This paper reported a
phenomenological study of public attitude towards persons with
mental illness. In-depth interviews were done to eight persons with
mental illness and their family members in Hong Kong. Their
personal experiences in daily interaction with members of communities
were explored. Their perceptions of stigma and label of mental illness;
their experiences in being labeled and stigmatized as well the
consequences and their coping with this labeling was explored.
Persons with mental illness have long been labeled and stigmatized by
the public as dangerous, violent and mythical (Link, et.al 1987;
Albrecht, Walker & Levy, 1982; Wilson, Nairn & Coverdale, 1999;
Ng, 1997; Repper & Brooker, 1996; Ojanen, 1992; Byrne, 1999).
Related studies can be roughly divided into three main components, the
stigma and label of mental illness; the labeling and stigmatization
process; and the consequences of labeling and stigmatization. Goffman
(1963) adopted the term `stigma’ from Greeks implying a mark that
represent immorality. Goffman further elaborated that stigmas can be
manifested and latent (Goffman, 1961; Link, et.al., 1989; Penn &
Martin, 1998). While stigmas represent an actual deficit or immorality,
label and stereotypes involve discrimination without the actual
deficits (Angoustinos & Ahrens, 1994; Judd & Park, 1993;
Kruger, 1996). Studies showed that persons with mental illness are the
most rejected among disabled groups (Albrecht, Walkeer & Levy,
1982; Link, et.al, 1987). They are labeled as unpredictably violent,
dangerous, insane and mythical (Phelar & Link, 1998; Ng, 1997;
Janes, 1998; Ng, 1997) Torrey (1994) asserted that the existence of
seriously mentally ill respondents who exhibit violent behavior
undermines efforts by health advocates to reduce the stigma of mental
illness by denying an association with violence.
Regarding the labeling and stigmatization process. Jones, (et.al. 1984)
asserted that the process of stigmatization depends on six dimensions
such as conceability, course, disruptiveness, aesthetic qualities,
origin and peril. In Jones’ (et.al, 1984) terms, the stigma of mental
illness contains high peril (unpredictable threat to others), various
conceability and aesthetic qualities among individuals (some with good
appearance, some with poor personal hygiene or odd and bizarre
behaviors), poor course (chronicity of mental illness increases
overtime) and very disruptive to oneself. In Chinese traditional
culture, people may interpret the origin of mental illness is due to
one’s misdeed in this life or previous life. Lemert (1951) and
Goody (1978) asserted that deviant behaviors and discrimination happens
in a vicious cycle. The more the individual being discriminated, the
more deviant his or her behaviors become. Wilson (et al, 1999) found
out that the image of dangerousness of mental illness is constructed by
special effects like appearance, music and sound effects, lighting,
language, intercutting, jump cutting, point of view shots, horror
conventions and intertextuality in television program. The public
belief of `dangerousness to self or others’ increased drastically from
4.2% in 1950 to 44% in 1996 in the United States (Phelan, Link, 1998).
Labeling and rejection of persons with mental illness tends to increase
in personal contact and self interest. (Page, 1977; Trute and Loewen,
1978; Byrne, 1999; Desforges, 1991, Angermeyer & Matischinger,
1996). Some studies showed that many clinicians may fail to address the
problems of stigma in the process of intervention (Gingerich, 1998;
Angermeyer & Matchinger, 1996). Link’s (et.al, 1987 & 1999)
studies showed that in terms of mis-beliefs of violence and
dangerousness, the general public labels persons with mental illness
even in the absence of odd and bizarre behaviors.
The impacts and consequences of stigmatization and labeling is highly
disruptive both the individual and the society. Related studies show
that persons with mental illness choose not to use mental health
services because of fear of labeling (Leaf, Bruce, Tischer &
Holzer, 1987; Kessler, et.al., 2001). Sirey’s (et.al. 2001) study
showed that persons with mental illness opt not to continue treatment
where labeling effects are manifested in treatment centers. Studies
also showed persons with mental illness is also self-labeled and
stigmatized themselves as shame, insane, crazy, low self esteem and
guilt. All these defeat their competence in recovery and normal social
functioning (Link, 1982; Link 1987; Link & Phelan, 2001; Ritsher
et.al., 2003). Finally, because of labeling of mental illness, persons
with mental illness are spontaneously excluded and discriminated in
normal social and daily activities (Link, 1982, Link, 1987; Link,
et.al, 1987; Corrigan, 2000; Corrigan & Watson, 2002; Farina &
Felner, 1973; Farina, et.al., 1973; Farina, et.al., 1974)).
Similarly, stigmatization and labeling of mental illness are common in
Hong Kong (Cheung, 1990; Mak, et.al., 1996; Chu, et.al., 1996; Pearson
& Yiu, 1993; Yip, 1991). Mak (et al, 1996) study implied about 45%
of people in Hong Kong think that persons with mental illness should
best be kept in hospitals. However, there are no related study to
explore the experiences of persons with mental illness in labeling and
stigmatization in Hong Kong. In this paper, the writer tries to
describe a phenomenological study in this area.
Aims of this Study
The aims of this study were as follows:
1. To examine what contribute to the label and stigma of mental illness in Hong Kong.
2. To explore the process of labeling and
stigmatization of the public towards persons with mental illness in the
3. To examine consequences and coping of labeling on persons with mental illness
Twenty clients were referred by rehabilitation agencies but only eight
of them and their family members were willing to participate in this
Justification of the use of a phenomenological approach
Studies in labeling and stigmatization of mental illness are mostly
quantitative in examining public attitudes towards mental illness.
There were only a few of them focus on the views of persons of mental
illness (Corrigan and Watson, 2002; Corrigan, & Lundin, 2001). The
views and experiences of persons with mental illness was neglected in
the research and related literature. All these are crucial in
generating effective measures for intervention and service. Thus,
in this study, the empirical phenomenological approach was involved in
data, hoping that experiences and views persons of mental illness can
be fully respected and revealed.
The Phenomenological Approach
Van Kaam (1966) described this approach as follows:
`The empirical phenomenological approach involves a return to
experience in order to obtain comprehensive descriptions that provide
the basis for a reflective structural analysis that portrays the
essences of the experience. The approach seeks to disclose and
elucidate the phenomena of behavior as they manifest themselves in
their perceived immediacy (van Kaam, 1966:15)
Giorgi (1985) outlines two descriptive levels of this approach: the
original data from open-ended questions and dialogue and reflective
analysis and interpretation respondents’ account or story (Giorgi, 1985
& Moustakas, 1994). In this study, during the interview process,
the writer tried to start with descriptive narrative provided by the
respondent who is viewed as co-researchers. The writer and the
respondent were engaged in smooth dialogue. Questions concerned were
aturally flowed out from the dialogue. In the whole process, the writer
avoided any interpretation or evaluation of the respondent (von
Phenomenological Data Analysis
Melearu-Ponty mentioned three criteria for phenomenological analysis,
genuine descriptive account by respondents; researcher’s interpretation
reduce to minimum and search for essence (Melearu-Ponty, 1962 and
Giorgi, 1985). In this study, once collected, the data were read and
scrutinized so as to reveal their structure, meaning configuration,
coherence and the circumstances of their occurrence and clustering (von
Eckartsberg, 1986). The writer focuses on the how respondents’ personal
experiences in daily interaction with members of community. In what way
the construction, process, consequences and coping of label and stigma
of mental illness were naturally flowed out from respondents’ own
What Contributes to the Stigma and Label of Mental Illness
The Views of Persons with Mental Illness
In this study, respondents with mental illness expressed the following views towards the stigma and label of mental illness.
`There is no such thing as mental illness. I am not a mental patient.
We are being labeled as mentally ill simply because my family, my
friend, my doctor and my boss perceive that I am mentally ill. Mental
illness is an excuse used by them to isolate, to blame and to oppress
us and deprive our rights to enjoy normal daily life.’
`I am mentally ill. My doctor and my parents told me that depression is
a serious mental illness. I have to depend on medication to counteract
my symptoms. I felt dreadful, I am hopeless and worthlessness as I am a
mental patient. The medication make me better, I have to follow the
instruction of my doctor and my parent so as to suppress my depressive
`Mental illness is a terrible stigma. People look down upon you simply
because you have a record of mental illness or showing any sign of
mental illness. For those who know your record of mental illness,
including your friends, your colleagues, they may labell any thing you
have done. Even you do a good job, they do not believe in that. If you
have some minor strange behaviors, or impulsive emotion, they would
quickly label them as symptoms of mental illness. For those who do not
know your record of mental illness, if you appears normal, no one
beware that you are a person with mental illness.
The Views of Family Caregivers
`C can be easily labeled by others as a person with mental illness. His
symptoms are so obvious. He always deludes that he is the famous movie
star “ Bruce Lee” (a former Chinese marital art master who is an
international movie star). He tries to dress and perform like `Bruce
Lee’. Our neighbors, relatives and friends all know that he is `insane’
and some even tries to make fun of him. Others try to avoid him fearing
that he may suddenly broke into violence and aggression.’
`Ever since the leaving of her girlfriend, E was so depressed. He
refused to go to work. He refused to clean himself. His personal
hygiene was poor that his odd smell clearly showed that he was `. Many
neighbors gossiped behind us saying that he was schizophrenic and with
potential violence. In fact, he was too depressed to care about his
personal hygiene. He was only a young man with a broken heart.’
B’ s mother
`When B is in good mood, she appears gentle and kind. She was able to
work and interact with others normally. However, whenever she feels
stressful, she cried bitterly and deluded that she was deserved by her
boyfriend. She might delude that the richest man in Hong Kong had
fallen in love with her. ’
Stigma and Labels are both Objectively and Subjectively Constructed
From the above narration by respondents and their family members, it is
interesting to note that stigma and label and mental illness can both
be objectively and subjectively constructed. Objective facts are odd
and bizarre behaviors (C’s odd behaviors and delusion to be Bruce Lee),
poor personal hygiene or outlook (E’s poor personal hygiene and bad
body smell). All these are easily misinterpreted by others as signs for
`violent’, `myths’, `troubles’ and `craziness’. (Phelan & Link,
1998; Ng, 1997: Torrey, 1994). However, it can also be subjectively
constructed. D asserted that the label was only subjectively
interpreted by others if even she did not exercise any symptoms and
bizarre behaviors only because of previous record of mental
illness. This seems to concur with the studies done by Link (et.al.
1999). In this study, persons with mental illness seemed to be more
sensitive to others’ subjective construction of label of mental
illness. Their family members tended to be more sensitive to objective
construction of mental illness as they faced symptoms and odd and
bizarre behaviors daily. Furthermore, mental state and symptoms might
affect the receptivity of the label of mental illness. For example, as
C was indulged in his active delusion of the marital art movie star, he
ignored others’ stigmatization. A’s depressive mood might intensify her
internalization of the stigma of mental illness. Her psychiatrist might
intensify this stigma so that to increase A’s drug compliance.
Nevertheless, as F’s mental state was stable, she was highly sensitive
to others’ labeling. Finally, though family members were empathic to
their relatives with mental illness. They understood that their
relatives’ conditions changed overtime. Sometimes they were better and
sometimes they were worse. They also understood their relatives’
feelings behind symptoms and odd and bizarre behaviors.
The Interactive Process in Public Stigmatization and Labeling
Nearly all respondents and their family members had unpleasant
experiences in being labeled and stigmatized by others in the community.
Respondent B and her mother had the following experience in a supermarket.
`My mother and me shopped in a supermarket. I wore a patient uniform
and was a bit dirty. When I entered the supermarket, everyone looked at
me. Some gossiped behind me. No one approached me. Suddenly, the
manager of the supermarket approached me and asked my mother what sort
of things I wanted to buy. I said I preferred to look around and buy a
box of drink. She pointed out where the drinks placed and left us
alone. However, she still kept an eye on us. Other customers avoid
coming close to us but they stayed at a distance. I could hear what
they said. Some said I was crazy and was a mental patient. Some said it
was a pity that a pretty young woman became insane. Some even said my
mental illness was a consequence of some bad deeds done by my
mother. Other questioned about my potential dangerousness.
When I came near the drink and snack corner. Some were afraid that I
would pick out some glass bottles and threw at them. They were very
alert when I picked up some bottles of drinks from the shelf and put
them down rudely. When I came close to the shelf placing kitchen
utensils, they were very nervous. They even approached the manager and
warned her that I might pick up some kitchen knives. I passed along
this corner quickly. They became more relaxed than before.’
C’s sister and C had the following unpleasant experience.
`One day my brother walked aimlessly and played marital art in the
middle of a street in a busy commercial area in Hong Kong. Because of
the fear of being stigmatized, I tried to stay a bit away from him.
People stared at him. They tried to keep at a safe distance away from
him while he was playing marital art. Finally, he slowed down and went
to a Chinese restaurant. He sat down quietly and ordered for some food
to eat. His untidy hair and strange body postures symbolized that he
was a mental patient. People in the restaurants sat at their seats and
kept looking at him. When he stood up and went to the toilet, they
moved away so as to keep a `safe’ distance away from him. Most of the
time, he dared to look at them. However, if my brother looked back,
they would appear nervous.’
D described the following experiences in an arcade.
` I sat on the corner of the ground of an arcade. They surrounded me. I
sat on the ground saying that I was sacked by my bad employer. I was
sent by the King of Heaven to punish any bad employer in this world.
People laughed at me. Some even invited me to punish their bad bosses.
Some were pity about me. Some took a glance and walked away..’
E said that she was frustrated by the following experiences in a children playground.
` Once I walked in a children playground within a public park. Nearly,
all parents there stared at me and watched me closely. They were highly
anxious with my behaviors fearing that I might harm their children. At
first I kept sitting at the corner of the playground. I felt very sad
and cried. They tended to pull their children back. After a short
while, I started to shout that I was deceived by someone. I hated every
young woman who always deceived men. At that moment, everybody in the
playground looked at me. They were very tense. Some parents immediately
stood in front of their children. Some even embraced their small kids
and started to go away. Some moved along to search for guards in this
park. A young father even nervously picked up a stick and ready to
defend him and his child.’
F had the following unpleasant experience in a shop.
`People around me watched me closely in the shoe shop, especially the
shopkeeper. She simply walked very close to me and tried to ensure that
I would not frighten other customers. I appeared normal except my body
posture was rigid and tense because of the side effect of the
medication. I picked up some shoes and tried to wear them. She could
not tolerate any further. She persuaded me that no shoe in her shoe
shop was suitable for me and advised me to went out and find another
The following unhappy experience was described by G’s mother.
` I and my daughter, G shopped in a large department store. Because of
her delusion as a modern dancer, she taped foot or danced slowly.
No sooner, it caught the attention of two sale girls. They tried to
predict what my daughter was going to do in the next movement. Finally,
to prevent further troubles, they called upon guards in the
department store. With the help of a guard, these two sale girls
escorted us to leave the department store.’
H had the following unhappy encounter in a Chinese restaurant.
` I was advised to leave the Chinese restaurant simply because of my
depressive mood. In fact, I had done nothing to disturb them. I only
cried bitterly for my misfortunes and yelled out my inner anger towards
life. However, the manager together with other waiters and customers
all agreed that I was irrational and insane. When I walked out of the
Chinese restaurant, many customers appreciated the prompt action of the
manager saying that he was determined to stop my disturbance. What I
needed was institution and detention rather than fooling around in the
The Socially Constructed Process in Public Stigmatization and Labeling: Interactive Action and Response
The experiences of respondents and their family members showed that
stigmatization and labeling of mental illness was a socially
constructed process by members in the public areas. The construction
process involved several elements: public areas, symbols or icons
representing mental illness, action and response among persons with
mental illness and the public. These public areas could be; supermarket
(in B’s experience); arcade (in D’s experience); children playground
(in E’s experience); shoes’ shop (in F’s experience); department store
(in G’s experience) and Chinese restaurant (in H’s experience). In all
these public areas, people come and go and engaged in well defined
activities such as shopping in shops and departmental stores, sitting
in public transport, dining in restaurants. According to respondents’
experience, stigmatization and labeling started with certain
behaviors, symptoms and signs that symbolized mental illness. It might
be depressive mood and crying (in D’s, E’s and H’s experiences). It
could also be odd and bizarre behaviors (C’s marital art;
E’s ventilation of her anger towards men and F’s dancing). It might be
some signs (F’s rigid and tense body posture due to side effect of
medication or B’s patient uniform). All these signs created
disturbances to the well defined norms within these public areas.
People there interpreted them as possible `outburst’ of unpredictable
and mythical danger, violence and danger’. Following such construction
of label of mental illness was the arousal of fear and immediate need
of self protection. That might be the reason why people in public
places tried to watch closely but keep a safe physical distance to
respondents in this study. For instance, B and her mother was watched
and gossiped by others in the supermarket. C was watched by others in
the street and in the Chinese restaurants; D, E and F was watched by
others in arcade, shops and department store. Instead of immediate
rejection and exclusion, respondents in this study were watched by
others for a certain period of time. Thus, B was able to look for some
good in the supermarket. C was able to play marital art in the middle
of the street in a commercial area. D was able to cry bitterly in the
arcade. E was able to stay quite a while in the children playground; F
was able to try some new pairs of shoe in a shoe store. G was able to
dance in the department store. They might be afraid that immediate
exclusion would provoke sudden outburst of the violent and crazy
Within this period of time, people around or responsible persons in
public areas spontaneously gossiped, discussed, assessed and prepared
for suitable actions. For example, in B’s experiences, customers in the
supermarket spontaneously gossiped behind her. In G’s case, her bizarre
dancing in the department store was watched by two sale girls. They
assessed, discussed and planned for appropriate actions. In E’s
experience, parents in the children playground were so anxious about
every action of E. They were well prepared to defend for their children
if E broke into violence and aggression.
Rejection, exclusion and defense finally evolved if these signs of
mental illness far exceeded the tolerance limits and threats clearly
manifested. Respondents F, G and H were finally being excluded from the
shoe store, Chinese restaurant and department store. However, it was
interesting to discover that, this sort of tolerance limit was in fact,
subjectively constructed by the public, especially by those who were
responsible to maintain order and safety in public areas. For instance,
F was excluded from the shoe store by the sale girl only because of her
rigid and tense body posture. G was escorted by a guard and two sale
girls to leave the department store.
In fact, not all people in public areas labeled persons with mental
illness. People with religious beliefs or similar situations may be
empathic to persons with mental illness. In this study, A had the
following pleasant experience in a bus.
` I got on a bus and sat on a seat on the upper deck. I cried bitterly,
saying that I was so frustrated by my failure in courtship, public
examination and employment. Later, a middle aged woman in nice dress
approached me. She hold my hands tightly and comforted me. She said
that she had similar experiences when she was young. She had very poor
results in public examination and her boy friend left her suddenly. But
she worked through all these because of her religious belief. She was a
devoted Christian. She even prayed for me and comforted me. Later she
gave a business card to me and told me to ring her anytime I needed
help. I looked at the card. Oh, she was a minister of a Christian
Consequences of Labeling: Social Exclusion and Coping
The findings in this study showed that social exclusion and
discrimination were common among persons with mental illness because of
the results of stigmatization and labeling. Different coping strategies
were used by various respondents. Some were healthy ones and some were
A tried to be patient hoping she could be recovered in the future.
` I am still troubled by my failure in courtship, public examination,
and employment. I am still deeply frustrated by others’ labeling and
stigmatization. I need to depend on medication to ease my depressive
mood. But with my support from my sister, I know that sooner or later I
can be better. In fact, the worst situation has gone. My psychiatrist
told me to wait patiently.’
B’s mother was so angry and shameful towards the labeling and discrimination.
B’s mother said: ` I had taken care of B for 12 years after her onset
of schizophrenia. I do not mind the never ending burden of caring B’s
daily life, reminding her to take medication and comforting her when
she felt upset. However, the reaction of the public, especially our
neighbors make us felt angry and shameful. A few of them are helpful
but most of them gossiped behind us. They always think that the
occurrence of my daughter’s mental illness is due to my bad deeds done
in my previous life (in Buddhism, one’s life fortune is pre-determined
by what s/he had done in his or her previous life). Whenever we walked
by, they stared at us strangely. I felt shameful in facing their eye
contacts. We have done nothing harmful to the neighborhood. Why
should they discriminate us. I am seventy three years old now. I
worried one day when I died, who can take care of B? Facing the
labeling by our neighbors, B always quarrels with them. It makes the
discrimination even worse.’ (B’s mother cried bitterly in the interview)
Facing the labeling and stigmatization, C’s sister avoided going out with C.
`My brother was so confused in his residual psychiatric symptoms. He
always deluded he was the famous marital art movie star, Bruce Lee.
Members in our community all knew that he was the `crazy dragon’. Some
even address him simply as `Silly Bruce’. Guards in nearby shopping
arcade tried to stop him going inside. People around gossiped and
excluded him. I was caught in a dilemma. On the one hand, I dared not
to go out with him fearing of others’ labeling. On the other hand, I
was afraid he was being caught by the police because of potential
dangerousness towards other by practicing marital art in the open area.
He also feared of others’ labeling. He said that there were too many
ones being jealous of her excellent marital art skills and reputation.
Thus, we rarely went out, instead, we locked ourselves in our home. He
tried to practice in his room by punching sand bags and watching movie
of Bruce Lee. Apart from reminding him to have regular medication, we
could do nothing.’
D felt humiliated and inferior towards the public labeling.
D said: `I feel humiliated by others. I am constantly labeled by others
as an `insane and crazy person. It is nothing wrong to feel frustrated.
Every one wants some supernatural forces to ride off those bad guys.
However, others’ labeling makes me felt deeply inferior and humiliated.
I dare not to look into others’ eyes. I get a feeling that their eye
contact judging me as a patient that I have to lock up in hospital. By
the way, I am only an insane mental patient. No one wants to employ me
nor no one dares to make friend with me. I feel lonely, helpless and
inferior. My social worker helped me to have a job in a sheltered
workshop, but it was really boring there. I preferred to work as a
guard in an arcade. I hoped one day, I can find such a job.’
E described that public labeling intensified his depressive symptoms.
E said: ` I dare not look into others’ eyes. I am a patient with
depression. People know that I have mental illness. They look down upon
me. I am sad, useless and hopeless. Every body looks down upon. To be
abandoned by my girl means that I am worthless. Others’ exclusion
further proves that I am worthless and hopeless. I think I am the most
worthless male in Hong Kong. Everyday, apart from sleeping, eating and
idling in the park near the psychiatric half-way house, I could do
nothing. I deeply hoped that one day my girlfriend can come back to me ’
F firmly asserted that labeling and stigmatization was a burden for her
recovery. Nevertheless, she tried her best to live a normal life.
F said: ` I struggled very hard in these years to get ride of the label
of an insane person. Others’ discrimination made me fear that it was
nearly impossible to be recovered or live a normal life again. I dared
not to go out, I dared not to find employment or even dared not to go
to church thinking that all of them may tease at my symptoms.
Fortunately, my church members and my sister were very supportive. They
accompanied me to go out. They tried to persuade with other church
members that I had a lot of strengths and ability. They encouraged me
to show concern to others. I hope all members in the community try not
to discriminate, or to exclude clients with mental illness. Their
normal respect is crucial and vital for our recovery. In fact, the most
important thing for recovery is to try my best to live a normal life
including a normal job, a normal daily life pattern, normal social
activities and normal family. .’
G’s mother described her worry with G.
`I was so worry about G. She was my own daughter. She became a
schizophrenic patient when she was only 15 years old. My husband died
five years ago. I am the only one to take of her. I am 55 years old
now. I was so worry about G’s future. I hope one day she can marry a
good guy and take care of her. However, her mental symptoms still
prevails. Everywhere she went, she was labeled by others as a `crazy
dancer. Her social worker in the halfway house encouraged her to work
in a sheltered workshop, but she always slept there. She was only
suitable to be a dancer. Now I can take care of her. But one day I die
who can take of her.’
H tried to live independently after her divorce.
`Being divorced by my husband was dreadful. But to be a depressive
patient was even dreadful. Within these five years, my life was ruined
by depression. Everyone looked down upon saying that I became crazy
after the divorce. I could not take care of my son. I could not go to
work. But now with the help of my mother, my social worker and my
psychiatrist, I am much better. I begin to recognize that I have to
stand on my own and be independent. I have to construct my own future
by reminding myself and training myself to live a healthy life. My
social worker helped me to found a good job as a cleaner in a arcade.
My mental state is stable. I hope sooner or later I can discharged from
this halfway house, return home and live together with my beloved
mother and my beloved son.’
Healthy or Unhealthy Coping
Public stigmatization and labeling brought along social exclusion of
persons with mental illness. In this study, respondents were excluded
from public areas like Chinese restaurants, department stores, children
playground and arcade. All respondents and their family members felt
angry, being looked down by others, and deeply humiliated. Different
respondents and their family members constructed various ways in coping
social exclusion. Some of them were unhealthy ways and some were
healthy ones. Unhealthy coping implied that respondents and their
family members internalized others’ stigmatization and labeling in form
of self stigmatization. For example, B’s mother felt shameful and
dared not to look at others’ eyes as her neighbors gossiped that her
daughter’s mental illness was a punishment of her misdeeds in her
previous life (in Buddhism, everyone’s fate is a result of one’s
behavior, in previous life and this life). Similarly, D felt lonely,
helpless and inferior because of being looked down by others. E also
dared not to look into other’s eyes thinking others might judge that
she was mentally ill. Together with self stigmatization might be self
exclusion. For instance, C’s sister dared not to go out with C fearing
that he might be caught by the police because of odd and bizarre
behaviors. B always quarreled with those who labeled her. To avoid
that, B’s mother tried to keep B at home. As a result, one’s competence
for recovery was greatly hindered. D always felt that he was only a
mental patient and no one wanted to employ him and no one wanted to
make friend with him. E also felt that he was useless and hopeless. He
was the most worthless male in Hong Kong. Apart from sleeping, eating
and idling, he could do nothing. G’s mother and D’s sister also felt
helpless and hopeless towards their relatives’ mental illness. Healthy
coping meant building up a positive attitude so that one could be
positive and constructive in recovery and living a normal life. All
these positive attitudes and coping strategies were needed to be
supported by empathic social workers, church members, family members
and neighbors. For instance, with the full support from her sister, A
tried to be patient with a hope that one day she could recover from her
depression. By means of the help of his social worker, D also hoped
that one day, he could find a good job. With the spontaneous and full
support from her church members, F tried to live a normal life
including a normal job, normal daily pattern, normal daily activities
and normal family.
Conclusion: Constructing A Supportive Community
As a conclusion, this paper describes the personal experiences of
clients with mental illness about in facing the labeling by members of
communities in Hong Kong. It seems that public stigmatization and
labeling of persons with mental illness in the community of Hong Kong
is a spontaneous social construction process between the members in the
community and persons with mental illness. As a result, social
exclusion and self stigmatization may occur that hinder recovery and
community integration of persons of mental illness. All these have
important implications to psychiatric rehabilitation intervention and
services. Related professionals, policy makers should try their
best to build up a caring and supporting community for persons with
mental illness. First, facing spontaneous labeling by members in the
community, persons with mental illness should be empowered to
counteract labeling and public stigmatization (Krauger, 2000;
Stormwell, 2002). Anti-oppressive psychiatric rehabilitation and
community program may include the following:
1. Helping clients with mental illness to express and communicate their
unpleasant feelings of being discriminated properly to members of
community. Assertive training of feeling expression sentences like: `I
feel uneasy about your staring. I hope you regards me as a normal
person’ may be a good start for such anti-oppressive assertion’.
2. Encouraging family members of clients to interact with their
neighbors and members in the community to share their burdens and
difficulties in family caregiving so that they can solicit their
respect and concern in accepting clients with mental illness to
interact normally in the community.
3. Exploring and identifying neighbors, friends and members in the
community who are empathic with clients with mental illness and allying
them to support a normal interaction of clients of mental illness in
Secondly, it is important to nurture constructive and gradual
interaction among persons with mental illness and members in the
community. It may first start with interaction with acceptable members
in the community and fully recovered persons with good social
functioning. Once such interaction is facilitated and encouraged, those
members in the community who are neutral to mental illness may be more
willing to interact with persons with mental illness. With their
support, the community may gradually move one step forward to accept
persons with some mild odd and bizarre behaviors and residual mental
symptoms. Finally, a supportive community for persons with mental
illness should be also protected by related legislation like
anti-discrimination ordinance and appropriated mental health education
so that members in the community can nurture their respect to concern
to persons with mental illness.
Angermeyer M.C., & Matschinger H., (1996) `the Effect of personal experience with
mentally ill on the attitude towards individual suffering for
disorder' Social Psychiatry & Psychiatric Epidemiology, 3, 321-326.
Annon, A., (1996) `Stigma and mental illness’ Administration and Policy in Mental Health, 24(1): 96.
Albrecht, G., Walker, V., & Levy, J., (1982) `Social distance from
the stigmatized a test of two theories’ Social Science Medicine, 16:
Augoustinos, M., Ahren, C., Innes, J., (1994) `Stereotypes and
prejudice: the Australian experiences’ British Journal of Social
Psychology, 33(1): 125-141.
Byrne, P., (1999) `Stigma of mental illness: Changing minds, changing behavior’ British Journal of Psychiatry, 174: 1-2.
Cheung, F.M., (1990), `People against the mentally ill: community
opposition to residential treatment facilities' Community Mental
Health Journal, 26, 205-212.
Chu, L., Chan K.F., Ng P., (1996) `Opinion of Hong Kong secondary
school respondents towards mental illness and its implications for
community education' Proceedings of the Joint World Congress of the
International Federation of Social Workers and the International
Association of Schools of Social Work, Vol. III, 154-157..
Corrigan, P.W., (2000) `Mental health stigma as social attribution:
Implications for research methods and attitude change’, Clinical
Psychological Science and Practice, 7(1): 48-67.
Corrigan, P.W., & Lundin, R., (2001) Don’t Call Me Nuts! Coping
with the Stigma of Mental Illness, Tinley Park IL: Recovery Press.
Corrigan, P.W., & Watson, A.C., (2002) `The paradox of self stigma
and mental illness’ Clinical Psychology-Science and Practice,
Desforges, D,M., Lord C.G., Ramsey, S.L., Mason, J.A., Van Leeuwen,
M.D., & West, S.C., (1991) `Effects of structured cooperative
contact on changing negative attitudes towards stigmatized social
groups' Journal of Personality and Social Psychology, 60, 531-544.
Farina, A. & Felner, R.D., (1973) `Employment interviewer reactions
to former mental patients’ Journal of Abnormal Psychology, 82(2) Oct
1973, US, http://www.
Farina, A., Felner, R.D., & Boudreau, L.A., (1973) `Reactions of
workers to male and female mental job applicants’ Journal of Consulting
and Clinical Psychology, 2(2): 108-112.
Farina, A, Thaw, J., Lovern, J.D., & Mangone, D., (1974) `People’s
reactions to a former mental patient moving to their neighborhood’,
Journal of Community Psychology, 2(2): 108-112.
Gingerich, S.L., (1998) `Stigma: Critical issues for clinicians
assisting individuals with severe illness- Response paper’
Cognitive Behavioral Practice, 5(2): 277-284.
Goffman. E. (1963) Stigma: Notes on the Management of Spoiled Identity, New Jersey: Englewood Cliff.
Goody, E., (1978) Deviant Behavior: An Interactionist Approach, New York: Prentice Hall.
Hoginbotham, C., (1998) `U.K. mental health practice can alter the stigma of mental illness’, Lancet, 352: 1052-1053.
James, A., (1998) `Stigma of mental illness: Forward’ Lancet, 352: 1048.
Jones, S., (1985)`The Analysis of depth interview' in R. Walkers
(ed) Applied Qualitative Research. pp55-70, New York: Gower.
Judd, C.M., & Park, B., (1993) `Definition and assessment of
accuracy in social stereotypes’ Psychological Review, 100(1) 109-118.
Kessler, R.C., Berglund, P.A., Bruce, M.L., Koch, R. Laska, E.M., Leaf,
P.J., et.al., (2001) `The prevalence and correlates of untreated
serious mental illness’ Health Services Research, 36: 987-1007.
Krauger, A., (2000) `Empowerment in social work practice with
psychiatrically disabled: Model and method.’ Smith College Studies in
Social Work’ 70 (3): 427-440.
Krauger, J., (1996) `Personal belief and cultural stereotypes about
racial characteristics’ Journal of Personality and Social Psychology,
Leaf, P.J., Bruce, M.L., Tischler, G.L., Holzer, C.E., (1987) `The
relationship between demographic factors and attitudes toward mental
health services’, Journal of Community Psychology, 15(2): 275-284.
Lemert, E., (1951), Social Pathology, New York: McGrow Hill.
Link, B.G., (1982) `Mental patient status, work and income:
An examination of the effects fo pscyhiatric label’ American
Sociological Review, 47: 202-215.
Link, B.G., (1987) `Understanding labeling effects in the areas of
mental disorders: An assessment of the effects of the expectations of
rejection’, American Sociological Review, 52(1); 96-112.
Link, B.G., & Phelan, J.C., (2001) `Conceptualizing stigma’ Annual Review of Sociology, 27: 363-385.
Link, B.G., Cullen, F.T., Frank, J. & Wozniak, J.F., (1987) `The
social rejection of former respondents: Understanding why label matter’
American Journal of Sociology, 92: 1461-1500.
Link, B. G., Phelan, J.C., Bresuhan, M., Stueve, A., Perscosolido,
B.A., (1999) `Public concepts of mental illness: Labels, causes,
dangerousness and social distance, American Journal of Public Health,
Link, B.G., & Phelan, J.C., (2001) `Conceptuality of stigma’ Annual Review of Sociology, 27: 365-385.
Penn, D.L., & Martin, J., (1998) `The stigma of severe mental
illness: Some potential solutions for a recalcitrant problem’
Psychiatric Quarterly, 69(3): 235-247.
Mak, K.Y., Ho, K., Chung, P.K., & Chou, K.L, (1996) Public Attitude Towards
Health Problems and Respondents in Hong Kong, The Hong Kong
Council of Social Service and Health Association of Hong Kong.
Ng., C.H., (1997) `The stigma of illness in Asian culture’ Australian and New Zealand of Psychiatry, 31(3): 382-390.
Ojanen., M., (1992) `Attitude towards respondents' The International Journal of Social Psychiatry, 38, 120-130.
Page, S., (1977) `Effects of the mental illness label in attempts to
obtain ccommodation’ Canadian Journal of Behavioral Sciences, 9: 85-90.
Patton., M.Q. (1980), Qualitative Evaluation Methods, London: Sage.
Pearson V., & Yiu, M.K., (1993), `Public attitude towards mental
health facilities: a study in Hong Kong' Social Work & Social
Science Review, 4, 59-82.
Phelan J.C., & Link B.G., `The growing belief that people with
mental illness are violent: the role of dangerousness criterion for
civil commitment’ Social Psychiatry and Psychiatric Epidemiology, 33:
Repper, J., & Brooker C., (1996), `Public attitude towards mental health facilities in the
community' Health and Social Care in the Community, 4, 290-294.
Ritsher, J.B., Otilingam, P.G., & Grajales, M., (2003)
`Internalized stigma of mental illness: psychosomatic properties of a
new measure’ Psychiatric Research, 121(1):31-49.
Sirey, J.A., Bruce M.L., Alexopoulos, G.S., Perlick, D.A., Raue, P.,
Friedman, S.J., (2001) `Perceived stigma as a predictor of treatment
discontinuation in young and older outpatients with depression’
American Journal of Psychiatry, 158(3): 479-481.
Stromwall L.K., `Is social work’s door open to people recovering from psychiatric disabilities’ Social Work, 47(1): 75- 83.
Torrey E.F., (1994) `Violent behavior by individuals with serious
mental illness’ Hospital and Community Psychiatry, 45(7): 653-662.
Trute, B., Loewen, A., (1978) `Public attitudes towards the mentally
ills: a function of prior personal experiences’ Social Psychiatry, 13:
Wilson, C., Nairn, R., & Coverdale J., Panapa, A., (1999)
`Constructing mental illness as dangerous: A pilot study’ Australian
and New Zealand and Journal of Psychiatry, 33(2):240-247.
Yip K.S. (1991) The Contemporary Issues of Mental Health Services in Hong Kong, Kam Ling Publisher, Hong Kong.