Article by S. Hussain Ather
Graphic design by Amy Assabgui
We often think of mental illness as solely a disorder of our minds and free from the biases and prejudices that come into play when we interact with each other. But it’s been observed that people of lower socioeconomic status may be more prone to mental illness.1 For a country with a diverse population — around 30% of the population identifying as PoC (person of color)2 — differences in the distribution of mental illness across race or ethnicity can never be ignored. Among the factors causing these disparities, there lie common themes of stigma and shame, intertwined in identity formation, further preventing individuals from seeking help.
Disparities in mental illness incidence and symptomatology
Health administrative databases in Ontario do not collect data on race or ethnicity as regularly as they could. However, efforts have been made to study how mental health disparities exist between individuals based on race. By identifying Chinese and South Asian surnames from various sources of data, Dr. Maria Chiu, Staff Scientist at Institute for Clinical Evaluative Sciences (ICES)3,4,5 observed a higher prevalence of mental illness among Chinese & South Asian ethnic groups.
There are many reasons why members of these groups don’t seek treatment, including self-stigma, internalizing stigmatizing ideas widely endorsed by the public, feelings of shame, and views and/or beliefs of mental illness that could prevent individuals from seeking treatment such as the notion that mental illness can make one weak or “inferior” to others.6,7,8,9 There is also high levels of public stigma, or how an individual’s community perceives mental illness.10
Asian values & mental health
The traditional values that govern Asian families create the common stigma and shame surrounding mental illness within Asian communities. The family is a unit: each member defined in specific roles with a hierarchy coexisting in harmony. Mental illness can reflect poorly on this harmony.
Asian societies also tend to be collectivist and emphasize the individual’s relationship to society as a whole, instead of the personal needs or desires of the individual. Group harmony, interdependence, and conformity rule above all, including one person’s needs to seek help.
The black community & mental health
Higher rates of psychiatric disorders have been reported among black Canadians. As well 30% of black respondents in the 2020 Statistics Survey reported experiencing moderate to severe generalized anxiety disorder, whereas roughly 24% of white individuals did.11
Stigma and a fear of being judged within the black community — and consequently shamed and embarrassed – have also been cited as reasons individuals may not seek help.12,13 Shame has also been observed among other ethnic groups such as Latinos.13
But what is it exactly about shame and stigma that keeps these individuals from reaching out for help? The answer may come down to how these illnesses change our perceived sense of identity. More than somatic/physiological changes in our body, they change the way we perceive ourselves and the ways others perceive us. Within those perceptions, shame and stigma lie.
The roots of stigma & shame from a philosophical view
According to the cognitivist views of emotions, emotions are object-oriented.14 Emotions like shame serve as guiding forces towards objects or goals. Shame, through this lens, serves to diminish one’s status as a member of a group – or stigmatize that person within a group.
For racial and ethnic minorities, group status is important as it relates to identity and broader collectivist ideals or how others in our respected community might judge that person. Being dependent on health services or medication may be a signal to others that we aren’t autonomous or strong, leading to these feelings of shame and stigma.
Next steps in combating social stigma surrounding mental illness
Understanding how these psychological forces are rooted in group identity can lead to individuals making more informed decisions on their personal health and well-being. This can include joining support groups within the community or reducing self-stigma through self-compassion and self-care. The ways one may relate to those groups and the identity and status that come from them are part of the puzzle in combating shame and stigma.
- Kim YM, Cho SI. Socioeconomic status, work‐life conflict, and mental health. American Journal of Industrial Medicine. 2020 Aug;63(8):703-12.
- Statistics Canada. “Visible Minority (15), Generation Status (4), Age (12) and Sex (3) for the Population in Private Households of Canada, Provinces and Territories, Census Metropolitan Areas and Census Agglomerations, 2016 Census‐25% Sample Data.” (2019).
- Shah BR, Chiu M, Amin S, Ramani M, Sadry S, Tu JV. Surname lists to identify South Asian and Chinese ethnicity from secondary data in Ontario, Canada: a validation study. BMC medical research methodology. 2010 Dec;10(1):1-8.
- Chiu M. Ethnic Differences in Mental Health and Race-Based Data Collection. Healthcare quarterly (Toronto, Ont.). 2017 Jan 1;20(3):6-9.
- Corrigan PW, Druss BG, Perlick DA. The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest. 2014 Oct;15(2):37-70.
- Bradby H, Varyani M, Oglethorpe R, Raine W, White I, Helen M. British Asian families and the use of child and adolescent mental health services: a qualitative study of a hard to reach group. Social science & medicine. 2007 Dec 1;65(12):2413-24.
- Leong FT, Lau AS. Barriers to providing effective mental health services to Asian Americans. Mental health services research. 2001 Dec;3(4):201-14.
- Loya F, Reddy R, Hinshaw SP. Mental illness stigma as a mediator of differences in Caucasian and South Asian college students’ attitudes toward psychological counseling. Journal of Counseling Psychology. 2010 Oct;57(4):484.
- Tiwari SK, Wang J. Ethnic differences in mental health service use among White, Chinese, South Asian and South East Asian populations living in Canada. Social psychiatry and psychiatric epidemiology. 2008 Nov;43(11):866-71.
- Taylor RE, Kuo BC. A Theory-Driven Exploration of Black Canadians’ Psychological Help-Seeking Intentions. Canadian Journal of Counselling and Psychotherapy. 2020 Aug 27;54(3):464-85.
- Jones, RP. Report on Black mental health a good first step, advocates say. CBC News: Ottawa. 2020 Aug.
- Ward EC, Heidrich SM. African American women’s beliefs about mental illness, stigma, and preferred coping behaviors. Research in nursing & health. 2009 Oct;32(5):480-92.
- Wong EC, Collins RL, Cerully J, Seelam R, Roth B. Racial and ethnic differences in mental illness stigma and discrimination among Californians experiencing mental health challenges. Rand health quarterly. 2017 Jan;6(2).
- Hutchinson P. Emotion-philosophy-science. In Emotions and understanding 2009 (pp. 60-80). Palgrave Macmillan, London.