Mental health is a global public health crisis, with 1 in 4 adults worldwide experiencing a mental illness at some point in their lives. While we know that mental health is just as important as physical health, there is still a stigma around those with mental health illness. Mental health stigma refers to how people may have negative prejudices, stereotypes, and attitudes towards those with mental health conditions because they view them as being less valuable than those who do not have mental health conditions.
This stigma can be seen on many different levels. For example, internalized stigma may refer to one’s own negative beliefs about their mental illness – that they are less valuable because they have mental illness, and have lower self-esteem or feel shame because of it. This may make them less likely to seek help for their condition, and in turn, worsen their symptoms. Social or public stigma may refer to the general public or societal reaction to mental health – for example, being fearful of those with mental illness or blaming them for their mental illness. This stigma can have serious negative effects on individuals’ health – they may have lower self-worth, be more depressed, be less likely to seek mental health treatment for their condition, or not feel they can talk to their family for fear of negative backlash, all of which can worsen their condition and contribute to the greater mental health crisis we are facing.
While mental health stigma exists everywhere, and can have negative effects on all groups, it is important to note that there are cultural differences in mental health stigma, and thus, very different mental health outcomes. A key example of this is the heightened mental health stigma in many Asian, Latin American, and Arab cultures – rates are significantly higher in China and Saudi Arabia, for example, than in the United States or Canada. In general, collectivism is prioritized over individualism in non-Western cultures, meaning that individuals are more interdependent, and the community is more important than the individual. This is in contrast to the United States, where individualism is more prioritized – individual success and value is more important than the community as a whole, and people are encouraged to be more independent and less interdependent on each other.
Because many of these countries are generally more collectivist, there is more importance placed on individuals being healthy, functioning members of their community who can contribute to greater societal systems. Mental illness can be considered a strain on these collective systems, as individuals with mental illness can be seen as potentially more unpredictable, unreliable, and even strange or dangerous. Additionally, in these collectivist countries, having mental illness may not just be regarded as shameful for the individual, but for their entire family – increasing feelings of guilt and shame and making individuals less likely to seek care either from their own family or from professionals.
Some studies have also found that Eastern countries are more likely to make moral attributions about where mental illness came from than those in Western countries – for example, that those with mental illness are morally weaker, possessed, abnormal, or shameful. Mental illness may be seen as a sign of emotional weakness or lack of control. For example, in Arab or Asian countries that have strong cultural norms of emotional stoicism, strength, and reliability, mental illness would be a violation of these norms. For example, one study found that Chinese employers were more likely to perceive people with mental illness as having a weaker work ethic and less loyalty, and thus were less likely to hire them as they didn’t see them as a valuable contribution to the company.
These different cultural norms have a real-world impact on individuals’ mental health, as well as their likelihood of seeking professional help for their mental health conditions. This is referred to as treatment-seeking behaviors. They may delay treatment-seeking behaviors, or not engage in them at all, for fear of being labeled, shamed, or misunderstood because of their condition – and without treatment, these conditions can become worse. For example, Asian American college students who maintained a stronger connection to their Asian cultural values were less likely to seek professional help and had more negative attitudes of seeking help, as they viewed seeking professional help as bringing disgrace to themselves and their families. By contrast, Asian American college students who had embraced American cultural values and had less strong connection to their Asian roots were more likely to seek professional help, and have more positive attitudes towards help-seeking. Young Asian Americans are also more likely to report that they don’t need professional help, but can figure out their issues themselves or utilize their personal support networks; likely because of the associated stigma of seeking professional care – one participant noted, “If I was depressed I would not even think about professional counseling, it’s not even in my set of available things to do . . . I would think of friends or sleep or something, but I wouldn’t even think of professional counseling”. It’s clear that in many Asian cultures, mental health is not openly discussed, and individuals may be more likely to hide, neglect, or deny their symptoms rather than seek help to improve their condition.
What can we do about this phenomenon that is clearly having a negative impact on so many individuals, young and old? The answer is complicated. Cultural norms and stigmas are deeply ingrained, and not likely to change quickly or drastically. However, some potential, long-term solutions have been proposed. Culturally tailored stigma reduction interventions are an example. These increase mental health literacy and awareness to reduce stigma by disconfirming stereotypes or providing examples of people who have overcome cultural stigma to cope with their condition. Another incredibly important example is the development of culturally sensitive and culturally competent care – this means training professionals in cultural differences, and tailoring care to meet the needs of specific populations. For example, a counseling session with an Asian American youth might begin with an acknowledgment of the courage it might have taken for them to seek help in the first place, or whether they felt any type of stigma for seeking help. This could also mean providing more opportunities to seek help anonymously to eliminate cultural fears of shame and maintain privacy – for example, creating online support groups or forums, or having anonymous communication with counselors online, which could eventually lead to in-person treatment.
There should also be greater representation of bilingual or culturally representative mental health professionals who have similar cultural or lived experiences – studies have found that young Asian American adults, as example, are more likely to find similarly Asian mental health professionals are more understanding. If there is an increase in cultural representation, individuals who need help might relate more to these professionals, and be more likely to seek help. Advocacy, education and public awareness efforts are other ways to decrease the stigma – for example, increasing positive messages about mental health, or teaching parents in highly stigmatized cultures how to talk to their children about mental health. Involving the school system or community, especially in more collectivist countries, in these initiatives is also important – for example, in cultures or communities where religion is important, they could have the local church advertise and hold mental health programs.
By beginning to incorporate some of these solutions, whether at an individual, community, cultural or structural level, we can begin to work towards improved mental health outcomes across all cultures.
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Assessed and Endorsed by the MedReport Medical Review Board
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