اثر علیت ادراک شده بر روی ادراکات افرادی که لکنت زبان دارند

This study examined the effects of the perceived cause of stuttering on perceptions of persons who stutter (PWS) using a 7-item social distance scale, a 25-item adjective pair scale and a 2-item visual analogue scale. Two hundred and four university students rated vignettes which varied on describing a PWS with different causalities for stuttering (psychological, genetic, or unknown). Ratings differed significantly according to assigned causality. The vignette with the stuttering due to psychological causes was rated more negatively on 14 adjective pairs and the Social Distance Scale Index when compared to the ratings of vignettes with stuttering caused by either genetic or unknown causes. Interestingly, there were no significant differences between ratings of the vignettes attributing stuttering to either genetic or unknown causes. Neither familiarity with PWS nor the perceived curability of stuttering had any significant association to the ratings. Implications of findings regarding negative stereotypes, stigmatization and perceived causality for PWS are discussed. Educational objectives: Readers will be able to describe and explain: (1) research regarding negative stereotypes and stigma associated with stuttering, (2) research about attribution theory and stigma, (3) two methods used to evaluate stereotypes and stigma in adults, and (4) the negative effects on ratings of PWS due to psychological causality.

Although the most visible aspects of stuttering are behavioral, it is now widely accepted that the disorder is multidimensional in nature and includes cognitive, linguistic, affective, and social factors that may play a role in stuttering development and maintenance (Bloodstein and Bernstein-Ratner, 2008 and Healey et al., 2004). Social pressures and demands elevate the susceptibility of people who stutter to stigmatization in the form of negative stereotypes and discrimination (Craig, Tran, & Craig, 2003). This introduction will review (a) social stigma and its consequences, (b) the stuttering stigma, (c) the impact of causal attribution on stigma, (d) the possible relationship between the stuttering stigma and causal attribution, and (e) the purpose of the current study. 1.1. Social stigma and its consequences The word stigma originates from the Greek meaning “branded or marked” (Goffman, 1963). Individuals and/or groups who are stigmatized are perceived as possessing attributes that are less desirable and different from the societal norm. These perceptions are based on physical attributes, religious beliefs, personality, intelligence, social circumstances, social class and disability (Towler & Schneider, 2005). A description of social stigma provided by Crocker, Major, and Steele (1998) states that “stigmatized individuals possess (or are believed to posses) some attribute, or characteristic, that conveys a social identity that is devalued in a particular context” (p. 505). Link and Phelan, 2001 and Link and Phelan, 2006 conceptualized the “stigma process” as the result of a logical ordering of four interrelated components that are applicable to all kinds of stigmatized groups. They include: (1) a human difference is identified and labeled; (2) the negative stereotyping process begins with linking the labeled person with undesirable characteristics according to current societal norms; (3) the stigmatized group becomes the “out-group;” (4) as members of the out-group they experience rejection, exclusion, discrimination, and loss in status by the non-stigmatized population. Before proceeding, a quick note on terminology used in this article will be addressed. For the sake of clarity, the term “stigma” will often be used in this article and should be interpreted as a broad, overarching term that encompasses several more specific components including stereotypes and discrimination. Stereotypes and discrimination are both elements of social stigma, and so any discussion related to the combined elements of negative stereotypes and discrimination will use the broader terms “stigma,” “stigmatized,” or “stigmatization.” There is evidence that many negative consequences can result from having a stigmatized condition. First, there is strong evidence suggesting that stigmatization is a concern to those in the “out-group” regarding discrimination in academic, work and social situations (Crandall and Eshleman, 2003, Crocker et al., 1998, Goffman, 1963, Major and O’Brien, 2005, Sidanius and Pratto, 1999, Tajfel and Turner, 1986 and Uleman et al., 2008). Second, the literature suggests individuals who are stigmatized may be less likely to seek and participate in treatment for their disability (Harris et al., 1992, Heatherton et al., 2000, Jussim et al., 2000, Major and O’Brien, 2005 and McKown and Weinstein, 2002). Third, stigmatization contributes to lower self-esteem, stress, social isolation, poorer psychological well-being, and increased physical problems (Abe and Zane, 1990, Hinshaw, 2006, Link and Phelan, 2006, Major and O’Brien, 2005, Rockloff and Schofield, 2004, Smart and Wegner, 1999 and Steele et al., 2002). Finally, individuals who are stigmatized may actually begin to believe and incorporate these negative attributes assigned by the non-stigmatized groups into their own identities (Crocker et al., 1998, Major and Eccleston, 2004, Major et al., 2002a, Major et al., 2002b, Schmitt and Branscombe, 2002, Spencer et al., 1999, Stangor et al., 2002, Steele, 1997, Steele and Aronson, 1995 and Weiner et al., 1988). Stigmatization is a major quality of life issue for persons in “out-groups” including individuals with disabilities (Craig, Blumgart, & Tran, 2009). The general process of stigmatization can be analyzed by measuring its specific components, including stereotypes and discrimination. Perceptions of personal characteristics, obtained from adjective descriptors, can be used in order to investigate the existence of negative stereotypes of a group of individuals. In addition, the existence and degree of discriminatory behaviors resulting from negative stereotypes can be measured indirectly through social distance scales (Angermeyer et al., 2003, Angermeyer et al., 1987, Angermeyer and Matschinger, 2005a, Angermeyer and Matschinger, 2005b, Angermeyer et al., 2004, Hayward and Bright, 1997, Link and Phelan, 2001, Link and Phelan, 2006, Phelan, 2002 and Saetermoe et al., 2001). Identifying and measuring the existence of negative stereotypes and practices of discrimination are critical for creating, implementing, and evaluating programs to reduce stigmatization. 1.2. The stuttering stigma Negative judgments of PWS have been reported by numerous groups including lay people (Craig et al., 2003, Craig et al., 2008, Crowe and Cooper, 1977, Doody et al., 1993 and Ham, 1990), educators (Crowe and Walton, 1981, Dorsey and Guenther, 2000, Hurst and Cooper, 1983a, Hurst and Cooper, 1983b, Lass et al., 1992, Lass et al., 1994, Ruscello et al., 1994, Woods, 1978 and Yeakle and Cooper, 1986), speech-language pathologists (Cooper and Cooper, 1996, Hulit and Wirtz, 1994, Lass et al., 1989, Ragsdale and Ashby, 1982, Turnbaugh et al., 1979 and Yairi and Williams, 1970), healthcare professionals (Silverman & Bongey, 1997), employers (Hurst & Cooper, 1983a), vocational counselors (Hurst & Cooper, 1983b), college students (Betz et al., 2008, Dorsey and Guenther, 2000 and Silverman and Paynter, 1990), and school-age children (Franck, Jackson, Pimentel, & Greenwood, 2003). These judgments seem to reveal negative stereotypes directed toward PWS. Negative stereotypes could lead to discrimination in social, educational, and occupational domains of life. Indeed, several studies conducted reveal that PWS believe stuttering has limited their life opportunities in these areas (Corcoran and Stewart, 1998, Crichton-Smith, 2002, Klompass and Ross, 2004 and Whaley and Parker, 2000). In addition, there is evidence that PWS are judged as being less occupationally competent than their fluent co-workers (Gable et al., 2003, Silverman and Bongey, 1997 and Silverman and Paynter, 1990), and that employers agree that stuttering decreases employability and interferes with promotion opportunities (Hurst and Cooper, 1983a and Hurst and Cooper, 1983b). The evidence of negative stereotypes and discrimination experienced by PWS result in what the authors label the “stuttering stigma.” Goffman (1963) in describing stigma identifies two types. “Discredited” refers to those stigmas that are instantly noticeable or obvious and “Discreditable” refers to those stigmas which are unknown during a social interaction. Although Goffman includes only a fleeting reference to stuttering in his seminal book, others have expanded on his concepts. Acton and Hird (2004) in their article “Toward a Sociology of Stuttering” discuss the stigma of stuttering in terms of covering-up, avoiding and hiding practices of PWS and their self-identity. They also contend that PWS employ the practice of “passing” to eliminate the negative stigma effects of the stuttering disability on social interactions. Evidence suggests that negative beliefs and stereotypes about PWS may begin during early years and adolescence (Blood and Blood, 2004, Blood et al., 2003, Franck et al., 2003 and Hearne et al., 2008). As a result of the perceived negative reactions of listeners, many PWS experience stigmatization which results in guilt, shame, self-consciousness, and hiding (Corcoran and Stewart, 1998, Crichton-Smith, 2002, Daniels and Gabel, 2004, Ginsberg, 2000, Ginsberg and Wexler, 2000, Hagstrom and Daniels, 2004, Klompass and Ross, 2004, Murphy, 1999 and Whaley and Parker, 2000). Research in this area also shows that negative attitudes experienced by PWS as a result of being stigmatized could continue throughout adulthood and impact the PWS's social identity, resulting in strengthening the relationship between stigma and stuttering (Daniels and Gabel, 2004, Hagstrom and Daniels, 2004 and Klompass and Ross, 2004). 1.3. Stigma and causal attribution Stigma is related to a psychological construct labeled attribution theory. Attribution Theory (Graham and Weiner, 1986, Weiner, 1985, Weiner, 1995 and Weiner, 2008) states that people have a need to understand behavior, either in themselves or in others, by attributing the behavior to a cause or explanation. In other words, attribution theory assumes that people want to understand the world around them and want to figure out why people do what they do. According to this framework, attributions can be categorized using three major dimensions. The first dimension is the locus of causality which refers to the cause of a problem or situation. This is also labeled as internal or external locus of control. The second dimension is labeled stability which refers to the changeability of the cause over time. The third dimension refers to controllability and whether a problem is controllable or uncontrollable. Oftentimes, the attribution or explanation assigned to a specific problem, disease or disorder increases or decreases the amount of stigma associated with the condition. In a series of experiments by Weiner, Perry, and Magnusson (1988), it was observed that physically based stigmatizing conditions (e.g., blindness) were perceived as onset-uncontrollable, and elicited pity, a desire to help, and no anger. However, the opposite was found in cases of mental-behavioral stigmatizing conditions (e.g., drug abuse) which were judged as onset-controllable, and elicited little pity, judgments to ignore rather than help, and much anger. It was also observed that physically based conditions were perceived as stable and irreversible, whereas most mental-behavioral conditions were considered unstable and reversible. This study demonstrates that the perceived origin of the condition and its anticipated course can greatly influence affective and behavioral reactions toward the stigmatized person, and will help to develop future expectations about the individual. Phelan (2002) suggested that the genetic or biological attribution for specific disorders (in her study mental illness) has the potential for reducing stigma. She suggested that the genetics revolution could be a powerful de-stigmatizing force which will expose mental illness as a biochemical disturbance in the brain rather than a character weakness or flaw. This viewpoint is supported by research on attribution theory which shows that stable, onset-uncontrollable conditions (e.g., a genetic illness or disability) reduce stigma via reduced blame, anger, and punishment and increased sympathy and help. It is the hope of genetic attribution theorists that distinctions between humans will decrease as a result of the “geneticization” (i.e., attributing genetic causes to disorders) of deviant behaviors, thus changing the dichotomy from an ‘us-them’ distinction between people with and without devalued characteristics to an appreciation of differences on more of a continuum (Phelan, 2005). A different prediction about the effects of geneticization is offered by the “genetic essentialism” viewpoint. This view suggests that assigning a genetic or hereditary component to a stigmatized characteristic/behavior will increase the ‘us-them’ distinction as a result of the stigmatized individual being perceived as more physically and fundamentally distinct from the non-stigmatized population (Mehta & Farina, 1997). In addition, the stigma label is more fixed and unchangeable, more serious and difficult to escape if it is linked to a genetic cause, and the hope of ever regaining a de-stigmatized status is severely reduced (Jones et al., 1984). Also, it is possible that family members of the stigmatized individual can be stigmatized as a result of geneticization due to the heritable condition of the disorder and the possibility that family members may have a stigmatized condition as well. Phelan (2005) reported on the effects of geneticization in another study using schizophrenia and major depression vignettes embedded in surveys containing varying attributions for these illnesses (i.e., the problem was either partly caused by genetics, or not due to genetics). The results provided support for predictions made by both genetic essentialists and genetic attribution theorists. Genetic attributions reduced blame and anger for stigmatized individuals; however they increased perceived seriousness of the disorder, persistence of the problem, and the logical belief that siblings/children were more susceptible to the same problem. This study reveals that the predictions made by genetic essentialists and genetic attribution theorists need not be mutually exclusive. Contradictory findings have also been reported on the benefits of genetic causality for mental illnesses. For example, Dietrich, Matschinger and Angermeyer (2006) presented participants with a vignette of a case of either major depression or schizophrenia. Participants who endorsed a biogenetic causal explanation (in this case brain disease) for major depression and schizophrenia rather than psychosocial stress, conditions of socialization, or something self-inflicted, perceived the individual in the vignette as more dangerous, resulting in greater fear and greater social distance. In another study, Lam and Salkovskis (2007) had participants watch a videotape of a person suffering from panic disorder. The group that was told that the panic was caused by biological factors reported more pessimistic attitudes about the possibility of recovery, and rated the seriousness of the condition higher when compared with the group that were told the panic disorder was caused by a psychological condition. These results add support to the predictions of genetic essentialists regarding the potential impact of geneticization on the perceptions of certain disorders. 1.4. Causal attribution and the stigma of stuttering Theories about the etiology, development and persistence of stuttering have been and continue to be disputed (Bennett, 2006, Bloodstein and Bernstein-Ratner, 2008, Guitar, 2006, Manning, 2001, Shapiro, 1999 and Subramanian and Yairi, 2006). These theories may modify the public's beliefs about the nature of stuttering by impacting perceptions about what causes stuttering. Disproven or unsubstantiated causal attributions could lead to misconceptions about stuttering and ultimately stigmatization of PWS. Recently, MacKinnon, Hall, and MacIntyre (2007) suggest that the “stuttering stereotype” (i.e., the widely held attitude that PWS as a group exhibit certain negative personality traits such as being shy, quiet, nervous, tense, afraid, self-conscious, etc.) can be explained by the anchoring-adjustment hypothesis. They tested the hypothesis by requesting 183 college students who did not stutter to read and rate vignettes of a hypothetical PWS, a person experiencing normal speech disfluency and a male who displayed neither disfluencies or stuttering using a 25-item semantic differential scale. Results showed that the ratings of the PWS and the person experiencing temporary disfluency were more negative and significantly different from the male with no disfluencies. The authors suggested that their findings supported the anchoring-adjustment hypothesis because participants could have been anchoring their judgments about PWS (and disfluencies) from their own personal experiences during normal speech disfluency. These typical responses may include nervousness, tension, fear, etc., which participants attributed to PWS. These characteristics could be generalized to the personality of PWS, and adjusted to account for the emotional intensity of the situation the speaker is in. Due to the perception that the normally disfluent person is in a highly emotional state, adjustments made by participants yielded more negative ratings for the normally disfluent individual than the PWS. This is an important study in our understanding of the origins of the stuttering stereotype which contributes to the stigma of stuttering. Based on the previous review, we concluded that the stuttering stigma could be the result of not only personal feelings, knowledge and experiences but also the effect of the cause attributed to the disorder. There is clear evidence for genetic factors being a component responsible for the onset of stuttering, as it is been established that stuttering is a heritable disorder in some cases (Ambrose et al., 1997 and Subramanian and Yairi, 2006). It has also been suggested that neuroanatomical and neurophysiological differences exist between PWS and those who do not stutter (Brown et al., 2005 and Watkins et al., 2008). Although researchers and clinicians have all but dismissed the personality, neurotic, or repressed needs theories as psychological underpinnings for the development of stuttering, the general public has not. There is evidence that the general public believes the cause of stuttering is more related to psychological factors rather than genetic or physiological factors. For example, Van Borsel, Verniers, and Bouvry (1999) analyzed the responses of a survey administered to 1362 participants in the general public. Nearly 70% of the respondents believed that stuttering was not hereditary, only 7% classified stuttering as having any neurological cause and nearly half (45%) of all respondents believed that stuttering had a psychogenic cause. Similarly, Xing Ming, Jing, Yi Wen and Van Borsel (2001) and de Britto Pereira, Rossia and Van Borsel (2008) reporting on public awareness and knowledge of stuttering in China and Brazil respectively, found the majority of the respondents were of the opinion that the cause of stuttering was emotional. Other authors have suggested that social identity issues and psychosocial issues may be an integral part of stuttering (Daniels and Gabel, 2004 and Hagstrom and Daniels, 2004). Craig (2003) in discussing services to PWS by clinical psychologists concludes that although the majority of PWS often cope and adapt successfully to stuttering, some are at risk for developing anxiety and social phobias that may require co-occurring treatments for both stuttering and associated psychological problems. The causality assigned to a disorder may increase the public's awareness and information, but may also contribute to misconceptions and potential negative stereotypes, stigmatization and discrimination. 1.5. The current study This study is the first to address the question of whether the stuttering stigma is affected by perceptions about what causes stuttering (i.e., causal attribution). With new reports finding more genetic and physiological links to stuttering, the debate between genetic attribution theorists and genetic essentialists is highly relevant to the stuttering stigma. It is possible that negative stereotypes and social distance that contribute to the development of this stigma may be related to beliefs about the cause of stuttering. Specifically, we wanted to determine the effects of attributing a specific cause to stuttering on perceptions of PWS. Due to the fact that negative stereotypes can be detected by analyzing perceptions of personality characteristics of a group of individuals, and the fact that discrimination can be assessed through social distance scales, we examined the impact of causal attribution for stuttering on the measures of adjective ratings and social distance scores related to a hypothetical PWS. Specifically, this study was designed to determine: (1) differences in university students’ perceptions of social distance to PWS after reading a vignette with a specific causality of stuttering (psychological, genetic, or unknown) on a 7-item social distance scale, (2) differences among university students’ perceptions of PWS after reading a vignette with a specific causality of stuttering (psychological, genetic, or unknown) on a 25-item adjective rating scale, (3) relationships between familiarity with PWS and both scale ratings, and (4) relationships between perceptions of curability of stuttering and both scale ratings.