Our effort is not without limitations. First, vignette
approaches can be sensitive to large and small changes
in core descriptions (10, 37). How the public would react
to individuals at different places along the diagnostic
spectrum remains unanswered. Our “cases” met DSM-IV
diagnostic criteria and simulated what individuals in the
community encounter—a person with “problem” behaviors
but no medical labels or history. This vignette strategy
allowed us to explore the association of a neurobiological
understanding of current or active “problem” behaviors
with stigmatizing responses. However, the assumption
underlying many antistigma interventions is that embracing
a neurobiological understanding of mental illness
will increase support for help-seeking behavior and subsequently
lead to treatment that can mitigate symptoms.
This in turn would reduce others’ stigmatizing responses.
Testing this idea of recovery and stigma reduction would
require a different set of vignette circumstances than ours. It
stands as an important hypothesis for future research. Second,
attitudes are not behaviors, and predispositions may
or may not closely track discrimination (38). Both classic
and recent studies suggest that attitudes reveal more negative
tendencies than individuals are willing to act upon in What appears to have been mistaken is the assumption
that global change in neuroscientific beliefs would translate
into global reductions in stigma. Our analyses suggest that
even if the embrace of neuroscience had been more pronounced,
a significant and widespread reduction in stigma
would not have followed. We are not the first to suggest
that there may be unintended consequences or a backlash
effect of genetic explanations of mental illness (41). Even in
1999, the Surgeon General’s report cautioned against a simplistic
approach, noting that most recent studies suggested
that increased knowledge among the public did not appear
to translate into lower levels of stigma.
The critical question centers on future directions. As
an alternative to our focus on neuroscience, we also considered
another approach that pervades public debates.
Given the efforts of the Treatment Advocacy Center to
link violence in mental illness to policy changes necessary
to improve the mental health system, we did a post
hoc analysis that looked at the associations among public
perceptions of dangerousness, social distance, and
public support for increased funding. As Torrey (42) has
argued, people who recognize the potential dangerousness
of untreated mental illness will support the infusion
of more resources to the mental health system. Americans’
assessments of dangerousness are high and, as in previous
research, significantly related to social distance (43).
However, a measure of public support for federally funded
services is not significantly associated with public perceptions
of danger. Far from providing the public support
needed to improve the mental health system, such fear
only appears to have a detrimental effect on community
acceptance.