Mental illness stigma and ethnocultural beliefs, values, and norms: An integrative review

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Abstract

The current literature on the problem of mental illness stigma in the United States must be expanded to better account for the role of culture. This article examines the relationship between mental illness stigma and culture for Americans of American Indian, Asian, African, Latino, Middle Eastern, and European descent. In this review, culture refers to the shared beliefs, values, and norms of a given racial or ethnic group. The reviewed literature indicates that there are differences in stigma among the various cultural groups; however, explanations as to why these differences exist are scant. Qualitative and quantitative studies indicate that cultural values are important with regard to stigma, particularly for Asian Americans and African Americans. Less is known about the interaction between cultural values and mental illness stigma for other cultural groups. Continued research in the area requires better organization and more exploration of the role of cultural history and values as they relate to mental illness stigma. To that end, a detailed, systematic approach to future research in the area is proposed.

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

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