Notes on Stigma, Culture, and Mental Health Literacy

Culture: Understanding and Definition

• Definition: A general way of life or behaviors of a group reflecting shared social experiences, values, attitudes, norms, and beliefs. Transmits through generations and evolves over time.

• Characteristics:

  • Learnt behaviors that can change over time.

  • Cyclical or self-reinforcing traits influence responses to distress and emotions.

  • Includes dimensions such as ethnicity, race, religion, age, sex, family values, and regional features.

  • Cultural traits can be tangible (physical characteristics) or intangible (emotional responses).

  • Beliefs and attitudes can be implicit (learned by observation) or explicit (written laws/rules).

Stigma: Understanding and Definition

• Definition: A profoundly discrediting attribute that reduces individual worth and defines the relationship between an attribute and a stereotype (Goffman, 1968).

• Challenges for Individuals:

  • Individuals with mental disorders face the disorder itself and associated stigma from misunderstandings.

  • Stigma exists not only among the general public but also among mental health professionals (Corrigan & Watson, 2002).

The Stigma Process

• Stages of Stigma:

  1. Labels: Beliefs assigned to stigmatized groups lead to negative stereotypes.

  2. Negative Stereotype: Affirmations that elicit emotional responses.

  3. Prejudice: Resulting behavior reflecting biases toward individuals with mental disorders.

  4. Discrimination: Behavioral manifestations of prejudice (Corrigan & Watson, 2002).

Forms of Stigma

• Public Stigma: Stigma directed by society.

• Self-stigma: Internalization of societal stigma by individuals.

• Courtesy Stigma: Stigma affecting those close to stigmatized individuals.

• Affiliate Stigma: Internalization of stigma by individuals related to those stigmatized.

• Institutional Stigma: Policies/regulations that limit choices for stigmatized individuals (Mitter et al., 2018).

Case Study: Stigma in Indonesia

• Attitudes of Professionals:

  • Generally positive, supporting inclusion of individuals with disabilities.

  • Shift in stigmatizing beliefs; hereditary sin no longer an excuse for disability.

• Experiences of Stigmatization:

  • Multi-contextual stigma starting from a young age, including neglect, bullying, and corporal punishment.

  • Adults often seek refuge in safe environments due to discrimination.

Common Mental Health-Related Stigmas

• Beliefs include images of weakness, danger, and incompetence among those with mental disorders, e.g.:

  • "People with mental disorders are weak or lazy."

  • "Individuals with mental disorders should be strong enough to cope."

  • Self-stigma Examples:

  • Fear of being ridiculed if seeking help.

  • Feelings of hopelessness regarding change.

Five Steps to Reduce Mental Health-Related Stigma

1. Educate Yourself:

   • Increase knowledge about mental health issues to decrease stigma; use appropriate language.

2. Talk About It:

   • Openness encourages others to discuss mental health, normalizing the topic.

3. Show Compassion:

   • Listening and offering support can alleviate stigma.

4. Seek Help:

   • Recognizing the necessity for help is crucial, even for psychology students.

5. Get Involved:

   • Engagement with stigmatized individuals or support groups promotes understanding and support.

Multilevel Strategies for Stigma Reduction

• Intrapersonal Level: Self-help and counseling.

• Interpersonal Level: Enhancing support from close networks.

• Community Level: Reducing public stigmatizing attitudes through advocacy and education.

• Organizational Level: Training and policy changes in institutions.

• Government Level: Implementing policies favoring those experiencing stigma (Rao et al., 2019).

Mental Health Literacy

• Definition: Knowledge and beliefs about mental disorders that aid in recognition, management, or prevention (Jorm et al., 1997).

• Components:

  1. Understanding prevention strategies.

  2. Recognizing signs of mental disorders.

  3. Knowledge of treatment options and self-help strategies.

Interplay Between Culture, Stigma, and Mental Health Literacy

• Stigma is a social construct influenced by culture, often exacerbated by collective beliefs and stereotypes.

• Cultural perceptions of mental illness affect help-seeking behavior, where supernatural beliefs may deter individuals from seeking professional help.

• Cultural-specific disorders (e.g. Latah, Amok) illustrate the intersection of culture and mental health diagnostic standards.

• DSM 5: culture-related diagnostic issues and culture formulation: A guide for clinicians to assess cultural aspects related to mental disorders

• Culture specific disorders, such as Latah, Amok

• Psychotic disorders, which are considered to have biological determinants, also have aspects that may be determined by culture: hallucinations and delusions

Action Points to Combat Stigma

• Engage in community education to dispel myths about mental health.

• Share stories and real-life instances to humanize mental health issues.

• Foster an environment where discussing mental health is normalized and safe.