Stigma related to culture, race, and health is said to be present in every society to varying degrees. It can occur as a result of certain generalisations regarding the personal attributes of other people. The universality of stigma has led to its rampant prevalence even in the field of mental health, where it rears its ugly head to discriminate and exclude individuals suffering from mental illnesses and physical deformities.
It also targets a variety of identities and ethnicities, leading to further undue victimisation and exploitation. A popular example is the cartoon character Eeyore from Winnie the Pooh, suggesting that such disheveled and glum-looking individuals are the face of classic depression, prompting the generalisation that all who are depressed appear equally glum and dejected.
Stigma is a complex social phenomenon that finds its roots in seemingly straightforward components. First, those suffering from mental health illnesses are often held responsible for their own condition, leading to an unfair blame game and a general lack of sympathy. Uncertainty regarding an individual’s condition with a slight possibility of improvement could still result in stigma in terms of being left or avoided by their family members.
The unpredictable and erratic nature of those suffering from poor mental health may lead to avoidance, labeling, and unfair social distance. Fears surrounding unpredictable acts of violence are unjustly associated with mental health patients causing harmless individuals to be stigmatised for no apparent reason. The intensity of such components heightens when introducing other social structures, such as culture, into the mix.
Mental health stigma is universally present; however, research has found cultural differences in perspectives surrounding mental illnesses, treatment utilisation, and community support for the same. Seen especially in India, China, Japan, and other Asian regions, mental illness is viewed as a shameful condition, something to lose societal standing over, and even deny advancement to family members, despite it not being under anyone’s control.
A study on U.S. college campuses as well showed that Asian students were less likely to disclose mental health illnesses or utilise mental health treatment facilities compared to students with European ancestry. Rather than focusing on the etiology of the illness, the East gravitates to collectivism: how mental health struggles would impact friends and family members’ social and economic well-being; having a mental illness being a direct violation of cultural norms; spillover concerns of ostracisation as a result of disclosure.
The fears and social concerns regarding mental health that plague the East generally manifest as anticipated and perceived stigma, wherein those suffering from mental health illnesses are tormented by the thoughts of being discriminated against by others in social scenarios.
This further contributes towards sweeping a mental health issue "under the rug" in a bid to avoid the shame and possibility of being ostracised by society. The inability to contribute effectively to a group, as is pivotal from the Eastern perspective, also explains why individuals from such cultures are significantly less likely to seek or receive any mental health care or intervention compared to Europeans or Americans.
It differs from findings in the West, where acceptance of the biomedical causality of mental health illnesses has greatly increased in recent times, and along with it, the propensity to seek help if suffering from mental health issues.
The stigma surrounding any mental health issue is so prevalent that even a scarily common issue of depression does not escape its clutches. A study on African-Americans found that approximately 63 percent viewed depression as a form of "personal weakness," about 30 percent would prefer dealing with the depression themselves, and more worryingly, only one-third would accept medication for the same from a medical professional. This makes it all the more difficult for mental health professionals to help those with mental health issues, requiring them to break through the barrier of stigma to ensure the provision of proper interventions.
Any attempts to reduce stigma in nations and cultures where mental health issues are frowned upon might require culturally tailored intervention strategies along with the presentation of mental health care services and issues in culturally-sensitive ways. This boils down to beliefs about mental health issues differing drastically between the collectivist perspective of the East and the biomedical perspective of the West. In a way, it can help to specifically target moral attributions, such as "bad character," and concerns of disclosure spillover leading to ostracisation to reduce the rates of stigma in the East.
Shifting attitudes and prejudices regarding any stigma, let alone regarding mental health, is not an easy task; however, experience and research can guide the way. Initiatives like large-scale awareness campaigns promoting social contact and inclusivity have been shown to have positive changes in public attitudes.
Many organisations have also started implementing anti-stigma strategies, such as WHO’s QualityRights initiative, which readily provides training materials, technical support, and guidance to promote recovery and inclusion. An educative, open, and supportive strategy is required to fight against stigma and reduce discrimination attached to mental health issues and those affected. The battle might just be a “never-ending story” requiring such sustained programmes and efforts instead of a short-lived campaign.
Hreem Mahadeshwar
Hreem Mahadeshwar, Junior Research Assistant at the Department of Psychology, Monk Prayogshala
