Mental health shame is shame associated with having a mental health symptom. This means that someone feels they are weak or inadequate, and have broke some standard when having a mental health symptom. Mental health shame is categorised into 4 types.
Negative attitudes of family/community
External shame
Internal shame
Reflected shame
Negative attitudes of family/community relates to your perspective of how your family or community will see people with a mental health symptom in general.
External shame relates to how you think your family or community will see you, when you have a mental health symptom.
Internal shame relates to how you see yourself when you have a mental health symptom.
Reflected shame involves 2 types. Family-reflected shame is how your family will be seen, when you have a mental health symptom. Self-reflected shame is how you will be seen, when your close familly member has a mental health symptom.
These can vary a lot by culture. In the original study led by Gilbert, Asian female students, who were studying at a UK university, had higher external and reflected shame than UK female students studying at the same university. In this study, they have also developed a scale to measure mental health shame, the Attitudes Towards Mental Health Problems Scale.
Our research compared Japanese workers working in Japan, and UK workers working in the UK. Japanese workers had higher levels of all types of mental health shame than UK workers.
Family-reflected shame was a significant predictor of mental health symptoms in Japanese workers, while self-reflected shame was a significant predictor in UK workers. A self-report measure was used, so of course there might have been response biases from cultural difference (e.g., self-enhancement reporting style of UK respondents) when comparing the 2 workforce groups, but the difference in the significant predictors suggests that to Japanese workers, addressing family-reflected shame may be one way to protect their mental health, whereas to UK workers, addressing self-reflected shame may be. Japanese workers worry a lot when they have a mental health symptom, about their family's reputation. "Would my depression damage my family's reputation?" On the other hand, UK workers worry their family's mental health symptom may damage their own reputation. "Would I be seen weak/inadequate, as my brother has depression?" This difference can be explained by a cultural difference of Individualism vs Colectivism.
As a solution, in both groups, the right knowledge of mental health may help address mental health shame, which in turn can protect mental health. If they and their workplace or community learn, for example, the heritability of mental health symptoms is not so high or anybody can have a mental health symptom or having a mental health symptom does not mean they are weak/inadequate, they would not have to experience the worries above.
That is why (but this is not the only reason!) these years a view that mental health as public health problem has been receiving attention. To solve mental health symptoms and improve people's mental health in the long-run, the right knowledge of mental health not only individually but also collectively is needed. "Collectively" but mental health is viewed very differently across cultures. That is why cross-cultural understanding of mental health is important. The findings in our Japan-UK study highlight a need for mental health education, and for further investigation into cross-cultural mental health.
Recently, we have developed a short version of the Attitudes Towards Mental Health Problems Scale, reducing the items from 35 in the original version to 14. Moreover, the Japanese versions of the original and short versions were also developed. Hope these tools will help mental health shame research.
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