GRSJ224/Stigma Towards Mental Health in Asian Countries

Mental Health in Asia

Psychiatric stigma is highly prevalent in Asian countries, such as China, Japan, Afghanistan, Korea, and the Philippines. With the largest proportion of the world's population (exceeding 3.5 billion people), over 450 million people are reported to suffer from mental or neurological disorders in the entire continent. Yet, despite global recognition of its significance in recent years, mental health remains relatively unprioritized and is often looked down upon in most Asian countries. The devaluation of mental health is attributed to a combination of factors, including historic and traditional interpretations fo mental health, societal attitudes towards mental health, and the collectivistic culture in Asia.

</gallery>

Confucius, Chinese philosopher from the Ming dynasty, whose ideas regarding practical moral values and correctness of social relationships, justice and sincerity came to influence many Asian cultures to achieve and protect harmony of the collective by suppressing the psychological expression of mental illnesses.

Historical and Traditional Interpretations of Mental Health

Historically, beliefs about the causes of mental illnesses have not always leaned towards science and medicine. The debate between science and religion as primary continues to exist in many cultures to this day, especially those that have preserved traditional beliefs, customs and practices. Broader cultural beliefs and practices such as supernatural, mystical and religious beliefs continue to influence how some individuals, such as those of Asian descent, interpret the causes of mental health illnesses

Many Asian cultures attribute the root of mental illness to different causes, from the possession by spirits, to witchcraft, the devil's eye, or even a holy message or spiritual awakening from a higher spiritual being such as God.

Afghanistan — Individuals with mental illness are viewed as possessed by evil spirits or Djinns, and there is generally no concept of “psychological problems” or “mental illness” in the Afghan culture.

China — Mental illness is seen as caused by evil spirits, or the lack of harmony in emotions.

Korea — The cause of mental illness is attributed to the disruption of harmony within the individual, or by ancestral spirits that return to haunt the patient due to negative past behaviour that needs to be punished. Other causes include bad luck, misfortune, and bad karma.

In general, mental illnesses are considered shameful in many Asian countries, such as the ones described.

Attitudes Towards Mental Health

It is believed that in general, social attitudes toward an individual with mental illness are worse than the actual illness itself. There are three different elements of stigma toward mental illness:

1. Stereotype — Negative beliefs about a certain group
   
2. Prejudice — Agreement with said beliefs
   
3. Discrimination — Behavioural responses to prejudice, such as avoidance and distancing
   

These three elements often go hand in hand and occur simultaneously when individuals form an opinion about those with mental health illnesses. In Asian countries, these three elements of stigma are highly prevalent, especially discrimination. Negative beliefs about individuals with mental health can be detrimental, as conditions that have stereotypes, prejudice and discrimination attached are often chronic, irreversible, and relapsing. These outcomes are viewed as a result of sorcery and spiritual punishment or social and moral transgressions.

In Asian cultures, a clear distinction between mind and body is lacking. Unlike Western cultures, where psychological and physical distress are expressed in their respective terms, somatization is much more common in Asian cultures. Thus, physiological distress is often expressed in the form of physical and somatic complaints. This results in a problematic barrier to identification of the underlying problem, and the failure to psychologize distress may cause individuals in Non-western cultures to interpret mental disorders as Alexithymia The suppression of psychological expression of distress may be caused by many factors, including the following: lack of vocabulary to express emotions in Asian languages, influence of traditional medicine, avoiding social stigma, social learning and expectations.

Collectivistic Culture in Asia

In collectivistic cultures, individuals are not seen as separate entities, but as a part of a larger group (i.e. Extended family, church, village, tribes). This interdependence places a spotlight on roles and experiences within a communal or group context and removes emphasis from the individual himself. Many Non-western countries such as those in Asia are considered collectivistic cultures, as they are highly group-oriented.

Regardless of their varying perceived root of mental health problems, it is common for individuals in collectivistic cultures to view the patient and his/her families as “bringing shame” to themselves by having a mental illness. Traditional teachings and philosophies of Confucius discourages displays of emotions for the purpose of maintaining social and familial harmony and avoiding exposure to personal weaknesses. This is emphasized and highly valued in collectivistic Asian cultures, and hinders the acknowledgment of mental health illness and treatment-seeking behaviors in patients.

Saving Face is the ability to preserve one's public appearance, such as that of the patient and their family, for the purpose of communal propriety. It is believed that the diagnoses of mental illnesses reflect poorly on one's family lineage, and negatively affects one's chances for marriage. This external pressure often results in somatization.

Effects on Help-Seeking Behaviours and Treatment Choices

When individuals are diagnosed with mental disorders, social distancing by family and friends often occurs, which further worsens stigma and creates barriers to employment, healthy living, and positive social relationships.

In Vietnam, beliefs about the causes of mental illnesses are not as mythical as other Asian countries. There is a growing belief that depression is a result of sadness, but people do not readily acknowledge it due to the stigma associated with mental illness. As a result, Vietnamese patients often resort to home remedies, Chinese herbs, spiritual consultations, and interpersonal relationships as a form of treatment or distraction to the disorder.

The same applies to Japan, where mental illnesses are seen as an undesirable form of weakness in the individual. Shame and stigma also prevent the Japanese from seeking appropriate help and treatment.

Mental Health Reform in Asia

The inaccessibility of proper treatment due to stigma is a large public health concern, as it prevents people from prioritizing and caring for their own mental health. Untreated mental health, especially in childhood and young adulthood, may have profound and long-lasting social and economic consequences on adulthood and later life.

Moreover, the shortage of adequately trained mental health staff in the Asia Pacific region hinders the progress of mental health reform.

Hence, many mental health non-governmental organizations (NGOs) in several Asian countries such as India, Malaysia, Thailand, Japan, and Korea have begun tackling mental health issues in the larger community . Approach methods include public education, raising awareness, and campaigning for increased emphasis on governmental mental health care. By opening a conversation about mental health, countries hope to see a decline in the stigmatization and de-emphasis of mental health problems.