Brijnath Bianca, Antoniades Josefine
National Ageing Research Institute and 2541 Monash University.
National Ageing Research Institute.
Transcult Psychiatry. 2018 Apr;55(2):178-197. doi: 10.1177/1363461518756519. Epub 2018 Feb 7.
This article applies the framework of moral experience to examine the cultural experience of stigma with Indian-Australians and Anglo-Australians living with depression in Melbourne, Australia. To date few studies have examined this dynamic in relation to mental illness and culture, and no studies have applied this framework in a culturally comparative way. Based on 58 in-depth interviews with people with depression recruited from the community, we explicate how stigma modulates what is at stake upon disclosure of depression, participants' lived experience following that disclosure, and how practices of health-seeking become stigmatised. Findings show that the social acceptance of depression jars against participants' experience of living with it. Denialism and fear of disclosure were overwhelming themes to emerge from our analysis with significant cultural differences; the Anglo-Australians disclosed their depression to family and friends and encountered significant resistance about the legitimacy of their illness. In contrast, many Indian-Australians, especially men, did not disclose their illness for fear of a damaged reputation and damaged social relations. For Indian-Australians, social relations in the community were at stake, whereas for Anglo-Australians workplace relations (but not community relations) were at stake. Participants' experiences in these settings also influenced their patterns of health-seeking behaviors and age and inter-generational relationships were important mediators of stigma and social support. These findings illuminate how stigma, culture, and setting are linked and they provide critical information necessary to identify and develop customised strategies to mitigate the harmful effects of stigma in particular cultural groups.
本文运用道德体验框架，审视了澳大利亚墨尔本患有抑郁症的印度裔澳大利亚人和英裔澳大利亚人对污名的文化体验。迄今为止，很少有研究探讨这种与精神疾病和文化相关的动态关系，也没有研究以文化比较的方式应用这一框架。基于对从社区招募的58名抑郁症患者的深入访谈，我们阐述了污名如何调节抑郁症披露时的利害关系、披露后参与者的生活经历，以及寻求健康的行为如何被污名化。研究结果表明，社会对抑郁症的接受与参与者与之共存的经历相冲突。否认和对披露的恐惧是我们分析中出现的压倒性主题，存在显著的文化差异；英裔澳大利亚人向家人和朋友披露了他们的抑郁症，并在其疾病的合法性方面遇到了重大阻力。相比之下，许多印度裔澳大利亚人，尤其是男性，由于担心声誉受损和社会关系破裂而没有披露自己的病情。对印度裔澳大利亚人来说，社区中的社会关系受到影响，而对英裔澳大利亚人来说，工作场所关系（而非社区关系）受到影响。参与者在这些环境中的经历也影响了他们寻求健康行为的模式，年龄和代际关系是污名和社会支持的重要调解因素。这些发现阐明了污名、文化和环境是如何联系在一起的，它们提供了关键信息，有助于识别和制定定制策略，以减轻污名对特定文化群体的有害影响。
