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Biomedical subjects

Arthur Kleinman

Publications and source records attributed to Arthur Kleinman.

16 recordsLinked to original sources
PubMed2006

Culture and stigma: adding moral experience to stigma theory.

Definitions and theoretical models of the stigma construct have gradually progressed from an individualistic focus towards an emphasis on stigma's social aspects. Building on other theorists' notions of stigma as a social, interpretive, or cultural process, this paper introduces the notion of stigma as an essentially moral issue in which stigmatized conditions threaten what is at stake for sufferers. The concept of moral experience, or what is most at stake for actors in a local social world, provides a new interpretive lens by which to understand the behaviors of both the stigmatized and stigmatizers, for it allows an examination of both as living with regard to what really matters and what is threatened. We hypothesize that stigma exerts its core effects by threatening the loss or diminution of what is most at stake, or by actually diminishing or destroying that lived value. We utilize two case examples of stigma--mental illness in China and first-onset schizophrenia patients in the United States--to illustrate this concept. We further utilize the Chinese example of 'face' to illustrate stigma as having dimensions that are moral-somatic (where values are linked to physical experiences) and moral-emotional (values are linked to emotional states). After reviewing literature on how existing stigma theory has led to a predominance of research assessing the individual, we conclude by outlining how the concept of moral experience may inform future stigma measurement. We propose that by identifying how stigma is a moral experience, new targets can be created for anti-stigma intervention programs and their evaluation. Further, we recommend the use of transactional methodologies and multiple perspectives and methods to more fully capture the interpersonal core of stigma as framed by theories of moral experience.

Culture↗
PubMed2006

Culture, moral experience and medicine.

No one can doubt any longer that culture is crucial to medicine. The evidence for health disparities across ethnic and racial groups as well as for cultural influences on health care practices is too impressive to overlook. Yet the concept of culture and how it is employed in medicine today is quite different from the way culture is now regarded in anthropology, the discipline that originated and popularized the concept. Rather than understand culture as a "timeless" ethnic stereotype applied to patients-which is a common but dangerous practice-physicians need to understand how culture influences doctors as much as patients. And physicians need to understand that culture is not only about differences in dress, etiquette and diet, but also and most profoundly, about what really matters to people. That is, culture is about the changing moral experiences of patients, families, and practitioners, and how those moral experiences powerfully affect the doctor-patient relationship. This article suggests that there is a moral crisis in today's medicine that reflects global cultural transitions. This crisis must be addressed if practitioners are to provide care at the highest moral and human level.

Culture↗
PubMed2005

Ethno-psychometric evaluation of the General Health Questionnaire in rural China.

BACKGROUND: Most mental health research tools are developed in Western, urban contexts. Few studies have evaluated the applicability of these research tools in rural populations of non-Western countries. We examined the cultural acceptance and psychometric performance of the 12-item General Health Questionnaire (GHQ) in China's rural villages. METHOD: Ethnographic investigations were conducted to assess the cultural applicability of self-report rating scales among villagers. This was followed by a survey of 1401 rural residents, randomly selected from 48 villages of Shandong province using stratified multistage cluster sampling. The respondents were administered the GHQ and the Composite International Diagnostic Interview (CIDI). RESULTS: The GHQ, when administered by trained interviewers, was culturally acceptable to rural residents. The scale had good psychometric properties in the study population. The area under the curve was 0.86. At a cut-off of 1/2, the sensitivity and specificity were 80.6% and 79.3% respectively. CONCLUSIONS: The ethno-psychometric evaluation showed that the GHQ was both culturally valid and psychometrically sound in the Chinese rural context.

Adult↗
PubMed2005

Stigmatizing experience and structural discrimination associated with the treatment of schizophrenia in Hong Kong.

This research examines the experience of stigma associated with psychiatric treatment among Chinese patients with schizophrenia in Hong Kong. In focus groups patients described stigma experiences related to clinic visits and the side effects of antipsychotic medications. Additionally, they revealed various adverse treatment experiences during hospitalization which point to the presence of structural discrimination. Based on the focus group findings, a questionnaire was developed and completed by 320 and 160 patients with schizophrenia and diabetes mellitus, respectively. Results showed that patients with schizophrenia were more likely to anticipate stigma, conceal illness, and default on clinic visits than patients with diabetes. Medication-induced stigma occurred in 48% of patients with schizophrenia. It brought about the unwelcome disclosure of illness, workplace difficulties, family rejection, and treatment non-adherence. Adverse experiences during hospitalization were reported by 44% of patients with schizophrenia. They included negative staff attitudes, excessive physical/chemical restraints, inadequate information/complaint systems, and limited rights. We conclude that stigma, at both individual and structural levels, represents a central experience of the treatment of schizophrenia in Hong Kong. Because inequitable health policy, resource allocation, and service organization privilege service providers' control over users, treatment-related stigma may be a prime example of the social production of stigma and discrimination based on power difference between the stigmatizers and the stigmatized. To examine this critically we need to redirect stigma research to tractable clinical circumstances and structural mechanisms that produce and maintain stigmatizing and discriminatory psychiatric practice. Destigmatization programs must be evaluated not only by change in public attitudes but also by how much they reduce structural stigma and improve patients' lives.

Adolescent↗
PubMed2005

The experience of SARS-related stigma at Amoy Gardens.

Severe Acute Respiratory Syndrome (SARS) possesses characteristics that render it particularly prone to stigmatization. SARS-related stigma, despite its salience for public health and stigma research, has had little examination. This study combines survey and case study methods to examine subjective stigma among residents of Amoy Gardens (AG), the first officially recognized site of community outbreak of SARS in Hong Kong. A total of 903 residents of AG completed a self-report questionnaire derived from two focus groups conducted toward the end of the 3-month outbreak. Case studies of two residents who lived in Block E, the heart of the SARS epidemic at AG, complement the survey data. Findings show that stigma affected most residents and took various forms of being shunned, insulted, marginalized, and rejected in the domains of work, interpersonal relationships, use of services and schooling. Stigma was also associated with psychosomatic distress. Residents' strategies for diminishing stigma varied with gender, age, education, occupation, and proximity to perceived risk factors for SARS such as residential location, previous SARS infection and the presence of ex-SARS household members. Residents attributed stigma to government mismanagement, contagiousness of the mysterious SARS virus, and alarmist media reporting. Stigma clearly decreased, but never completely disappeared, after the outbreak. The findings confirm and add to existing knowledge on the varied origins, correlates, and impacts of stigma. They also highlight the synergistic roles of inconsistent health policy responses and risk miscommunication by the media in rapidly amplifying stigma toward an unfamiliar illness. While recognizing the intrinsically stigmatizing nature of public health measures to control SARS, we recommend that a consistent inter-sectoral approach is needed to minimize stigma and to make an effective health response to future outbreaks.

Adaptation, Psychological↗
PubMed2005

Experience of social stigma by people with schizophrenia in Hong Kong.

BACKGROUND: Research on stigma often focuses on general public attitudes and overlooks patients' subjective experiences of everyday stigma arising from significant others. AIMS: To document and compare the interpersonal experiences of stigma in patients with schizophrenia and patients with diabetes mellitus in Hong Kong. METHOD: Four focus groups were conducted to generate a self-report questionnaire. Data were collected from out-patients with schizophrenia (n=320) and diabetes (n=160). RESULTS: Significantly more patients with schizophrenia (>40%) than diabetes (average 15%) experienced stigma from family members, partners, friends and colleagues. Over 50% anticipated stigma and about 55% concealed their illness. Dysphoria occurred in over half. CONCLUSIONS: Interpersonal (especially intrafamilial) stigma was pervasive, hard to avoid and devastating to patients with schizophrenia. Family support had to be realised rather than assumed, despite the emphasis on relationship bonds in Chinese society. Programmes that build the family as a rehabilitative resource should start early to reduce the development and adverse impacts of stigma.

Adolescent↗
PubMed2003

Poverty and common mental disorders in developing countries.

A review of English-language journals published since 1990 and three global mental health reports identified 11 community studies on the association between poverty and common mental disorders in six low- and middle-income countries. Most studies showed an association between indicators of poverty and the risk of mental disorders, the most consistent association being with low levels of education. A review of articles exploring the mechanism of the relationship suggested weak evidence to support a specific association with income levels. Factors such as the experience of insecurity and hopelessness, rapid social change and the risks of violence and physical ill-health may explain the greater vulnerability of the poor to common mental disorders. The direct and indirect costs of mental ill-health worsen the economic condition, setting up a vicious cycle of poverty and mental disorder. Common mental disorders need to be placed alongside other diseases associated with poverty by policy-makers and donors. Programmes such as investment in education and provision of microcredit may have unanticipated benefits in reducing the risk of mental disorders. Secondary prevention must focus on strengthening the ability of primary care services to provide effective treatment.

Developing Countries↗