Schizophrenia and the Cultural Epidemiology of Stigma in Bangalore, India

R. Raguram · Thubarahalli M. Raghu · Penelope Vounatsou · Mitchell G. Weiss

130 citations0/0 files storedThe Journal of Nervous and Mental Disease

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Mental Health Treatment and Access Schizophrenia research and treatment Mental Health and Psychiatry

Abstract

Illness-related stigma is a complex and important issue, and its social impact contributes to a hidden burden of many health problems. Mitigating effects of stigma are a priority for mental health policy, especially for schizophrenia. Although numerous studies document its impact on patients and their families, health studies of stigma typically regard it in global terms without adequate attention to the conceptual and practical importance of sociocultural contexts and the particular features of illness that evoke stigma. Research at a psychiatric referral center in Bangalore, India, studied the cultural epidemiology of schizophrenia and stigma in interviews with family caretakers of 60 patients, using a locally adapted EMIC interview and the Positive and Negative Symptom Scale. An index of 13 stigma queries based on Goffman's formulation covered relevant aspects and proved to be internally consistent (Cronbach alpha = 0.81). Multivariate statistical regression and qualitative analysis of narratives were used to analyze this stigma index and identify explanatory variables based on cultural patterns of distress (PD), perceived causes (PC), and previous help seeking (HS). Significant variables included suspiciousness and inappropriate sexual behavior (PD), heredity and bad deeds (PC), and informal help seeking (HS). Previous allopathic help seeking was negatively associated with stigma. Analysis of coded text segments from respondent narratives showed how these variables were related to family-perceived stigma, with reference to marriage practices, moral meanings of schizophrenia, and ways in which effective allopathic care minimized stigma. Findings identify features of schizophrenia-related stigma in India, contribute to comparative culture studies, and inform practical approaches to mitigate stigma through community awareness and improved mental health services.

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References

2001Conceptualizing Stigma 1964Stigma: Notes on the Management of Spoiled Identity.1999Mental Health: A Report of the Surgeon General 1987The Social Rejection of Former Mental Patients: Understanding Why Labels Matter 1999Mental Health Consumers' Experience of Stigma 2001Stigma as a Barrier to Recovery: Perceived Stigma and Patient-Rated Severity of Illness as Predictors of Antidepressant Drug Adherence 2002Subjective experiences of stigma. A focus group study of schizophrenic patients, their relatives and mental health professionals 1991The Effectiveness of Stigma Coping Orientations: Can Negative Consequences of Mental Illness Labeling be Avoided?

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2017Experiences of stigma and discrimination faced by family caregivers of people with schizophrenia in India 2008Experiences of stigma and discrimination endured by people suffering from schizophrenia 2020Stigma in mental illness: Perspective from eight Asian nations 2011Living with schizophrenia in India: Gender perspectives 2007Stigma and the Sexual Isolation of People with Serious Mental Illness

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