Page 140 - GHES-3-1

Global Health Economics and
Sustainability
Reducing public stigma related to psychosis

emotions, harms or brings disadvantages to those who are or deny assistance (Corrigan, 2006; Corrigan et al.,
stigmatized (Corrigan et al., 2003; Dovidio et al., 2010). The 2015; Muñoz et al., 2015; Pingani et al., 2011). Fear and
belief that individuals with psychosis are dangerous fosters apprehension arise when dangerous behaviors are linked
aversion and fear, leading to discriminatory actions such to an individual, leading to avoidance or fearful reactions
as avoidance and coercive interventions (Corrigan & Bink, (Corrigan et al., 2002; Muñoz et al., 2015). In contrast,
2016), which in turn perpetuate a cycle of disadvantage and if the behavior is attributed to external, uncontrollable
stigma (Corrigan et al., 2003; Corrigan & Shapiro, 2010). factors, the individual is less likely to be blamed (Corrigan,
To fully understand stigma within health and societal 2006; Corrigan et al., 2003; Sousa et al., 2012) and may
contexts, it is important to recognize how public stigma instead receive sympathy and support (Corrigan et al.,
is interconnected with self-stigma and structural stigma 2003; Weiner, 1995).
(Livingston, 2013). Self-stigma occurs when individuals Although stigma against PMIH is widespread, it is
internalize the negative views and discrimination they also influenced by differences in sociocultural norms and
face, leading to feelings of “shame, blame, hopelessness, beliefs (Angermeyer & Dietrich, 2006; Cheon & Chiao,
guilt, and fear of discrimination associated with mental 2012; Yang et al., 2007). Emotional reactions are shaped
[ill-health]” (Brohan et al., 2010, p. 2). This internalization, by culturally specific beliefs about mental ill-health, and
combined with emotional distress, worsens the loss of behaviors related to these beliefs vary depending on what
self-esteem and self-efficacy, creating a cycle of ongoing is socially acceptable (Cheon & Chiao, 2012, p. 1059).
psychosocial decline and disempowerment (Lucksted & Since local values are closely linked to the development
Drapalski, 2015; Stuart et al., 2005; Corrigan et al., 2003; of stigmatizing attitudes (Abdullah & Brown, 2011),
Corrigan & Watson, 2002b). Structural stigma refers to cultural beliefs should be considered when developing
“societal-level conditions, cultural norms, and institutional interventions tailored to specific contexts (Dalky, 2011;
policies that constrain the opportunities, resources, and Kutcher et al., 2016).
well-being of the stigmatized” (Hatzenbuehler & Link, Given the social context of our study, Singapore is a
2014, p. 2). These restrictions support public stigma multiethnic nation with strong Asian cultural influences
(Hatzenbuehler & Link, 2014; Livingston, 2013) and result (Singapore Department of Statistics, 2021). In this setting,
in systematic disadvantages across various life areas for behaviors and meanings related to mental health issues
PMIH, particularly individuals with psychosis (Dovidio may be viewed as contrary to Asian values of conformity
et al., 2010; Hinshaw & Stier, 2008; Corrigan et al., 2004).
In occupational settings, individuals may need to disclose and emotional self-control (Abdullah & Brown, 2011).
their history of mental ill-health, which can lead to fewer Psychological difficulties are often perceived as deviations
job opportunities, exclusion from community activities from social norms (Abdullah & Brown, 2011) and are
(Ong et al., 2020; Sheehan et al., 2016; Suto, 2012), and associated with dangerousness, unpredictability, and
higher rates of unemployment, thereby limiting their career mental instability, which contribute to misconceptions
advancement (Stuart, 2006) and leading to disruptions in about individuals’ ability to manage their emotions (Ong
educational progress (Mojtabai et al., 2015) and social et al., 2020; Lai et al., 2000). These misconceptions lead
marginalization (Kapadia, 2023). to prejudicial attitudes, such as fear and mistrust, toward
PMIH (Ong et al., 2020).
1.3. Sociocognitive aspects of stigma Research indicates that stigma toward PMIH is more

Attribution theory is a sociocognitive framework that pronounced in Asian countries than in European countries
explains how cognitive processes contribute to the (Shamblaw et al., 2015). In Singapore, an epidemiological
development of public stigma (Corrigan, 2006; Weiner study by Subramaniam et al. (2017) found that individuals
et al., 1988). It suggests that people seek to understand with psychological difficulties are often viewed as weak,
behaviors and events by making attributions (Corrigan, dangerous, and unpredictable. A nationwide survey
2006; Heider, 1958). These attributions can involve revealed that 44.5% of participants used derogatory terms
assigning responsibility and assessing potential danger like “crazy” to describe PMIH (Pang et al., 2017). In
(Corrigan et al., 2015; Corrigan et al., 2003; Pingani et al., Singapore’s collectivistic culture, shared societal goals are
2011). According to the attribution of responsibility model, emphasized over individual ones (Shamblaw et al., 2015).
people make judgments about the causes and controllability This trend may lead to discrimination against those with
of an individual’s mental health issues, which then leads to mental ill-health (Tan et al., 2020). Psychological issues
assigning responsibility for the condition (Corrigan et al., are frequently attributed to family dynamics, suggesting
2003). When responsibility is attributed to PMIH, it often that they reflect familial flaws or moral shortcomings
results in anger and a tendency to enforce punishment (Subramaniam et al., 2017; Yang, 2007). Consequently,

Volume 3 Issue 1 (2025) 132 https://doi.org/10.36922/ghes.3363