2015). A recent study by Calder-Sprackman and colleagues (2014) showed that television and film can be a source of information and misinformation about medical disorders. For the most part, the representation of GTS is inaccurate in fictional movies and television shows. For example, coprolalia (involuntary and repetitive use of obscene language) is routinely overrepresented and it is sometimes alluded to be the main manifestation of GTS. In the popular media, the relations and attitudes of physicians, family, and/or schoolmates toward individuals with GTS are generally negative and disparaging.

As the media are the most accessible resource both for patients and the public, their influence may perpetuate stigmatizing beliefs about GTS (Calder-Sprackman et al., 2014). Hurtful media representations of mental disorders are biased because they are derived from lack of knowledge, pejorative judgments and misconceptions (Stout et al., 2004). This in turn amplifies misconceptions and stereotypes toward people with mental disorders consequently leading to an increase of stigma, prejudice, and discrimination. Furthermore, with the advent of all-accessible internet video streaming media (e.g., Youtube, Vimeo) clips of negative and insensitive portrayals of GTS, usually considered as “humorous”, receive significantly more views than neutral or positive portrayals of people presenting that condition (Fat et al., 2012).

In dealing with this problem there are two approaches that suggest ways to reduce the stigma of mental illness. First, the normalcy approach, proposes a use of a narrative regarding people with mental illness as “a neighbor next door or an average person”. The second approach is rooted in the idea of embracing and enhancing sense of solidarity with people with mental disorders (Corrigan, 2016).

Taking under consideration these two frameworks may yield two general predictions. The first prediction, based on the normalcy stand, is that exposure to a person with GTS presenting symptoms but behaving politely/respectfully in an everyday situation will not increase the stigma toward that person. The second prediction takes into account the media bias that crystalized the stigma toward people with GTS and suggests that this effect will overcast the neutral setting and will lead to greater stigmatization in comparison to a control group without exposure to any mental health related behaviors.

The purpose of the study was to test these predictions with the aim of providing insights into the course of action to be taken when dealing with stigma toward people with mental disorders (normalcy view vs. solidarity view). The choice of GTS as mental disorder is based on two key elements. First of all, due to the low prevalence of GTS among adults, the likelihood of people from the general population to encounter a GTS patient is very low. This enabled us to assume that attitudes toward people with GTS are mainly derived from media exposure and not from personal encounters. Second, presenting a GTS person behaving politely in a neutral and common setting stands directly as a clear contrast to the plethora of media depictions of people with GTS in unusual and inflammatory settings (see for example the TV series Ally McBeal or movies such as Deuce Bigalow).

Although, there are numerous experimental studies focusing on stigma of mental disorders, the vast majority of them focused on schizophrenia, bipolar disorders, and other more salient illnesses (Ellison et al., 2015). The purpose of this study was to target the lacuna in the literature concerning people with GTS.