Thomas J. Schoeneman, Katherine A. Schoeneman, and Jelena Obradovic

Lewis & Clark College

Abstract

We identified 106 pictures relating to AIDS/HIV from the 79 abnormal psychology textbooks published from 1984-2001. This sample depicted 173 persons with AIDS/HIV status or risk and 107 AIDS-related objects. Content analyses of 38 areas of category information achieved an overall inter-rater reliability of 97%. Pictures appeared in chapters on stress-related disorders, sexual disorders, substance abuse, and organic brain disorders. Individuals were either at risk for HIV/AIDS (48%), HIV-positive (12%), or diagnosed with AIDS (41%) and overwhelmingly male (80%), white (69%), adult (84%), of unknown sexual orientation (79%) and undiagnosed with mental disorder (67%). AIDS-related objects appeared in almost 3/4 of the pictures. The most frequent were prevention signs and posters, hospital furnishings, and drug paraphernalia. Qualitative inspection of the sample revealed thematic motifs of sick hospital patient, information source, junkie, support group, celebrity, innocent child victim, protestors, condom dispensary, and T-cell invasion. Consistent with Social Representations Theory and previous research, images of AIDS continue to be anchored to concepts of the Other, death, victimization and culpability. Despite attempts to the contrary, textbooks may also inadvertently present AIDS as a disease of homosexuals and as associated with mental disorder.

Thomas J. Schoeneman, Katherine A. Schoeneman, and Jelena Obradovic

Lewis & Clark College

How do people develop everyday knowledge and stereotypes of new social phenomena such as AIDS? Moscovici’s (1984) Social Representations Theory (SRT) suggests that individuals interact with each other and with cultural ideologies to form the negotiated understandings that make up their socially constructed reality.

Social representations of AIDS and other unfamiliar phenomena are formed through two processes. Anchoring involves "the classification and naming of unfamiliar objects or social stimuli by comparing them with an existing stock of familiar and culturally accessible categories" (Augoustinos & Walker, 1995, p. 138). By the late 1980s, a number of investigators had identified the metaphoric anchors that had served to characterize AIDS. The disease and its victims were identified with death, plague, evil, cancer, punishment, sexually transmitted diseases, homosexuality, war, crime, urban areas, contamination, victim and perpetrator, and a general status as "the Other" (see Table 1 for details).

The research described here aimed to discover and characterize pictorial stereotypes of AIDS in abnormal psychology textbooks. We chose this source of pictures for two reasons. First, we have been doing content analytic research on depictions of mental disorder as they have appeared in these textbooks since the 1980s (Schoeneman, Brooks, Gibson, Routbort, & Jacobs, 1994; Schoeneman & Marley, 1995; Schoeneman, Henderson, & Ma, 1997). We had the materials at hand and we noticed an increasingly frequent appearance of AIDS depictions in our sample of pictures. Second, the transformation of the metaphoric anchors of AIDS into images in these textbooks presents an interesting problem in balance. On the one hand, we would expect temperance and sympathy for AIDS patients from the authors of these textbooks: references to contamination, plague, evil, the wrath of God and the like should be muted or even absent. On the other hand, if authors of textbooks stray too far from the culture’s established anchors in depictions of AIDS and AIDS patients, they risk incomprehensibility. Whether and how the pictures in our sample strike this balance is part of our interest in this investigation.

Method

Using the 79 abnormal psychology textbooks published from 1984 to 2001 in the United States, the authors identified 106 pictures relating to AIDS/HIV. These 106 pictures contained 173 persons with AIDS/HIV status or risk and 107 AIDS-related objects. The second and third authors analyzed pictures using a coding manual that defined 38 areas of category information (e.g., gender, race, AIDS risk status, psychiatric diagnosis, sexual orientation, etc.; Schoeneman, Obradovic, & Schoeneman, 2001). Raters then met with the first author to compare notes and reconcile differences. Using this procedure, inter-rater agreement for each of the 38 stereotype ratings fell within a range of 80-100%, with 31 of the 38 ratings showing agreement better than 90%. Overall agreement was 97% (5112 out of 5269 categorizations).

Results

Pictures related to AIDS appeared in 45 of our 79 textbooks (57%). Thus, the average number of AIDS-related pictures per book in the entire sample was 1.3 (106/79) and in the subsample of only those books that included AIDS pictures the average per book was 2.4 (106/45). The 106 pictures appeared primarily in chapters on stress-related disorders (45%), sexual disorders (29%), substance abuse (10%), and organic brain disorders (9%). AIDS-related objects were found in 71% of the pictures.

The sample contained 45 pictures with one focal person (42%), 33 pictures with two focal persons (31%), 7 each having 3 or 4 persons (7%), 4 having 5 or more (4%), and 10 showing no persons but only AIDS-related objects (9%). Individuals depicted in our sample were either at risk for contracting AIDS/HIV (48%), diagnosed as having AIDS (41%), or diagnosed as HIV-positive (12%). Risk factors for contracting AIDS/HIV were predominantly sexual intercourse (32%; homosexual [11%], heterosexual [9%], or unspecified [12%]), IV drug use/abuse (16%), and transmission from mother to child (4%); the remaining 49% of focal persons were unspecified for risk factor. The gender of focal persons was 80% male, 16% female, and 4% unknown/group, and the racial breakdown was 69% White, 27% Black, 1% Asian, 0% White/Hispanic, and 3% unknown/mixed group. The sample was comprised of adults (84%) and children (15%), with only one elderly individual (<1%). Focal persons’ sexual orientation was unknown (79%), homosexual (11%), or heterosexual (10%). The psychiatric diagnosis status of focal persons was defined as not diagnosed (67%), diagnosed (22%), and at risk for a mental disorder (11%). For those classified as having mental disorders, the most frequent diagnoses were drug abuse (47%), multiple diagnoses (24%), and organic brain syndrome (17%). Finally, 16% of our sample were depicted as visibly physically sick.

The sample of pictures also contained depictions of 107 AIDS-related objects. Those that appeared most frequently were AIDS prevention signs and posters (primarily fear-based messages, 22%), hospital furnishings (16%), drug paraphernalia (14%), AIDS memorial items (ribbons, quilts; 11%), condoms (8%) and needle exchange containers (7%).

AIDS was first named in late 1982. Its cause, human immunodeficiency virus (HIV) was discovered in 1984. The first AIDS-related picture in an abnormal psychology textbook appeared in 1984, a single picture with the headline "AIDS: The gay plague." The picture shows five men in a parade carrying a banner that reads "San Francisco A.I.D.S. Fund." The accompanying text notes that "clearly, AIDS has become an epidemic of frightening proportions. It imposes on members of the gay community a cruel choice: renounce casual sexual relations or face the risk of permanent disablement or death" (Coleman, Butcher, & Carson, 1984, p. 282).

Four years elapsed before the next pictures of AIDS appeared. A new edition of the pioneering textbook of 1984 dropped the "gay plague" reference and picture in favor of three new depictions: "the AIDS virus . . . attacking a helper T-cell" (Carson, Butcher, & Coleman, 1988, p. 255); two men in the foreground of a gay rights parade carrying signs that say "SILENCE = DEATH" (p. 445); and a male doctor drawing blood from a young man to test for "syphilitic infection and other sexually transmitted diseases" (including, as the text on the same page makes clear, AIDS; p. 458). A second textbook (Meyer & Salmon, 1988, p. 389) included a photograph of two young men sitting at a table with a sign that says "AIDS Information Center." Behind them is a sign that lists numbers of AIDS cases and deaths in New York City and nationwide; the numbers on the sign are crossed out, with higher figures written in alongside.

These five pictures constitute the entire set of AIDS-related depictions in the first chronological third of our sample (1984-1989). There were 19 textbooks published in this period, giving a ratio of 0.3 pictures per textbook. In the next six year period (1990-1995) the ratio jumped to 1.6 (36 pictures in 22 textbooks) and leveled off at 1.7 (65 pictures, 38 books) in the final third (1996-2001). In the 1990s, AIDS-related pictures became a standard feature in abnormal psychology textbooks.

The first two pictures of actual AIDS patients didn’t appear until 1990 and 1991. Both are pictures of AIDS patients in support groups. The first shows three young men with eyes closed, holding hands above the caption "Group support is one of the components of current therapy with AIDS patients" (Davison & Neale, 1990, p. 366). The second shows four young men seated in a quarter-circle; one man sits behind a walker and another holds a cane. The caption reads, in part, "Support groups may improve the quality of life of AIDS victims" (Rathus & Nevid, 1991, p. 177).

Qualitative inspection of the sample of pictures revealed a number of themes. Prominent motifs depicted AIDS figures as:

As a final note, we observed some interesting trends involving race. There were no white heterosexual couples in our sample; most of the individuals coded as heterosexual were African American. In addition, all of the gay males in the sample were white.

Discussion

Gilman (1988) suggests that depictions of the diseased and ill help us to project our own fears of collapse and dissolution onto an "Other," a "not-me" who is sick and an opposite to the healthy "me." As Ross (1986) puts it, "the metaphor of otherness provides comfort to those who use it because it implies they will be spared harm and responsibility" (p. 18). Although we doubt that the authors of abnormal psychology textbooks intend to promote this kind of distance by objectifying AIDS in pictures, it seems unavoidable: Pictures of people who have the status of "patient," whether in hospital, clinic or support group–and especially those who are visibly sick–cannot help but put the viewer and the viewed on opposite sides of the boundary between health and illness.

The pictures in our sample construct AIDS patients as the Other in two additional ways. First, conceptions of AIDS since its emergence in the early 1980s have been anchored using categories of the Other that have a long history: the homosexual, the drug addict and the syphilitic (Gilman, 1988; Markova & Wilkie, 1987; Norton et al., 1990; Sontag, 1990). All of these compoundings of categories of the Other are present in our sample. Second, Sontag (1990) has noted what she sees as a common tendency in the conceptualization of diseases such as cancer and AIDS: "the move from the demonization of an illness to the attribution of fault to the patient is an inexorable one" (p. 99). Weiner et al. (1988) have shown that their college student informants see AIDS as a disease that has causes that are controllable by it victims. As a result, AIDS patients are seen as responsible for their misfortune. In our sample, authors are careful not to assign blame to AIDS victims in captions or the accompanying text. However, the pictures that show drug addicts shooting up, babies whose mothers have transmitted HIV to them, and posters that urge young adults not to engage in unprotected sex send a message of past or future blame.

It seems clear that the authors of these textbooks are trying to avoid stereotyping. They tend, for example, to avoid identifying the sexual orientation of figures in the pictures. This restraint can be juxtaposed against the overwhelming number of male figures in our sample. Only 14% (18/131) of the males in our sample were identified by caption or visual cues as homosexual, but the 78% whose sexual orientation was unspecified included pictures of young men in pairs and groups. What would the average reader of the textbook assume about the men in these pictures?

Textbook authors also avoid identifying people who are at risk for AIDS or those who have contracted HIV or AIDS as mentally ill. The concentration of pictures in chapters on stress, sexual disorders, drug abuse and OBS, and the very fact of their inclusion in a textbook of abnormal psychology probably suggest an identification of AIDS/HIV status or risk with mental disorder, a potential double stigmatization.

The authors, editors, and publishers of abnormal psychology textbooks thus propagate social representations of AIDS that illustrate and reinforce the anchoring of the disease in concepts such as Otherness, death, victimization, and culpability. They do so unwittingly and, in fact, unavoidably: Once the agents in a web of social communication construct an understanding of a phenomenon such as AIDS, it is very difficult to avoid using those terms that have come to define the disorder. What we have found in the realm of textbook publishing is merely a microcosm of the larger society: Gilman’s (1988) analyses of largely sympathetic, unsensationalized print media depictions in the 1980s are quite similar to ours.

We do not believe that eliminating pictures of AIDS-related subjects in textbooks will resolve the problems that we have identified: The anchors of AIDS in Table 1 are also present in written communication as metaphors. Nor does it seem desirable to ignore the topic of AIDS altogether. We hope that our findings will inform discussions about how to represent AIDS in a way that avoids its more problematic stereotypes.

References

Augoustinos, M., & Walker, I. (1995). Social cognition: An integrated introduction. London: Sage.

Carson, R. C., Butcher, J. N., & Coleman, J. C. (1988). Abnormal psychology and modern life (8th ed.). Glenview, IL: Scott, Foresman.

Coleman, J. C., Butcher, J. N., & Carson, R. C. (1984). Abnormal psychology and modern life (7th ed.). Glenview, IL: Scott, Foresman.

Davison, G. C., & Neale, J. M. (1990). Abnormal psychology (5th ed.). New York: Wiley.

Gilman, S. L. (1988). Disease and representation: Images of illness from madness to AIDS. Ithaca, NY: Cornell University Press.

Markova, I., & Wilkie, P. (1987). Representations, concepts and social change: The phenomenon of AIDS. Journal of the Theory of Social Behaviour, 17, 389-409.

Meyer, R. G., & Salmon, P. (1988). Abnormal psychology (2nd ed.). Boston: Allyn & Bacon.

Moscovici, S. (1984). The phenomenon of social representations. In R. M. Farr & S. Moscovici (eds.), Social representations (pp. 3-69). London/Paris: Cambridge University Press/Maison des Sciences de l'Homme.

Norton, R., Schwartzbaum, J., & Wheat, J. (1990). Language discrimination of general physicians: AIDS metaphors used in the AIDS crisis. Communication Research, 17, 809-826.

Rathus, S. A., & Nevid, J. S. (1991). Abnormal psychology. Englewood Cliffs, NJ: Prentice-Hall.

Ross, J. W. (1986). Ethics and the language of AIDS. Federation Review, IX (3), 15-19.

Schoeneman, T. J., Brooks, S., Gibson, C., Routbort, J., & Jacobs, D. (1994). Seeing the insane in textbooks of abnormal psychology: The uses of art in histories of mental illness. Journal for the Theory of Social Behaviour, 24, 111-141.

Schoeneman, T. J., Henderson, C., & Ma, V. (1997, April). Interior landscapes of mental disorder in textbooks of abnormal psychology. Paper presented at the meeting of the Western Psychological Association, Seattle, WA.

Schoeneman, T. J., & Marley, C. (1995, June). Who’s who in textbooks of abnormal psychology: Pictures of notable heroes and victims. Paper presented at the meeting of the American Psychological Society, New York, NY.

Schoeneman, T. J., Obradovic, J., & Schoeneman, K. A. (2001). Picture coding of HIV/AIDS in abnormal psychology textbooks. (Unpublished coding manual).

Sontag, S. (1990). Illness as metaphor and AIDS and its metaphors (combined ed.). New York: Anchor.

Weiner, B., Perry, R. P., & Magnusson, J. (1988). An attributional analysis of reactions to stigmas. Journal of Personality and Social Psychology, 55, 738-748.

Table 1: AIDS and its Anchors