Abstract
The objective of this research was to use intersectionality to explore Asian men’s experiences of stigma and mental illness to tease out the ways in which stigma of mental illness among Asian men is mediated by age, immigration experiences, sexual and gender identities, racism and racialization processes, normative expectations about masculinity, and material inequality. The data for this research are based on a 4-year, multi-site (Calgary, Vancouver, and Toronto) mixed-methods intervention study that evaluated the effectiveness of interventions in reducing self and social mental health stigma among Asian men (Livingston et al. International Journal of Social Psychiatry 64, 679-689, 2018; Guruge et al. Contemporary Clinical Trials 71, 133–139, 2018). Participants were Asian men living with or affected by mental illness and community leaders interested in stigma reduction and advocacy. Quantitative survey data captured participants’ self-reports of stigma, psychological flexibility, valued life domains, mindfulness, and empowerment readiness. Qualitative data included focus group transcripts, field notes, and participants’ logs about anti-stigma activities in their communities. The data analyzed here are from ten pre-intervention and seven post-intervention focus groups conducted at the Vancouver site. The data collected pre- and post-interventions revealed that men understand and experience stigma as inextricably linked to social location, specifically age, race, masculinity, ethnicity, and time of migration. Our analysis also revealed that mental health stigma cannot be understood in isolation of other social and structural barriers. The application of intersectional frameworks must figure prominently in psychological research and in public health policies that seek to reduce mental health stigma in racialized communities.
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Notes
In the context of this paper, we use the term “‘Asian”’ broadly to refer to people from countries including China, Japan, Taiwan, Southeast Asia, Korea, India, Pakistan, and the Philippines.
Asia represents the top source of recent immigrants, with 61.8% of new Canadians in 2016 having been born in Asia (Statistics Canada 2017).
Two of the seven focus groups were immediately post-intervention and five of the focus groups were six 6 months post-intervention.
References
Anisef, P., & Kilbride, K. M. (2003). Managing two worlds: the experiences and concerns of immigrant youth in Ontario. Toronto: Canadian Scholars Press.
Augsberger, A., Yeung, A., Dougher, M., & Hahm, H. C. (2015). Factors influencing the underutilization of mental health services among Asian American women with a history of depression and suicide. BMC Health Services Research, 15(1), 542.
Beiser, M., Simich, L., & Pandalgat, N. (2011). Stresses of passage, balms of resettlement and posttraumatic stress disorder among Sri Lankan Tamils in Canada. Canadian Journal of Psychiatry, 56, 333–340.
Chen, X., & Tse, H. C.-H. (2010). Social and psychological adjustment of Chinese Canadian children. International Journal of Behavioral Development, 34, 330–338.
Chen, C., Smith, P., & Mustard, C. (2010). The prevalence of over-qualification and its association with health status among occupationally active new immigrants in Canada. Ethnicity & Health, 15, 601–619.
Chiu, M. Y. L., Yang, X., Wong, H. T., & Li, J. H. (2015). The mediating effect of affective stigma between face concern and general mental health – the case of Chinese caregivers of children with intellectual disability. Research in Developmental Disabilities, 36, 437–446.
Chow, H. P. (2010). Growing old in Canada: physical and psychological well-being among elderly Chinese immigrants. Ethnicity & Health, 15, 61–72.
Cole, E. (2009). Intersectionality and research in psychology. American Psychologist, 64(3), 170–5 180.
Combahee River Collective. (1977). The Combahee River Collective statement. Retrieved from http://www.sfu.ca/iirp/documents/Combahee%201979.pdf. Access July 3, 2019.
Connell, R. W. (1995). Masculinities. St Leonards: Allen and Unwin.
Courtenay, W. H. (2000a). Engendering health: a social constructionist examination of men’s health beliefs and behaviors. Psychology of Men & Masculinity, 1(1), 4–15.
Courtenay, W. H. (2000b). Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Social Science and Medicine, 50(10), 1385–1401.
Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: a Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, 1989(8), 139-67.
Crenshaw, K. (1991). Mapping the margins: intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43, 1241–1299.
Dardas, L. A., & Simmons, L. A. (2015). The stigma of mental illness in Arab families: a concept analysis. Journal of Psychiatric and Mental Health Nursing, 22(9), 668–679.
Davis, A. (1981). Women, race and class. New York: Random House.
Demetriou, D. (2001). Connell’s concept of hegemonic masculinity: a critique. Theory & Society, 30(3), 337–361.
Desai, S., & Sabramanian, S. (2003). Colour, culture and dual consciousness: issues identified by South Asian immigrant youth in the greater Toronto area. In P. Ansief & K. Murphy (Eds.), managing two worlds: the experiences and concerns of immigrant youth in Ontario. Toronto: Canada Scholars Press Inc.
Dossa, P. (2002). Narrative mediation of conventional and new “mental health” paradigms: reading the stories of immigrant Iranian women. Medical Anthropology Quarterly, 16(3), 341–359.
Falicov, C. (2007). Working with transnational immigrants: expanding meanings of family, community, and culture. Family Process, 46(2), 157–171.
Fung, K., & Wong, Y.-L. R. (2007). Factors influencing attitudes towards seeking professional help among East and Southeast Asian Immigrant and Refugee women. The International Journal of Social Psychiatry, 53, 216–231.
George, U., Thomson, M., Chaze, F., & Guruge, S. (2015). Immigrant mental health, a public health issue: looking back and moving forward. International Journal of Environ. Res. Public Health, 12, 13624–13648.
Gilroy, P. (1987). There ain’t no black in the union jack: the cultural politics of race and nation. Chicago: University of Chicago Press.
Gorman, R. (2013). Mad nation? Thinking through race, class, and ad identity politics. In R. Menzies, G. Reaume, & B. LeFrançois (Eds.), Mad matters: A critical reader in Canadian Mad studies. Toronto: Canadian Scholars Press.
Guruge, S., Fung, K., Sidani, S., Este, D., McKenzie, K., Morrow, M., & Wong, J. (2018). Study protocol: mobilizing Asian men in Canada to reduce stigma of mental illness. Contemporary Clinical Trials, 71, 133–139.
Han, M., & Pong, H. (2015). Mental health help-seeking behaviors among Asian American community college students: the effect of stigma, cultural barriers, and acculturation. Journal of College Student Development, 56(1), 1–14. https://doi.org/10.1353/csd.2015.0001.
Hankivsky, O. (Ed.). (2011). Health inequities in Canada: intersectional frameworks and practices. Vancouver: UBC Press.
Hill Collins, P., & Bilge, S. (2016). Intersectionality. Cambridge: Polity Press.
Kalich, A., Heinemann, L., & Ghahari, S. (2016). A scoping review of immigrant experience of health care access barriers in Canada. Journal of Immigrant and Minority Health, 18, 697–709.
Kishore, J., Gupta, A., Jiloha, R. C., & Bantman, P. (2011). Myths, beliefs and perceptions about mental disorders and health-seeking behavior in Delhi, India. Indian Journal of Psychiatry, 53(4), 324–329.
Lapalme, J., Haines-Saah, R., & Frohlich, K. L. (2019). More than a buzzword: how intersectionality can advance social inequalities in health research. Critical Public Health. https://doi.org/10.1080/09581596.2019.1584271.
Lauber, C., & Rossler, W. (2007). Stigma towards people with mental illness in developing countries in Asia. International Review of Psychiatry, 19(2), 157–178.
Li, S., Hatzidimitriadou, E., & Psoinos, M. (2014). “Tangled wires in the head”: older migrant Chinese’s perception of mental illness in Britain. Journal of Aging Studies, 30, 73.
Liu, C., & Bryson, S. (2017). Why informally employed Chinese women do not go to the doctor. Health Promotion International, 32(3), 558–566.
Livingston, J., Patel, N., Bryson, S., Hoong, P., Lal, R., & Morrow, M. (2018). Stigma Associated with mental illness among Asian men in Vancouver, Canada. International Journal of Social Psychiatry, 64, 679–689. https://doi.org/10.1177/0020764018805125.
Man, G. (2004). Gender, work and migration: deskilling Chinese immigrant women in Canada. Women's Studies International Forum, 27(2), 135–148.
McKenzie, K., Agic, B., Tuck, A., & Antwi, M. (2016). The case for diversity: building the case to improve mental health services for immigrant, refugee, ethco-cultural and racialized populations. Report to the Mental Health Commission of Canada. Ottawa: National Library of Canada.
Mohanty, C., Russo, A., & Torres, L. (Eds.). (1991). Third world women and the politics of Feminism. Bloomington: Indiana University Press.
Morrow, M., Halinka Malcoe, L (Eds) (2017) Critical inquiries for social justice in mental health. University of Toronto Press.
Morrow, M., & Hardie, S. (2014). An intersectional approach to inequity. In W. Bryant, J. Fieldhouse, & K. Bannigan (Eds.), Creek’s Occupational Therapy and Mental Health (5th ed., pp. 188–203). UK: Elsevier Publishing.
Morrow, M., Smith, J., Lai, Y., & Jaswal, S. (2008). Shifting landscapes: immigrant women and post partum depression. Health Care for Women International, 29(6), 593–617.
Nadal, K. L., Escobar, K. M., Prado, G., David, E. J. R., & Haynes, K. (2012). Racial microaggressions and the Filipino American experience: recommendations for counseling and development. Journal of Multicultural Counseling and Development, 40, 156–173.
Nadal, K. L., Griffin, K. E., Wong, Y., Hamit, S., & Rasmus, M. (2014). Racial microaggressions and mental health: counseling clients of color. Journal of Counseling & Development, 92, 57–66.
Noone, J., & Stephens, C. (2008). Men, masculine identities, and health care utilisation. Sociology of Health & Illness, 30(5), 711–725.
Pahwa, P., Karunanayake, C. P., McCrosky, J., & Thorpe, L. (2012). Longitudinal trends in mental health among ethnic groups in Canada. Chronic Diseases and Injuries in Canada, 32, 164–176.
Rossiter, K., & Morrow, M. (2011). Intersectional frameworks in mental health: moving from theory to practice. In O. Hankivsky (Ed.), Health Inequities in Canada: Intersectional Frameworks and Practices (pp. 312–330). Vancouver: UBC Press.
Somerville, K. (2007). Life cycle events and the creation of transnational ties among second generation South Indians. In L. Tepperman & H. Dickinson (Eds.), Sociology in Canada: A Canadian Sociological Association Reader. Canada Oxford University Press.
Spivak, G. C. (1988). Can the subaltern speak? Basingstoke: Macmillan.
Statistics Canada (2017). Immigration and ethnocultural diversity: key results from the 2016 Census Ottawa, ON. Retrieved from: https://www.150.statcan.gc.ca/n1/en/daily-quotidien/171025/dq171025b-eng.pdf?st=bkg5mQbV.
Tam, L. (2013). Whither indigenizing the Mad movement? Theorizing the social relations of race and madness through conviviality. In R. Menzies, G. Reaume, & B. LeFrançois (Eds.), Mad matters: A critical reader in Canadian Mad studies (pp. 281–297). Toronto: Canadian Scholars Press.
Thomson, M., Chaze, F., George, U., & Guruge, S. (2015). Improving immigrant populations’ access to mental health services in Canada: A Review of Barriers and Recommendations. Journal of Immigrant and Minority Health, 17(6), 1895–1905.
Thompson, A., Anisimowicz, Y., Meidema, B., Hogg, W., Wodchis, W., Aubrey-Bassler, K. (2016) The influence of gender and other patient characteristics on health care-seeking behaviour: A QUALICOPC study. In BMC Family Practice. Vol. 38(17):1471-2296.
Yang, L. H., & Kleinman, A. (2008). ‘Face’ and the embodiment of stigma in China: the cases of schizophrenia and AIDS. Social Science & Medicine, 67(3), 398–408.
Yang, L. H., Thornicroft, G., Alvarado, R., Vega, E., & Link, B. G. (2014). Recent advances in cross-cultural measurement in psychiatric epidemiology: utilizing ‘what matters most’ to identify culture-specific aspects of stigma. International Journal of Epidemiology, 43(2).
Yeung, KT., Stombler, M., Wharton, R. (2006) Making men in gay fraternities: resisting and reproducing multiple dimensions of hegemonic masculinity. Gender & Society, Vol. 20(1), pp.
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This research was supported by the Movember Foundation (Canada).
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Research on stigma and mental health has rarely investigated the specific needs of Asian men. Our research showed the importance of understanding mental health stigma in the context of other social factors that impact the lives of Asian men, such as experiences of migration, deskilling, racism and age. Attention to these social factors will help to develop more effective anti-stigma programs and supports in mental health.
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Morrow, M., Bryson, S., Lal, R. et al. Intersectionality as an Analytic Framework for Understanding the Experiences of Mental Health Stigma Among Racialized Men. Int J Ment Health Addiction 18, 1304–1317 (2020). https://doi.org/10.1007/s11469-019-00140-y
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DOI: https://doi.org/10.1007/s11469-019-00140-y