Lawrence H Yang

Chair and Professor of Social and Behavioral Sciences

Associate Director, Global Center for Implementation Science

Founding Director, Global Mental Health and Stigma Program

Professional overview

Dr. Lawrence Yang is Professor and Chair of the Department of Social and Behavioral Sciences; Associate Director of the Global Center for Implementation Science at NYU; and Founding Director of NYU’s Global Mental Health and Stigma Program. He is also PI of a generous donor gift from the Li Ka Shing Foundation to fund an initiative to promote Global Mental Health and Wellness (see link).

Dr. Yang has received extensive interdisciplinary training, including clinical psychology (Boston University), psychiatric epidemiology (Columbia University) and medical anthropology (Harvard University).  Dr. Yang has received six national awards in stigma, including the Maltz Prize for Innovative and Promising Schizophrenia Research in 2021 (Brain and Behavior Research Foundation; see link). Dr. Yang has >175 peer-reviewed publications, including in journals such as the JAMA, JAMA Psychiatry, British Journal of Psychiatry, and the American Journal of Public Health. Regarding currently-funded NIH grants, he is PI of three separate R01 grants (below), is multiple PI of a D43 Implementation Science Training Grant in Vietnam, and is co-investigator on 4 R01-level grants. Lawrence is also applying his expertise to address the novel topic of “Migration Stigma”, where he led a think tank and conference sponsored by the prestigious Ernst Strüngmann Forum (June, 2022; see link), which has resulted in a recently-published book by MIT press (Migration Stigma (mit.edu)) and a publication in JAMA (see link).

Brief Research Narrative: If every public health researcher had a calling card, Dr. Lawrence Yang's would be stigma.

What began as a curiosity to think, study and write about his own culture -- Chinese culture and its influences on how stigma is expressed-- drove the GPH Professor to develop a framework for how stigma acts to impede social recovery that could be applied to cultural groups to improve the lives of countless people with mental illness and their families around the world. Dr. Yang also conducts several ongoing research studies on the forefront of global mental health and implementation science.

Building upon dissertation research conducted in Beijing, China, Lawrence initiated his stigma research via an NIMH K-award (2005-2010). Lawrence conducted a study in New York City of how stigma shapes the course of mental illness among Chinese immigrants. Lawrence formulated how culture relates to stigma--i.e. the “What Matters Most” framework—to help implement interventions to improve recovery for stigmatizing conditions. He learned that upholding face (to achieve lineage obligations) was essential, as it is for Asians in many countries. Lawrence then formulated an anti-stigma intervention to help people with mental illness take a powerful step towards regaining face. To inform global programs, Lawrence then applied the ‘what matters most’ approach to HIV stigma in Botswana. Lawrence identified that “womanhood” in Botswana is signified by “having and caring for children” (AJPH, 2021).  These cultural imperatives bring pregnant women into contact with free antenatal services, including routine HIV testing, where their HIV status is discovered before their male partners, leading women diagnosed with HIV to be blamed and stigmatized. Lawrence used this framework in a completed NIMH-funded R21 grant to implement an intervention to counter culturally-salient aspects of HIV stigma that impede anti-retroviral treatment. This stigma intervention, by utilizing the perspective that a woman in Botswana who achieves ‘what matters most’ can be protected from HIV stigma, has shown promising results. Lawrence has received a new R01 (R01 TW012402) to expand this intervention for use with women with HIV with serious mental illness in Botswana. He also participated as a Scientific member of the “NIH Office of AIDS Research & NIMH HIV-Related Intersectional Stigma” Working Group (2020).

Lawrence has advanced global mental health research in China as PI of two NIMH-funded R01 studies (R01MH108385; R01 MH127631) with co-PI's, Dr.’s Michael Phillips, William Stone and Matcheri Keshavan, seeking to characterize the cognition of completely untreated psychosis in China. Recently, China has implemented programs to detect untreated psychosis countrywide. Ascertaining participants in rural China, the study has enrolled~ 300 untreated psychosis participants, who are then matched with ~300 treated psychosis participants and an additional ~300 healthy control participants. The study’s first publication shows that cognitive performance may continue to decrease as the duration of untreated psychosis becomes prolonged (JAMA Psychiatry, 2020), thus potentially shifting the scientific thinking about schizophrenia by suggesting possible novel neurodegenerative processes in the natural course of chronic psychosis. A 3-year Supplement also examines the neurobiological markers of untreated psychosis to validate three psychosis subgroups that exhibit neurobiologically distinct differences (or ‘biotypes’). A follow-up longitudinal, 5-year R01 proposal (2021-2026) to capitalize upon this rare cohort has been funded by NIMH.

Relevant to implementation science, Lawrence leads a project to help address the gap in global mental health treatment among those who need but do not receive care for mental disorders, which is disproportionately high in low- and middle-income countries.  There has been a call to scale-up mental health services via sharing of mental health care with a broader array of nonspecialists (e.g., community health workers). Yet, knowledge on how to successfully implement task-sharing mental health strategies in real-world settings is lacking. Lawrence is PI of a third NIMH-funded R01 (with co-PI, Dr. Judy Bass; R01 MH122851) to validate a newly-developed measure that enables rapid assessment of modifiable critical factors affecting the implementation of task sharing mental health strategies. This R01 is based upon the “Shared Research Project”, where Dr.’s Yang and Bass examined the barriers and facilitators to scale-up task-sharing interventions in four previous, NIMH-funded global regional networks spanning 4 global hubs (i.e., Latin America; Africa, and India/ Pakistan). This current study will validate this measure within three additional, ongoing NIMH-funded task-sharing mental health programs in South Africa, Chile, and Nepal, thus advancing implementation science globally.

Education

BA, High Honors and Phi Beta Kappa, Wesleyan University, Middletown, CT

PhD, Boston University, Boston, MA

Clinical Fellowship, Harvard Medical School (Massachusetts Mental Health Center)

Postdoctoral Fellowship, Columbia Mailman School of Public Health (NIMH funded T32 Training Program in Psychiatric Epidemiology)

Honors and awards

Maltz Prize for Innovative and Promising Schizophrenia Research -- Brain and Behavior Research Foundation (2021)

NIH Fellow-Training Institute for Dissemination & Implementation Research in Health (TIDIRH) (2019)

Fellow (Elected), American Psychopathological Association (2018)

Award for Emerging Leadership, Americal Psychological Association (2012)

Award for Advancing Minority Mental Health, American Psychiatric Foundation (2012)

Young Investigator Award, NARSAD/ Brain and Behavior Foundation (2010)

Emerging Leader Award for Significant Contributions to the Advancement of Ethnic Minority Psychology, American Psychological Association (2010)

Calderone Award for Junior Faculty, Columbia University School of Public Health (2009)

REACH for the R01 Award, Columbia University Irving Institute for Clinical and Translational Research (2009)

Early Career Research Award, American Psychological Association (2008)

Early Career Award, Asian American Psychological Association (2008)

Dalmas A. Taylor Outstanding Student Dissertation Award, American Psychological Association (Division of Clinical Psychology- Ethnic Minority Focus) (2002)

Outstanding Dissertation Award, American Psychological Association (Division of International Psychology) (2002)

Areas of research and study

Cognition and Psychosis

Global Health

Implementation science

Mental Health

Stigma of Health Conditions

“At-Risk” States for Psychosis

Publications

Publications

Public stigma associated with psychosis risk syndrome in a college population: Implications for peer intervention

Yang, L. H., Anglin, D. M., Wonpat-Borja, A. J., Opler, M. G., Greenspoon, M., & Corcoran, C. M. (n.d.).

Publication year

2013

Journal title

Psychiatric Services

Volume

64

Issue

3

Page(s)

284-288

10.1176/appi.ps.003782011

Abstract

Abstract

Objectives: This study compared stigma associated with the psychosis risk label and diagnostic labels for nonpsychotic and psychotic mental disorders among young adult peers. Methods: Urban college respondents (N5153) read an experimental vignette describing a young adult experiencing prodromal symptoms who was randomly assigned a diagnostic label (major depression, generalized anxiety disorder, schizophrenia, or psychosis risk with and without accurate information about the psychosis risk label) and answered questions about stigma toward the individual in the vignette. Results: Compared with labels for nonpsychotic disorders, schizophrenia elicited more negative stereotyping and the at-risk label invoked greater social distance and less willingness to help. Any increased social distance appeared to be reduced by accurate information about the at-risk state. No differences in stigma were found for the psychosis risk and schizophrenia labels. Conclusions: The psychosis risk label alone appeared to evoke greater status loss and discrimination. Accurate information may minimize some stigmatizing attitudes among college peers.

Relation of rural versus urban context to employment outcome for people with schizophrenia in a population-based study in China

Yang, L., Phillips, M., Li, X., Yu, G., Zhang, J., Shi, Q., Song, Z., Ding, Z., Pang, S., & Susser, E. (n.d.).

Publication year

2013

Journal title

British Journal of Psychiatry

Volume

203

Page(s)

272-279

Causal beliefs and effects upon mental illness identification among chinese immigrant relatives of individuals with psychosis

Yang, L. H., & Wonpat-Borja, A. J. (n.d.).

Publication year

2012

Journal title

Community mental health journal

Volume

48

Issue

4

Page(s)

471-476

10.1007/s10597-011-9464-z

Abstract

Abstract

Identifying factors that facilitate treatment for psychotic disorders among Chinese-immigrants is crucial due to delayed treatment use. Identifying causal beliefs held by relatives thatmight predict identification of 'mental illness' as opposed to other 'indigenous labels' may promote more effective mental health service use. We examine what effects beliefs of 'physical causes' and other non-biomedical causal beliefs ('general social causes', and 'indigenous Chinese beliefs' or culture-specific epistemologies of illness) might have on mental illness identification. Forty-nine relatives of Chinese-immigrant consumers with psychosis were sampled. Higher endorsement of 'physical causes' was associated with mental illness labeling. However among the nonbiomedical causal beliefs, 'general social causes' demonstrated no relationshipwithmental illness identification,while endorsement of 'indigenous Chinese beliefs' showed a negative relationship. Effective treatment- and community-based psychoeducation, in addition to emphasizing biomedical models, might integrate indigenous Chinese epistemologies of illness to facilitate rapid identification of psychotic disorders and promote treatment use.

Effects of labeling and interpersonal contact upon attitudes towards schizophrenia: Implications for reducing mental illness stigma in urban China

Yang, L. H., Lo, G., WonPat-Borja, A. J., Singla, D. R., Link, B. G., & Phillips, M. R. (n.d.).

Publication year

2012

Journal title

Social psychiatry and psychiatric epidemiology

Volume

47

Issue

9

Page(s)

1459-1473

10.1007/s00127-011-0452-y

Abstract

Abstract

Purpose As mental illness stigma contributes to poor outcomes for schizophrenia in China, locating strategies to reduce public stigma is imperative. It is currently unknown whether diagnostic labeling and contact with different help-seeking sources increase or decrease public stigma in China. Further, it remains unresolved whether prior personal contact acts to reduce stigma in this context. Advancing understanding of these processes may facilitate stigma-reduction strategies. Methods We administered an experimental vignette randomly assigning one of four labeling conditions to respondents to assess social distance towards a psychotic vignette individual in a sample of 160 Northern, urban Chinese community respondents. Results As expected, respondents given a "non-psychiatric, indigenous label" + "lay help-seeking" condition endorsed the least social distance. Unexpectedly, the labeling condition with a "psychiatric diagnostic label" + "lay help-seeking" condition elicited the greatest social distance. UnlikeWestern studies, personal contact did not independently decrease community stigma. However, prior contact reduced social distance to a greater extent in the labeling condition with a "non-psychiatric, indigenous label" + "lay help-seeking" condition when compared with all other labeling conditions. Conclusion The results indicate that cultural idioms do provide some protection from stigma, but only among respondents who are already familiar with what mental illness is. Our finding that the condition that depicted untreated psychosis elicited the greatest amount of stigma, while the "treated psychosis" condition was viewed relatively benignly in China, suggests that improved access to mental health services in urban China has the potential to decrease public stigma via labeling mechanisms.

Eugenics, genetics, and mental illness stigma in Chinese Americans

WonPat-Borja, A. J., Yang, L. H., Link, B. G., & Phelan, J. C. (n.d.).

Publication year

2012

Journal title

Social psychiatry and psychiatric epidemiology

Volume

47

Issue

1

Page(s)

145-156

10.1007/s00127-010-0319-7

Abstract

Abstract

Background The increasing interest in the genetic causes of mental disorders may exacerbate existing stigma if negative beliefs about a genetic illness are generally accepted. China's history of policy-level eugenics and genetic discrimination in the workplace suggests that Chinese communities will view genetic mental illness less favorably than mental illness with non-genetic causes. The aim of this study is to identify differences between Chinese Americans and European Americans in eugenic beliefs and stigma toward people with genetic mental illness. Methods We utilized data from a 2003 national telephone survey designed to measure how public perceptions of mental illness differ if the illness is described as genetic. The Chinese American (n = 42) and European American (n = 428) subsamples were analyzed to compare their support of eugenic belief items and measures of stigma. Results Chinese Americans endorsed all four eugenic statements more strongly than European Americans. Ethnicity significantly moderated the relationship between genetic attribution and three out of five stigma outcomes; however, genetic attribution actually appeared to be de-stigmatizing for Chinese Americans while it increased stigma or made no difference for European Americans. Conclusions Our findings show that while Chinese Americans hold more eugenic beliefs than European Americans, these attributions do not have the same effect on stigma as they do in Western cultures. These results suggest that future anti- stigma efforts must focus on eugenic attitudes as well as cultural beliefs for Chinese Americans, and that the effects of genetic attributions for mental illness should be examined relative to other social, moral, and religious attributions common in Chinese culture.

Schizophrenia, culture and neuropsychology: Sensory deficits, language impairments and social functioning in Chinese-speaking schizophrenia patients

Yang, L., Chen, S., Chen, C. M., Khan, F., Forchelli, G., & Javitt, D. C. (n.d.).

Publication year

2012

Journal title

Psychological Medicine

Volume

42

Issue

7

Page(s)

1485-1494

10.1017/S0033291711002224

Abstract

Abstract

Background While 20% of schizophrenia patients worldwide speak tonal languages (e.g. Mandarin), studies are limited to Western-language patients. Western-language patients show tonal deficits that are related to impaired emotional processing of speech. However, language processing is minimally affected. In contrast, in Mandarin, syllables are voiced in one of four tones, with word meaning varying accordingly. We hypothesized that Mandarin-speaking schizophrenia patients would show impairments in underlying basic auditory processing that, unlike in Western groups, would relate to deficits in word recognition and social outcomes.Method Altogether, 22 Mandarin-speaking schizophrenia patients and 44 matched healthy participants were recruited from New York City. The auditory tasks were: (1) tone matching; (2) distorted tunes; (3) Chinese word discrimination; (4) Chinese word identification. Social outcomes were measured by marital status, employment and most recent employment status.Results Patients showed deficits in tone-matching, distorted tunes, word discrimination and word identification versus controls (all p<0.0001). Impairments in tone-matching across groups correlated with both word identification (p<0.0001) and discrimination (p<0.0001). On social outcomes, tonally impaired patients had a lower-statusa jobs overall when compared with tonally intact patients (p<0.005) and controls (p<0.0001).Conclusions Our study is the first to investigate an interaction between neuropsychology and language among Mandarin-speaking schizophrenia patients. As predicted, patients were highly impaired in both tone and auditory word processing, with these two measures significantly correlated. Tonally impaired patients showed significantly worse employment-status function than tonally intact patients, suggesting a link between sensory impairment and employment status outcome. While neuropsychological deficits appear similar cross-culturally, their consequences may be language-and culture-dependent.

Stigma and restriction on the social life of families of children with intellectual disabilities in Vietnam

Ngo, H., Shin, J. Y., Nhan, N. V., & Yang, L. H. (n.d.).

Publication year

2012

Journal title

Singapore Medical Journal

Volume

53

Issue

7

Page(s)

451-457

Abstract

Abstract

INTRODUCTION Intellectual disabilities are as prevalent in East Asian countries as in the West (0.06%-1.3%). Widespread discrimination against intellectual disabilities in Asia may initiate stigma that places unfair restrictions on the social life of these individuals and their caregivers. We utilised established stigma frameworks to assess the extent to which a child's intellectual disability contributes to the social exclusion of caregivers in Vietnam. MeThODs A mixed quantitative and qualitative approach was employed to examine the experience of social life restriction among parents of children with intellectual disabilities. The child's disability level and restrictions on caregivers' social experiences were assessed among 70 mothers and fathers recruited from schools in Hue City, Vietnam. Qualitative responses describing social exclusion were also recorded. ResUlTs Caregivers reported elevated levels of social exclusion. As hypothesised, parents of children with greater intellectual disability experienced more restrictions on their social life (Beta = 0.79, 95% confidence interval 0.27-1.30, standard error = 0.26, p < 0.01). Qualitative analyses indicated that the threatening of core cultural norms (inability to be employed or married upsets community harmony) initiated labelling, social exclusion and efforts to keep the condition secret or withdraw from others. CONClUsION This study is among the first to demonstrate the impacts of intellectual disabilities on caregivers' social functioning in Asia. The findings illustrate how traditional Asian norms initiate stigma, which in turn restricts key social interactions among caregivers. Psycho-educational interventions may address the social domains in which caregivers are impacted and encourage sustained help-seeking among caregivers for their children.

Stigma in early stages of psychosis illness: connections to cognitive neuroscience

Yang, L., Wonpat-Borja, A. J., Opler, M. G., Compton, M., Kelly, M., Purdie-Vaughns, V., & Corcoran, C. M. (n.d.). In Vulnerability to Psychosis: From Neurosciences to Psychology (1–).

Publication year

2012

Page(s)

159-176

Arrest outcomes associated with outpatient commitment in New York State

Link, B. G., Epperson, M. W., Perron, B. E., Castille, D. M., & Yang, L. H. (n.d.).

Publication year

2011

Journal title

Psychiatric Services

Volume

62

Issue

5

Page(s)

504-508

10.1176/ps.62.5.pss6205_0504

Abstract

Abstract

Objective: This study examined whether assisted outpatient treatment (AOT) under New York's "Kendra's Law" is associated with reduced arrests for violent and nonviolent offenses. Methods: Arrest records of 183 study participants attending outpatient clinics in New York City, 86 of whom were ever and 97 of whom were never assigned to AOT, were compiled to yield 16,890 months of observation. For each month the data indicated whether an arrest did or did not occur and whether a participant was or was not assigned to AOT. Generalized estimating equations and fixed-effects analyses were used to compare arrest rates within different periods (before, during or shortly after, and more than six months after) for those ever assigned and between the ever- and never-assigned groups. Results: For those who received AOT, the odds of any arrest were 2.66 times greater (p<.01) and the odds of arrest for a violent offense 8.61 times greater (p<.05) before AOT than they were in the period during and shortly after AOT. The group never receiving AOT had nearly double the odds (1.91, p<.05) of arrest compared with the AOT group in the period during and shortly after assignment. Conclusions: Outpatient commitment under Kendra's Law in New York State is associated with a reduced risk of arrest. The coercion necessitated by application of the law may forestall, at least for some people, the potentially more potent and consequential coercion they would have experienced in the criminal justice system.

Ethnicity and psychosis

Anglin, D. M., Lee, R., Yang, L., Lo, G., & Opler, M. (n.d.). In Health Education: Examining the nature of the relationship (1–).

Publication year

2011

Page(s)

119-144

The role of subtypes in understanding disease processes within schizophrenia: a case example of 'Deficit Syndrome'

Yang, L. H., Tu, M. C., Liu, H. T., & Opler, M. (n.d.).

Publication year

2011

Journal title

Shanghai Archives of Psychiatry

Volume

23

Issue

2

Page(s)

109-111

Use of indigenous cultural idioms by chinese immigrant relatives for psychosis: Impacts on stigma and psychoeducational approaches

Yang, L. H., & Singla, D. R. (n.d.).

Publication year

2011

Journal title

Journal of Nervous and Mental Disease

Volume

199

Issue

11

Page(s)

872-878

10.1097/NMD.0b013e3182349eb7

Abstract

Abstract

Indigenous interpretations of mental illness might negatively impact treatment adherence. However, psychiatric "labeling" potentially leads to stigma among Chinese groups, thus encouraging the use of indigenous idioms. We examined how relatives' use of indigenous labeling varied with the consumers' experience of illness and whether indigenous labeling protected relatives from internalized and experienced forms of stigma. Forty-nine relatives of Chinese-immigrant consumers with psychosis were sampled. Although consumers had progressed to the middle stages of psychosis, 39% of relatives used indigenous idioms to label psychosis. Indigenous labeling decreased when illness duration increased and when visual hallucinations were present. Indigenous labeling further predicted lower internalized stigma among relatives. Relatives who used indigenous labeling also reported fewer indirect stigma experiences, although not after controlling for illness severity. The frequency of direct discrimination among relatives did not differ by labeling. These forms of felt stigma might be embedded into relatives' psychoeducation programs to mitigate adverse consequences of psychiatric labeling.

Excessive thinking as explanatory model for schizophrenia: Impacts on stigma and "moral" status in Mainland China

Yang, L. H., Phillips, M. R., Lo, G., Chou, Y., Zhang, X., & Hopper, K. (n.d.).

Publication year

2010

Journal title

Schizophrenia bulletin

Volume

36

Issue

4

Page(s)

836-845

10.1093/schbul/sbn180

Abstract

Abstract

Although psychiatric stigma in China is particularly pervasive and damaging, rates of high expressed emotion ("EE" or family members' emotional attitudes that predict relapse) are generally lower than rates found in Western countries. In light of this seemingly incongruous juxtaposition and because Chinese comprise approximately one-fifth of the world's mentally ill, we examine how one of the most widely held causal beliefs of schizophrenia- excessive thinking (xiang tai duo)-may powerfully shape how those exhibiting psychotic symptoms pass from "normal" status to stigmatized "other." Using a framework by which stigma threatens an actor's capacity to participate in core everyday engagements, we examine how expressions of excessive thinking intersect with psychotic symptoms and how this idiom reduces stigma by preserving essential moral standing. Four focus groups with family members (n 5 34 total) of schizophrenia outpatients, who had participated in psychoeducation, were conducted in Beijing. Open coding was conducted by 2 bilingual coders achieving high interrater agreement. Common expressions of excessive thinking-taking things too hard that is perceived as a causal factor and unwarranted suspicion that is used to benignly interpret paranoid symptoms encapsulated disruptive behaviors that closely overlapped with psychotic symptoms. Because excessive thinking is understood to occur universally, this idiom encourages socially accommodating behavior that signifies acceptance of these individuals as full-status community members. In contrast, due to beliefs implying moral contamination, those labeled mentally ill are threatened with both subtle and outright social exclusion. We discuss implications of this idiom for EE and the detection of schizophrenia "prodrome" in China.

Loss, psychosis, and chronic suicidality in a Korean American immigrant man: Integration of cultural formulation model and multicultural case conceptualization

Shea, M., Yang, L. H., & Leong, F. T. (n.d.).

Publication year

2010

Journal title

Asian American Journal of Psychology

Volume

1

Issue

3

Page(s)

212-223

10.1037/a0020951

Abstract

Abstract

Culture shapes the nature, experience, and expression of psychopathology and help-seeking behavior across ethnically diverse groups. Although the study of psychopathology among Asian Americans has advanced, clinicians remain in need of culturally appropriate tools for the assessment and diagnosis of severe mental disorders including psychotic symptoms among Asian Americans. In this article, we present a brief overview of two culturally relevant conceptual tools: a) the Cultural Formulation Model, and b) the Multicultural Case Conceptualization approach. We use a case scenario to illustrate the integration of these two approaches in providing culturally responsive clinical conceptualization, assessment and treatment of a Korean American immigrant suffering from prominent psychiatric symptoms. We intend this discussion to engender further empirical work to advance our knowledge of the manifestation and experience of severe mental illness including psychotic disorders among Asian Americans, and contribute to culturally competent prevention and intervention of chronic and persistent mental illness within this group.

Potential stigma associated with inclusion of the psychosis risk syndrome in the DSM-V: An empirical question

Yang, L. H., Wonpat-Borja, A. J., Opler, M. G., & Corcoran, C. M. (n.d.).

Publication year

2010

Journal title

Schizophrenia Research

Volume

120

Issue

1

Page(s)

42-48

10.1016/j.schres.2010.03.012

Abstract

Abstract

While the "clinical high-risk state" for psychosis has demonstrated good reliability and fair predictive validity for psychotic disorders, over 50% of identified subjects do not progress to psychosis. Despite the benefits that early detection and treatment might offer, debate concerning the official inclusion of a "psychosis risk syndrome" in the upcoming DSM-V frequently involves concerns about the impact of stigma on patients, families and institutions. We add to this debate by providing an analysis of the theoretical and empirical stigma literature to evaluate the potential effects of stigma associated with the psychosis risk syndrome. Theorists' conceptualizations of how stigma exerts its negative effects emphasize internalization of pejorative societal stereotypes ('self-stigma'), negative emotional reactions, harmful behavioral coping strategies, and structural discrimination as key mechanisms. Studies assessing the comparative effects of symptomatic behavior when compared with a psychiatric diagnosis label in predicting rejecting social attitudes indicate that treating symptomatic behaviors is likely to diminish overall stigma. However, any publically held 'preexisting conceptions' about what a psychosis risk syndrome means are still likely to exert negative effects. Additionally, particular features of this syndrome-that it occurs during adolescence when identity formation may be in flux- may also shape manifestations of stigma. Utilizing other well-established 'at-risk' conditions (e.g., genetic susceptibility) to model potential discrimination for this syndrome, we suggest that future discrimination is likely to occur in insurance and family domains. We conclude by proposing stigma measurement strategies, including recommending that field trials prior to DSM-V adopt systematic measures to assess any stigma that this psychosis risk syndrome might confer via future community use.

Beliefs in traditional chinese medicine efficacy among chinese americans: Implications for mental health service utilization

Yang, L. H., Corsini-Munt, S., Link, B. G., & Phelan, J. C. (n.d.).

Publication year

2009

Journal title

Journal of Nervous and Mental Disease

Volume

197

Issue

3

Page(s)

207-210

10.1097/NMD.0b013e3181999513

Abstract

Abstract

We examined how community attitudes towards traditional Chinese conceptions of health and Western dichotomization of illness might affect perceptions of traditional Chinese medicine (TCM) efficacy in order to identify factors underlying psychiatric service underutilization among Chinese-Americans. We administered an experimental vignette to assess perceived illness, severity, and beliefs of TCM efficacy for physical and psychiatric disorders among 90 Chinese-Americans ascertained through a national telephone survey. Perceived illness severity was unrelated to assessment of TCM effectiveness. However, psychiatric conditions tended to be viewed as distinct from physical disorders, and TCM use was endorsed as less effective for psychiatric illnesses when compared with physical illnesses. Furthermore, differences in perceived TCM efficacy appeared to be magnified among US-born respondents, with US-born respondents endorsing lower efficacy for psychiatric disorders than foreign-born respondents. These findings suggest that TCM use for psychiatric disorders may decrease with Westernization, but might delay access to psychiatric services among first-generation immigrants.

Prenatal malnutrition and adult Schizophrenia: Further evidence from the 1959-1961 chinese famine

Xu, M. Q., Sun, W. S., Liu, B. X., Feng, G. Y., Yu, L., Yang, L., He, G., Sham, P., Susser, E., St. Clair, D., & He, L. (n.d.).

Publication year

2009

Journal title

Schizophrenia bulletin

Volume

35

Issue

3

Page(s)

568-576

10.1093/schbul/sbn168

Abstract

Abstract

Objective: Evidence from the 1944-1995 Dutch Hunger Winter and the 1959-1961 Chinese famines suggests that those conceived or in early gestation during famines, have a 2-fold increased risk of developing schizophrenia in adult life. We tested the hypothesis in a second Chinese population and also determined whether risk differed between urban and rural areas. Method: The risk of schizophrenia was examined in Liuzhou prefecture of Guangxi autonomous region. Rates were compared among those conceived before, during, and after the famine years. Based on the decline in birth rates, we predicted that those born in 1960 and 1961 would have been exposed to the famine during conception or early gestation. All psychiatric case records in Liuzhou psychiatric hospital for the years 1971 through 2001 were examined and clinical/sociodemographic data extracted by psychiatrists blind to exposure status. Data on births and deaths in the famine years were also available, and cumulative mortality was estimated from later demographic surveys. Evidence of famine was verified, and results were adjusted for mortality. Relative risks (RRs) for schizophrenia were calculated for the region as a whole and for urban and rural areas separately. Results: Mortality-adjusted RR for schizophrenia was 1.5 (1960) and 2.05 (1961), respectively. However, the effect was exclusively from the rural areas RR = 1.68 (1960) and RR=2.25 (1961). Conclusions: We observe a 2-fold increased risk of schizophrenia among those conceived or in early gestation at the height of famine with risk related to severity of famine conditions.

Race/ethnicity and incidence of psychosis: new directions for research

Angelin, D., Lee, R., Yang, L., & Lo, G. (n.d.). In Social Science in Health Care and Practice (1–).

Publication year

2009

'Face' and the embodiment of stigma in China: The cases of schizophrenia and AIDS

Yang, L. H., & Kleinman, A. (n.d.).

Publication year

2008

Journal title

Social Science and Medicine

Volume

67

Issue

3

Page(s)

398-408

10.1016/j.socscimed.2008.03.011

Abstract

Abstract

The majority of theoretical models have defined stigma as occurring psychologically and limit its negative effects to individual processes. This paper, via an analysis of how 'face' is embodied in China, deepens an articulation of how the social aspects of stigma might incorporate the moral standing of both individual and collective actors defined within a local context. We illustrate (1) how one's moral standing is lodged within a local social world; (2) how one's status as a 'moral' community member is contingent upon upholding intrapersonal and social-transactional obligations; and (3) how loss of face and fears of moral contamination might lead to a 'social death'. We first draw from Chinese ethnographies that describe the process of human cultivation before one can achieve fully 'moral' status in society. We integrate findings from empirical studies describing how social-exchange networks in China are strictly organized based on the reciprocation of favors, moral positioning, and 'face'. We further ground these Chinese constructs within a theoretical framework of different forms of capital, and discuss the severe social consequences that loss of face entails. By utilizing the examples of schizophrenia and AIDS to illustrate how loss of moral standing and stigma is interwoven in China, we propose a model highlighting changes in moral status to describe how stigma operates. We suggest that symbolic restoration of moral status for stigmatized groups takes place as local-level stigma interventions. By analyzing the moral aspects of 'face', we propose that across cultures, stigma is embedded in the moral experience of participants, whereby stigma is conceived as a fundamentally moral issue: stigmatized conditions threaten what matters most for those in a local world. We further propose that stigma jeopardizes an actor's ability to mobilize social capital to attain essential social statuses.

Stigma and Beliefs of Efficacy Towards Traditional Chinese Medicine and Western Psychiatric Treatment Among Chinese-Americans

Yang, L. H., Phelan, J. C., & Link, B. G. (n.d.).

Publication year

2008

Journal title

Cultural Diversity and Ethnic Minority Psychology

Volume

14

Issue

1

Page(s)

10-18

10.1037/1099-9809.14.1.10

Abstract

Abstract

In this study we examined community attitudes of efficacy and shame to investigate the factors that may underlie mental health service underutilization among Chinese Americans. We administered an experimental vignette to assess beliefs of efficacy and shame toward using traditional Chinese medicine (TCM) as opposed to Western health services in a sample of 90 Chinese Americans obtained through a national telephone survey. Contrary to predictions, beliefs of efficacy for treating mental disorders were found to be greater for Western psychiatric services when compared with TCM. As predicted however, Chinese Americans perceived greater community attitudes of shame when accessing Western psychiatric services as opposed to TCM to treat a mental disorder. Furthermore, these differences in community attitudes of shame only occurred among respondents who received a psychiatric condition vignette, but not with respondents who were administered a vignette of a physical disorder. These findings suggest that perceived shame may play an important role in help seeking and that integration of TCM with Western psychiatric care may have implications for reducing shame for Chinese Americans.

Stigma Measurement Approaches

Yang, L. H., Link, B. G., & Phelan, J. C. (n.d.). In Understanding the Stigma of Mental Illness: Conceptual Origins and Current Applications (1–).

Publication year

2008

Page(s)

175-192

10.1002/9780470997642.ch11

Stigma of mental illness

Yang, L. H., Cho, S. H., & Kleinman, A. (n.d.). In International Encyclopedia of Public Health (1–).

Publication year

2008

Page(s)

219-230

10.1016/B978-012373960-5.00047-2

Abstract

Abstract

Stigma is a pervasive force that has powerful consequences and reduces the life opportunities of those that it affects. Society also becomes burdened by the costs of those who neglect adequate treatment and whose illness conditions worsen due to fears of stigma. The concept of stigma includes internal psychological processes within the person, interpersonal social processes between individuals and groups, and large-scale processes on the level of culture and politics. These models identify different mechanisms by which stigma exerts its negative effects on others. Further, current anti-stigma interventions have drawn upon these conceptualizations to reduce stigma and its effects. © 2008

Application of mental illness stigma theory to Chinese societies: Synthesis and new directions

Yang, L. H. (n.d.).

Publication year

2007

Journal title

Singapore Medical Journal

Volume

48

Issue

11

Page(s)

977-985

Abstract

Abstract

The rapidly-evolving literature concerning stigma towards psychiatric illnesses among Chinese groups has demonstrated pervasive negative attitudes and discriminatory treatment towards people with mental illness. However, a systematic integration of current stigma theories and empirical findings to examine how stigma processes may occur among Chinese ethnic groups has yet to be undertaken. This paper first introduces several major stigma models, and specifies how these models provide a theoretical basis as to how stigma broadly acts on individuals with schizophrenia through three main mechanisms: direct individual discrimination, internalisation of negative stereotypes, and structural discrimination. In Chinese societies, the particular manifestations of stigma associated with schizophrenia are shaped by cultural meanings embedded within Confucianism, the centrality of "face", and pejorative aetiological beliefs of mental illnesses. These cultural meanings are reflected in severe and culturally-specific expressions of stigma in Chinese societies. Implications and directions to advance stigma research within Chinese cultural settings are provided.

Application of stigma theory to Chinese groups with mental illness: synthesis and new directions

Yang, L. (n.d.).

Publication year

2007

Journal title

Singapore Medical Journal

Volume

48

Issue

11

Page(s)

977

Culture and stigma: Adding moral experience to stigma theory

Yang, L. H., Kleinman, A., Link, B. G., Phelan, J. C., Lee, S., & Good, B. (n.d.).

Publication year

2007

Journal title

Social Science and Medicine

Volume

64

Issue

7

Page(s)

1524-1535

10.1016/j.socscimed.2006.11.013

Abstract

Abstract

Definitions and theoretical models of the stigma construct have gradually progressed from an individualistic focus towards an emphasis on stigma's social aspects. Building on other theorists' notions of stigma as a social, interpretive, or cultural process, this paper introduces the notion of stigma as an essentially moral issue in which stigmatized conditions threaten what is at stake for sufferers. The concept of moral experience, or what is most at stake for actors in a local social world, provides a new interpretive lens by which to understand the behaviors of both the stigmatized and stigmatizers, for it allows an examination of both as living with regard to what really matters and what is threatened. We hypothesize that stigma exerts its core effects by threatening the loss or diminution of what is most at stake, or by actually diminishing or destroying that lived value. We utilize two case examples of stigma-mental illness in China and first-onset schizophrenia patients in the United States-to illustrate this concept. We further utilize the Chinese example of 'face' to illustrate stigma as having dimensions that are moral-somatic (where values are linked to physical experiences) and moral-emotional (values are linked to emotional states). After reviewing literature on how existing stigma theory has led to a predominance of research assessing the individual, we conclude by outlining how the concept of moral experience may inform future stigma measurement. We propose that by identifying how stigma is a moral experience, new targets can be created for anti-stigma intervention programs and their evaluation. Further, we recommend the use of transactional methodologies and multiple perspectives and methods to more fully capture the interpersonal core of stigma as framed by theories of moral experience.