A Cross-National Study of the Stigmatization of Severe Psychiatric Illness: Historical Review,Methodological Considerations and Development of the Questionnaire
Restricted accessResearch articleFirst published online June, 2007
A Cross-National Study of the Stigmatization of Severe Psychiatric Illness: Historical Review,Methodological Considerations and Development of the Questionnaire
Despite their potential significance for public policy and health provision in different societies, popular conceptualizations of and social responses to severe psychiatric illness remain relatively unexamined. Two general research procedures may be identified: (1) the anthropological approach uses ethnographic methods to look at explicit categorizations, and (2) the sociological approach employs quantitative survey methods to examine the public `stigma' of psychiatric illness. This article reviews methodological and conceptual approaches to the study of stigma and describes the development of an ethnographically grounded questionnaire to examine `stigmatization' from data in different cultures. The difficulties of achieving cross-cultural comparability of meaning are discussed and the psychometric properties of the instrument are presented.
Ainlay, S.C. , Becker, G. , & Coleman, C. (1986). The dilemma of difference: A multidisciplinary view of stigma. New York: Plenum Press .
2.
Askenasy, A.R. (1974). Attitudes toward mental patients: A study across cultures. Hague, The Netherlands: Mouton .
3.
Beiser, M. , Waxler-Morrison, N. , Iacono, W.G. , Lin, T.-Y. , Fleming, J.A.E. , & Husted, J. (1987). A measure of the `sick' label in psychiatric disorder and physical illness . Social Science & Medicine, 25, 251—261 .
4.
Benedict, R. (1934). Anthropology and the abnormal . Journal of General Psychology, 10, 59—80 .
5.
Benning, T.B. , O'Leary, M. , Avevor, E.A. , & Avevor, E.D. (2006). Biology and stigma (letter) . British Journal of Psychiatry, 188, 89 .
6.
Ben-Tovim, D.I. (1987). Development psychiatry: Mental health and primary health care in Botswana. London: Tavistock .
7.
Bhattacharya, D.P. (1986). Pagalami: Ethnopsychiatric knowledge in Bengal . New York: Syracuse University South Asian Series Noll.
8.
Bourdieu, P. (1977). Outline of a theory of practice. Cambridge: Cambridge University Press .
9.
Briggs, S.R. , & Cheek, J.M. (1986). The role of factor analysis in the development and evaluation of personality scales . Journal of Personality , 54, 106—148 .
10.
Byrne, P. (2001). Psychiatric stigma . British Journal of Psychiatry, 178, 281—284 .
11.
Caplan, G. (1964). Principles of preventive psychiatry. New York: Basic Books .
12.
Cheung, F.M. (1987). Conceptualisations of psychiatric illness and help-seeking behaviour among Chinese. Culture , Medicine and Psychiatry, 11, 97—106 .
13.
Chiu, M.L. (1981). Insanity in imperial China: A legal case study . In A. Kleinman & T.-Y. Lin (Eds.), Normal and abnormal behaviour in Chinese culture (pp. 75—94). Dordrecht , Germany: Reidel .
14.
Clausen, J. (1981). Stigma and mental disorder: Phenomena and terminology . Psychiatry, 44, 287—296 .
15.
Clausen, J. , & Yarrow, M.R. (1955). The impact of mental illness on the family [Special issue] . Journal of Social Issues, 11, 1—65 .
16.
Cohen, A. (1992). Prognosis for schizophrenia in the Third World: A reevaluation of cross-cultural research . Culture, Medicine and Psychiatry, 16, 53—75 .
17.
Cooper, J.E. , & Sartorius, N. (1977). Cultural and temporal variations in schizophrenia: A speculation on the importance of industrialization . British Journal of Psychiatry, 130, 50—55 .
18.
Crisp, A. (2004). Every family in the land: Understanding prejudice and discrimination against people with mental illness. London: Royal Society of Medicine .
19.
Crisp, A.H. , Gelder, M.G. , Rix, S. , Meltzer, H.I. , & Rowlands, L.J. (2002). Stigmatisation of people with mental illness . British Journal of Psychiatry, 177, 4—7 .
20.
Crocetti, G.M. , Spiro, H.R. , & Siassi, I. (1974). Contemporary attitudes towards mental illness . Pittsburgh, PA: University of Pittsburgh Press .
21.
Cumming, J. , & Cumming, E. (1955). Mental health education in a Canadian community . In B . D. Paul & W. B. Miller (Eds.), Health, culture and community: Case studies of public reactions to health programs. New York: Russell Sage Foundation .
22.
Dain, N. (1964). Concepts of insanity in the United States 1789—1865 . New Brunswick, NJ: Rutgers University Press .
23.
Davies, T.W. , & Morris, A. (1989). A comparative quantification of stigma . Social Work and Social Sciences Review, 1, 109—122 .
24.
Davis, K. (1938). Mental hygiene and the class structure . Psychiatry, 1, 55—65 .
Edgerton, R.B. (1966). Conceptions of psychosis in four East African societies . American Anthropologist, 68, 408—425 .
27.
Edgerton, R.B. (1969). On the `recognition' of mental illness. In S. C. Plog & R. B. Edgerton (Eds.), Changing Perspectives in Mental Illness (pp. 49—72). New York: Holt, Rinehart and Winston .
28.
Eisenbruch, M. (1990). Classification of natural and supernatural causes of mental distress: Development of a mental distress explanatory model questionnaire . Journal of Nervous and Mental Disease, 178, 712—719 .
29.
El-Islam, M.F. (1979). A better outlook for schizophrenics living in extended families . British Journal of Psychiatry, 135, 343—347 .
30.
Estroff, S.E. (1981). Making it crazy: An ethnography of psychiatric clients in an American community. Berkeley: University of California Press .
31.
Estroff, S.E. (1982). Long-term psychiatric clients in an American community: Some sociocultural factors in chronic mental illness. In N. Chrisman & T. W. Maretzki (Eds.), Clinically applied anthropology (pp. 369—393). Dordrecht , Germany: Reidel .
32.
Fabrega, H. (1982). Culture and psychiatric illness: Biomedical and ethnomedical aspects. In A. J. Marsella & G. M. White (Eds.), Cultural conceptions of mental health and therapy (pp. 39—68). Dordrecht , Germany: Reidel .
33.
Fabrega, H. (1991). Psychiatric stigma in non-Western societies . Comprehensive Psychiatry, 32, 543—551 .
34.
Favazza, A. , & Faheem, A.D. (1982). Themes in cultural psychiatry 1975—1980. Columbia: University of Missouri Press .
35.
Favazza, A. , & Oman, M. (1977). Anthropological and cross-cultural themes in mental health: An annotated bibliography 1925—1974. Columbia : University of Missouri Press .
36.
Feinberg, R. (1990). Spiritual and natural etiologies on a Polynesian outlier in Papua New Guinea . Social Science & Medicine , 30, 311—323 .
37.
Foster, G.M. (1976). Disease etiologies in non-Western medical systems . American Anthropologist, 78, 773—782 .
38.
Freeman, H.E. , & Simmons, O.G. (1961). Feelings of stigma among relatives of former mental patients . Social Problems, 8, 312—321 .
39.
Gaines, A.D. (1982). Cultural definitions, behaviour and the person in American psychiatry. In A. J. Marsella & G. M. White (Eds.), Cultural conceptions of mental health and therapy (pp. 167—192). Dordrecht , Germany: Reidel .
40.
Goffman, E. (1970). Stigma: Notes on the management of spoiled identity . Harmondsworth , UK: Penguin .
41.
Gove, W.R. , & Howell, P. (1974). Individual resources and mental hospitalisation: A comparison and evaluation of the societal reaction and psychiatric perspectives . American Sociological Review, 39, 86—100 .
42.
Haghigat, R. (2001). Stigmatisation of schizophrenia. PhD thesis, University College London , UK.
43.
Haghigat, R. , & Littlewood, R. (1995). What should we call patients with schizophrenia? A socio-linguistic analysis . Psychiatric Bulletin, 19, 407—410 .
44.
Hollingshead, A.B. , & Redlich, F.C. (1958). Social class and mental illness. New York: Wiley .
45.
Horwitz, A.V. (1982). The social control of mental illness. New York: Academic Press .
46.
Hunt, S.M. , & McKenna, S.P. (1991). Cross-cultural measurement of health perceptions . Paper presented at the British Sociological Association Conference on `Health and Society'
47.
Hutchinson, G. , Neehall, J.E. , Simeon, D.T. , & Littlewood, R. (1999). Perceptions about mental illness among the clinical medical students in Trinidad and Tobago . West Indian Medical Journal, 48(2), 81—84 .
48.
Jahoda, M. (1958). Current concepts of positive mental health. New York: Basic Books .
49.
Janzen, J.M. (1978). The quest for therapy: Medical pluralism in Lower Zaire. Berkeley: University of California Press .
50.
Jenkins, J.H. (1988). Conceptions of schizophrenia as a problem of nerves: A cross-cultural comparison of Mexican-American and Anglo-Americans . Social Science & Medicine, 26, 1233—1243 .
51.
Katz, M.M. , Marsella, A. , Dube, K.C. , Olatawura, M. , Takahashi, R. , Nakane, Y. , Wynne, L.C. , Giff, T. , Brennan, J. , Sartorius, N. , & Jablensky, A. (1988). On the expression of psychosis in different cultures: Schizophrenia in an Indian and in a Nigerian community . Culture, Medicine and Psychiatry, 12, 331—355 .
52.
Kleinman, A. (1980). Patients and healers in the context of culture . Berkeley: University of California Press .
53.
Kleinman, A. (1988). Rethinking psychiatry: From cultural category to personal experience. New York: Free Press .
54.
Krause, B. (1989). The sinking heart: A Punjabi conceptualisation of distress . Social Science & Medicine, 29, 563—575 .
55.
Langness, L.L. , & Levine, H.G. (1986). Culture and retardation: Life histories of mildly mentally retarded persons in American society. Dordrecht , Germany: Reidel .
56.
Leff, J.P. , Wig, N.N. , Ghosh, A. , Bedi, H. , Meon, D.K. , Kuipers, L. , Neilsen, J.A. , Thestrup, G. , Korten, A. , Ernberg, G. , Day, R. , Sartorius, N. , & Jablensky, A. (1987). Expressed emotion and schizophrenia in North India III: Influence of relatives' expressed emotion on the course of schizophrenia in Chandigarh . British Journal of Psychiatry, 151, 156—173 .
57.
Lefley, H. (1990). Culture and chronic mental illness . Hospital and Community Psychiatry, 41, 277—286 .
Link, B.G. , Struening, E.L. , Neese-Todd, S. , Asmussen, S. , & Phelan, J.C. (2001). The consequence of stigma for the self-esteem of people with mental illnesses . Psychiatric Services, 52, 1621—1626 .
60.
Littlewood, R. (1988). From vice to madness: The semantics of naturalistic and personalistic understandings in Trinidad local medicine . Social Science & Medicine, 27, 129—148 .
61.
Littlewood, R. (1990). From categories to contexts: A decade of the `new cross-cultural psychiatry'British Journal of Psychiatry, 156, 308—327 .
62.
Littlewood, R. (1991a). Against pathology: The new psychiatry and its critics . British Journal of Psychiatry, 159, 696—702 . Reprinted in R. Littlewood (2002) Pathologies of the west , London: Continuum .
63.
Littlewood, R. (1991b). Psychiatric diagnosis and racial bias: empirical and interpretative approaches . Social Science & Medicine , 34, 141—149 .
64.
Littlewood, R. (1998). Cultural variation in the stigmatization of mental illness . Lancet, 352(9133), 1056—1057 .
65.
Littlewood, R. , & Dein, S. (1995). The effectiveness of words: Religion and healing among the Lubavitch of Stamford Hill . Culture, Medicine and Psychiatry, 19, 339—383 .
Maclean, C.M.U. (1967). The determination of community attitudes to mental illness. PhD thesis, University of Edinburgh , UK.
68.
Maclean, U. (1969). Community attitudes to mental illness in Edinburgh . British Journal of Preventative and Social Medicine, 23, 45—52 .
69.
Malhotra, H.K. , & Wig, N.N. (1975). Vignettes for attitudinal studies in psychiatry . Indian Journal of Psychiatry, 17, 195—199 .
70.
Marsella, A.J. , & White, G.M. (1982). Cultural conceptions of mental health and therapy. Dordrecht, Germany: Reidel .
71.
McDaniel, J. (1989). The madness of the saints: Ecstatic religion in Bengal. Chicago: University of Chicago Press .
72.
McLean, A. (1990). Contradictions in the social production of clinical knowledge: The case of schizophrenia . Social Science & Medicine, 30, 969—985 .
73.
Murphy, H.B.M. (1976). Review of Askenasy . Transcultural Psychiatric Research Review, 13(April), 48—51 .
74.
Murphy, H.B.M. (1982). Comparative psychiatry: The international and inter-cultural distribution of mental illness. Berlin: Springer .
75.
Nunnally, J. (1961). Popular conceptions of mental health. New York: Holt, Reinhart and Winston .
76.
Nunnally, J.C. , & Bernstein, I.H. (1994). Psychometric theory (3rd ed.). New York: McGraw-Hill .
77.
Orley, J.H. (1970). Culture and mental illness: A study from Uganda. Makarere, Uganda: East African Publishing House .
78.
Orley, J.H. , & Leff, J.P. (1972). The effect of psychiatric education on attitudes to illness among the Ganda . British Journal of Psychiatry , 121, 137—141 .
79.
Persaud, R.D. (1991). Report on Mental Health Foundation MORI survey investigating public attitudes to mental health . Psychiatric Bulletin, 15, 164 .
80.
Pilgrim, D. , & Rogers, A. (2005). Psychiatrists as social engineers: A study of an anti-stigma campaign . Social Science & Medicine, 61, 2546—2556 .
81.
Porter, R. (1998). Can the stigma of mental illness be changed ? Lancet, 352(9133), 1049—1050 .
82.
Price, R.H. , Ketterer, R.K. , Bader, B.C. , & Monahan, J. (1980). Prevention in mental health: Research, policy and practice. Thousand Oaks, CA: SAGE .
83.
Radden, J. (1985). Madness and reason. London : Allen and Unwin .
84.
Ramon, S. (1985). Psychiatry in Britain: Meaning and policy. London: Croom Helm .
Rogler, L.H. , & Hollingshead, A.B. (1965). Trapped: Families and schizophrenia. New York: Wiley .
87.
Rorty, R. (1980). Philosophy and the mirror of nature. Oxford: Blackwell .
88.
Sartorius, N. , Jablensky, A. , Korten, A. , Ernberg, G. , Naker, M. , Cooper, J.E. , & Day, R. (1986). Early manifestations and first-contact incidence of schizophrenia in different societies: A preliminary report on the initial evaluation phase of the WHO Collaborative Study on Determinants of Outcome of Severe Mental Disorders . Psychological Medicine, 16, 909—928 .
89.
Sartorius, N. , & Schulze, H. (2005). Reducing the stigma of mental illness: A report from a global programme of the World Psychiatric Association. Cambridge: Cambridge University Press .
90.
Scheff, T.J. (1974). The labelling theory of mental illness . American Sociological Review, 30, 444—452 .
91.
Scheper-Hughes, N. (1979). Saints, scholars and schizophrenics: Mental illness in rural Ireland. Berkeley: University of California Press .
92.
Scheper-Hughes, N. (1987). `Mental' in `Southie': Individual, family and community responses to psychosis in South Boston . Culture, Medicine and Psychiatry, 11, 53—78 .
93.
Schwartz, C. , Myers, L. , & Astracian, B. (1974). Psychiatric labelling in the rehabilitation of the mental patient . Archives of General Psychiatry, 31, 329—334 .
94.
Sedgwick, P. (1982). Psycho politics. London: Pluto .
95.
Shepherd, M. , Cooper, M. , Brown, A.C. , & Kalton, G. (1966). Psychiatric illness in general practice. Oxford: Oxford University Press .
96.
Shweder, R. (1991). Thinking through cultures: Explorations in cultural psychology. Cambridge, MA: Harvard University Press .
97.
Siegler, M. , & Osmond, H. (1974). Models of madness, models of medicine. New York: Macmillan .
98.
Simons, B. (1978). Mind and madness in ancient Greece. Ithaca, NY: Cornell University Press .
99.
Skultans, V. (1991). Women and affliction in Maharastra: A hydraulic model of health and illness . Culture, Medicine and Psychiatry , 15, 321—359 .
100.
Soddy, K. , & Ahrenfeldt, R.H. (1965). Mental health in a changing world. London: Tavistock .
101.
Sow, I. ( 1978). Les structures anthropologiques de la folie en Afrique Noire. Paris: Pagot .
102.
Spitzer, S.P. , & Denzin, N.K. (1968). The mental patient: Studies in the sociology of deviance. New York: McGraw-Hill .
103.
Steiger, J.H. (1990). Structural model evaluation and modification: An interval estimation approach . Multivariate Behavioural Research, 25, 173—180 .
104.
Steiger, J.H. , & Lind, J.C. (1980). Statistically-based tests for the number of common factors . Paper presented at the annual spring meeting of the Psychometric Society in Iowa City, May 30. Available with corrections [Accessed 15 June 2006]: www.statpower.net/Steiger%20Biblio/Steiger-Lind%201980.pdf
105.
Swift, C.F. (1980). Primary prevention: Policy and practice. In R. H. Price , R. K. Ketterer , B. C. Bader , & J. Monahan (Eds.), Prevention in mental health: Research, policy and practice (pp. 207—300). Thousand Oaks, CA: SAGE .
106.
Tabachnick, B.G. , & Fidell, L.S. (1996). Using multivariate statistics (3rd ed.). New York: Harper Collins .
107.
Townsend, J.M. (1978). Cultural conceptions and mental illnesses. Chicago: University of Chicago Press .
108.
Townsend, J.M. (1979). Stereotypes and mental illness: A comparison with ethnic stereotypes. Culture , Medicine and Psychiatry, 3, 205—230 .
109.
Verghese, A. (1974). Public attitudes towards mental illness: The Vellore study . Indian Journal of Psychiatry, 16, 8—18 .
110.
Wagner, W. , Duveen, G. , Themel, M. , & Verma, J. (1999). The modernization of tradition: Thinking about madness in Patna, India . Culture and Psychology, 5, 413—445 .
111.
Warner, R. (2004). Recovery from schizophrenia: Psychiatry and political economy (3rd ed.). New York: Routledge and Kegan Paul .
112.
Waxler, N.E. (1976). Social change and psychiatric illness in Ceylon: Traditional and modern conceptions of disease and treatment. In W. Lebra (Ed.), Culture-bound syndromes, ethnopsychiatry and alternative therapies (pp. 222—240). Honolulu: University Press of Hawaii .
113.
Waxler, N.E. (1979). Is outcome for schizophrenia better in non-industrialised societies? The case of Sri Lanka . Journal of Nervous and Mental Disease, 167, 144—158 .
114.
Weiss, M.G. , Jadhav, S. , Raguram, R. , Vounatsou, P. , & Littlewood, R. (2001). Psychiatric stigma across cultures: local validation in Bangalore and London . Anthropology and Medicine, 8(1), 71—87 .
115.
Whately, C.D. (1959). Social attitudes towards discharged mental patients . Social Problems, 6, 313—320 .
116.
White, G.M. (1982). The ethnographic study of cultural knowledge of `mental disorder' In A. J. Marsella & G. M. White (Eds.), Cultural conceptions of mental health and therapy (pp. 69—96). Dordrecht , Germany: Reidel .
117.
Wig, N.N. , Suleiman, M.A. , Routledge, R. , Srinivsa Murthy, R. , Ladrido-Ignacio, L. , Ibrahim, H.H.A. , & Harding, T.W. (1980). Community reactions to mental disorders: A key informant study in three developing countries . Acta Psychiatrica Scandinavica, 61, 111—126 .
118.
Wing, J. (1978). Reasoning about madness. Oxford : Oxford University Press .
