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Download Thesis This electronic thesis or dissertation has been downloaded from the King’s Research Portal at https://kclpure.kcl.ac.uk/portal/ The perception, management and experience of stigma among people with mental illness in Japan Kunitoh, Namino Awarding institution: King's College London The copyright of this thesis rests with the author and no quotation from it or information derived from it may be published without proper acknowledgement. END USER LICENCE AGREEMENT Unless another licence is stated on the immediately following page this work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence. https://creativecommons.org/licenses/by-nc-nd/4.0/ You are free to copy, distribute and transmit the work Under the following conditions: Attribution: You must attribute the work in the manner specified by the author (but not in any way that suggests that they endorse you or your use of the work). Non Commercial: You may not use this work for commercial purposes. No Derivative Works - You may not alter, transform, or build upon this work. Any of these conditions can be waived if you receive permission from the author. Your fair dealings and other rights are in no way affected by the above. Take down policy If you believe that this document breaches copyright please contact [email protected] providing details, and we will remove access to the work immediately and investigate your claim. Download date: 26. Sep. 2021 The Perception, Management and Experience of Stigma among People with Mental Illness in Japan Namino Kunitoh A thesis submitted to King’s College London in fulfilment of the requirements for the degree of Doctor of Philosophy 1 Acknowledgement I am deeply indebted to my supervisors, Professors Nikolas Rose and Ilina Singh, without whose guidance this thesis would not have been possible. I am also grateful to the people who helped me to recruit interview participants, although I cannot name them here in respect for their privacy. On a more personal note, I appreciate my friends and family, who supported me whilst I was undertaking this research. Last but not least, I am deeply appreciative of the interview participants, who discussed their personal experiences for this study. I would like to dedicate this thesis to these individuals. 2 Abstract The present study aimed to: (1) clarify the time trends in social attitudes to mental illness in Japan, (2) clarify how people with mental illness perceive, manage and experience stigma in Japan, with a sub-focus on changes over time and (3) describe the relationships between the perception, management and experience of stigma in detail. Social attitudes were explored in order to better understand what reasons lie behind the perception, management and experience of stigma among people with mental illness. The study employed: (1) an analysis of newspaper articles, (2) an analysis of magazine articles and (3) interviews with those with a diagnosis of either schizophrenia or depression. The results of the analysis of the newspaper articles showed that articles regarding mental illness had changed from an emphasis on reporting its dangerousness to reporting of the personal stories of those affected and the relationship with stress between 1987 and 2014. The analysis of magazine articles revealed that many people with mental illness had perceived negative images of mental illness in society, concealed their illness and were discriminated against or faced others’ lack of understanding of mental illness. There were few qualitative changes in their perception, management and experience of stigma over time. The results of an analysis of the interview data showed that the perception, management and experience of stigma were part of the process of living with a self that has changed because of mental illness and psychiatric diagnosis. The interview participants’ self-perception changed after they had accepted their psychiatric diagnosis, and they perceived, managed and experienced stigma in the process of living with a self that had changed. The findings of the study suggested that the perception, management and experience of stigma could be universal, although there may be different cultural or social reasons behind the perception, management and experience. 3 List of tables Table 1. Story themes in the previous studies and present study……………………90-91 Table 2. Demographic, diagnostic and employment profile of participants……………..98 Table 3. Story themes of newspaper articles between 1987 and 2014…………...104-105 Table 4. Trend by newspaper………………………………………………..…………106 Table 5. Variation by diagnosis………………………………………….……………..107 Table 6. Story themes of magazine articles……………………………………………115 Table 7. Elements of stories………………………………………………...…………116 List of figures Figure 1. Changes in the number of psychiatric beds in Japan per 1,000 population between 1947 and 2012………………………..……………………………………..21 Figure 2. Trends in the estimated number of patients who were continuously receiving treatment for mental illness, 2002-2011………………………………..…………….25 Figure 3. Trends in the estimated number of outpatients who received treatment for mental illness, 2002-2011 (per day)………………………………………………………….26 Figure 4. Trends in the estimated number of inpatients who stayed in medical institution for mental illness, 2002-2011 (per day)………………………………………………26 Figure 5. Number of articles in three magazines……………………………………….114 Figure 6. Living with the self that has changed…………………………………..128-129 Figure 7. An identity-threat model of stigma (Major and O’Brien, 2005)…………….185 4 TABLE OF CONTENTS PREFACE..................................................................................................................... 8 CHAPTER ONE: MENTAL HEALTH CARE AND MENTAL ILLNESS IN JAPAN ... 12 1-1. Historical background: how were people with mental illness treated in Japan? .... 12 1-1-1. From the seventh century to the nineteenth century ..................................... 12 1-1-2. The twentieth century and onwards ............................................................. 17 1-2. Mental health care in contemporary Japan ......................................................... 21 1-2-1. Health care system ...................................................................................... 22 1-2-2. Psychiatric institutions and the services they offer ........................................ 22 1-2-3. Numbers of people who used health and/or welfare services .......................... 24 1-3. Employment and financial status of people with mental illness ............................ 26 1-4. Changes in law and policy .................................................................................. 29 1-5. Delay in deinstitutionalisation ............................................................................ 34 1-6. Summary .......................................................................................................... 36 CHAPTER TWO: CONCEPT OF STIGMA AND SOCIAL ATTITUDES TOWARDS MENTAL ILLNESS IN JAPAN ................................................................................... 38 2-1. The concept of stigma ........................................................................................ 38 2-2. Validity of employing the concept of stigma in a study in Japan .......................... 40 2-3. The concept of social attitudes ............................................................................ 41 2-4. Prior studies on social attitudes towards mental illness in Japan .......................... 41 2-4-1. Studies employing representative samples .................................................... 41 2-4-2. Studies using convenience samples ............................................................... 47 2-4-3. International comparative studies ................................................................ 52 2-5. Social attitudes towards mental illness in the media ............................................ 56 2-6. Summary .......................................................................................................... 56 CHAPTER THREE: THE PERCEPTION, MANAGEMENT AND EXPERIENCE OF STIGMA AMONG PEOPLE WITH MENTAL ILLNESS ............................................ 58 3-1. Findings of quantitative studies .......................................................................... 58 3-1-1. Perception of stigma .................................................................................... 58 3-1-2. Management of stigma ................................................................................ 64 3-1-3. Experience of stigma ................................................................................... 68 3-1-4. Longitudinal studies .................................................................................... 73 3-2. Qualitative studies ............................................................................................. 76 3-3. Studies on the perception, management and experience of stigma among people with mental illness in Japan ...................................................................................... 81 3-4. Summary .......................................................................................................... 83 CHAPTER FOUR: METHODS ................................................................................... 85 5 4-1. Research design ................................................................................................. 85 4-2. Analysis of newspaper articles ...........................................................................
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