Stigmatization of mental disorders has detrimental consequences for psychiatric patients. This study examined how perceived stigma and coping orientations of secrecy, withdrawal, and education were related to schizophrenic patients' self-esteem and quality of life (QOL). Coping orientations as mediators of perceived stigma on the outcome variables were also investigated. A total of 80 schizophrenic patients in Singapore participated in the study. Results show that perceived stigma predicted self-esteem over and above gender and depression, perceived stigma and education predicted QOL over and above depression, and education partially mediated the effect of perceived stigma on QOL. Findings indicate that stigma perceptions and education coping are important focus areas in clinical interventions.

This study focuses on the therapeutic process and perceived helpfulness of dang-ki, a form of Chinese shamanistic healing, in Singapore. It aims to understand the healing symbols employed in dang-ki, whether or not patients find them helpful and whether their perceived helpfulness can be explained by the symbolic healing model (Dow, Am Anthropol 88(1): 56-69, 1986; Levi-Strauss, Structural anthropology. Basic Books, New York, 1963). Although many researchers have applied this model to explain the efficacy of shamanistic healings, they did not directly provide empirical support. Furthermore, the therapeutic process of a shared clinical reality as proposed by the model may be achievable in small-scale traditional societies that are culturally more homogeneous than in contemporary societies that are culturally more diversified due to globalization and immigration. Patients may hold multidimensional health belief systems, as biomedicine and alternative healing systems coexist. Thus, it would be interesting to see the relevance and applicability of the symbolic healing model to shamanistic healing in contemporary societies. In this study, ethnographic interviews were conducted with 21 patients over three stages: immediately before and after the healing and approximately 1 month later. The dang-ki healing symbols were identified by observing the healing sessions with video recording. Results show that dang-kis normally applied more than one method to treat a given problem. These methods included words, talismans and physical manipulations. Overall, 11 patients perceived their consultations as helpful, 4 perceived their consultations as helpful but were unable to follow all recommendations, 5 were not sure of the outcome because they had yet to see any concrete results and only 1 patient considered his consultation unhelpful. Although the symbolic healing model provides a useful framework to understand perceived helpfulness, processes such as enactment of a common meaning system and symbolic transformation are complex and dynamic, and may be carried over several healing sessions.

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This article explores the processes of transformation of the self in dang-ki healing, a form of Chinese spirit mediumship in Singapore, drawing on more than a decade of ethnographic research. In dang-ki healing, it is believed that a deity possesses a human, who is called a dang-ki, to help clients (i.e., devotees). Through the dang-ki, clients can interact with powerful deities in ways that help them feel hopeful and supported. The dang-kis themselves may also benefit therapeutically from their participation as mediums. Many dang-kis suffer from personal conflicts and distress before becoming a medium and they express and transform their distress through the idiom of spirit possession. Since deities represent traits and moral values promoted in Chinese culture, possession by a deity allows the dang-ki to embody an ideal self and to acquire spiritual knowledge by engaging in ritual practices involving cleansing, self-mortification, stereotyped movements, and altered consciousness. At the same time, junior possessing deities must undergo training under the guidance of senior deities to achieve a higher level of spiritual existence by helping clients through the dang-ki's body. Thus, in dang-ki healing, practitioners, clients and possessing deities are transformed in parallel ways. The dynamics of this reciprocal and interdependent healing process differ from the individualistic approaches in Western psychotherapy and shed light on the links between healing processes, cultural ontologies, and concepts of personhood.

Past research has shown that many adolescents with depression and anxiety disorders do not consult mental health professionals. This study examines how emotional distress, ambivalence over emotional expression, and causal attribution of depressive and anxious symptoms are related to adolescents' preferred sources of help for these symptoms. 300 secondary school students in Singapore were surveyed. Results show that distress, ambivalence, psychosocial causation, and biomedical causation were positively correlated with each other; distress was inversely associated with preference for seeking help from a family doctor; ambivalence was inversely associated with preference for a Traditional Chinese Medicine (TCM) physician; physiological causation was positively associated with preference for a medical doctor and TCM physician; and psychosocial causation was positively associated with preference for a mental health professional. These findings are discussed from an Asian cultural perspective and their implications for school mental health services will also be discussed.

The purpose of this paper is to discuss the relevance of folk therapies or traditional medicine to counselling in Singapore. It addresses the meanings of the indigenous psychotherapies and then the rationales for understanding them. Three popular Chinese indigenous psychotherapies have been selected for discussion in terms of their aetiology and treatment beliefs about emotional problems: traditional Chinese medicine, dang‐ki (Chinese shamanism), and feng‐shui (Chinese geomancy). Findings from an empirical study are briefly presented to show that Chinese Singaporean clients hold eclectic belief systems encompassing both beliefs derived from thse indigenous psychotherapies and those from Western psychotherapies (e.g. psychodynamic and behavioural therapies). Two cases are presented to illustrate the application of these indigenous psychotherapies in counselling practice.

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