The relationship between shame and perceived ...

Psychology, Health & Medicine

ISSN: 1354-8506 (Print) 1465-3966 (Online) Journal homepage: http://www.tandfonline.com/loi/cphm20

The relationship between shame and perceived biological origins of mental illness among South Asian and white American young adults Sameera Mokkarala, Erin Keely O’Brien & Jason T. Siegel To cite this article: Sameera Mokkarala, Erin Keely O’Brien & Jason T. Siegel (2015): The relationship between shame and perceived biological origins of mental illness among South Asian and white American young adults, Psychology, Health & Medicine, DOI: 10.1080/13548506.2015.1090615 To link to this article: http://dx.doi.org/10.1080/13548506.2015.1090615

Published online: 12 Oct 2015.

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Date: 15 October 2015, At: 12:39

Psychology, Health & Medicine, 2015 http://dx.doi.org/10.1080/13548506.2015.1090615

The relationship between shame and perceived biological origins of mental illness among South Asian and white American young adults Sameera Mokkaralaa, Erin Keely O’Brienb and Jason T. Siegelb

Downloaded by [Claremont Colleges Library] at 12:39 15 October 2015

a

Department of Psychology, Pomona College, Claremont, CA, USA; bSchool of Social Science, Policy & Evaluation, Health Psychology and Prevention Science Institute, Claremont Graduate University, Claremont, CA, USA

ABSTRACT

Mental illness (MI) affects one in four people in their lifetime and a failure to seek help for MI can have grave consequences. To decrease stigma and increase help seeking, prior campaigns have promoted the biological origins of MI. Even though some research supports the efficacy of this approach, other research does not. We propose cultural differences as a partial explanation for these inconsistent results. The current study assessed ethnic differences in the relationship between perceived causes of MI, shame associated with MI and perceived family support for help seeking. White and South Asian American (SAA) undergraduate students completed an online survey (n = 177). Results indicated that SAAs were significantly more likely than whites to perceive character deficits as the cause of MI. Further, among those who had sought help for MI, ethnic differences emerged in perceptions of MI based on perceived cause. SAAs who believed that MI had biological origins perceived more shame and less family support for seeking help compared to SAAs who believed MI was due to character deficits. The converse was true for whites – those who believed that MI had biological origins perceived less shame and more family support for help seeking compared to whites who believed MI was due to character deficits. The results of the current study illuminate the role that culture plays in perceptions of MI. Further, these results have implications for interventions targeting South Asian populations and for mental health outreach in general.

ARTICLE HISTORY

Received 13 March 2015 Accepted 24 August 2015 KEYWORDS

South Asian; help seeking; mental illness; shame; family support

Introduction Mental illness (MI) affects one in four people in their lifetime (Kessler, Chiu, Demler, Merikangas, & Walters, 2005; World Health Organization [WHO], 2001), costs over one-hundred billion dollars per year in lost productivity in the US (Kessler et al., 2008), and is a leading cause of disability worldwide (WHO, 2001). Unfortunately, only one-third of people with MI seek treatment (Andrews, Issakidis, & Carter, 2001). Common reasons for

CONTACT Jason T. Siegel © 2015 Taylor & Francis

[email protected]


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not seeking help include discomfort with disclosing personal information, anticipated lack of utility of treatment, social stigma, and fear of betraying social norms (Vogel, Wester, & Larson, 2007). The latter two reasons are particularly common among South Asians (Bradby et al., 2007; Das & Kemp, 1997). To increase help seeking, researchers have tested whether emphasizing the b iological origins of MI can reduce associated shame and stigma (e.g. Deacon & Baird, 2009; Lebowitz & Ahn, 2012; Phelan, 2005). Even though some scholars have found that emphasizing the biological origins of MI positively impacts perceptions of MI (e.g. Goldstein & Rosselli, 2003), others have posited that promoting the biological origins of MI could elicit negative responses (Phelan, 2005; Read, 2007). Several factors may explain these inconsistent findings, and we believe that culture is one of them. The goal of the current study is to examine the relationship between perceived cause of MI, shame associated with MI, perceived family support, and help seeking for MI among white and South Asian American (SAA) young adults.

Culture and biological approaches to stigma reduction A useful approach for reducing illness-related stigma is to change the perceptions of culpability of the victim (Weiner, Perry, & Magnusson, 1988). In the realm of MI, this has taken the form of placing responsibility for the illness on biological explanations such as a chemical imbalance, hormone changes, or genetics (Blais & Renshaw, 2012). Previous research has found the utility of this approach to be inconsistently effective (for a review, see Jorm & Oh, 2009). Some studies indicate that blaming biogenetic factors can reduce negative attitudes toward people with MI (Lebowitz & Ahn, 2012) and reduce stigma (Goldstein & Rosselli, 2003). However, other studies indicate either no benefit or even negative effects resulting from this approach (for reviews see Angermeyer et al., 2011; Read, 2007). These inconsistent findings can be explained by several factors. First, the measures and manipulations used across studies vary widely. Second, even though focusing on genetics might reduce blame, it could also simultaneously increase perceptions of persistence and risk to family members (Phelan, 2005). Third, the utility of the biological explanation could depend on cultural context. In support of the third explanation, Siegel and colleagues (2012) found that among whites, perceiving a loved one’s depression to be due to character deficits was associated with increased anger even though among Spanish-speaking Latinos, such perceptions were associated with increased sympathy. Likewise, even though a study conducted in the US found that attributing MI to biological causes was associated with positive attitudes (Lebowitz & Ahn, 2012; Siegel, Lienemann, & Tan, 2015), a study conducted in India found that participants were more likely to distance themselves from people with MI when the illness was described as biological in origin (Kermode, Bowen, Arole, Pathare, & Jorm, 2009). One reason a focus on biology could lead to differential results based on the culture is the emphasis that different cultures place on familial relations and group-oriented identity. Collectivists perceive the actions and deeds of the individual as reflecting upon the individual’s close others (Triandis & Gelfand, 1998). When publicly admitting to having MI already brings stigma upon one’s family (Raguram, Raghu, Vounatsou, & Weiss, 2004), attributing MI to biology could result in increased shame, rendering help seeking unappealing and difficult. Families who understand their loved one’s MI as being biologically based could blame themselves for their relative’s condition (Pejlert, 2001). Further, they could experience



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greater associative stigma, such as loss of social standing and reduced marriage prospects as a result of the heritable nature of biological disease (Phelan, 2005). Even though there are different perceptions of MI across cultures (e.g. Cheon & Chiao, 2012), the current study focuses on a comparison of whites and SAAs. There are two reasons for our focus on SAAs. First, even though the loss of social standing and marriage prospects are concerning across cultures, the impact of MI on these factors is particularly problematic among SAAs. This is due to the collectivist orientation and the reflection of individual traits upon the family unit (Pejlert, 2001; Triandis & Gelfand, 1998), as well as the pervasive practice of arranged marriage within the South Asian community (Dale & Ahmed, 2011; Sonalde Desai & Lester Andrist, 2010). If SAAs react differently to biological attributions of MI than whites do, this may explain why emphasizing biology may not have universal utility in reducing shame related to MI. Second, SAAs were selected for investigation due to having a greater risk for suicide (Neeleman, Mak, & Wessely, 1997). Furthermore, SAA college students have expressed increased MI related stigma and more negative attitudes toward counseling services compared to whites (Loya, Reddy, & Hinshaw, 2010). South Asian cultural values, such as emotional restraint, avoidance of bringing family shame, and collectivist orientation (Das & Kemp, 1997), constitute ‘avoidance variables’ that prevent SAA young adults from seeking mental health services (Corrigan et al., 2002; Vogel et al., 2007). Even though SAAs are diverse in terms of income, education, religion, and language ability (South Asians Leading Together, 2012), they are rarely studied separately from Asian Americans (Durvasula & Mylvaganam, 1994; Leong & Lau, 2001). For these reasons, there is benefit in studying SAAs in aggregate.

The current study The goal of the current study is to test whether perceptions of MI differ based on ethnicity and perceived cause. Specifically, we examine whether SAAs perceive MI to be more shameful and anticipate less family support when they believe MI originates in biology, as well as whether white Americans perceive MI as less shameful and anticipate more family support when they believe MI originates in biology. Perceptions of MI will be measured by perceived shame related to MI and perceived family support for help seeking, as family perceptions are particularly important for SAAs (Ahmed & Lemkau, 2000; Chadda & Deb, 2013). The current study will not test causal relationships; however, it will reveal whether the relationship between perceptions of MI and perceived cause differs by culture. If cultural differences are found, it would indicate that a campaign attributing MI to biological factors may be helpful for one culture, but harmful for another. Our hypotheses are as follows: H1: Ethnicity and perceived cause will interact to predict shame associated with MI, such that whites who believe MI is due to biological causes will express the least shame, and SAAs who believe that MI is due to biological causes will express the most shame. H2: Ethnicity and perceived cause will interact to predict perceived family support for help seeking, such that whites who believe that MI is due to biological causes will perceive that they have the most family support, and SAAs who believe MI is due to biological causes will feel that they have the least family support.

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Method


Participants and procedures The present study is a secondary analysis of data collected for a student thesis project on MI and help seeking in young adults. Participants (N = 177) for this study were recruited by posting survey links on the Facebook page of several student government and South Asian student organizations at universities throughout the United States. This does not constitute a random sample of SAA young adults and those with low income may be underrepresented. Still, this strategy is useful, as 87% of online adults aged 18–29 use Facebook (Duggan, Ellison, Lampe, Lenhart, & Madden, 2014). Facebook samples have been found to be representative of the US population (Ramo & Prochaska, 2012), and Facebook has been heralded as an effective means of recruiting specific demographic groups (Bhutta, 2012; Samuels and Zucco, 2013). A total of 61 SAA and 116 non-Hispanic white consenting participants completed the 15-minute survey on SurveyMonkey. Measures Items selected for secondary analysis included ethnicity (white or SAA) and whether or not the participant had consulted with a mental health professional in the past (Deacon & Baird, 2009). A single-item measure of perceived origin of MI was also created based on participant ratings of the degree to which several potential causes contribute to MI. Participants rated four different potential causes on their likelihood of causing MI: biology, genetics, deficits of character, and supernatural forces. Only two participants rated supernatural causes higher than the scale’s minimum and were excluded from the analysis. Participant responses were grouped into two categories based on these ratings: those who believed that MI has primarily biological or genetic origins, and those who believed that character deficits are the primary cause. Eight participants (three whites and five SAAs) who rated biology and character deficits as equally causal were excluded from the final analysis. Perceived shame (α = .68) Perceived shame related to MI was measured by four items, which participants responded to on a four-point Likert scale (strongly disagree to strongly agree). The items were: ‘Experiencing MI is shameful to the affected individual’; ‘If I were to experience a mental health problem, I would do my best to hide it from those around me’; ‘If I were to experience a mental health problem, it would become a source of embarrassment for my family;’ and ‘I feel that it is my duty to my family to conceal any mental distress that I might experience.’ Family support for help seeking (α = .71) Perceived family support for help seeking was measured by three items, each having a fivepoint Likert response scale. The first item began with a vignette, asking participants to imagine that they had been feeling sad and anxious for over a month, and then asking them the likelihood that their parents would recommend seeking formal mental health services (not at all likely to very likely). The second asked the extent to which they believed their family would approve of them if they had sought mental health services in the same vignette (disapproval to approval). The last item was reverse coded, and asked how much they believed their family would inhibit their seeking help from mental health services (not at all likely to very likely).


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Table 1. Demographic characteristics of sample and ethnic differences. Variable Gender (male) Education High school Undergraduate Graduate Financially independent of parents Total income