We found that relatability explained a large proportion of the association between vignette type (depression versus schizophrenia) and social distance. When joined with the allied measure of “us versus them” continuum beliefs, the proportion of the association explained rose to 83%. These findings have implications for (1) how we understand the gap in social distance between depression and schizophrenia, (2) how we might decrease the gap by intervening to increase relatability and (3) how we might explain the results of trend studies showing a widening gap.

Understanding differences in the desire for social distance between disorders

At first glance, our findings align with the proposed distinction between depression and schizophrenia, pointing toward relatability as a key difference between different mental disorders or states of mind. By positing “relatable” disorders against “unrelatable” ones, Jaspers, Star and Rosenberg constructed a polar difference in relatability between “Gemütskrankheiten” and “Geisteskrankheiten”, or between the “sane” and the “insane”, either from a general point of view based on psychopathology (Jaspers), or as individual or societal reactions to unpredictable behavior (Star and Rosenberg). In our study, however, the difference in reactions toward depression or schizophrenia is largely mediated by dimensional constructs. We used a continuous measure of relatability, and in fact, the person with schizophrenia was not perceived as completely unrelatable, but, on average, as less relatable than the person with depression. There was variance in relatability for both disorders, there were respondents more or less able to relate to the person described, and for both disorders, more relatability was associated with less social distance. Our results thus challenge a postulated categorical difference between relatable and unrelatable states of mind. Rather, they show that differences in relatability can be integrated within a continuous model of mental illness. To quote Rosenberg again, we did not find “the human bond [being] snapped”, but rather stretched, to a lesser or stronger degree. Dimensional constructs, in turn, open up the opportunity to think about how to improve the ability of people to relate to someone with a severe mental health problem. In terms of anti-stigma interventions, more relatability seems to be a much more achievable goal than total relatability.

With regard to continuum beliefs, our findings also broaden our understanding of their importance for the stigma of mental illness: our study suggests that here, the continuum between mental health and illness is of particular relevance if it is not solely framed as an abstract continuum between two poles (health and illness, or normality and abnormality, as measured with our items on general continuum beliefs), but also between “us” and “them” [14, 22]. From the angle of illness concepts, too, the willingness to personally relate one’s own experiences to the experiences of the described person seems particularly relevant.

Interventions to increase relatability toward people with schizophrenia

Our findings further suggest that increasing the relatability of mental illness, particularly of schizophrenia, will reduce the desire for social distance from people with this condition. There are studies examining different strategies to directly promote the understanding of the experience of having schizophrenia, but with mixed effects. For example, simulations of either auditory or visual hallucinations showed mixed, and sometimes counter-productive effects on empathy, stereotypes and social distance (Ando et al., 2011; Della Libera 2023). Seemingly, giving respondents first-hand experiences of acute symptoms of psychosis risks making states of psychosis appear even more strange and disturbing to them.

Another, highly plausible way to increase relatability are contact interventions. Corrigan laid out principles of strategic stigma change through contact [23]: To effectively reduce stigma, contact needs to be targeted to specific situations and audiences, credible in terms of recovery, continuous, and local also in a cultural sense. Seen through the lens of relatability, these principles all seem to increase relatability. Encountering someone who is relatable, because they share biographical, cultural and professional attributes with us, and who have recovered from a seemingly unrelatable state of psychosis, but can explain how they experienced this state themselves, might increase relatability even in such extreme circumstances as acute psychosis [24]. Measuring relatability before and after such interventions could potentially help evaluate the effectiveness of contact and other anti-stigma interventions.

Are there ways to maximise intervention effects on relatability, and, simultaneously on the perception of an us/them continuum? Obviously, we can only hypothesize on that, but would propose three avenues. First, informing about the overlap of symptom experiences withcommon, normal experiences might strengthen relatability, and continuum beliefs. Second, stressing the relatable emotional experience behind symptoms that are difficult to relate to might show that even strange symptoms are experienced by a person I can relate to. Third, narratives of recovery from psychosis, transitioning from a difficult-to-relate to an easy-to-relate state might also increase the notion of a relatable person experiencing states that appear strange and unfamiliar. From the literature on contact interventions [25, 26] we gather that these messages would be most effectively delivered by people with lived experience with a mental illness.

Can changes in relatability explain the growing gap between attitudes towards depression and schizophrenia?

The rise in biological illness explanations for mental disorders during the 1990s (the “decade of the brain”) has been used as a backdrop to explain why attitudes towards people with schizophrenia have deteriorated [1, 2, 27]. Biological illness explanations have been shown to be associated with greater perceptions of differentness and dangerousness, and in turn, with a greater desire for social distance [28, 29]. Among medical doctors, biological causal explanations decreased, and psychosocial causal explanations increased general empathy toward patients with mental disorders [30], hence a strong focus on neurobiology might as well have decreased relatability among the general public.

A negative effect of biological illness explanations has been shown most consistently for schizophrenia. It does not, however, explain the improvement of attitudes towards depression, a disorder that has similarly been increasingly associated with biological illness mechanisms [2]. Arguably, relatability of depression (and probably also other common mental disorders) has increased over the last decades, not the least by messages that normalize the experience of depression, and emphasize the susceptibility of everyone to it [31]. Newspaper analyses show that depression is much more often portrayed in the media than schizophrenia, and reports are much more balanced, including information on therapy and very little reference to crime – quite opposite to schizophrenia, which is much less frequently the subject of media reporting, and if mentioned, is predominantly contextualized with crime, without mention of therapeutic options [32, 33].