Books! The best weapons in the world…against stigma. The role of foregrounding on empathy and identification with the story character, and stigma reduction of depression

:speech_balloon: Speaker: Giulia Scapin @Giulia_Scapin

:classical_building: Affiliation: Vrije Universiteit Amsterdam - ELIT Network

Title: Books! The best weapons in the world…against stigma. The role of foregrounding on empathy and identification with the story character, and stigma reduction of depression

Abstract (long version below): I explored the possibility to use literary texts as a tool to reduce stigmatization of people living with depression. In a serie of four studies, I explored the hypothesis that deep processing of foregrounding, one of the key elements for “literariness”, is positively related to the reader’s empathic reactions and identification with the story character. By presenting stories with characters with depressive behaviors, we observed a reduction of stigma towards people living with depression. The last step of this project will be to design an intervention to help readers to deeply process foregrounding elements, which is connected with attitudes changes (i.e., reduction of stigma), by the adaptation of Shared Reading methodology in solitary reading.

Scapin_Poster IGEL-ELIT 2023_v4.pdf (603.9 KB)

:newspaper: Long abstract

In my research, I addressed the social problem of stigmatization of people living with depression (e.g., Arpino & Pasqualini, 2021; Rössler, 2016; Yokoya et al., 2018). Stigma represents an issue not only for the stigmatized person, but for the whole society since it hinders prevention, early recognition of symptoms, and approach to treatment. One of the interventions that is mostly applied to reduce the stigmatization of marginalized populations is interpersonal contact (Corrigan et al., 2021). In my PhD, I explored the possibility of using reading literary texts and the “contact” with fictional characters (the “meeting of minds” in Oatley, 1999; see also Mar & Oatley, 2008; Mar, 2018) as an alternative tool to have contact with this population and improve attitudes. In particular, I focused my attention on foregrounding, as one of the key elements of “literariness” (Miall & Kuiken, 1999), that “helps to upset the stereotypical schemata through which we usually make sense of the world” (Koopman, 2016, p. 64). The project tries to disentangle and empirically support the relationship between foregrounding and empathy and its potential role in reducing stigma by applying a different approach based on recent findings (e.g., Harash, 2019; 2021).

I first explored the assumption that foregrounding is linked with affective reactions and that some foregrounding elements are perceived similarly by different readers (e.g., Miall & Kuiken, 1994; Van Peer, 1986). Participants read one of two selected stories and highlighted either the parts they considered foregrounded or affect evoking. We found a pattern relating foregrounding and affect, but no agreement among participants on what they perceived as foregrounding.

Second, I dived deeper into the way participants actually processed the foregrounding elements they perceived in the text, analyzing their open answers by applying a coding system based on the Failed Foregrounding Theory of Harash (2019, 2021). Five categories were created: Shallow, Failed, Partial and Full Processing of Foregrounding, and Not Applicable. The results (Scapin et al., 2023) showed that readers actually process foregrounding differently, and this is connected with the way they empathize with the story character.

Therefore, once established a relationship between foregrounding and empathy, we explored the hypothesis that empathy and identification with the story character mediate the effect of the different processing of foregrounding on the reduction of stigma. To test this hypothesis, we first revised the Identification Scale of Cohen (2001), in order to have a clearer understanding of the role of its sub-dimensions (Absorption, Shared Goals, Empathy; currently under validation) in the mediation. Second, we create four vignettes representing the four types of processing of Foregrounding (Full, Partial, Failed, or Shallow) we identified in literature (Harash, 2019, 2021) and in our previous study. All participants read the same text and answered the revised version of the Identification Scale, the Depression Stigma Scale (Griffith et al., 2008), and chose one of the vignettes created to self-assess their foregrounding processing. Results supported our hypothesis that deeper processing of foregrounding is related to higher identification and empathy with the story character, which are connected to a lower level of stigma for people living with depression.

The third and final study will involve Shared Reading organizations. In the previous studies, we observed that the processing of Foregrounding plays a role in the empathic reaction and identification with the story character, which then influences the stigmatization of people with depression. However, it was not possible to clarify the direction of the relationship between the processing of foregrounding and empathy. Is the deeper processing of foregrounding that helps the reader to empathize with the character? Or vice versa, is the empathic reaction of the reader that directs the attention towards foregrounding elements and sustains deeper processing? The planned study will try to manipulate the processing of foregrounding, inducing deeper processing in one group of readers and comparing it with a control group. To induce deeper processing of foregrounding, we will base on the methodology used in Shared Reading groups (The Reader, 2023). The manipulation will be designed under the guidance of expert Reader Leaders. We expect that selected prompts inspired by the Shared Reading methods will elicit deeper processing of foregrounding compared to the group reading without these prompts, clarifying the effect of foregrounding processing over empathy.


Arpino, B., & Pasqualini, M. (2021). Effects of Pandemic on Feelings of Depression in Italy: The Role of Age, Gender, and Individual Experiences During the First Lockdown. Frontiers in psychology, 12.

Cohen, J. (2001). Defining Identification: A Theoretical Look at the Identification of Audiences With Media Characters. Mass Communication & Society, 4(3), 245–264.

Corrigan, P. W., Morris, S. B., Michaels, P. J., Rafacz, J. D., & Rüsch, N. (2012). Challenging the public stigma of mental illness: a meta-analysis of outcome studies. Psychiatric services (Washington, D.C.), 63(10), 963–973.

Griffiths, K. M., Christensen, H., & Jorm, A. F. (2008). Predictors of depression stigma. BMC Psychiatry, 8(1), 1–12.

Harash A. (2019). Attention, Aesthetic Appraisal and Semantic Noise while Reading of a Literary Text (Unpublished doctoral dissertation or master’s thesis). Tel Aviv University, Tel Aviv.

Harash, A. (2021). The model of failed foregrounding. Psychology of Aesthetics, Creativity, and the Arts. Advance online publication.

Koopman, E. M. (2016). Effects of ‘Literariness’ on Emotions and on Empathy and Reflection after Reading. Psychology of Aesthetics, Creativity, and the Arts, 10 (1), 82–98. doi:10.1037/aca0000041

Mar, R. A. (2018). Evaluating whether stories can promote social cognition: Introducing the Social Processes and Content Entrained by Narrative (SPaCEN) framework. Discourse Processes, 55(5-6), 454-479. doi:10.1080/0163853x.2018.1448209

Mar, R. A., & Oatley, K. (2008). The Function of Fiction is the Abstraction and Simulation of Social Experience. Perspectives on Psychological Science, 3(3), 173–192.

Miall, D. S., & Kuiken, D. (1994). Foregrounding, defamiliarization, and affect: Response to literary stories. Poetics, 22(5), 389-407.

Miall, D. S., & Kuiken, D. (1999). What is literariness? Three components of literary reading. Discourse Processes, 28(2), 121-138. doi:10.1080/01638539909545076

Oatley, K. (1999). Meetings of minds: Dialogue, sympathy, and identification, in reading fiction. Poetics, 26(5-6), 439-454. doi:10.1016/s0304-422x(99)00011-x

Rössler, W. (2016). The stigma of mental disorders. EMBO Reports, 17(9), 1250-1253. doi:10.15252/embr.201643041

Scapin, G., Loi, C., Hakemulder, F., Bálint, K., & Konijn, E. (2023). The role of processing foregrounding in empathic reactions in literary reading. Discourse Processes, 1-21.

The Reader (2023, June 30). The Reader.

Van Peer, W. (1986). Stylistics and psychology: Investigations of foregrounding. Routledge.

Van Peer, W., Sopcak, P., Castiglione, D., Fialho, O., Jacobs, A.M., Hakemulder, F. (2021.). Foregrounding. In Kuiken, D., Jacobs, A., (Ed.), Living Handbook of the Empirical Study of Literature (pp. 145-176). Berlin/Boston: de Gruyter.

Yokoya, S., Maeno, T., Sakamoto, N., Goto, R., & Maeno, T. (2018). A Brief Survey of Public Knowledge and Stigma Towards Depression. Journal of Clinical Medicine Research, 10(3), 202-209. doi:10.14740/jocmr3282w

Can’t wait to see the outcome of study 2. Would be lovely to have a chat about it!