Mental illness stigma and ethnocultural beliefs, values, and norms: An integrative review
Research highlights
► Literature indicates differences in mental illness stigma among various cultures. ► Examined potential relationship between mental illness stigma and cultural values. ► Proposed detailed, systematic approach to future research in the area.
Section snippets
Considering culture
Culture, which materializes as a result of human–environment interaction (Triandis, 2007), refers to the shared attributes, belief systems, and value orientations that a group of people have in common and that influence their customs, norms, practices, social institutions, psychological processes, and organizations (American Psychological Association, 2003, U.S. Department of Health and Human Services, 2001, Fiske et al., 1998). In this article, culture primarily refers to the shared beliefs,
Stigma
The word stigma is derived from a Greek term that refers to marks or signs that were cut or burned into people's bodies to indicate that there was something immoral, unusual, or bad about them and they should be avoided (Goffman, 1963). Thus, stigma is an attribute that discredits an individual, makes the person different from others, and essentially reduces the person's status from a “whole and usual person to a tainted, discounted one” (Goffman, 1963, p. 3). Pescosolido, Martin, Lang, and
Stigma susceptibility
Several dimensions have been identified as contributing to an individual's susceptibility to stigmatization. Jones et al. (1984) conceptualized six dimensions to describe characteristics or conditions prone to stigmatization: concealability, course, disruptiveness, peril, aesthetics, and origin. Although they did not apply their dimensions to mental illness stigma, others have. Concealability refers to how easily detectable the characteristic or condition is. With regard to mental illness, any
Types of stigma
There are two types of mental illness stigma: public stigma and self-stigma (Corrigan and Kleinlein, 2005, Corrigan and Wassell, 2008). Each type impacts the stigmatized person differently, but they likely interact to exacerbate the occurrence and negative effects of stigma.
How stigma operates
Researchers have proposed several theories regarding how mental illness operates on a social level. Early competing theories were labeling theory (Scheff, 1984) and the “psychiatric perspective” (Gove, 1982). Labeling theory proposed that public stigma is associated with labeling because of the “heavy weight of moral condemnation” (Scheff, 1984, p. 30) that labels such as “mentally ill” carry. Labeling leads to the arousal in the general public of negative emotions such as anger and fear that
Stigma and culture
Studies conducted in other countries have investigated cross-national differences in mental illness stigma (e.g., Angermeyer et al., 2004, Littlewood et al., 2007, Weiss et al., 2001) and found that culture is of critical importance in the variation in stigma experience. While these studies examined stigma using groups in different countries, few studies in North America or Western Europe, which have countries and cities with some of the most racially diverse populations, have examined
Cultural norms, values, and socialization impacting stigma
Fig. 2 depicts our new conceptualization of how public and self-stigma operate based on the idea that cultural influences, rather than race and ethnicity, influence people's stigmatizing beliefs, attitudes and actions. There may be several features of cultural influences that impact public and self-mental illness stigma, including culture-specific beliefs regarding the etiology of mental illness, culture-specific stigmatizing beliefs about mental illness, historical injustices and mistreatment
Systematic approach to future research
To address the gaps, disorganization, and limitations of extant research on stigma, we propose a six-step systematic approach to future research in the area (see Fig. 3). This approach assumes that cultural factors are important in the study of mental illness stigma and specifies the research that is needed to develop anti-stigma interventions targeting specific cultural groups. Keep in mind that, although our approach involves steps, the research process is an iterative one, meaning results
Summary and conclusion
Raguram et al. (2004) statement that stigma “is not just a feature of a particular disease or disability but is inevitably situated in a web of social interactions that reflect the influence of cultural meanings” (p. 736) perhaps best describes the findings of this review. There is no overwhelming consensus as to which cultural groups stigmatize mental illness more or less than others; however, we argue that such a comparative evaluation is minimally relevant if at all. Since mental illness
References (87)
- et al.
Rethinking theoretical approaches to stigma: A framework integrating normative influences on stigma (FINIS)
Social Science & Medicine
(2008) - et al.
Culture and stigma: Adding moral experience to stigma theory
Social Science & Medicine
(2007) - et al.
Perception of and attitude towards mental illness in Oman
International Journal of Social Psychiatry
(2002) - et al.
Counseling challenges within the cultural context of the United Arab Emirates
The illusion of reality or reality of illusion: Hallucinations and culture
British Journal of Psychiatry
(1995)- et al.
The experience of stigma among Black mental health consumers
Journal of Health Care for the Poor and Underserved
(2008) Ethical principles of psychologists and code of conduct
American Psychologist
(2002)Guidelines for multicultural education, training, research, practice, and organizational change in psychologists
American Psychologist
(2003)- et al.
Culture and clinical practice: Recommendations for working with Puerto Ricans and other Latinas(os) in the United States
Professional Psychology: Research and Practice
(2006) - et al.
Effects of labelling on public attitudes towards people with schizophrenia: Are there cultural differences?
Acta Psychiatrica Scandinavica
(2004)
Racial differences in stigmatizing attitudes toward people with mental illness
Psychiatric Services
The experience of Black consumers in the mental health system—Identifying barriers to and facilitators of mental health treatment using the consumers' perspective
Issues in Mental Health Nursing
Mental illness stigma and disclosure: Consequences of coming out of the closet
Issues in Mental Health Nursing
Mental illness and principal physical diagnosis among Asian American and Pacific Islander users of emergency services
Issues in Mental Health Nursing
Counseling in Turkey: A blend of western science and eastern traditions
Constructing validity: Basic issues in objective scale development
Psychological Assessment
Racial differences in attitudes toward professional mental health treatment: The mediating effect of stigma
Journal of Gerontological Social Work
Mental illness stigma and care seeking
The Journal of Nervous and Mental Disease
Identification of patient attitudes and preferences regarding treatment of depression
Journal of General Internal Medicine
How stigma interferes with mental health care
American Psychologist
How clinical diagnosis might exacerbate the stigma of mental illness
Social Work
The impact of mental illness stigma
Shame, blame, and contamination: A review of the impact of mental illness stigma on family members
Journal of Mental Health
Understanding and influencing the stigma of mental illness
Journal of Psychosocial Nursing
Barriers to care-seeking for depressed African Americans
International Journal of Psychiatry in Medicine
Providing mental health services to Arab Americans: Recommendations and considerations
Cultural Diversity and Ethnic Minority Psychology
The cultural matrix of social psychology
Dimensions of mental illness stigma: What about mental illness stigma causes social rejection?
Journal of Social and Clinical Psychology
Stigma beliefs of Asian Americans with depression in an internet sample
Canadian Journal of Psychiatry
The path of good medicine: Understanding and counseling Native American Indians
Journal of Multicultural Counseling and Development
Stigma: Barrier to mental health care among ethnic minorities
Issues in Mental Health Nursing
Stigma: Notes on the management of spoiled identity
The current status of the labelling theory of mental illness
Stigma of mental illness among American Indian and Alaska Native nations: Historical and contemporary perspectives
Issues in Mental Health Nursing
Psychiatric care of African Americans
Working with Arab American families: Culturally competent practice for school psychologists
Psychology in the Schools
Differences in cultural beliefs and values among African American and European American men with prostate cancer
Cancer Control: Journal of the Moffitt Cancer Center
Attitudes of Jordanian mental health nurses toward mental illness and patients with mental illness
Journal of Mental Health Nursing
Content validity in psychological assessment: A functional approach to concepts and methods
Psychological Assessment
Stigma and mental illness: A review and critique
Journal of Mental Health
The strengths of Black families
Stigma and mental illness: Developmental issues and future prospects
The mark of shame: Stigma of mental illness and an agenda for change
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