²Face² and the manifestation of stigma among Chinese immigrants with schizophrenia: A qualitative investigation

Background: “Face” is a Chinese specific concept that represents a person's moral status in their local world. It has a regulatory role in Chinese society and fundamentally impacts how stigma is experienced. In the Chinese socio-cultural context, stigma undermines an individual's sense of self and access to social resources, which causes an individual to lose “face”. Therefore, loss of “face” due to mental illness severely threatens ‘what matters most' to the individual. Objective: To examine how stigma manifests itself in Chinese immigrants with schizophrenia, and how it relates to “face”. Methods: Participants were recruited from two Chinese-English bilingual psychiatric inpatient units in NYC. Participants were diagnosed with psychosis using DSM-IV-TR Diagnosis Structural Clinical Interview (SCID or SCID-Chinese version). Interviews were conducted in an open-manner to survey experiences of stigma. Qualitative analyses were conducted by four highly trained coders with high interrater agreement (>80%). Results: When loss of “face” occurred, stigmatized individuals perceived their access to social capital as profoundly diminished. Loss of “face” was linked to lack of access to employment and marriage opportunities. Participants consistently attributed their illness as a barrier to earning money and to attaining moral standing in the community. Difficulty with establishing and maintaining intimate relationships was also expressed. Discussion: Knowledge regarding the social consequences of stigma and its impact on ‘what matters most' to this Chinese immigrant group emphasizes the importance of developing anti-stigma interventions that aim to restore one's moral status (“face”). Such focal approaches may be essential in countering culture-specific effects of stigma.