A striking aspect of stigma about mental disorders is its universality. Stigma has been recognised as important in mental health care in countries with extensive services (1,2) and those with limited services (3-5). For too long the deviance model has dominated the public discourse. A very recent example is the manner in which the September 11 terrorists have been referred to as 'crazy' or 'mad' by the politicians and the media. Such association does not help in the fight against stigma.
Against the universality of stigma, studies across the globe present different pictures of stigma experiences in different countries and communities. In Ethiopia, 75% of family members are stigmatised. Urban residents experience more stigma, as well as the older age group (3). In Canada, persons of 60 years and older are more socially distancing (2). Studies from Bangalore, India found that persons presenting with somatic forms of depression are less stigmatised than those with psychological symptoms (6). Persons with depression in London experience restricted disclosure as stigma, while Indian patients experience discrimination in the marital area (6).
In the recently completed WPA stigma project from India, conducted in four cities with 463 ill persons with schizophrenia and 651 family members, two thirds reported discrimination (7). Women were more stigmatised, as well as those living in urban areas. There was less stigma and more acceptance in those with limited literacy. Males experienced greater discrimination in the job area, while women experienced more problems in the family and social area. Relatively high experience of subtle discrimination (decreased love, avoidance, rejection, distance, excessive caution) was reported in the family area. The differing types and areas of stigma emphasise the need to consider the 'local' experiences.
Programmes to fight stigma and discrimination should address the study of local experiences in different groups using qualitative and quantitative methods; the interventions should be group specific and the effort at mental health literacy (8) should focus on the understandability of mental phenomena and on the 'normalcy' model rather the deviance model.
References
- 1.Surgeon General . Mental health: a report of the Surgeon General - executive summary. Rockville: Department of Health and Human Services; 1999. [Google Scholar]
- 2.Stuart H. Arboleda-Flórez J. Community attitudes toward people with schizophrenia. Can J Psychiatry. 2001;46:245–252. doi: 10.1177/070674370104600304. [DOI] [PubMed] [Google Scholar]
- 3.Shibre T. Negash A. Kullgren G, et al. Perception of stigma among the family members of individuals with schizophrenia and major affective disorders in rural Ethiopia. Soc Psychiatry Psychiatr Epidemiol. 2001;36:299–303. doi: 10.1007/s001270170048. [DOI] [PubMed] [Google Scholar]
- 4.Raghuram R. Weiss MG. Channabasavanna SM, et al. Stigma, depression and somatisation in south India. Am J Psychiatry. 1966;153:1043–1049. doi: 10.1176/ajp.153.8.1043. [DOI] [PubMed] [Google Scholar]
- 5.Thara R. Srinivasan TN. How stigmatising is schizophrenia in India? Int J Soc Psychiatry. 2000;46:135–141. doi: 10.1177/002076400004600206. [DOI] [PubMed] [Google Scholar]
- 6.Weiss MG. Jadhav S. Raghuram R, et al. Psychiatric stigma across cultures: local validation in Bangalore and London. Anthropol Med. 2001;8:71–87. [Google Scholar]
- 7.Srinivasa Murthy R. Shankar R. Sharma A, et al. Stigma experiences of patients with schizophrenic illness and the family members from India. 2001. Unpublished data. [Google Scholar]
- 8.Goldney RD. Fisher LJ. Wilson DH. Mental health literacy: an impediment to the optimum treatment of major depression in the community. J Affect Disord. 2001;64:277–284. doi: 10.1016/s0165-0327(00)00227-5. [DOI] [PubMed] [Google Scholar]