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«Lay perceptions of collectives at the outbreak of the H1N1 epidemic: heroes, villains and victims Pascal Wagner-Egger, Adrian Bangerter, Ingrid ...»

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Published in Public Understanding of Science 20, issue 4, 461-476, 2011

which should be used for any reference to this work

Lay perceptions of collectives at the outbreak of the H1N1

epidemic: heroes, villains and victims

Pascal Wagner-Egger, Adrian Bangerter, Ingrid Gilles, Eva Green, David Rigaud,

Franciska Krings, Christian Staerklé and Alain Clémence

Lay perceptions of collectives (e.g., groups, organizations, countries) implicated in the 2009 H1N1 outbreak were studied. Collectives serve symbolic functions to help laypersons make sense of the uncertainty involved in a disease outbreak. We argue that lay representations are dramatized, featuring characters like heroes, villains and victims. In interviews conducted soon after the outbreak, 47 Swiss respondents discussed the risk posed by H1N1, its origins and effects, and protective measures. Countries were the most frequent collectives mentioned. Poor, underdeveloped countries were depicted as victims, albeit ambivalently, as they were viewed as partly responsible for their own plight. Experts (physicians, researchers) and political and health authorities were depicted as heroes. Two villains emerged: the media (viewed as fear mongering or as a puppet serving powerful interests) and private corporations (e.g., the pharmaceutical industry). Laypersons’ framing of disease threat diverges substantially from official perspectives.

Keywords: collectives, disease threat, epidemic, social representations, swine flu

1. Introduction Lay perceptions of risks are dramatized on the stage of various mass media (Bauer et al., 2001), making them more concrete and thus more real. As a special class of risk, emerging infectious diseases (EIDs) are also subject to media dramatization, as has been documented in several studies (Ungar, 1998, 2008; Wallis and Nerlich, 2005). Who are the dramatis personae on the stage of the disease threat drama? In this article, we argue that the main actors are collectives, in other words large social systems that are constituted by demographic and cultural factors, or institutionalization based on shared values and norms (Brewer and Chen, 2007; Etzioni, 1968). These characteristics empower collectives to act as coherent units. Collectives may include nations, organizations, or even informal groups and other social categories.

An analysis of the social history of disease outbreaks supports the idea of collectives as actors. For example, in many cases, nations, not individuals, are depicted as being threatened by disease. Thus, disease spreads from one nation to another, much as the Black Death plague Authors Pascal Wagner-Egger is lecturer at the University of Fribourg (Switzerland). His main interests of research are the study of reasoning, attitudes, beliefs and social representations.

Correspondence:Département de Psychologie, Université de Fribourg, Rue Faucigny 2, CH-1700 Fribourg, Switzerland; e-mail: pascal.wagner@unifr.ch advanced through Europe from Asia in the Middle Ages and avian influenza advanced through Europe some years ago. Nations can seal their borders to outsiders or block imports of contaminated foreign foodstuffs, as many did with British beef in the wake of the BSE scare. Many other collectives are actors. There are political authorities, who act to contain the disease, initiate public health measures or disseminate disease-relevant information. There are private corporations like pharmaceutical companies who manufacture vaccines and drugs for a profit. And there are groups defined by ethnicity, sexual orientation and other dimensions, who are often perceived as vulnerable to disease threat or as carriers of disease. For example, in the history of AIDS, gays, intravenous drug users, prostitutes and scientists have variously shared the dubious honour of being originators or propagators of the disease in the public eye (Joffe, 1999; Kalichman, 2009). Finally, all of these collectives are orchestrated through depictions in the mass media. Although the media have classically been treated as an “invisible environment” (Glessing and White, 1976), i.e., as part of the scenery, increasing evidence suggests they are perceived by the public as key characters in the drama.

Such perceptions are not inconsequential epiphenomena, because the symbolism with which collectives are construed has cognitive, affective and behavioural consequences. Social psychological research shows that trust in institutions constitutes an important psychological buffer against anxiety caused by fear of death (Solomon, Greenberg and Pyszczynski, 1991) or loss of control (Kay et al., 2009), both feelings often associated with a sudden disease outbreak. Traumatic collective events can lead individuals to increase trust in institutions (Chanley, 2002), while individuals’ distrust of institutions like health authorities is associated with various forms of risky health behaviour (e.g., Bird and Bogart, 2005). Despite the importance of collectives as actors in the drama of EIDs, little systematic attention has been devoted to their study. In this article, we investigate collectives mentioned by Swiss laypersons at the outbreak of the H1N1 (“swine flu”) pandemic in May 2009 and the themes associated with them. Before describing our study, we review research on lay perceptions of disease threat and on individuals’ symbolic relationship to collectives in times of crisis.

2. Lay perceptions of infectious disease threat: from public health to social representations approaches Much existing research on how laypersons perceive the threat of infectious disease is framed according to a public health approach, which traditionally focuses, among other factors, on the public’s knowledge of facts about disease prevention (Des Jarlais et al., 2006; Eurobarometer, 2006; Raude and Setbon, 2009). Public health research thus often proposes that correct knowledge is important to contain an epidemic, thus exemplifying a more general assumption about lay knowledge and attitudes that is known as the deficit model of public understanding of science (Sturgis and Allum, 2004; Wynne, 1991; Ziman, 1991): insufficient knowledge leads the public to develop irrational attitudes and behaviour toward scientific or technological innovations, or sudden threatening events, as in the case of EIDs. While it is important to promote correct public knowledge about disease threat, this kind of research is silent about the symbolic and functional aspects of public perceptions of infectious diseases. It is therefore important to complement public health studies with approaches that explore lay perceptions as symbolic sense-making processes (Wagner, Kronberger and Seifert, 2002).

The social representations approach (Wagner and Hayes, 2005) emphasizes the symbolic aspects of coping with disease threat through interpersonal and mass media communication.

Extensive research by Joffe and colleagues has shown how disease outbreaks around the world are viewed as being caused by collective actors in the form of outgroups. This has been shown for Ebola as apprehended by the British press and laypersons (Joffe and Haarhoff, 2002), AIDS as viewed by Zambian adolescents (Joffe and Bettega, 2003), SARS in the British press (Washer, 2004) or avian influenza as viewed by Hong Kong Chinese (Joffe and Lee, 2004). Outgroups were construed as being at fault because of dirty practices or immoral behaviour (Joffe and Staerklé, 2007) or by intentionally (i.e. malevolently) plotting to disseminate disease (Joffe, 1999). Recent work from this approach emphasizes the role of institutions as central elements in representations of disease threat. For example, in British media coverage of MRSA (the “hospital superbug”) the National Health Service plays a prominent role symbolizing a decaying institution and nostalgia for an earlier age of order and hygiene (Washer and Joffe, 2006). This recent work suggests that groups, institutions and other collectives feature prominently in laypersons’ representations of disease. We therefore build on the social representations approach to disease to systematically focus on the role of collectives as actors.

3. Collectives as heroes, villains and victims

The Russian folklorist Propp (1968) distinguished several basic character types in folk tales.

We use some results of his analysis without going into details of the similarities between traditional folklore and modern social representations (for a discussion, see Bangerter, 2008, or Moscovici, 1992). Two of Propp’s types, the hero and the villain, are useful as a rough but vivid classification of collectives as actors. We define heroes as characters depicted as trustworthy and imbued with a protective function, whereas villains are depicted as untrustworthy and animated by malevolent intentions. We add a third type of character, the victim, a collective directly or indirectly affected by the consequences of infectious disease. In what follows, we define the main attributes of these three character types as well as the role they play in a dramatized social representation of disease.

Heroes Heroes are collectives viewed as trustworthy protective agents or as leaders. These may include public health organizations or respected health professionals. Sometimes, charismatic individuals can be cast as heroes. For example, the political movement known as AIDS denialism propagates the belief that HIV is not the cause of AIDS. It relies heavily on claims made by a rogue scientist, Peter Duesberg (Kalichman, 2009). Duesberg has been depicted by denialists as a lone crusader for the truth against a corrupt and conspiratorial scientific establishment (Cohen, 1994), i.e., as a hero. A second example is the figure of the “matron” identified in Washer and Joffe’s (2006) analysis of British press coverage of MRSA. This personification of a profession, namely a senior nursing figure of the past, symbolizes the strict hygienic standards that have purportedly slipped in modern hospitals, thereby facilitating the spread of MRSA.

These examples converge with theory and empirical research in the social sciences on charismatic leaders. In Max Weber’s (1947) classical analysis, the charismatic leader emerges in a time of crisis where people feel anxious or helpless. The leader’s vision and direction serve to reduce collective anxiety. This collective anxiety-reducing function of the hero is not unlike the functions institutions serve. Social psychological experiments (Kay et al., 2009) show that individuals show increased support for governmental institutions when asked to recall experiences where they lacked personal control, suggesting that trust in (heroic, protective) institutions may help reduce collective anxiety in situations of sudden, unexpected crisis, e.g., outbreaks of infectious disease.

Villains Villains are characters depicted as untrustworthy and animated by malevolent intentions. A prime candidate for the role of villain is often the disease itself, as when the British media personified SARS as a “killer,” or a “single unified entity” (Wallis and Nerlich, 2005: 2634).

Such allegories have a long cultural history. For example, in the Bible, the threat of disease is symbolized by Pestilence, one of the Four Horsemen of the Apocalypse. In many situations, though, laypersons tend to construe the origin of the disease as being due to malevolent actions of groups of humans. The narrative genre that best frames the actions of the villain character is the conspiracy theory, of which there are basically two kinds (Campion-Vincent, 2005; Wagner-Egger and Bangerter, 2007). The first kind (called evil others by CampionVincent, 2005) is historically very old. It depicts outgroups as villains, typically foreigners, stigmatized groups or other minorities (Moscovici, 1987). The classical example of an evilother narrative is the belief that the Black Death was caused by Jews conspiring with the Devil to poison Christian wells (Kelly, 2005). Evil-other conspiracy theories are special cases of the more general narrative of blaming “others” (i.e., outgroups; Joffe, 1999) for causing disease, typically through attributions of unhygienic or immoral practices. What distinguishes them from the garden-variety other-blame narrative is precisely the malevolent intentions of the villain (Klein and Van der Linden, 2010). The second kind of conspiracy theory (called evil elites by Campion-Vincent, 2005) is more recent (perhaps having emerged with the Enlightenment; Campion-Vincent, 2005). It depicts powerful elites as villains. Examples abound in popular culture, for example, the widespread belief that the US government has engineered AIDS to control the Black population (Goertzel, 1994). It is unclear what kind of symbolic function villains serve, although by defining a scapegoat (Berkowitz, 1962), they may provide a relatively simple explanation for an otherwise unfathomable phenomenon.

Moreover, evil-other narratives may also fulfil social identity needs, with the derogation of an outgroup.

Victims Victims are collectives (sometimes personified as individuals) depicted as directly or indirectly affected by disease. Victims have ambivalent status. They are to be pitied for their plight but are also dangerous because they can potentially carry the disease (Wallis and Nerlich, 2005; Washer, 2010). Victims also often need to be protected or helped, because they are unable to cope with disease themselves. The other-blame narrative (Joffe, 1999) operates here again. Indeed, British media reports of the Ebola outbreak depicted Africans as passive victims of the virus who were unable to control it themselves. Western medical science, however, was able to contain it (Joffe and Haarhoff, 2002). As we will see in our study, developing nations are sometimes depicted in such a role. The ambivalent and potentially blameworthy nature of the victim character converges with social psychological research on victim blame and the belief that the world is a just place (Furnham, 2003) where individuals get what they deserve, suggesting that victims may also serve collective coping functions.

4. Aims of the study

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