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“The Man in the Red Hoodie”

The insightful and thought-provoking letter written by Ms. Diane Allen, which is published in this issue, describes an incident that took place at the 2013 APNA conference in which both emotional and behavioral reactions were driven by a stereotype rather than a personalized understanding of the “man in the red hoodie.” Stereotypes are enduring knowledge structures that are generalized characteristics of members of social groups (Hilton & von Hippel, 1996). They are stable systems of beliefs about attributes and behaviors of the members of a specific group. Although stereotypes do include positive traits, negative traits are most typically associated. Stereotypes are viewed as adaptive products of normal human cognition that increase efficiency of information processing and meaning-making. However, stereotypes also reflect pernicious interpersonal and social processes. In general, people tend to attribute positive traits to groups with which they strongly identify and negative traits to out-groups or groups not included as part of the self. Stereotypes are often associated with theories of causality. They tend to include a coherent set of characteristics that are linked to beliefs about cause—causes that are often both innate and immutable (Bodenhausen & Richeson, 2010). Stereotypes and the process of stereotyping also vary by social status and power hierarchy (Operario & Fiske, 2001). While stereotypes refer to belief systems or structures, stereotyping refers to the thinking process used to understand people and the groups to which they belong. Persons in high status and/or high power social positions are more likely categorize (stereotype) a subordinate, rather expending cognitive effort to attend to individualizing characteristics. Furthermore, negative stereotypes can be used to ensure stability of the power differential. In her letter, Ms. Allen draws our attention to the way that nonconventional self-presentation rapidly activated a threatening stereotype and associated emotions (fear) and behavior (call for help). As I read Ms. Allen’s letter, I was reminded of the many ways that stereotypes and stereotyping affect the persons we care for and treat. People suffering with mental illness continue to be victimized by stereotyping, stigma, and prejudice. Results of a multistage area probability sample survey of over 1,800 adults living in the United States showed that 31% believed that schizophrenia was the result of bad character and 65% believed that alcohol dependence was due to bad character (up from 49% in 1996; Pescosolido et al., 2010). Furthermore, 62% indicated that they were unwilling to work closely with a person diagnosed with schizophrenia, and 60% indicated that it was likely that the individual would be violent toward others. Although attitudes of mental health care providers including psychiatrist, nurses, therapists, and case managers were more positive compared with the general public, more than 30% believed that persons with depression and schizophrenia are unable to make decisions related to their treatment and management of money (Stuber, Rocha, Christian, & Link, 2014). However, of greatest concern is evidence that persons with mental disorders internalize the negative stereotypes and define themselves in ways consistent with the stereotypes. These negative self-conceptions, in turn, predict increases in symptoms and lowered selfefficiency and life satisfaction (Markowitz, Angell, & Greenberg, 2011). As Markowitz et al. (2011) conclude, “The ways in which people think about persons with mental illness affect the beliefs and actions of those with mental illness, in turn shaping the trajectory of illness” (p. 161). As psychiatric and mental health nurses and clinicians, the most critical issue is interventions that are effective in decreasing stereotyping, stigma, and prejudice that target persons with mental illness and their caretakers. Although the literature on this topic is extensive (see Paluck & Green, 2009, for a review), the one intervention that appears to effectively reduce stereotyping and its negative consequences is involvement. Becoming personally involved with the target of the stereotype leads to more detailed, personalized understanding of the person and a more complex heterogeneous view of the group. Interpersonal relationships that are characterized by equal status, common goals, and institutional support are key to reducing stereotypes and prejudice both in the short term and in the long term (Turner, Hewstone, Voci, Paolini, & 569176 JAPXXX10.1177/1078390315569176Journal of the American Psychiatric Nurses AssociationStein research-article2015