Where does research design fall short? Mental health related‐stigma as example

Abstract

Efforts to challenge mental health‐related stigma have been limited by an insufficient conceptualization of the problem space. As is common in health communication, practitioners have neglected the multiple tacit understandings the public embody in everyday life. Using the example of our recent research into the public’s social representations of mental health and illness, in this paper, we will work through the theoretical‐methodological considerations involved in how we approached expanding the problem space. Using social theory, we tailored thematic analysis and natural language processing techniques to examine the public’s polyphasic sense‐making processes. The approach is novel, as it diverges from standard methods in understanding health communication and the possibilities for behaviour change. Instead, we root our approach in a dynamic and relational epistemology to iteratively reveal in greater complexity some of the contents and processes that sustain mental health‐related stigma.

Charting an Alternative Course for Mental Health-Related Anti-Stigma Social and Behaviour Change Programmes

“…Public health efforts have a greater impact when they respond to the social contexts through which key groups sustain mental health-related stigma [ 4 , 16 , 55 , 56 ]. Whilst there is a broad appreciation for the need to address the social context of stigma, the dominant approach in public health commonly considers content outside of the process of social and behavioural change [ 57 , 58 , 59 , 60 ]. Specifically, mental health-related anti-stigma efforts typically reduce social context to individuals’ perceptions of other people’s attitudes and beliefs [ 2 , 58 ].…”

“…Whilst there is a broad appreciation for the need to address the social context of stigma, the dominant approach in public health commonly considers content outside of the process of social and behavioural change [ 57 , 58 , 59 , 60 ]. Specifically, mental health-related anti-stigma efforts typically reduce social context to individuals’ perceptions of other people’s attitudes and beliefs [ 2 , 58 ]. This is inadequate, as it neglects how axioms of time and space are foundational to the public’s perceptions of mental health and illness [ 13 , 53 , 61 ].…”

“…For example, during the situated experience of intimate contact in a university setting with someone perceived to have a mental health problem, people distanced representations of mental health problems as ‘foreign’, ‘unknown’ and ‘unfamiliar’ in response to concerns for the Self and one’s in-group [ 28 ]. Similarly, public concerns about intergroup contact show remarkable historical consistency: common stigmatising images, metaphors and symbols reproduce socially shared representations of mental illness [ 26 , 27 , 58 ].…”

“…These motivated representations may be communicated non-consciously through the public’s ritualised effects, cognitions and behaviours [ 26 , 28 , 63 , 64 , 65 ]. Indeed, Othering is thought to be reproduced in the often-latent ambivalences present in communication [ 58 , 65 , 66 ]. Communication comes in multiple forms and may simultaneously be intra-psychological (e.g., within themselves), interpersonal (e.g., conversations with friends and family) and institutional (e.g., mass media) [ 64 ].…”

“…It is the interactive interdependence between them that produces different styles of thinking and communicating” (Marková 2008, p. 479). A theory of cognitive polyphasia provides a basis to conceptualize how groups relate to social context [ 58 , 72 ]. Cognitive polyphasia describes how, at the level of representation, individuals and groups engage multiple types of knowledge or beliefs to function within their particular social context [ 70 ].…”