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Mental Illness Stigma

      Joe Tinkham
General Information
● Cognitive Tolerance -- embracing both traditional health methods
  and modern medical practices
● Somatization -- express emotional distress somatically
   ○ well documented in some Arabian Gulf countries as well as
     Eastern Asian countries
   ○ excessive somatization used as metaphor to convey state of
     mind
      ■ e.g. "sinking of the heart" or "broken heart"
      ■ reflect cultural conceptualization and understanding of mental
        process, not deficit in emotional expression
      ■ may relate to using spirit possession as
        metaphor/conceptualization in other cultures
         ■ e.g. spirit catches you
● Idiom of Distress -- most commonly accepted way of
  communicating stress/distress in various cultural settings, which
  may not be common in other cultural settings
   ○ "playing the sick person"
   ○ helps remove stigma of being diagnosed with mental illness
Arabic Countries
● Arabic denotes common language, geography, history, and
  shared values/characteristics
● Treatment for Arab patients primarily includes
  pharmacotherapy
   ○ using psychiatrist/psychologist viewed as personal
     weakness and disgrace of family
   ○ prefer using general healer and refrain from disclosing
     family information
      ■ family hires companion to accompany family member to
        therapy
      ■ they grow close and in many cases the companion
        takes on traits of the client
● Somatization found in Arabic countries
● No distinctive boundaries between self and body
● Certain Doctor/Patient role expectations
   ○ doctor seen as omnipotent, omniscient, mysterious
Egypt
● Cairo is center of mental health research and teach in Arab world
    ○ 70% of professionals in Arab world are Egyptian
    ○ treatment in hospitals is free, but stigma associated with so most
      people prefer private practitioners
● Cultural belief in "Zar Cult" or belief in evil spirits that possess a
  person, causing unhappiness, misfortune, and mental/physical
  illness
    ○ possess certain people who are vulnerable to envy and jealousy
      of others
    ○ can never remove, only appease spirits
● family often have negative attitudes towards mental health
  professionals because they are resistant from making relationships
  outside family/cultural background and they feel guilty, frustrated,
  alienated, and helpless when communicating with them
● "maalesh" or "never mind" attitude toward mental illness and
  bizarre behavior
● varying beliefs in causation ranging from evil eye to heredity
● fear of treatment, especially ECT, often family organizes and
  structures the persons life, which is thought to help
Ghana
● often lack of agreement on how to understand mental illness
  in low-income, developing countries
● greater reliance on culturally specific, traditional explanations
  of mental illness in rural areas
● degree of stigma is influenced by how much blame is
  attributed to the person
   ○ traditional views remove blame from the person and
     places it on social and spiritual forces beyond their control
● more acceptance and support of strong traditional belief
  systems in general
● greater acceptance of biomedical model in urban centers
● Conclusion:
   ○ develop more integrated mental health services to reflect
     different beliefs and include more traditional views
Southern India
● Diversity in beliefs in causes of mental illness related to
  severity of stigma
● Patients and relatives often hold multiple and contradictory
  beliefs about mental illnesses
   ○ not static, but dynamic and adaptive to situation
● Patient beliefs tended to focus on biomedical and karma/evil
  spirits causes
   ○ family relatives tended to focus on karma/evil spirit beliefs
● Almost all believe in treatment of doctor, while also holding
  faith in other treatments such as traditional healers and
  religious cures
●
Japan
● people are more reluctant to use psychiatric labels to
  describe mental disorders, unless they are the more extreme
  forms
● Japan places greater emphasis on hospital care
● less likely to discuss mental health issues outside of the
  family and close friend
● more likely to endorse the helpfulness of private information
  sources
   ○ e.g. books, internet
   ○ Despite the stigma associated with seeking outside help,
     there is a general belief that professional help is beneficial,
     especially psychotropic medication
   ○ however, not optimistic about full recovery
● The predominant view in Japan is that trait neuroticism is a
  major risk factor for depression
   ○ seen as a sign of weakness of character and highly
     stigmatized
Japan continued
● The stigma attached to mental health may also be related to
  a stigma against expressing negative emotions
● Collectivistic cultures tend to focus less on their internal state
  and cognitions
   ○ would affect Japan's bias against expressing negative
     emotions because focusing on one's negative emotions is
     asserting themselves over the importance of the group
● A large part of Japanese culture that may be strongly
  influencing the personal and perceived stigma is the
  "tatamae" and "honne" culture
● Tatamae = things people say in order to maintain positive
  relationships, but may not actually believe
● Honne = what the person is truthfully thinking and believing
● While people still hold negative attitudes towards mental
  disorders (especially more mild cases), they overrate the
  attitudes of the community as being more negative they they
  actually
Fiji Islands
● Urban areas associated with acceptance of Western model
   ○ positive views toward hospitals and medication (majority
     view)
● Rural areas associated with acceptance of traditional etiology
  views
   ○ e.g. witchcraft and use of traditional healers
● Majority do not view witchcraft or heredity as causes of
  mental illness
   ○ lack of belief in witchcraft causes likely due to increasing
     Western influence
   ○ lack of belief in heredity causes likely due to locus of
     control would shift from individual to family -> indicating
     "bad genes"
● Health workers more positively disposed toward those with
  mental illness
   ○ contact with those with mental illness
Australia

● Japan and Australia share a common belief that personal
  vulnerability factors contribute to each disorder, but different
  kinds
● In Australia, there is an emphasis on genetic predisposition
  as a risk factor for developing mental illness
● Greater emphasis on community care
General Findings

● Factors associated with positive attitudes toward mental
  illness:
    ○ direct contact with persons with mental illness
    ○ younger age
    ○ higher education
    ○ more prestigious occupation
● Urban areas tend to favor biomedical model and treatment
  methods
    ○ rural areas tend to favor traditional model and treatment
      methods
● Several studies conclude that education/health education
  have the potential to help reduce stigma
    ○ several also indicate integrating traditional views into
      mental health services

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Mental illness stigma ppt slides - cultural info

  • 1. Mental Illness Stigma Joe Tinkham
  • 2. General Information ● Cognitive Tolerance -- embracing both traditional health methods and modern medical practices ● Somatization -- express emotional distress somatically ○ well documented in some Arabian Gulf countries as well as Eastern Asian countries ○ excessive somatization used as metaphor to convey state of mind ■ e.g. "sinking of the heart" or "broken heart" ■ reflect cultural conceptualization and understanding of mental process, not deficit in emotional expression ■ may relate to using spirit possession as metaphor/conceptualization in other cultures ■ e.g. spirit catches you ● Idiom of Distress -- most commonly accepted way of communicating stress/distress in various cultural settings, which may not be common in other cultural settings ○ "playing the sick person" ○ helps remove stigma of being diagnosed with mental illness
  • 3. Arabic Countries ● Arabic denotes common language, geography, history, and shared values/characteristics ● Treatment for Arab patients primarily includes pharmacotherapy ○ using psychiatrist/psychologist viewed as personal weakness and disgrace of family ○ prefer using general healer and refrain from disclosing family information ■ family hires companion to accompany family member to therapy ■ they grow close and in many cases the companion takes on traits of the client ● Somatization found in Arabic countries ● No distinctive boundaries between self and body ● Certain Doctor/Patient role expectations ○ doctor seen as omnipotent, omniscient, mysterious
  • 4. Egypt ● Cairo is center of mental health research and teach in Arab world ○ 70% of professionals in Arab world are Egyptian ○ treatment in hospitals is free, but stigma associated with so most people prefer private practitioners ● Cultural belief in "Zar Cult" or belief in evil spirits that possess a person, causing unhappiness, misfortune, and mental/physical illness ○ possess certain people who are vulnerable to envy and jealousy of others ○ can never remove, only appease spirits ● family often have negative attitudes towards mental health professionals because they are resistant from making relationships outside family/cultural background and they feel guilty, frustrated, alienated, and helpless when communicating with them ● "maalesh" or "never mind" attitude toward mental illness and bizarre behavior ● varying beliefs in causation ranging from evil eye to heredity ● fear of treatment, especially ECT, often family organizes and structures the persons life, which is thought to help
  • 5. Ghana ● often lack of agreement on how to understand mental illness in low-income, developing countries ● greater reliance on culturally specific, traditional explanations of mental illness in rural areas ● degree of stigma is influenced by how much blame is attributed to the person ○ traditional views remove blame from the person and places it on social and spiritual forces beyond their control ● more acceptance and support of strong traditional belief systems in general ● greater acceptance of biomedical model in urban centers ● Conclusion: ○ develop more integrated mental health services to reflect different beliefs and include more traditional views
  • 6. Southern India ● Diversity in beliefs in causes of mental illness related to severity of stigma ● Patients and relatives often hold multiple and contradictory beliefs about mental illnesses ○ not static, but dynamic and adaptive to situation ● Patient beliefs tended to focus on biomedical and karma/evil spirits causes ○ family relatives tended to focus on karma/evil spirit beliefs ● Almost all believe in treatment of doctor, while also holding faith in other treatments such as traditional healers and religious cures ●
  • 7. Japan ● people are more reluctant to use psychiatric labels to describe mental disorders, unless they are the more extreme forms ● Japan places greater emphasis on hospital care ● less likely to discuss mental health issues outside of the family and close friend ● more likely to endorse the helpfulness of private information sources ○ e.g. books, internet ○ Despite the stigma associated with seeking outside help, there is a general belief that professional help is beneficial, especially psychotropic medication ○ however, not optimistic about full recovery ● The predominant view in Japan is that trait neuroticism is a major risk factor for depression ○ seen as a sign of weakness of character and highly stigmatized
  • 8. Japan continued ● The stigma attached to mental health may also be related to a stigma against expressing negative emotions ● Collectivistic cultures tend to focus less on their internal state and cognitions ○ would affect Japan's bias against expressing negative emotions because focusing on one's negative emotions is asserting themselves over the importance of the group ● A large part of Japanese culture that may be strongly influencing the personal and perceived stigma is the "tatamae" and "honne" culture ● Tatamae = things people say in order to maintain positive relationships, but may not actually believe ● Honne = what the person is truthfully thinking and believing ● While people still hold negative attitudes towards mental disorders (especially more mild cases), they overrate the attitudes of the community as being more negative they they actually
  • 9. Fiji Islands ● Urban areas associated with acceptance of Western model ○ positive views toward hospitals and medication (majority view) ● Rural areas associated with acceptance of traditional etiology views ○ e.g. witchcraft and use of traditional healers ● Majority do not view witchcraft or heredity as causes of mental illness ○ lack of belief in witchcraft causes likely due to increasing Western influence ○ lack of belief in heredity causes likely due to locus of control would shift from individual to family -> indicating "bad genes" ● Health workers more positively disposed toward those with mental illness ○ contact with those with mental illness
  • 10. Australia ● Japan and Australia share a common belief that personal vulnerability factors contribute to each disorder, but different kinds ● In Australia, there is an emphasis on genetic predisposition as a risk factor for developing mental illness ● Greater emphasis on community care
  • 11. General Findings ● Factors associated with positive attitudes toward mental illness: ○ direct contact with persons with mental illness ○ younger age ○ higher education ○ more prestigious occupation ● Urban areas tend to favor biomedical model and treatment methods ○ rural areas tend to favor traditional model and treatment methods ● Several studies conclude that education/health education have the potential to help reduce stigma ○ several also indicate integrating traditional views into mental health services