Introduction

In the book Clinical Psychology Review, there is a section in Volume 31, Issue 6 titled "Mental Illness Stigma and Ethnocultural Beliefs, Values, and Norms: An Integrative Review" written by Tahirah Abdullah and Tamara Brown. This review thoroughly examines the relationship between culture and the public/self-stigma attributed to mental illness by diving into what stigma is, theories regarding how it operates, and how stigma developed sociologically, historically, and anthropologically in different cultures. It also discusses a possible new approach to further research on this subject and ways to institute anti-stigma campaigns based on specific stigma/cultural beliefs. This review covers many groupings of people, each diverse in their country of ancestry, religious beliefs, etc but nevertheless holding common cultural values. These groupings are American Indians, Asians, Africans, Latinos, Middle Eastern people, and those of European descent (Caucasian).

What is Stigma

The term "stigma" refers to the social judgment, devaluing, degradation, and disgracing of individuals, in this case pertaining specifically to people with or displaying symptoms of mental illness. This word stems 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." In this case, stigma associates those with mental illnesses with demeaning stereotypes (dangerous, incompetent, weak, etc), usually leading to discrimination of those people. There are two types of stigma: self-stigma and public stigma. The first defines one with mental illness internalizing public stigma; they may believe they are lesser or bad because of their disorder, possibly leading to demoralization which worsens their mental health and can lead to self-sabotaging behaviors such as not seeking out new opportunities in life because they believe, for whatever reason, that their mental illness makes them unable to. The second pertains to the discriminatory response the general public has to those with mental illnesses. Both, but especially public stigma, can affect not only the person with the disorder, but also their family, friends, and mental health professionals and can make individuals avoid seeking treatment despite knowing something is wrong. Public stigma, in particular, affects these people very harshly. Depending on the situation, those discriminated against could lose or be unable to find good jobs and proper housing, and the likelihood of run-ins with the justice system is heightened. Family members may be impacted socially and parents, in particular, are often blamed for the ailment with children being viewed as having less worth; these things can all also affect those with mental illnesses whether that is by their own family members' response or guilt over the way their families are being treated and viewed.

Further Effects of Stigma

Public and self-stigma work together to worsen the effects of the other. For instance, a person that feels they are incompetent due to their mental illness (most likely due to stereotypes they picked up while growing up) may still try to seek employment. A manager that discovers they have an ailment or witnesses tics or symptoms during an interview may look them over as a candidate, leading the person to believe their thoughts of being incompetent are correct, keeping them from seeking out employment again. Statistics also show that 68% of Americans are not willing to have those with mental illness marry into their family, 58% do not want to work closely with them, and 56% refuse to spend a lengthened amount of time socializing with them. Studies also show that stigma may be detrimental to recovery for multiple reasons: it works as a barrier to seeking help, it worsens mental health problems, and it continues to impact those with mental health problems even after they receive help (particularly in older clients).

Differing Views on Mental Illness

Looking over the six focus groups of this review, I've chosen three (American Indians, Asians, and Caucasians) to look over and compare the ways they view mental illness. Out of the three, natives of America are the only grouping that is affected not only by public/self-stigma but by the government: in the late 1880s, the Hiawatha Asylum was established specifically for American Indians due to the belief that they had "unique mental afflictions", leading to mistrust of the government and the institutions run by it which in turn promotes stigmatization of mental health treatment by professionals. Looking at the American Indians and Caucasian people, there are cultural values that are completely opposite one another: "being" and materialism. Whereas natives are more focused on existing and becoming more enlightened, Caucasians typically are more focused on gaining wealth, material possessions, status, or power. On the natives' side, this means that those with mental illness are less likely to be stigmatized for not being able to produce material things and may be valued if treatment is used to further develop the inner self. The opposite is seen in Caucasians where those with mental illness may be discriminated against for the same thing, deemed as lower status. Another difference is seen between American Indians/Asians and those of European descent: sharing and cooperation/collectivism, and individualism. Native tribes, depending on the viewpoint, may discriminate against the afflicted due to their inability to provide/being seen as an ailment to the whole, or band together to encourage the person struggling to "withdraw from the group to engage in spiritual exploration." Asians, in retrospect, believe that having a mental illness is a reflection on the whole family and can bring it shame, which can be prompted further by said person's difficulty to achieve tasks that bring recognition to their families. Both of these cultures are also big on family which highly influences these views. On the flip side, Caucasians value independence and individual recognition which can lead to stigmatization of those that require assistance from others. Research (though more needs to be conducted) shows that stigma on mental health differs among natives ranging from some tribes holding none and others stigmatizing all mental illnesses. It also shows that Asian Americans older than 16 generally were more stigmatic than their Caucasian counterparts with males holding greater stigma and participants between 46 and 60 endorsing less.

Conclusion

This review is incredibly detailed, making sure that nothing is overlooked and that everything is noted very specifically. Due to this, it shows greatly (and is stated multiple times) that more research needs to be done on how culture shapes stigma, especially when it comes to mental health illnesses. Culture is a huge part of our lives which means that it dictates how we are raised and which stereotypes we pick up along the way which influences our stigma toward certain people/things. It is illogical not to focus more on how culture shapes stigma when doing research on stigma-based studies. Even with the limited amount of research, this review shows how even cultures that hold similar values will interpret them differently based on their specific viewpoints. It is my hope that more research will go toward this specific topic and that the six-step plan at the end of the review is implemented, leading toward further abilities to lessen culture-based stigmatization.