Dr. Lawrence Yang, a professor of social and behavioral sciences at New York University, gave an InCHIP lecture on Thursday discussing global mental health and stigma. The main topic of Dr. Yang’s lecture was global mental health and cognition in untreated psychosis. He has been studying each of these phenomena for approximately 20 years and explained his findings in ways that made it easy for anyone ranging from trained anthropologists to 18-year-olds like myself to understand.
Dr. Yang applied a “what matters most” framework to findings from three specific studies he performed over the last 20 years: the stigmas surrounding Chinese groups and their transition into the U.S., HIV in women from Botswana and pregnant women with cancer. He uses this framework because the stigma society places on mental illnesses is what threatens the things that matter most to people.
Dr. Yang shared a quote from a study he and other colleagues performed that further explains this: “Mental illness stigma acts in culturally-salient ways to impair an actor’s capacity to take part in the core, everyday engagements that certify one as a fully viable member of a local community.”
In other words, if the world doesn’t believe you are capable of worthiness because of something you have no control over, the world will make sure it’s proven right and that their stigma reigns true.
The first study Dr. Yang shares is about Chinese immigrants in the U.S. and the risk of them developing psychosis. Some immigrants are brought to the United States by a group called the Snakehead Gang. Practically from the moment they arrive in the U.S., pressure is put on them to pay up to an $80,000 travel debt to the gang. If the immigrants do not pay the due within a time frame reasonable in the eyes of the gang, they will face relentless violence and potentially death.
This pressure is added on top of the inherent ones that come with any immigrant. They are responsible for sending money to their families in their home country, continuing their lineage and working to attain legal status in the U.S. Now, to top it off, they need to look behind them constantly for a gang member out to get them.
How does this relate to mental illness? In Chinese culture, there is a concept of losing “lian.” Lian is one’s ability to be a decent human being and their capability of serving those who need them. Once you lose this quality, you cannot get it back. If Chinese immigrants in their time of stress develop psychosis, schizophrenia or any mental illness, they may lose their lian in the eyes of their culture.
This is detrimental because most Chinese immigrants are first employed by other Chinese families. If an immigrant’s status is discovered, how will they be able to attain and maintain a job that will help them pay their debts to the gang? This stigma around mental health can put people in life-or-death situations.
The second study Dr. Yang explained surrounds the HIV epidemic in Botswana and how it targets women. In Botswana, promiscuity is culturally-based, meaning that if there is evidence of HIV in a couple, the woman is automatically blamed for the contraction of HIV by their partner. The women of Botswana face structural vulnerability.
As an interviewee from Dr. Yang’s study puts it, “Perceived promiscuity violates womanhood to intensify HIV stigma.”
Even in a married couple, the wife is always tested for HIV before her husband because it is assumed that she is the only one who could bring it upon them. This further hurts the woman because if she is discovered to have HIV, no one will find her respectable enough to marry her or have children with, and in Botswana, motherhood is an essential component of one’s identity as a woman.
Finally, there is the stigma around pregnant women with cancer. The main situation Dr. Yang explained was the decision for a woman to get a hysterectomy because bearing another child will likely risk her life. When a woman decides to undergo this procedure, society often looks down on her for not living up to their womanhood to the fullest extent.
As Dr. Yang phrases it, “You are asking the woman to decide between two deaths: physical death and social death.”
No matter which one she chooses, someone will be disappointed in her.
The lessons presented to us by Dr. Yang should leave us with this thought: illness doesn’t always hurt people, but stigma always does.
When you say “stigma”, do you not mean prejudice? Is the one not disguise for the other? It is.
Harold A Maio