Mental illness: Stigma, culture and family

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Family members and friends play important roles in helping people cope with, manage and recover from illness – physical or mental.  However, the stigma that still surrounds mental illness prevents many from seeking help and support, especially from those closest to them. Shame, embarrassment, lack of understanding and the fear of discrimination and rejection are just some of the barriers preventing diagnosis and effective treatment as well as family and community support.  This is unfortunate because mental illness can be treated.

Stigma and culture

No matter what our background or ethnicity, our culture strongly influences our beliefs about mental illness and shapes our attitudes towards the mentally ill. Some of these cultural factors include: 

• Importance of social status. Many cultures place a high value on social status and reputation. For example, in many Asian countries, the concept of “Face”, or public embarrassment, is extremely important. People will go to great lengths to save “Face”. A mental health issue may be viewed as a public embarrassment that could damage reputations. As such, those suffering and their families are less likely to see help.

• Gender roles. Most cultures discourage men from exhibiting physical or mental weakness. Extensive public health campaigns in many Western countries have encouraged more men to seek medical help but many remain resistant, especially those from more male-dominated cultures.

• Attitudes towards medicine. Not every culture accepts or trusts Western medical practices and instead prefers to treat any illness with traditional approaches. Others do not consider mental illnesses to be medical issues. Instead they believe they are caused by a lack of emotional harmony or evil spirits.

• Age. Younger people of all cultures, religions and ethnicities living in Western countries are more likely to seek help for mental issues. Older people, especially those who have emigrated from very different cultures, will be less likely to change their attitudes or behaviours.

This generational clash of values and priorities can lead to increased stress and risk of anxiety or mood disorders for younger people – especially those living in Western countries. Many cultures require young adults to make decisions that will enable them to care for their parents rather than following their own path or prioritizing their own needs.

• Lack of access to care. Many people do not have workplace health programs and supplemental benefits. Others may have no access to any medical care -- especially undocumented workers or visiting family members.

• Lack of mental health specialists. Stigma associated with mental disorders can result in fewer people choosing to work in the mental health field. Studies involving medical students in Colombia, Saudi Arabia, and Spain and medical residents in Romania demonstrated the negative attitudes that can exist towards specialization in mental health. Eighty-two percent of Saudi Arabian students and 52 percent of Romanian students surveyed felt that “if a student expresses interest in psychiatry, he or she risks being … seen by others as odd, peculiar, or neurotic.” In addition, a large proportion of students had been discouraged from pursuing a career in psychiatry by their teachers, family, friends and fellow students.

• Religious beliefs and spirituality. Buddhism and Taoism advocate for a spiritual understanding of disease and believe that mental problems can be the result of bad deeds in previous lives. Non-Christians living in Western countries are often  hesitant to seek help from the mental health professionals because they feel there is a lack of understanding about, and respect for, their religious beliefs.

The cost of stigma

While culture plays a significant role in our individual attitudes towards mental illness, the fact is that no country can afford to ignore the economic and personal ramifications of poor mental health.  According to the World Health Organization (WHO), “mental disorders account for nearly 12 percent of the global disease burden and depression, one of the most common mental illnesses, will become the leading cause of disability by 2020.” In Canada, it’s estimated that one in five people will be affected with a mental health challenge at some point in their life. The rest of us will be touched by someone we know or love having a mental illness.

You can help reduce stigma and support a family member, friend or coworker experiencing a mental health issue. The Canadian Mental Health Association recommends the STOP criteria to recognize attitudes and discriminatory actions that support the stigma of mental illness. Ask yourself if what you hear: