The Stigma of Mental Illness in Developing Countries

The grade of genial Illness in Developing CountriesThe Stigma of Mental Illness in Developing CountriesSeeking intercession for kind disease after part be a daunting task. Even in the United States, where medical c ar is relatively easy to obtain, there is a injury surrounding psychic affection. In my own experience of living in a small, close-knit community, I found it tight terrifying to tattle to my primary c argon physician about the anxiety and depression I was experiencing. In my town, parking my car at the counseling center was like admitting that I couldnt take c ar of myself. The common perception in the community was that people need to suck it up and not rely on doctors or therapists to loaf through life. With this clear and prevalent grunge against psychological affection and give-and-take, it took me years to finally get the help that I needed. This issue of marque was soothe on my mind when I started looking for a topic for this research project. I was curious about how non-Western and developing countries viewed the issue and what was being done to help change magnitude the filth of psychogenic illness worldwide.What is Stigma?In order to take a close look at mental health stigma in cultures around the world, we first need to understand exactly what is meant by stigma. The dictionary definition of stigma is a mark of disgrace or infamy a stain or reproach, as on ones reputation (Dictionary.com). This is a good place to start, but it does not accurately define the measurable feelings of stigma, which is necessary for researchers to be able to read it. Link et al. (2004) address several theoretical perspectives for stigmatization in general and the stigma of mental illness in particular. Most utilitarian for the purposes of this paper is the framework laid out by Link and Phelen (2001) and discussed and elaborated upon by Link et al. (2004) that bring ups several interrelated categories differentiateing, stereotyping, sepa rating, wound up reactions, status loss, and stigmas dependence on power structure. Labeling is a natural way that humans categorize differences, and many labels (shoe size, favorite foods) are not socially salient. Other labels, such as cozy preference or nationality, are more(prenominal) more relevant. Both the selection of salient characteristics and the creation of labels for them are social achievements that need to be understood as essential components of stigma (Link et al. 2004). In the stereotyping component, the researchers suggest that the labeled differences are linked to negative assumptions about the labeled person or others with similar characteristics. The attached typeface of the stigma process is separating, which is the us versus them mindset. Link et al. (2004) suggest that one place the initial conceptual framework about stigma is lacking is in the underre pitchation of emotional reactions We believe that this underrepresentation needs to be corrected, bec ause emotional responses are critical to understanding the behavior of both stigmatizers and people who are recipients of stigmatizing reactions. Status loss and discrimination can be everyplacet, like refusing employment to someone with a mental illness, but it can also be much more insidious and pervasive. Link et al. (2004) gives the typesetters case that considerably less funding exists for schizophrenia research and facilities for schizophrenia treatment are a great deal located in less desirable locations. The final aspect of the stigma framework is its dependence on power structures Link et al. (2004) state that this aspect is very important because without social, cultural, economic and political power the concept of stigma would be much less useful.Now that we understand at least one way in which stigma can be defined, we must next go about looking at the ways stigma is measured. Link et al.(2004) state that there is a considerable lack of study of mental illness stigm a in the developing world they reviewed a large number of studied conducted worldwide, and found only a few in Asia and Africa, though the researchers did finish up that this index have been because their review was restricted to English language journals. This paper will focus on a few key studies, but it is certain(prenominal) that more study in this area is needed to get an in-depth look at differences between cultures and the relative stigma of mental illness.Some studies focus on the stigma of the general population towards those with mental illness, while others focus on the opinions of people who suffer from mental illness. One survey I found to be particularly interesting and useful is the man Mental Health Survey, in which subjects with mental health issues were asked about their perceive stigma (Alonso et al. 2008). For this survey, stigma was considered to be present if respondents reported both embarrassment and perceived discrimination related to illness. Among pe ople with significant activity limitations (i.e., at least moderate difficulty with cognition, mobility, self-care, or social), the perceived stigma rate was highest in the Ukraine, with 32.1% of respondents reporting stigma. The poorest rate was 3.2% in Germany. The average rate of perceived stigma in developing countries was 22.1%, compared to 11.7% in develop countries (Alonso et al. 2008, Table 1). The researchers decision was that perceived stigma associated with mental disorders is universal, but considerably more frequent in developing countries however, the implications of this finding were not discussed, though they suggest it may be of interest to investigate social, cultural and health service characteristics that differentiate countries in which patients feel less excluded from countries in which patients are more credibly to report perceived stigma (Alonso et al. 2008312). The researchers also found that perceived stigma is strongly associated with common mental diso rders, particularly with comorbid mood and anxiety (Alonso et al. 2008306). The implications of this survey are bothfold first, developing and developed countries have different ways of associating stigma with mental illness, although the reasons for this are not clear. Second, people with mental illness are much more likely to perceive stigma relating to illness than, for example, people with chronic physical ailments. Most interesting to me is the fact that the statistics from Alonso et al.s (2004) study shows that developing countries have nearly double the rate of perceived stigma as developed countries.Studies of Stigma in Developing CountriesLauber and Rossler (2006) conducted a review of literature that summarizes imports of research on the stigma of mental illness in developing Asian countries. They state that this research is very important because The stigma of mental illness and discrimination against mental patients are believed to be a significant obstacle to developm ent of mental health care and to ensuring quality of life of those suffering from mental illness (Lauber and Rossler 2006 158). They supply a clear discussion of how they defined developing and developed countriesA developing coarse is a country with a low-income average, a relatively undeveloped base and a poor human development index when compared to the global normDevelopment entails developing a modern infrastructure (both physical and institutional), and a move away from low value tallyed sectors such as agriculture and natural resource extraction. Developed countries usually have economic systems based on continuous, self-sustaining economic yield (Lauber and Rossler 2006160).This definition helps clarify some of the general differences between developing and developed countries.Lauber and Rosslers (2006) review of literature found that people in developing countries in Asia are generally afraid of those with mental illness. They also found that many studies reported res pondents who felt that mental illness symptoms were a normal reaction to stress this finding suggests that awareness of mental illness and the need for medical intervention is lacking in these cultures. However, the results of these studies are similar to the results in Western countries (Lauber and Rossler 2006). Another finding of this study was in regards to help-seeking behaviors it is much more likely for those seeking help for mental illness to rely on family members instead of professional mental health function (Lauber and Rossler 2006). I found it interesting that the researchers suggest the differences in mental health care in developing Asian countries is due not only to a different cultural understanding of health and health care, but also the stigmatizing attitude of health care professionals as well (Lauber and Rossler 2006).Gureje and Lasebikan (2005) studied the use of treatment services for mental illness in the Yoruba-speaking part of Nigeria through face-to-face interviews with nearly 5,000 adults. They found that few than 1 in 10 people with mental health disorders over the past 12 months had received any treatment whatsoever, compared with 25% in the United States (Gureje and Lasebikan 2005). They also found that respondents who did receive treatment were much more likely to be treated in the general medical sector rather than by a mental health specialist these results are similar to those found in other developing countries as well as developed nations. Another significant finding was that people with mental illness were considerably less likely to use complimentary health providers than those with other non-mental disorders This observation flies in the face of the common belief that traditional healers provide service for a high proportion of persons with mental disorders in developing African countries (Gureje and Lasebikan 200548). The authors suggest that many of the problems with mental health utilization in Nigeria result from i ts inadequate health service personnel and facilities, financial constraint, as well as poor experience of and negative attitude to mental illness (both of which are rampant in Nigeria) (Gureje and Lasebikan 200548). This suggests that in addition to the need for better health systems in developing countries, we also need to address the issue of stigma towards mental health treatment.Another study in 2005 attempted to look at the existing attitudes towards mental illness in the same Yoruba-speaking part of Nigeria. Gureje et al. (2005) studied over 2000 respondents and found widespread stigmatization of mental illness. The researchers found that respondents were often misinformed about the cause of mental illness with 80.8% stating that mental illness could be caused by dose or alcohol abuse, 30.2% claiming possession by evil spirits as a cause, followed by about equal responses of trauma, stress, and genetic inheritance (Gureje et al. 2005 Table 2). The researchers add that only about one-tenth of respondents believed that biological factors or brain disease could be the cause of mental illness, and 9% felt that Punishment from God was a possible cause (Gureje et al. 2005).In addition to the misunderstood causes of mental illness, the researchers found that many Nigerians have generally negative views towards people with mental illness fewer than half of respondents believed that the mentally ill could be treated outside of hospitals, and only thought that mentally ill people could work at a mending job. The researchers found that these negative attitudes were equally spread across the socioeconomic spectrum (Gureje et al. 2005). The stigma associated with mental illness in Nigeria is evident in the responses that show most respondents were grudging to have social interactions with someone with mental illness, including fear of having a conversation with or working with a mentally ill person (Gureje et al. 2005437). 83% of respondents would be ashamed of people knowing that someone in their family was mentally ill, and only 3.4% responded that they could marry someone with a mental illness (Gureje et al. 2005 Table 4). These results support the findings of the World Mental Health Survey that the stigma of mental illness is considerably higher in developing countries than in developed countries, but the research still does not show any distinct variables that could be identified in order to help reduce the associated stigma.Griffiths et al. (2006) performed a comparison of stigma in response to mental disorders between Australia and Japan, and found some interesting results. This was the only research I found that used similar methodologies to survey the public in two different cultures. Though both Japan and Australia are developed nations, the cross-cultural comparison is relevant to this study. Griffiths et al. (2006) found a significantly higher proportion of the Japanese respondents held stigmatizing attitudes and social distan ce towards mental illness. The authors give several possible reasons for this difference. First, conformity is more highly valued in Japan, so people who deviate from the norm because of mental illness would be more negatively impacted. Secondly, the treatment options in the two countries differ in Japan, long-term institutionalization is common, while in Australia, community and replacement services are emphasized. The implication is that even among developed countries, significant differences in the rates of stigma and the way it affects a society occur therefore, any fag to combat stigma needs to take into account these cultural differences. The authors suggest that this study may point to ways in which interventions programs for reducing stigma might be tailored for each country (Griffiths et al. 2006).Attempts to Reduce Stigma Associated With Mental IllnessMany countries and cultures have made attempts to reduce the stigma associated with mental illness. Lauber and Rossler (2 006) discuss the attempts in some Asian countries to rename schizophrenia in order to reduce the stigma associated with the disease however, results show that a less pejorative label has little effect on the stigma associated with schizophrenia. Stein and Gureje (2004) suggest the approach of medicalization of suffering, or training healthcare providers to recognize the depression and anxiety that are often related to violence, chronic illness, and poverty in order for this to be successful, however, overcoming the stigma related to mental health issues is of primary importance. Lauber and Sartorius (2007) states that work towards reducing the stigma of mental illness is very important as a human rights issue Societal or structural discrimination finds its expression in legal power that restricts the civil rights of people with mental illness in, for example, voting, parenting or serving jury duty, inequities in medical insurance coverage, discrimination in housing and employment, and the reliance on jails, prisons and homeless shelters as the way of disposing of people with mental illness (103). They discuss the importance of the normalization paradigm in which people with mental disorders are seen as similar to and not different from other people and medicalization, the idea that mental illness is a treatable medical condition rather than a personal defect, in the anti-stigma endeavors (Lauber and Sartorius 2007).Form (2000) suggests that one important aspect of reducing mental health stigma is to increase what he calls mental health literacy or knowledge about mental health disorders he outlines several education programs that were widespread in the 80s and 90s in the United States the Depression Awareness, Recognition and Treatment Program and the field of study Depression Screening Day. These programs received widespread media attention, but their effects have not been studied. Form suggests that one good way to help improve mental health literacy is t o target specific populations, such as high school students. However, Forms research says little about how these ideas would work in developing countries.In conclusion, a look at the research on stigma associated with mental illness shows significant differences in developing and developed countries, but the reasons for this are still unclear. I had hoped to conclude this research with a set of key differences between high-stigma and low-stigma cultures, but this information, if it exists, was not found. I believe that research on identifying causes for and reducing incidences of the stigma of mental illness is a very important topic in medical anthropology and one I believe will see continued advancement in research in the future.References CitedAlonso, J., A. Buron, R. Bruffaerts, Y. He, J. Posada-Villa, J-P. Lepine, M.C. Angermeyer, D.Levinson, G. de Girolamo, H. Tachimori, Z.N. Mneimneh, M.E. Medina-Mora, J. Ormel, K.M.Scott, O. Gureje, J.M. Haro, S. Gluzman, S. Lee, G. Vilagut, R.C. Kessler, M. Von Korff, theWorld Mental Health Consortium.2008 Association of perceived stigma and mood and anxiety disorders results from the worldMental Health Surveys. Acta Psychiatrica Scandinavica 118305-314.Griffiths, Kathleen M., Y Nakane, H. Christensen, K. Yoshioka, A. F. Jorm, and H. Nakane.2006 Stigma in response to mental disorders a comparison of Australia and Japan. BMCPsychiatry 2006, 621.Gureje, Oye, and V. Lasebikan2005 Use of mental health services in a developing country results from the Nigerian surveyof mental health and well-being. Social Psychiatry Psychiatric Epidemiology 4144-49.Gureje, Oye, V. Lasebikan, O. Ephraim-Oluwanuga, B. Olley, and L. Kola2005 Community study of knowledge of and attitude to mental illness in Nigeria. The BritishJournal of Psychiatry 2005 186436-441.Jorm, A. F.2000 Mental Health Literacy Public Knowledge and Beliefs About Mental Disorders. TheBritish Journal of Psychiatry 2000 177396-401Lauber, Christopher and N. Sartorius2007 At Issue Anti-stigma endeavors. International Review of Psychiatry. April 200719(2)103-106.Lauber, Christopher and W. Rossler2007 Stigma towards people with mental illness in developing countries in Asia. InternationalReview of Psychiatry, April 2007 19(2) 157-178.Link, Bruce, L. H. Yang, J. C. Phelan, and P.Y. Collins2004 Measuring Mental Illness Stigma. Schizophrenia Bulletin 30 (3)511-541Stein, Dan J., O. Gureje.2004 Depression and anxiety in the developing world is it time to medicalise the suffering?The Lancet Vol. 364.stigma. (n.d.). Dictionary.com Unabridged. Retrieved December 1, 2010, from Dictionary.comwebsite http//dictionary.reference.com/browse/stigma