Stigma and Mental Illness: Pilot Study of Laypersons and Health Care Providers with the EMIC in Rural West Bengal, India

It was found that indicators of mental illness-related stigma were more prominent among health care providers compared with laypersons, and self-perceived stigma was also higher among femaleLaypersons than males.

Abstract

Objective: Recognizing the importance of stigma as an important factor in mental illness, intensifying the suffering and interfering with efforts to seek useful help, this study examined indicators of stigma for various mental health problems among laypersons and health care providers (HCP) of various kinds in a rural community of rural West Bengal, India. Method: An instrument for study of cultural representations of illness, the EMIC, was adopted and translated into Bengali and administered to a random sample of 21 Iaypersons and 17 health care providers in a rural area of West Bengal. These interviews examined indicators of stigma based on Goffman’s concept of spoiled identity with reference to the following mental health problems: depression, somatoform disorders, deliberate self-harm, psychosis, hysteria and possession. Case vignettes depicting typical presentations of these conditions were the focus of these interviews. Results: The responses on the ‘stigma’ section of the EMIC from both the groups were analyzed and compared. A stigma scale based on indicators we examined was constructed and used to compare stigma between groups and for different conditions. It was found that indicators of mental illness-related stigma were more prominent among health care providers compared with laypersons. Self-perceived stigma was also higher among female laypersons than males. Among the various mental health problems we examined, stigma was greatest for deliberate self-harm. Conclusion: Stigma is a great impediment for early detection and treatment of mental diseases. The high level of stigma in the illness representations of health care providers indicates the need for mental health awareness programmes targeting them as well as laypersons. Although findings from this pilot study are tentative, it indicates an approach to studying and comparing stigma that will be useful in designing and assessing the effectiveness of public mental health policy and programmes.