THE ANDREA YATES EFFECT: PRIMING OF MENTAL ILLNESS STEREOTYPES THROUGH EXEMPLIFICATION OF POSTPARTUM DISORDERS By Lynette Marie Holman A dissertation submitted to the faculty of the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the School of Journalism and Mass Communication. Chapel Hill 2010 Committee: Rhonda Gibson, Ph.D. Francesca Dillman Carpentier, Ph.D. Laura Ruel Tanya Chartrand, Ph.D. Mary Frances Luce, Ph.D. ©2010 Lynette Marie Holman ALL RIGHTS RESERVED ii ABSTRACT LYNETTE MARIE HOLMAN: The Andrea Yates Effect: Priming of Mental Illness Stereotypes Through Exemplification of Postpartum Disorders (Under the direction of Rhonda Gibson) Postpartum depression is a common disorder that can occur after a woman has given birth. Unfortunately, many who suffer from postpartum depression do not seek treatment — one reason may be because of the stigma perpetuated by media accounts of women with postpartum psychosis who commit infanticide (Holman, 2009; Chewning, 2008). Although such incidents are incredibly rare — only 1 in 1,000 new mothers develops postpartum psychosis, and of these, only 4% commit infanticide (Parry, 1995) — women make the news when they kill their infants. This study sought to determine whether an exemplar of extreme maternal mental illness (i.e., Andrea Yates, the Texas woman who drowned her five children in 2001) is more likely to trigger, or prime, harsher judgments of a target character who suffered from postpartum depression than would a non-extreme exemplar. This study used a priming technique whereby participants — 40 pregnant women, 20 for each condition — were exposed to online slideshow stories, one about Andrea Yates and one about a woman who suffered from the milder postpartum depression. Later, their memory was triggered via a subliminal priming technique consisting of flashes of images from either slideshow. The participants then watched a video clip of the target character and were asked to evaluate her. This study sought not only to isolate a media effect, but also to determine how this effect iii may be influencing behavioral intentions such as postponing speaking with their doctors about depression in order to avoid medication. The findings of this study suggest that the non-extreme prime triggered harsher judgments of the target character once that character’s sanity was called into question, whereas the extreme prime prompted participants to correct their judgments of the target character and to evaluate her more positively when her sanity was in question. The non- extreme prime triggered higher perceptions of the risk of developing postpartum disorders than the extreme prime. However, in spite of harsher judgments and higher perceptions of risk, those in the non-extreme condition were more likely than those in extreme condition to engage their health care providers if they thought they were depressed. iv ACKNOWLEDGMENTS First and foremost, I would like to thank my husband, Philip Holman, and my two children, Claudia and Liam, for their unyielding love and support through these three long years. You were my saving grace. I would also like to thank my mother, Linda Seabrook Huck, who not only supported me emotionally; she literally provided her expertise as a Registered Nurse. My gratitude also extends to my in-laws, Wilhelmina and Tony Holman, who helped us hold down the home fort while I pursued my doctoral studies. Others who are literally a part of my dissertation, either by providing voiceovers for the stimulus website or by appearing in the Web video, include my brother, Dr. Mark Chewning, Heather Cigeroglu, Dr. Barbara Friedman, Daniel Siler, Chris Higginbotham, and Samantha Ewing. I am especially appreciative of Samantha Ewing’s bravery in sharing her personal experience with postpartum depression. I would also like to acknowledge all of my friends and family members who have cheered me on through this process. I am grateful for the guidance and support I have received from my dissertation chair, Dr. Rhonda Gibson. She stood by me through every hurdle and pushed me to do better. I would also like to thank my committee. The research I have done with Dr. Francesca Dillman Carpentier provided me with the groundwork for this dissertation. In addition to helping me with my stimulus materials for this study, Laura Ruel has been a great support for me in my personal and professional life. Dr. Tanya Chartrand has been so helpful in focusing my method, and has helped me see a research stream, or story, beyond this one. Dr. Mary v Frances Luce has opened my eyes to medical consumer behavior, which gave me the courage to pursue a study of this population. Finally, I would like to thank the clinicians who supported me in this effort. I am grateful to the physicians, nurses and staff of the OB/GYN Health Center, Volusia OB/GYN, and the Daytona Beach Women’s Center who allowed me to conduct my research with their patients and in their space. I am most grateful to Dr. John Meyers, without whom this study would have never moved forward. Not only did he allow me to recruit his patients, he actively helped me get my proposal through the UNC-Chapel Hill Institutional Review Board. In addition, I am grateful to Dr. Vagovic and Dr. Tapia-Santiago for opening up their offices for my study. I would also like to thank Dr. James Moore for lending his expertise as a mental health practitioner. vi TABLE OF CONTENTS Chapters I. INTRODUCTION............................................................................................... 1 II. MENTAL HEALTH STIGMA IN A MEDIATED CULTURE......................... 14 III. AUTOMATICITY OF STEREOTYPING AND IMPLICIT PREJUDICE...... 18 Awareness .......................................................................................... 21 Intent .................................................................................................. 22 Efficiency............................................................................................ 22 Control................................................................................................ 23 IV. MEDIA PRIMING AND EXEMPLIFICATION.............................................. 26 The Influence of Knowledge Accessibility in Social Cognition and Social Judgment............................................... 26 Media Priming of Stereotypes ............................................................. 29 Exemplification Theory ....................................................................... 31 The Exemplification Effect .................................................................. 35 V. MEDICAL DECISION-MAKING AND AVOIDANCE .................................... 44 Attractive Sources: Influence of Medical Professionals ....................... 46 Strong Logical Arguments: Possible Path for Persuasive Health Messages .......................................................... 47 Non-Conscious Paths to Persuasion and Decision-Making .................. 49 Avoidance Behavior............................................................................ 51 VI. HYPOTHESES AND RESEARCH QUESTIONS ........................................... 54 VII. METHOD.......................................................................................................... 58 Overview ............................................................................................ 58 vii Participants ......................................................................................... 59 Experiment Procedure......................................................................... 61 Study Administration and Ethical Issues.............................................. 63 Stimulus Material................................................................................ 67 Primary Independent Variable............................................................. 68 Primary Dependent Variables.............................................................. 68 Manipulation Checks and Control Variables........................................ 74 Analysis Used in the Results Section................................................... 75 VIII. RESULTS ......................................................................................................... 77 Priming............................................................................................... 77 Exemplification Effect ........................................................................ 86 Behavioral Intentions .......................................................................... 90 Mediation of Activated Goals on Behavioral Intentions....................... 91 Posttest Involvement ........................................................................... 92 IX. DISCUSSION.................................................................................................... 93 Limitations........................................................................................ 104 X. CONCLUSION ................................................................................................ 106 Findings............................................................................................ 106 Future Studies ................................................................................... 110 TABLES.................................................................................................................. 112 FIGURES................................................................................................................