Go beyond the individual: an intersectional perspective on mental illness stigma in China

Abstract

Abstract Background: Stigma is a pervasive and severe issue for individuals with mental illness in China. It is a complex and multifaceted phenomenon that is influenced by social, cultural, and political factors. However, few concerned about mental illness stigma in China through intersectional perspective. This study aims to employ an intersectional lens to examine mental illness stigma in China and explore its heterogeneity and the disparities it creates among patients. Methods: The study is based on 16 months of ethnographic research conducted in a psychiatric hospital in 2019. The study sample includes 11 patients, 3 patients’ family members, and 23 medical workers from F hospital in Guangdong province. Data were collected through participant observation, interviews, and document analysis. Results: The research reveals that mental illness stigma is deeply ingrained in Chinese society, affecting individuals not only at a personal level but also within their families, healthcare facilities, and wider institutions. The study underscores that, social determinants, including education, rural-urban disparity, and economic circumstances, exacerbate the deleterious effects of stigma. In addition, the research reveals that medical professionals harbor unfavorable attitudes towards their patients or families, and that such attitudes are reflected through cultural symbols, such as the creation of a "mental illness hierarchy" within hospitals based on patients' socioeconomic status. Furthermore, the study highlights that mental illness stigma is not a monolithic construct and is characterized by individual differences, and that its effects may be mitigated by time and the resilience and self-efficacy of patients. Conclusions: This study contributes to the understanding of mental illness stigma in China and informs future anti-stigma efforts. It highlights the need to consider not only the stigma attached to mental illness but also the broader socio-cultural factors that exacerbate the experiences of disadvantaged individuals. To effectively address stigma, it is vital to recognize its heterogeneity and its intersection with social, cultural, and political factors. The findings of this study have implications for mental health policy and practice in China and beyond.