What is stigmatization?
Stigmatization refers to (Mayo Clinic Staff. 2017):
when someone views another individual in a negative way because he/she has a distinguishing characteristic or personal trait that’s thought to be, or actually is, a disadvantage (a negative stereotype).
Indeed, attitudes to mental illness can encompass positive attitudes such as acceptance, more neutral attitudes like tolerance, to negative ones such as stigma and even fear. Unfortunately, attitudes and beliefs toward people who have mental health conditions are usually negative.
Contrary to popular belief, mental health professionals can also sometimes have negative attitudes towards individuals with mental illness. According to a Singapore based study, (Yuan et al., 2017) although mental health professionals had significantly more positive attitudes to mental illness than the general public in Singapore, their attitudes on ‘social distancing’ were similar to that of the general public.
Why do Asian communities have stronger stigmatization towards mental health than the Western community?
Many people from minority and immigrant groups look at mental distress in totally different ways from the way most majority white people do. Mental health is a Western concept that revolves around the notion of Cartesian dualism, which considers the mind and body as separate entities (Kalibatseva & Leong, 2011). Moreover, as seen in the Social health insurance systems in western Europe, arrangements made to further improve and sustain the Quality of Life (QoL) includes health services to sustain the physical and psychological conditions of individuals (Saltman, Busse & Figueras, 2004).
In this article, traditional Asian beliefs will be compared to Western views of mental health, thus explaining the differences in stigmatization.
Traditional Asian beliefs about mental health
According to Kramer, Kwong, Lee and Chung (2002) mental illness are seen as disharmony of emotions, or possession of evil spirit. Moreover, some Asian beliefs of mental health also include that of payback for past transgressions. Since the predominant religion of Asians who don’t practice Christianity or Muslim religion is Buddhism, this ties in with the Buddhist belief that mental illness is because of transgressions committed in a past life. As such, we do see some overlaps between the Asian beliefs among the Chinese, Japanese and Koreans.
Western perception of mental health
According to a study done by American Psychological Association (APA), (Americans Becoming More Open About Mental Health, 2019) 87% of American adults agreed that having a mental health disorder is nothing to be ashamed of, and 86% believed that people with mental health disorders can get better.
Compared to Asian societies, mental health care in the United States focuses more on Western science and medicine, which emphasize scientific inquiry and objective evidence.
However, there is still stigma present, with 33% of Americans agreeing with the statement, “people with mental health disorders scare me,” and 39% said they would view someone differently if they knew that person had a mental health disorder.
Stigmatization In Singapore Across Races
Singapore is a multi-ethnic country, with its population comprising of three main ethnic groups: Chinese (74.2%), Malay (13.4%) and Indian (9.2%), while 3.2% belong to other ethnic groups (Department of Statistics Singapore, 2019).
Among Singaporean Chinese, there are indeed some traditional Chinese beliefs about Mental Illness that are still persist till today due to the influence by culture as mentioned above. This can be seen in a study conducted among Singaporean youths that found that Chinese youths showed higher sense of ’physical threat’ and lower ’social tolerance’ than those of other ethnicities (Pang et al., 2017).
Aside from the influences of culture, another possible explanation is the Chinese concept of ‘face’ which describes a person’s moral standing in society. Having a mental illness may be seen as ‘losing face’ (丢脸),which can be seen as bringing shame to oneself and one’s family. (Pang et al., 2017)
Singaporean Malays and Indians
Results from the same study also highlighted that one’s cultural background may influence one’s views and attitudes towards the mentally ill. The study found that Indian and Malay participants scored lower on a social distance measure despite having higher personal stigma.
A possible reason for this would be that individuals from minority ethnic groups are less likely to support prejudicial attitudes about mental illness (Corrigan, Morris, Michaels, Rafacz & Rüsch, 2012). They suggested that this was possibly because people from minority ethnic groups experience mental health stigma more harshly than those in the majority group.
Overall, across the 3 main ethnic groups of Singapore, a large proportion of participants appear to have misconceptions towards mental illness, highlighting how stigmatization in Singapore is still uncommon.
While stigmatization is often seen as external influences on individuals, sometimes they are can also be self-imposed. This can be seen in a 18-month study conducted by Singapore’s IMH. In the study, 280 outpatients from IMH suffering from depression, schizophrenia, anxiety or obsessive compulsive disorder (OCD), were found to have self-imposed stigma that may have influenced the impact of perceived stigma, quality of life, self-esteem and function (Self-Imposed Stigma Compounds Struggles Of Individuals With Mental Illness, 2017).
Effect of stigmatization on mentally ill patients
Delay in help seeking – Case Study: Hong Kong
If we were to examine stigmatization in Hong Kong, Hong Kong people are generally sceptical about mental illness and there is social stigmatization is still a huge challenge. Infact, many individuals are hesitant to disclose their mental disorders in fear of social distancing and embarrassment (Wong, Lau, Kwok, Wong &, Tori, 2017). As a result, the duration of untreated mental health condition could be as long as 1 to 2 years.
Moreover, stigmatization by mental health professionals towards individuals with mental illness has a negative impact on the treatment, as could ultimately affect the quality of care received by the patients (Yuan et al.,2017)
Americans Becoming More Open About Mental Health. (2019, March). Retrieved from https://www.apa.org/news/press/releases/2019/05/mental-health-survey
Corrigan, P., Morris, S., Michaels, P., Rafacz, J., & Rüsch, N. (2012). Challenging the Public Stigma of Mental Illness: A Meta-Analysis of Outcome Studies. Psychiatric Services (Washington, D.C.), 63, 963–973. https://doi.org/10.1176/appi.ps.201100529
Department of Statistics Singapore, Ministry of Trade & Industry, Republic of Singapore. Population Trends. Singapore, 2019. https://www.singstat.gov.sg/-/media/files/publications/population/population2019.pdf
Kalibatseva, Z., & Leong, F. T. L. (2011). Depression among Asian Americans: Review and recommendations, Depression Research and Treatment, 2011, 1-9.
Kramer, E. J., Kwong, K., Lee, E., & Chung, H. (2002). Cultural factors influencing the mental health of Asian Americans. The Western journal of medicine, 176(4), 227–231.
Mayo Clinic Staff. (2017, May 24). Mental health: Overcoming the stigma of mental illness. Retrieved from https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/mental-health/art-20046477
Pang, S., Liu, J., Mahesh, M., Chua, B., Shahwan, S., Lee, S. P., … Subramaniam, M. (2017). Stigma among Singaporean youth: A cross-sectional study on adolescent attitudes towards serious mental illness and social tolerance in a multiethnic population. BMJ Open, 7–10. https://doi.org/10.1136/bmjopen-2017-016432
Saltman, R. B., Busse, R., & Figueras, J. (2004). Social health insurance systems in western Europe (1st ed.). Maidenhead: Open University Press.
Self-imposed stigma compounds struggles of individuals with mental illness. (2017, October 10). Retrieved from https://www.channelnewsasia.com/news/health/self-imposed-stigma-compounds-struggles-of-individuals-with-9286462
Wong, D. F. K., Lau, Y., Kwok, S., Wong, P., & Tori, C. (2017). Evaluating the Effectiveness of Mental Health First Aid Program for Chinese People in Hong Kong. Research on Social Work Practice, 27(1), 59–67. https://doi.org/10.1177/1049731515585149
Yuan, Q., Picco, L., Chang, S., Abdin, E., Chua, B., Ong, S., … Subramaniam, M. (2017). Attitudes to mental illness among mental health professionals in Singapore and comparisons with the general population. PLOS ONE, 12, e0187593. https://doi.org/10.1371/journal.pone.0187593