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Social factors play a significant role in the health outcomes of those struggling with mental or physical health issues. People with mental illness experience more social stigmatization and receive less concern for their welfare than do those with physical illness. However, the cognitive and neural mechanisms by which such a bias in attitude arises remain unclear. This functional MRI study examined whether a lack of self-other similarity during mental state attribution affects perceivers’ theory of mind and, subsequently, how they value a patient’s welfare. During scanning, participants were asked to respond to an expression of caring and sympathetic concern from either their own perspective or while adopting the perspective of patients labeled physically ill or mentally ill. Participants reported that physically ill patients would share their affective responses to the situations, but mentally ill patients would not. Furthermore, mentalizing about physically ill patients was associated with increased activity in the ventromedial prefrontal cortex (vmPFC), a critical region for empathic concern and value-based decisions. In contrast, mentalizing about mentally ill patients preferentially engaged the dorsal anterior cingulate cortex (dACC) and anterior insula, regions previously implicated in empathic distress, in which activity correlated with individual differences in prejudice control. The findings indicate that a lack of perceived self-other similarity poses a challenge to the theory of mind and thus requires greater cognitive resources and neural computations. This might give rise to stereotyped beliefs about and prejudice against the mentally ill and failure to respond with appropriate empathy and care.

The Neurobehavioral Mechanisms Underlying Attitudes Toward People With Mental or Physical Illness