国外心理疾病烙印影响研究概述

心理疾病污名足加诸在心理疾病患者身上的耻辱标记,世界卫生组织2001年指出"心理和行为障碍患者康复的最大阻碍就是社会对他们的污名和与之相连的歧视".作者对国外污名领域的研究进行了回顾,论述了心理疾病污名的概念、有关其影响机制的理论和实证研究.从公众污名和自我污名两方面论述了污名对心理疾病患者的影响以及消除污名的方法.     

心理疾病污名形成理论述评

心理疾病污名是加诸于患者身上的耻辱标记,妨碍患者的治疗和康复。心理疾病污名的成因理论包括功能主义和生物文化两个派别,污名的发展模型解释了污名的形成过程,身份威胁模型对污名的作用机制进行了阐述。通过抗议、教育和接触可以有效地减少污名。在中国开展相关研究应注重分析传统文化、心理疾病类型与污名的关系,探讨各种减少污名策略的可行性     

基于未感染者与感染者双重视角的艾滋病污名

艾滋病污名由公众污名和自我污名两部分构成。前者指公众所持有的对艾滋病和艾滋病感染者的偏见、刻板印象和歧视; 后者指艾滋病感染者感知到的来自公众的偏见、刻板印象和歧视, 并由此产生的负面自我认知。测量主要从未感染者和感染者两个层面展开。艾滋病的公众污名与自我污名广泛存在于个人、家庭、医疗、媒体等诸多领域, 阻碍艾滋病的有效防治并损害社会平等。减少艾滋病污名的干预既需要消除公众的偏见、刻板印象和歧视, 改善社会环境; 也需要感染者自我的心理健康和治疗意愿, 提升生活质量。未来应该从未感染者和感染者的双重视角出发, 对其相互作用机制、测量工具、干预措施及连带污名等进行深入研究。     

社会标签理论对艾滋病防治工作的启示

传统文化中,艾滋痛是一种性质极其严重的因越轨行为所致的疾病,标签理论是分析越轨行为产生的社会学理论.从标签理论的角度,分析艾滋病患者的心理变化及需求,分析偏见和歧视对艾滋病患者的负面影响,探索为艾滋病患者建立良好社会支持环境的思路.     

污名研究:概念、理论和模型的演进

关于污名(stigma)的研究在西方已有半个世纪的历史,社会心理学、历史学、社会学、人类学等学科对污名研究的推进做出了各自的贡献。但是,学科的分野也造成了今天污名理论和实践的不同面相共存但缺乏整合的局面。本文系统梳理了不同学科关于污名的概念、模型和理论视角的演进脉络,在反思当下反污名实践的基础上探讨整合不同研究视角的可能性和路径。同时也为国内学界在充分理解西方污名研究的基础上实现对与特定疾病(如躯体残障、精神疾病、艾滋病、癌症、糖尿病、肥胖症等)、社会身份(如性别、年龄、民族以及边缘群体等)相关的本土化污名研究提供参考。     

体重污名:对肥胖的歧视与偏见

体重污名指个体因超重或肥胖受到的社会污名,主要表现为公众对这一群体的歧视、偏见、消极态度,其测量主要从公众和被污名群体自身展开。它会对被污名个体的心理、行为、身体产生消极影响,且这些影响之间存在递进关系。现有体重污名干预研究主要聚焦于减少公众污名、降低体重以及缓解体重污名消极心理影响三个方向。未来研究可以在体重污名影响机制、测量工具和行之有效的干预策略方面进一步扩展。     

污名化对被污名个体人际互动的影响

污名是指个体所具有不受欢迎的特征, 这种特征会导致个体在一定社会背景下被主流文化群体贴负性标签、贬低、侮辱而遭受到污名化。污名化对个体或群体本身会有消极影响, 不仅会使个体遭受到来自他人的歧视、排斥或拒绝等这些直接作用于自身的外部影响, 还会进一步消极影响被污名个体在人际互动中的表现和行为反应。被污名个体与主流文化群体之间的消极互动又会进一步加剧主流文化对被污名个体或群体的排斥, 形成恶性循环。从被污名个体的角度出发, 有助于更加深入地探讨污名化对被污名个体人际互动方面的影响以及被污名个体采取的应对方式。     

污名的道德解析

作为现代社会当中一个普遍而又特殊的社会现象,污名不仅是一种社会分类,同时也是一种身份建构,其导致了蒙受污名者与常人之间的分别与对立,更使蒙受污名者成为常人社会当中的他者。在现实生活中,污名实际是作为一种"恶名"而被界定和运用,具有非常鲜明的道德倾向性,这使其成为一种道德反思的对象。当前学界对于污名的研究,主要集中在社会学与心理学范畴,但对于污名的道德研究却乏人问津,本文因此试图对此进行一个针对性的探讨。     

污名应对策略的研究现状与展望

应激与应对的理论发展构建了污名应对研究的基本框架。污名应对策略是指被污名者在具体污名情境中为减少压力的消极影响而有目的地采用的情绪、认知和行为反应。目前, 关于被污名者应对污名策略的研究, 特别是艾滋病污名应对策略的研究日趋增多。根据不同的划分标准, 可以区分出问题聚焦性与情绪聚焦性策略、卷入与摆脱策略以及前摄性与反应性策略; 对于可隐藏污名而言, 还涉及到表露/隐藏策略。在研究方法上, 质性研究范式日益发挥重要作用。未来应该注重污名应对策略的情境性, 加强不同污名领域的专题研究, 关注对应对策略的评价并构建污名应对策略的层次模型。     

道德直觉分析：内涵、形成机制与加工判断机制

自Haidt 提出道德判断的社会直觉模型后,道德直觉便成为道德心理研究中的重要课题。本文围绕这三方面的问题就最近10多年来道德直觉的相关理论与实证研究进行了评述,得到如下结论：（1）道德直觉作为社会直觉的一种,它既有一般社会直觉的一些共性特点,又有其特殊性。从目前道德的神经认知研究结果来看,与一般社会直觉的神经机制相比,道德直觉过程还涉及到眶额皮层、颞顶联合区以及前额叶的更多脑区。相关研究表明这些脑区涉及到情绪刺激的再评价、以及对行为动机、意图、心理理论等认知成分的联合处理。（2）对于道德直觉的起源与形成问题,尽管道德直觉表现出跨文化的普遍性,但是目前还没有充分的证据支持道德直觉的先天论;同时,本研究认为基于“进化-文化-个人”的具身隐喻过程可能是道德直觉形成的重要机制。（3）目前道德判断研究的有关理论与实证研究仍然难以回答道德直觉加工的情理之争问题,但有几点发现值得注意：一是从加工的水平差异角度来看,道德直觉可能存在不同的亚类形式,且不同类型的道德直觉可能有着不同的学习获得机制与加工机制;二是道德直觉判断不完全是情绪直接作用的结果,而与道德情境中的情绪认知以及情绪背后的道德规则（信念）之间有着重要联系。     

Personal Meaning,Social Support,and Perceived Stigma in Individuals Receiving HIV Mental Health Services

Human immunodeficiency virus (HIV) stigma represents a significant source of stress among individuals living with HIV disease, prompting interest in research to identify factors that may help to ameliorate the stress burden associated with HIV stigma. Consistent with this research line, the current study was conducted as a cross-sectional investigation examining associations between positive global personal meaning, social support, and perceived HIV stigma. Global personal meaning refers to beliefs and aspirations through which one ascribes value and purpose in living. The study sample was comprised of individuals living with HIV disease who presented for an initial visit in a specialty HIV mental health services program. In bivariate analyses, social support was negatively correlated with multidimensional aspects of HIV stigma that included distancing, blaming, and discrimination stigma, whereas personal meaning was negatively associated only with blaming stigma. In further analyses using structural equation modeling, social support significantly mediated the association between personal meaning and both distancing and blaming stigma. Interactions between positive personal meaning and social support may be useful to consider in future research on psychological resource factors and HIV stigma. Understanding these interactions may also inform clinical efforts to address HIV stigma concerns.     

Beliefs Contributing to HIV‐related Stigma in African and Afro‐Caribbean Communities in the Netherlands

Thirty years after the first diagnosis, people living with HIV (PLWH) around the world continue to report stigmatizing experiences. In this study, beliefs contributing to HIV‐related stigma in African and Afro‐Caribbean diaspora communities and their cultural context were explored through semi‐structured interviews with HIV‐positive (N = 42) and HIV‐negative (N = 52) African, Antillean and Surinamese diaspora community members in the Netherlands. Beliefs that HIV is highly contagious, that HIV is a very severe disease, and that PLWH are personally responsible for acquiring their HIV infection were found to contribute to HIV‐related stigma, as did the belief that PLWH are HIV‐positive because they engaged in norm‐violating behaviour such as promiscuity, commercial sex work, and, for Afro‐Caribbean diaspora, also homosexuality. These beliefs were found to be exacerbated and perpetuated by cultural taboos on talking about HIV and sexuality. HIV‐related stigma reduction interventions should focus on changing these beliefs and breaking cultural taboos on HIV and sexuality in a manner that is participatory and consistent with the current theory and empirical findings. Copyright © 2011 John Wiley & Sons, Ltd.     

Situating Moral Justification: Rethinking the Mission of Moral Epistemology

This is the first of two companion articles drawn from a larger project, provisionally entitled Undisciplining Moral Epistemology. The overall goal is to understand how moral claims may be rationally justified in a world characterized by cultural diversity and social inequality. To show why a new approach to moral justification is needed, it is argued that several currently influential philosophical accounts of moral justification lend themselves to rationalizing the moral claims of those with more social power. The present article explains how discourse ethics is flawed just in this way. The article begins by identifying several conditions of adequacy for assessing reasoning practices designed to achieve moral justification and shows that, when used in contexts of cultural diversity and social inequality, discourse ethics fails these conditions. It goes on to argue that the failure of discourse ethics is rooted in its reliance on a broader conception of moral epistemology that is invidiously idealized. It concludes by pointing to the need to rethink both the mission and the method of moral epistemology.     

HIV Testing and Pregnancy: A Case of Cultural Moral Equivocation

The concept of “moral equivocation” may be defined in the context of an ethical framework for moral judgment. This framework comprises two universal principles of right: the Dependency Principle, found (but not endorsed) in Plato's Republic, and the Democracy Principle. Moral equivocation is evident in a violation of either of these two principles. At the cultural level, coping with moral equivocation often requires moral compromise, as is evident in applying the Dependency-Democracy Principles Ethical Framework to the issue of HIV testing for pregnant women.     

HIV-related stigma in African and Afro-Caribbean communities in the Netherlands: manifestations, consequences and coping

HIV-related stigma in African and Afro-Caribbean diaspora communities in the Netherlands was investigated. Interviews with HIV-positive and HIV-negative community members demonstrated that HIV-related stigma manifests as social distance, physical distance, words and silence. The psychological consequences of HIV-related stigma among those diagnosed with HIV reported were emotional pain, sadness, loneliness, anger, frustration and internalised stigma. The social consequences included decreased social network size, limited social support and social isolation, and resulted from not only enacted stigma but also self-imposed social withdrawal. Also, poor treatment adherence was a health-related consequence. People living with HIV employed both problem-focused and emotion-focused coping strategies to mitigate the negative consequences of stigma. Problem-focused coping strategies included selective disclosure, disengagement, affiliating with similar others, seeking social support and, to a lesser extent, activism. Emotion-focused strategies included distraction, positive reappraisal, religious coping, external attributions, disidentification and acceptance. HIV-related stigma clearly permeates African and Afro-Caribbean communities in the Netherlands, and should be targeted for intervention.     

Understanding the Relationships Among HIV/AIDS-Related Stigma,Health Service Utilization,and HIV Prevalence and Incidence in Sub-Saharan Africa: A Multi-level Theoretical Perspective

HIV-positive individuals often face community-wide discrimination or public shame and humiliation as a result of their HIV-status. In Sub-Saharan Africa, high HIV incidence coupled with unique cultural contexts make HIV-positive individuals particularly likely to experience this kind of HIV/AIDS-related (HAR) stigma. To date, there is a relatively small amount of high-quality empirical literature specific to HAR stigma in this context, supporting the notion that a better understanding of this phenomenon is needed to inform potential interventions. This paper provides a thorough review of the literature specific to HAR stigma in Sub-Saharan Africa, finding (a) qualitative support for the existence of important relationships between HAR stigma and health service utilization and barriers; (b) a need for more quantitative study of stigma and its relationships both to health service utilization and to HIV outcomes directly; and (c) a disconnect between methodological techniques used in this context-specific literature and well-known theories about stigma as a general phenomenon. This paper then draws from its empirical literature review, as well as from well-known theoretical frameworks from multiple disciplines, to propose a theoretical framework for the ecological and multilevel relationships among HAR stigma, health service utilization, and HIV outcomes in this context.     

A Preliminary Examination of Sexual Orientation as a Social Vulnerability for Experiencing HIV/AIDS-related Stigma

This investigation is a preliminary examination of sexual orientation as a social vulnerability for experiencing HIV/AIDS-related stigma, specifically concerns about disclosure and public attitudes. Participants were 36 heterosexual men and 82 gay men with HIV/AIDS. Consistent with prediction, a heterosexual sexual orientation was significantly associated with HIV/AIDS disclosure concerns. This effect was evident after controlling for various demographic variables, CD4 T-cell count, time since HIV diagnosis, self-esteem, and coping styles. Also, as predicted, similar levels of enacted stigma were evident regardless of sexual orientation. Further work is needed to understand the process of HIV/AIDS disclosure for heterosexual men with this illness and to differentiate the experience of HIV/AIDS-related stigma among gay and straight men with HIV/AIDS.     

Stigma towards psychosis: Cross‐cultural differences in prejudice,stereotypes, and discrimination in White British and South Asians

Public stigma towards people with mental health problems has been demonstrated in Western societies. Little is known about non‐Western cultures and whether cultures differ in their perceptions of people with mental health problems. Aim of this study was to examine cultural differences in prejudice, stereotypes, and discrimination towards people with psychosis. Participants were from White British and South Asian backgrounds (N = 128, aged 16–20 years) recruited from two schools and colleges in the United Kingdom. They completed a cross‐sectional survey on affective, cognitive, and behavioural dimensions of stigma. Results revealed significant cultural differences on all three stigma dimensions. South Asians attributed higher anger (prejudice) and dangerousness (stereotypes) to people with psychosis than White British. They also reported lower willingness to help, greater avoidance, and higher endorsement of segregation (discrimination). The effects of ethnic group on helping intentions, avoidance, and segregation endorsement were mediated by anger and by dangerousness. Understanding cultural differences in stigma towards psychosis will be important for designing stigma interventions as well as treatments for people with different cultural backgrounds.     

HIV/AIDS reduces the relevance of the principle of individual medical confidentiality among the Bantu people of Southern Africa

The principle of individual medical confidentiality is one of the moral principles that Africa inherited unquestioningly from the West as part of Western medicine. The HIV/AIDS pandemic in Southern Africa has reduced the relevance of the principle of individual medical confidentiality. Individual medical confidentiality has especially presented challenges for practitioners among the Bantu communities that are well known for their social inter-connectedness and the way they value their extended family relations. Individual confidentiality has raised several unforeseen problems for persons living with HIV/AIDS, ranging from stigma and isolation to feelings of dejection as it drives them away from their families as a way of trying to keep information about their conditions confidential. The involvement of family members in treatment decisions is in line with the philosophy of Ubuntu and serves to respect patients’ and families’ autonomy while at the same time benefiting the individual patient.