Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany.
Center for Public Mental Health, Gösing am Wagram, Austria.
Epidemiol Psychiatr Sci. 2021 Mar 17;30:e26. doi: 10.1017/S2045796021000111.
The theory of 'what matters most' (WMM) has been developed to understand differences in mental illness stigma between cultures, postulating that stigma becomes most pervasive in situations that matter most in a specific cultural context. The rise of populism in Western societies demonstrates that also within one cultural context, different values 'matter most' to different groups. We expand the WMM framework to explore the spectrum of stigma manifestations within Western societies, relating it to both conservative/authoritarian and liberal/modern values. From our findings, we will develop hypotheses on how further research into value orientations and stigma might address potential blind spots in stigma research.
Based on a narrative review of the literature on mental illness stigma and value orientations, we apply the WMM framework to cultural mechanisms of stigma within modern Western societies.
There are several studies showing an association between traditional, authoritarian, conservative values with stronger mental illness stigma, while studies examining the stigma within liberal, modern value orientations are scarce. We hypothesise on situations where encountering a person with mental illness could threaten liberal values and thus might provoke stigma among persons with such value orientations. For example, living with a person with mental illness could be seen as consuming energy and time, thereby jeopardising 'self-actualisation', the modern value of realising one's own full potential. As a result, a person highly valuing self-actualisation might try to avoid contact with persons with mental illness. Instances of potential 'liberal stigma' also include structural stigma or self-stigma, when, e.g. changing assumptions of what is considered 'normal' increase perceptions of being fundamentally different when experiencing mental illness.
'WMM' appears to be a useful framework to direct research to potential blind spots within the field of stigma research. Looking at instances where liberal values conflict with dealing with a person with mental illness could provide a more comprehensive understanding of stigma experiences among persons with mental illness. However, for measuring stigma, tapping into liberal variations of mental illness stigma is methodologically challenging. Qualitative work could be the first step to elicit potential stigma experiences based on conflicts with liberal values.
“最重要的是什么”（WMM）理论是为了理解文化间精神疾病污名的差异而发展起来的，它假定在特定文化背景下，在最重要的情况下，污名变得最为普遍。西方社会民粹主义的兴起表明，即使在同一文化背景下，不同的价值观对不同的群体“最重要”。我们扩展了 WMM 框架，以探索西方社会中污名表现的范围，并将其与保守/专制和自由/现代价值观联系起来。从我们的发现中，我们将提出关于进一步研究价值观取向和污名如何解决污名研究中潜在盲点的假设。
我们基于对精神疾病污名和价值观取向文献的叙述性综述，将 WMM 框架应用于现代西方社会中的文化污名机制。
有几项研究表明，传统的、专制的、保守的价值观与更强的精神疾病污名之间存在关联，而研究自由、现代价值观取向内的污名的研究则很少。我们假设在遇到患有精神疾病的人可能会威胁到自由价值观的情况下，具有这种价值观取向的人可能会产生污名。例如，与患有精神疾病的人一起生活可能被视为消耗精力和时间，从而危及“自我实现”，即实现自身全部潜力的现代价值观。因此，高度重视自我实现的人可能会试图避免与患有精神疾病的人接触。潜在的“自由污名”的情况还包括结构性污名或自我污名，例如，当改变对什么是“正常”的假设增加了在经历精神疾病时感到根本不同的看法时。
“WMM”似乎是一个有用的框架，可以将研究引向污名研究领域的潜在盲点。关注自由价值观与与患有精神疾病的人打交道发生冲突的情况，可以更全面地了解患有精神疾病的人所经历的污名。然而，对于衡量污名，从自由角度切入精神疾病污名在方法学上具有挑战性。定性工作可能是根据与自由价值观的冲突来引出潜在污名体验的第一步。
