Chinese Lay Theory and Mental Illness Stigma: Implications for Research and Practices

Stigma has been identified in the literature as a prominent factor negatively affecting individuals with mental illness and their families in various cultures (Corrigan, 2005; Corrigan, & Kleinlein, 2005; Corrigan, Watson, & Miller, 2006; Tsang, Tam, Chan & Cheung, 2003a, 2003b). The negative effects of stigma include discrimination from the public and increases consumers' reluctance to seek professional help. Cultural and philosophical beliefs held deeply by the individuals may contribute to stigma formation and act as a barrier to rehabilitation and recovery. These culturally determined beliefs are typically referred to as folk beliefs or lay theories. Haslam (2005) asserted that it is important to understand laypeople's conceptions of mental illness and its associated stigma as these conceptions and beliefs influence the public's help-seeking decisions and attitudes towards mental illness, especially when these conceptions originate in different cultural contexts. Unlike most Western nations, China is a fairly homogeneous culture with 95% of its population belonging to Han Chinese. Though China has 55 ethnic minorities (e.g., Miao, Manchu, Yi, Tibetan, etc), the focus of this paper is on the primary beliefs of the largest group, Han Chinese. There are some traditional core Chinese values shared by all Chinese groups that have significant influence on understanding and interpreting mental illness and its stigma. These folk values and beliefs are rooted in the philosophical and religious constructs of Confucianism, Taoism and Buddhism. Chinese core cultural values endorse 1) harmonious view towards nature, 2) family as the core unit of daily life and resource for support, 3) harmonious social and interpersonal relations, and 4) avoidance of extreme emotional reaction (Tseng, Lin, & Yeh, 1995). As pointed out by Lin (1981) most, if not all, of traditional Chinese health beliefs regarding mental illness are deeply rooted in the Chinese core culture and have evolved along with the historical development of that culture. Their content cannot be comprehended without adequate understanding of this cultural background. (p. 107). Prevailing sociocultural views on mental illness is essentially a reflection of the society's philosophical and core beliefs (Fabrega, 1991). Considering stigma in light of these contextual elements necessitates a shift from an individual perspective to how stigma is intertwined with cultural and social forces and enacted in daily life. As noted, some key cultural and philosophical influences that guided important aspects of Chinese social behavior for thousands of years are Confucianism, Taoism, and Buddhism and each is briefly described below. Confucianism Confucianism is a world-view, a social ethic and a way of life. It is not a formal religion but rather a moral philosophy. It has exerted profound influence on Chinese political and social culture for over a thousand years. The main features that characterize Confucianism are ethical and moral values; filial piety; respect for elders and ancestor worship (Tan, 1981). Confucianism, as the Chinese social ethic, has filial piety as a fundamental value, and it encourages moral excellence and the cultivation of harmony within self, family, society and universe. In the view of Confucianism, one's destiny depends mainly on one's moral effort and a negative outcome is solely due to one's moral failure. Traditional Confucian values have great impact on modern Chinese culture including medicine and health care (Guo, 1995; Yu, 1996). The Confucian paradigm has a fundamental focus on stable relationships in society which translates to an ideal for social harmony and order. The maintenance of social harmony is so important that it takes priority over the expression of one's own opinions and values (Pearson, 1995). Harmonious interdependence is embodied by the Five Cardinal Relations (wu lun): between sovereign and subject, father and son, elder and younger brother, husband and wife, and friend and friend (King & Bond, 1985). …