Academic journal article Indian Journal of Psychiatry

Stigmatization of Severe Mental Illness in India: Against the Simple Industrialization Hypothesis

Academic journal article Indian Journal of Psychiatry

Stigmatization of Severe Mental Illness in India: Against the Simple Industrialization Hypothesis

Article excerpt

Byline: Sushrut. Jadhav, Roland. Littlewood, Andrew. Ryder, Ajita. Chakraborty, Sumeet. Jain, Maan. Barua

Background: Major international studies on course and outcome of schizophrenia suggest a better prognosis in the rural world and in low-income nations. Industrialization is thought to result in increased stigma for mental illness, which in turn is thought to worsen prognosis. The lack of an ethnographically derived and cross-culturally valid measure of stigma has hampered investigation. The present study deploys such a scale and examines stigmatizing attitudes towards the severely mentally ill among rural and urban community dwellers in India. Aim: To test the hypothesis that there are fewer stigmatizing attitudes towards the mentally ill amongst rural compared to urban community dwellers in India. Materials and Methods: An ethnographically derived and vignette-based stigmatization scale was administered to a general community sample comprising two rural and one urban site in India. Responses were analyzed using univariate and multivariate statistical methods. Result: Rural Indians showed significantly higher stigma scores, especially those with a manual occupation. The overall pattern of differences between rural and urban samples suggests that the former deploy a punitive model towards the severely mentally ill, while the urban group expressed a liberal view of severe mental illness. Urban Indians showed a strong link between stigma and not wishing to work with a mentally ill individual, whereas no such link existed for rural Indians. Conclusion: This is the first study, using an ethnographically derived stigmatization scale, to report increased stigma amongst a rural Indian population. Findings from this study do not fully support the industrialization hypothesis to explain better outcome of severe mental illness in low-income nations. The lack of a link between stigma and work attitudes may partly explain this phenomenon.

Major international studies suggest that schizophrenia has better prognosis in low-income nations and in rural settings.[sup] [1],[2],[3] The industrialization hypothesis has been advanced to explain this differential outcome[sup] [4] but remains untested. Briefly, this hypothesis argues that industrial economies and attendant life styles lead to poor support, intolerance, rejection, isolation, segregation and institutionalization of the severely mentally ill. The value placed on the autonomous individual in industrialized settings therefore accentuates social extrusion of the chronic mentally ill patient who assumes personal responsibility for the illness. In consequence, prognosis worsens in urban industrialized settings. Attempts to test such hypotheses have until recently been hampered due to a lack of culturally valid, ethnographically derived instruments.[sup] [5]

Stigma has been argued to be a major determinant of outcome of severe mental illness across cultures.[sup] [5] Studies on stigma and mental illness in the Indian setting have focused both on measurement of stigma and on locally important sociocultural factors shaping stigma.[sup] [6],[7],[8],[9] Research at the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, focused on the cultural dimension and cross-cultural comparison of stigma related to depression. This landmark study measured illness experience, symptom prominence and indicators of stigma among 80 outpatients from mainly urban backgrounds using the Explanatory Model Interview Catalogue (EMIC).[sup] [7] In addition, patients were clinically assessed on the Structured Clinical Interview for DSM-IIIR and the Hamilton Depressive Rating Scale. The EMIC approach is unique in that it facilitates clarifying the nature of relationship between stigma ratings, symptoms, narratives of suffering and clinical features. The study concluded, amongst other findings, that patients reporting somatic symptoms had lower stigma scores than those reporting psychological symptoms. …

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