A Look at Culture and Stigma of Suicide: Textual Analysis of Community Theatre Performances

Abstract

Stigma against suicidal ideation and help-seeking is a significant barrier to prevention. Little detail is provided on what types of stigma interfere with help-seeking, how stigma is expressed, and how to reduce it. Five groups of two ethnically diverse community theatre programs were formed to analyze differences in Eastern Montana Caucasian and Native American adolescents and young adults’ experiences with stigma about mental illness and mental health treatment that affect help-seeking for suicidal thoughts and experiences. Over a ten-week period, a grassroots theatre project was used to recruit members from the same population as the audience to write and perform a play on suicide and depression (n = 33; 10 males, 23 females; 12 Native American, 21 Caucasian, ages 14–24). Using textual analysis, the community- and campus-based performance scripts were coded for themes related to stigma. Both ethnic groups reported that stigma is a barrier to expressing emotional vulnerability, seeking help, and acknowledging mental illness. We found that Caucasians’ experiences were more individually oriented and Native Americans’ experiences were more collectively oriented. Understanding the cultural bases of experiences with stigma related to mental health treatment for suicide is necessary to create educational programs to reduce stigma for diverse groups of adolescents and young adults.

Stigma of mental illness and cultural factors in Pacific Rim region: a systematic review

“…13 studies [ 2 , 18 , 22 , 24 , 33 , 35 , 36 , 38 , 41 , 42 , 46 , 47 , 51 ] addressed self-stigma of persons with mental illness. Evidence suggested that self-stigma regarding mental health was associated with lower level of self-esteem, which in turn resulted in negative outcomes [ 41 ].…”

“…Development of culture-specific stigma measures played an important role in implementation of community mental health care in Latin American contexts. Keller et al, 2019 [ 47 ] Individualist orientation was more common for Caucasians, collectivist orientation was more common for Native Americans, indicating that it was necessary to address culture difference during the process of formulating programme to reduce stigma of mental illness. Kurumatani et al, 2004 [ 31 ] Japanese and Taiwanese displayed similar knowledge, beliefs and attitudes with regard to schizophrenia with the general public in Western countries.…”

“…Apart from Asian societies, Latino Americans, Native Americans and African Americans also engaged in collectivism and cooperation [ 42 , 47 ], which is contradictory to Caucasian Americans that mainly value individualism. In contrast, Caucasian people might be less likely to pay attention to whether individuals have harmonious relationships.…”

“…For example, compared with their counterpart in China, Caucasian American employers concerned more whether their employees had the required skills to finish the job rather than placing value on social relationships [ 34 ]. This might be that Caucasian Americans tend to consider mental illness as an individual experience in nature [ 47 ]. Consequently, Caucasian American employees might suffer from less stigma [ 34 ].…”

“…One possible mechanism was that individualist cultures was highly relevant to tolerate diversity and deviation from social norms. Apart from that, mental illness was described as an individual issue, especially amongst Caucasians [ 47 ].…”