Title
[原著］Attitudes toward mental illness : A cross-cultural
comparative study of nurses and high school teachers in
Canada and Japan
Author(s)
Naka, Koichi; Oda, Melanie; Randall, Maxine; Inoue, Shimpei;
Ishizu, Hiroshi
Citation
琉球医学会誌 = Ryukyu Medical Journal, 15(4): 165-172
Issue Date
1995
URL
http://hdl.handle.net/20.500.12001/3228
Attitudes toward mental illness: A cross-cultural comparative study of
nurses and high school teachers in Canada and Japan
KoichiNaka ,MelanieOda ,MaxineRandall ,
Shimpei Inoue* ** and Hiroshi Ishizu
Department of Mental Health and Research Center of Comprehensive Medicine,
Department ofNeuropsychiatry, Faculty of Medicine, University of the
ill:
Ryukyus, Okinawa 903-01, Japan;
Queen Street Mental Health Centre, Toronto, Canada,
Kochi Medical School, Kochi, Japan
(Received on July 26, 1995, accepted on October 24, 1995)
ABSTRACT
A cross-cultural comparative study examining attitudes of nurses and high school teachers in Canada and Japan toward mental i】lness was undertaken. The population sampled included 76 Canadian nurses and 77 high school teachers, 187 0kinawan nurses and 179 high school teachers, and 98 Kochi nurses and 107 high school teachers. A self-administered questionnaire, which included the semantic differential, attitudes toward mental illness, and social distance scales as well as case vignettes, was utilized to ascertain the knowledge and attitudes regarding menta一 illness and
the acceptance or rejection of the-mentally ill. The main findings of this investigation were: 1) the Japanese subjects seemed comparatively less able to discriminate differences in causality, diagnosis, and prognosis of the various psychiatric disorders described. 2) the Japanese, whether from Okinawa or Kochi, desired a greater distance than the Canadians from the mentally ill. 3) the Canadians tended to have a more positive realistic attitude toward the mentally ill. A careful assessment of these differences in attitudes from the social and cultural context in which they originate provides some insight into how a more realistic and supportive attitude toward the mentally ill might be instituted or improved in all three cultural groups investigated. Our findings point not only to the importance of recognizing the influence of culture on attitudes toward mental illness, but also to the importance of the effect of cultural variables on the interrelationship between attitudes,
education and service delivery. Ryukyu Med. J., 15(4)165- 172, 1995
Key words: attitudes, mental illness, cultura一 variab】es
INTRODUCTION
In order to implement positive changes in a mental health system it is important to identify and understand the context of that system. Not only do sociocultural factors affect the development and effectiveness of the system, but also influences the attitudes held by the recipients of mental health services as well as those who deliver those services. The purpose of this study was to examine the attitudes toward mental illness held by nurses and high school teachers from Canada (Ontario) and Japan (Oki-nawa, Kochi) by identifying those attitudes and attempting to understand them from a sociocultural perspective. After review of the literature and in recognition of the differences that exist in the social and cultural values of the different societies, it was hypothesized that Canadian subjects, re-gardless of group, would have a more positive attitude
toward mental illness than Japanese subjects.
SUBJECTS AND METHODS
The populations sampled totaled 724 subjects: 76 Canadian nurses and 77 high school teachers; 187 0kinawan nurses and 179 high school teachers; 98 Kochi nurses and 107 high school teachers. A self-administered question-naire which included a semantic differential scale, measures of attitudes toward mental illness, case vignettes and a social distance scale was utilized to ascertain the knowledge and
attitudes regarding menta一 illness and the acceptance or
rejection of the mentally ill. Portions of the questionnaires differed based on the profession of the subjects. The nurses were asked in the vignette portion about their opinion
as to whether the individua一 described required
hospitaliza-tion or should consult a psychiatrist. The high school teachers were asked whether they had had contact with a mentally ill individual and if so, where. They were also asked to indicate whether they had ever met a person like
166 Attitudes toward mental illness: A cross-cultural comparison
the ones described in the case vignettes. In the personal background column, a question was included inquiring whether the subjects had received prior information
regard-ing menta一 illness and from where they received such information. The Canadian survey for both groups in-eluded a question pertaining to ethnic identity since the population is comprised of people from various ethnic and cultural backgrounds. There was such great diversity within the Canadian population by 1971 that a national policy regarding multiculturalism was established. The data was collected from August, 1991 to June, 1992.
Descriptive statistics were employed to analyze and compare the responses of the subjects. Given the history and unique culture of Okinawa, and the possibility of biasing the results, Kochi was also selected and regarded as a separate location in the analysis.
RESULTS
Through the use of the Semantic Differenctial Scale (Fig.1) it was found that血e Canadian nurses generally had a more positive image of the mentally ill than the nurses
from Okinawa and Kochi. Within the nursing group the
items of significant difference are as follows: soft/hard (p-0. 0001) ; good/bad (p-(p-0. 0004) ; strong/weak (p-(p-0. 0001) ; clean/dirty (p-0.0002) ; positive/negative (p-0.0001) ; sharp/dull (p-0. 0099) ; gay/plain (p-0. 0006) ; familiar/-weird (p-0. 0041) ; bright/dark (p-O. OOOl) ; safe/danger-ous (p-0.0001); complex/simple (p-0.0179); and li-vely/apathetic (p-O. OOOl).
Niras
芸‡巾"蜘ご叩仙仙二軸曇
. I G l d =サl-サ, , tart .- L It・ --" 蝣- ----i goodL I _ I i I I l _ . . I L l l I L _.J=r -a- CんN人0人 -0- OKINAWA .サ. KOCH l l I r-I - , ircng -, - dean l -I I p.°畠bYe -:一一:叫 l l i oay -ト 1 ¥airim3′ -, ! bri如 -' 1 nil° -i 1 mucUl瓜n° - ;‥ - dover 一 °bedl:ent l一 ‥: cD叫u
⋮
ニ
ー
I
:
:
:
!
!
-i 1 ----, understan由由h. J -ト oondtt l I -し ---' fv叫 机sLIトWali i (Til *p<0.05 -p<0.01 p < 0.001The results of山e high school similar to those of the nurses. The
teachers images of the mental一y ill
each other than either was to the Significant differences were apparent
soft/hard (p-0. 0001) ; goodルad (p= (p-O. OOOl); clea〟dir亡y (p-0. 0009)
teacher groups were Okinawan and Kochi were more similar to Canadian counterpart. in the following items:
こ0. 0001) ; strong!weak
i positive,/negative (p
-0.0002) ; familiar/weird 0.0058) ; bright/dark 0. 0001) ; safe/dangerous 0. 0143) ; clever/foolish (p-0.0002); and lively/apathetic (p-0.0001). For the two items, sharp/dull (p-0.0076) and calm/tense (p-0.023) the Canadian teachers had a significantly more negative image of the mentally ill than the teachers from either Okinawa or Kochi.
Overall, the Canadian nurses and high school teachers had a more positive image of the mentally ill山an the subjects from either Okinawa or Kochi.
The Attitudes Toward Mental Illness scale (Fig.2) indicated that nurses from both Okinawa and Kochi felt, to a greater degree than their Canadian counterparts, that psyc-hiatric patients were: more violent and fearful; should be sterilized; could not make correct judgments; lacked interest to improve; and should be segregated by gender on a psychiatric ward. A genetic cause for psychiatric illness and being fearful with a psychiatric patient were also more strongly held beliefs among Okinawan and Kochi nurses than those in Canada. The Kochi nurses, relative to the Okinawan and Canadian nurses, respectively, would choose a psychiatric hospital in a remote area for someone in their family and felt that a psychiatric patient in a fami一y would
High School Teachers
son 卜・ ‥ト I I bad ' I *v :-r dangoroua f" = r I InnMiw ト-Y一一・一卜 l I I Pt tens* r l simple r一Hr -r-not undi肝由山1如 し= ・ ->- C仙 くトOIKINAWA .*_ KOCH
Fig.l Comparative semantic differential scale for nurses and high school teachers.
._し…上目J l I I t I I l l l r t 1 --L ( 1
山
叫
〓
蜘
叫
.'....」....I I I I l I l H. _… ・ britft l I I r-I-1 1 I--トー-p- i mascuin* I I I I I I I I --,--7- 1 ---- --1 compln ....L. -.J-. -1 鵬IJ止血LL l I I _" "___ gaila I I 肌iiskal-WilU t>n ・oォ0.05 -p <0.01 -p 40.001 t ' : ⋮ : : t miNurses
donl know
High Schoo一 Teachers
not tn.le true
1. Psychiatric illness may occur by supernatural power 2. All psychiatric illness may be genetic
3. All psychiatric patients are violent and fearful 4. I would leel fearful with a psychiatric patient 5. Psychiatric patients should be sterilized
6. Psychia廿jc pa由nts should be hospitanzed voluntanEy choices: always, sometimes, never
7. The main purpose of a psychla叫c hospitall i3 10 sedude patents
S. I'd choose a psychiatric hospital in a remote area (or my tamily
9. Psychiatric patients need to be con厄ned to a psychiatric hospita1
10. Many patients in a psychiatric hospital are violent or excitable
ll. Psychiatric patients in a lamily will hinder仙e mamage prospects of other family members.
12. History of admission to a psychia抗c hospital wi‖ impar social functionlng
13. Psychiatric patients lack interest to improve 1 4. Psychiatric patients can not make correct judgements 15. Psychiatric patients should be segregated by gender
on a psychiatric vlard 一・- cAN▲D人 ・{ト OKINAW▲
一詛- KOCH
Fig.2 At【nudes toward mental illness.
I 1 I l I - - - I -1 1 1 I l l I I l I I l l ︼ l l m I l- - ..,_ I .・ .I._ -l - -l .・ .I._ -l - -l J l I l I- - -I_ _ _I_ I l I l I I I- - -I- - -I-l I I l I I _ _ - - - - -I l l l l I I l l 1 I I l l l l l l l I l I- - -
J _ __ ._l -hinder the marriage prospects of a family member. The Canadian nurses believed that patients in a psychiatric hospital were more violent or excitable than the Japanese nurses did. The Okinawan nurses held the strongest belief
that psychiatric il一ness may occur by supernatural power compared to the nurses from Kochi or Canada.
The high school teachers had significant differences in every item of this scale. The strongest degrees of differ-ences appeared in the Canadians disagreeing with the statements that: patients are violent or fearful; psychiatric patients need to be confined to a psychiatric hospital; psychiatric patients lack interest to improve; psychiatric patients are not able to make co汀ect judgments; and psychiatric patients should be segregated by gender on a psychiatric ward. Although differences were significant in only the high school teacher group, bo【h Okinawan teachers and nurses had a stronger tendency to attribute the cause of
psychiatric illness to supernatura一 power.
On the Concept of Mental Illness scale (Fig.3) the
Canadian nurses and high schoo】 teachers believed that a
﹁ . 1 -1 ﹂ Kru skaトWal li s lest p <0.01 °…pく0.001 * * * ★ t ★ ★ ⋮⋮ 一 l l l i I I l _ _ _ -I l I ⋮⋮ i i
mental i一lness was serious, yet indicated a more positive outlook on life in the community and the ability of a mentally ill individual to go to work or school.
Although no figure is shown, concerning appropriate facility for consultation, the Canadian subjects identified more service options than the Japanese subjects did. The Okinawan nurses chose psychiatric hospitals more frequent-ly than any other faci】lty appropriate for consultation. The high school teachers in all three locations identified a variety of facilities as being appropriate for consultation. Once again, the Okinawan high school teachers believed that the most appropriate faci】lty for consultation was a psychiatric hospital.
Regarding previous contact with a mentally ill in-dividual, 84% of the high school teachers from Canada had had previous contact with a mentally ill person, Kochi high school teachers had the least contact at 68. 9%, whereas 75.3% of the Okinawans had met a mentally ill person. The Canadians had considerably more contact with a mentaHy ill individua】 in most areas but not "in my
168
1.Mental illness is a serious i‖ness?
2. A mental dsorder can be cured?
3. Marriage for a mentally ilf individual will be diffiadt?
4. A mentally ill individual can live in the community and not have to be hosprtalized?
5. A mentally ill individual will be able to go to work or school?
6. The family of a mentally ill individual should decide if the patient requires hospital izati on 7
7. A mentally ill individual should consull【 a doctor?
6. The general public's attitude toward mental i‖ness?
=1‥ warcou
-0- OKINAWA
一詛- KOCHl
2. This contfrti°n Isこ
3. This person is:
4. This 0°ixfidon:
5. Mamlmgサvrtl bo:
6- LJta叫horn°YdI b°:
7. Uti° h仙community win bo:
a. ah. i° wont or g° lo sdilcd:
9. Consult d psychiatrist: 1 0. Bサ(1°叫ittltod: -I- Ciradt -0- Ounawi -4-i KocM . n°t抑°U8 mmtaly A can t*即-A with°ut problems ponbto posdblf Ytl Yq yP
Attitudes toward mental illness: A cross-cultural comparison
not serious can be curl】d J no di珊culty yes yes yes yes n egati ve not serious
--J- L willgetworse can becured
・・・Hr -, impossible no difficulty
""1`…H yes
虹
High School Teachers
: 「こ"蝣TIC-.1 ' ***・ l i-t-i---,- Wl‖getwcrse l I l l 1 l I I l l l I I > ___い‥トimpossible yes -r n-‥r-・…i n0 ... >ォ>s posi tive Kru staトWalli s test `pく0.05 p<0.01 "p <0.001 n egati ve I l I I ' -1-‥ト‥L niO *#* l l l l l I I I l l I I I l l !r-i-r l I I I l l I I t I l‥r no 1 very si°n°u8 rL°t mentally II will got wctm impQSdLle impossM° I mpossible lmpossibl e rK) I___L-_] no Pu故山Walfis .toS "*p <0.01 ド lはPTiT'TiT
High School Teacher 1. This岬 °t抑*Jォ 1 I ￨
1 1 1
3. TWs p-, ¥x montatty iB
4 This cond由n: Cm b q∬d
6. lift 61homowill bサ: 「一一
7. AMb to work or go to sen°dニ yu
a. Consult a doctor -*- Cifmdt 廿okinawa -*- JCocこH i 買7VT I l -; veryson。山 not montaJly il will got灯Se - -I 1 impossible t ] l l I I 1--n lmpossb。 I l l I l I I l l l I l 1岬ssiUo 」 lD K仙WiU* 蝣・It ・D-<0.05 -D40.01 -p <O.OOI
Fig.4 Case vignette : Acute psychosis.
neighbourhood, workplace, or among my friends or ac-quaintance .
Case vignettes for mental retardation, epilepsy, mania, acute psychosis, depression, process schizophrenia and depressive neurosis were used to assess the subjects'level of understanding of the problem as we】] as their attitude toward persons with such problems. Fig.4, showing the results of the vignette for acute psychosis, is given as a representative example of the findings.
In all the case vignettes the Canadian nurses and high school teachers tended to view the cases in a more realistic fashion. They were more apt to label a case as a mental illness, except for the mentally retarded and the epileptic. The trends were generally similar between Okinawa and Kochi regardless of the occupational background. In-terestingly, when the Japanese identified an individual as strange, as in the case of mania, acute psychosis and process schizophrenia, they were more reluctant to label it as a mental illness, and viewed the curability in a more optimis-tic light. However, in the case of mental retardation, epilepsy and depressive neurosis, the nurses as well as high
Nurses
strongけ
agree disagree
1. It would be wlS8 tO discourage former pati即tS Ot a mental hospital rom entering yoir neighbourhood.
2. It would be unwise to encourage the dose friendship ol someone who had been in 8 mental hospital.
3. You wou一d be willing to sponsor a former patient of a mental hospita一 tor membership in your
favourite dub or society.
4・ If you were a personne一 manager, you would be willing to hレe a former patient of a mental hospital.
5. If you were responsible for renting apartments in your building, you would hesitate to rent living qu町ters to someono who was formerly a patient in a montaJ hospital.
5・ You would甜ongly d】scoirage your dill廿on 什om marrying someone who was formerly a patent in a mental hospital.
7. II would be unwise to trust a former mental hospital patient with your dl印*en.
... c▲N▲DA -0- OKINAWA -.- KOCH 1 1 1 1 1 1 1 1 1 I I I I .^^^H^^^H^^^H' I L I_ I I 】 l I I ト ー
1-■■ト-school teachers in both Okinawa and Kochi viewed the individuals as strange, and labeled them as mentally ill; they
were not regarded as such by the Canadian subjects.
The Social Distance scale (Fig.5) indicated that within the nursing group, the Canadians were more accepting of a mentally ill patient; a significant difference existed in the item regarding trusting one's children with a former mental hospital patient. In this item the Canadian nurses were more rejecting. There was a significant difference noted in a】1 items within the high school teacher group. The Canadian high school teachers did indicate more willingness overall to accept a mentally ill individual. In this group the significant difference was between Canadians and both the Kochi and Okinawa groups.
The Fear of Illness scale (Fig.6) showed that for all three groups, nurses feared cancer and psychiatric lllness the most. The Canadian nurses feared cancer the most and equally feared psychiatric i一lness and stroke. Both Japa-nese groups feared psychiatric illness more than any other iHness.
Regarding the degree of exposure to mental illness
High School Teachers
strongV strong吋
dlsagr的 agreo agree disagree
[ ''
, I I I I I I I I I I I I I I I I I I I I l l I I I I I l l I I I I I _ J I I-I I-I I-I I-I I-I I I I I I l I I I I ■ト-トーH-」 ★** I I I I I l I I I I -一蝣-一蝣ォ I l l I I I I I I I l l I I I I I I I I I l I I l I I I I I l I I し-Jl -」一一〇 Kru sfcaトWa l li s amii `pく0.05 pく0.01 "p <0.001Fig.5 Social distance scale.
An assessment of the level of social accestability of persons with mental desorder
I I I I I l l l l l I l l I I I I l ',._L_」 I I I I I I I I I ト ー H - -I .-I i ト ー H - -I .-I I I I I I I I I I I I l I I I I I l I I I l I し_ 」__」_■■
◆」-」
170
Fig.6 Fear of illness scale.
Attitudes toward mental illness: A cross-cultural comparison
High School Teachers
High Setlool Teachers
Fig.7 More information pertaining to mental health.
information that high school teachers have received, the results indicated that in all areas, the Canadians reported having received more previous information pertaining to mental illness than either the teachers from Okinawa or Kochi. Information pertaining to mental illness was most frequently received from the newspaper and television.
The request for more information pertaining to mental illness results (Fig.7) emphasized that overa日, the Canadian subjects, regardless of profession indicated a desire to receive more education about mental lUness as well as have educational materials available.
DISCUSSION
The Canadian subjects generally had a more positive, realistic attitude about the mentally ill, and did indicate to a greater extent than their Japanese counterparts that hos-pitahzed patients could be violent. Both nurses and high school teachers seemed to more clearly discriminate differ-ences in causality, diagnosis, and prognosis of the various psychiatric disorders described. These findings could be related to the fact that because mental health services are community as well as hospital based, mentally ill individ-uals are more visible within the general public. This in turn would probably increase the likelihood of contact with such individuals, which was apparent in the results. The fact that the high school teachers from Canada also indicated having had more information pertaining to mental illness may have influenced the more positive attitudes.
The Japanese, on山e other hand, whether from Oki-nawa or Koch: tended to express a less positive image of the mentally ill and more rejecting attitudes. The desire to maintain distance from the mentally ill suggests thaL negative attitudes toward the mentally ill held in the past persist today. Both nurses and high school teachers were reluctant to label an individual as mentally ill. However, when the Japanese did label an individual as mentally ill, i.e. epileptic, mentally retarded, the Canadians did not. This is an example of cultural differences in classification of disorders. The results also indicated that the Japanese teachers had 一ess contact wi山the mentally ill and had received less information regarding mental illness, than the Canadians. This was not only evident in the semantic differential, where a positive image was apparent but also in the case vignettes. This may be attributed to the fact that the number of years of education for the Canadians was higher than that of the Japanese. It appears that the Canadians are more specialized in their education and training. This could be due to the fact that the Canadians undergo more severe competition in entering the work force, whereas the Japanese have much stricter and competitive requirements for entering University. Regardless of the national differences the results are in agreement with
findings of Malla and Shaw's , Chinnayya's31 and Eker and ArkarVl山at education and training will have a positive effect on attitudes toward mental illness.
The more positive attitude of high school teachers could have been influenced by the increased contact with a mentally ill individual, as weH as their higher level of education and receipt of more information about mental illness than the Kochi and Okinawan teachers. Regarding education, the Canadian high school teachers possessed either a Bachelors degree or Masters in a larger proportion than the Japanese subjects. These findings are similar to those ofPratt 〉and Crocetti, Spiro and Siassi.
The fact that there is a greater variety of services available for psychiatric patients may influence the more
have expanded from the once large institutional settings to
more community-based, out-patient programs. With the
expansion of services, the result has been higher visibility of mentally l】 individuals in the community. In Japan the greatest source for psychiatric treatment remains the institu-tion, predominantly psychiatric hospita】Sト9'
Although there is evidence to support the supposition that more contact and education will positively affect attitudes toward mental illness, a closer examination of the reasons for increased exposure and more education needs to be addressed. The sociocultural environment of any given area will influence practical aspects of a given society such as health care, education and government policy . Of course it also has an impact on the attitudes and thinking of
the people. We can not examine the efficacy of a system,
i.e. health care, education or government, without also taking into consideration the cultural and social values that are intricately woven into the fabric ofa society. From this perspective, we presume that an understanding and appre-ciation of the sociocultural factors which affect a given society should be examined in order to comprehend the differences. The types of services available and various occupations present in the mental health field, especially
evident in Canada, not on】 ref一ect government policy
regarding health care and funding for mental health services and education but also reflect and affect the attitudes toward
mental illness.
When considering both Japanese and Canadian
cul-tures, the concept of humans and their environment are
fundamentally different. In a Western culture, the
in-dividual is valued and seen as a separate unit distinct from the environment and independent of su汀ounding persons and things. The expectation is that persons think, feel and act on their own accord and responsibility. That is not to say that the inte汀elationship between other persons and objects is not important, but the individual entity is the starting point .
By contrast, Japanese culture sees individuals in rela-tion to the other people and things around them. A person is considered a member of a group, the family, the organization, the society. It is always the larger whole, rather than the individual parts that are of importance The Japanese sense of the necessity of harmony, not only with nature but also within one s group, may be one reason why an individual who is different or appears to disrupt
group harmony is often excluded or set apart. When an
individual requires hospitalization, there seems to be a transfer of the dependence on the family group to depen-dence on the institution which by nature is tolerant of disruptive behavior. This could be one of the reasons why Japanese have leng山ier hospitalizations (average 一ength of hospitalization in Canada is 90 days and in Japan is 536 days). Although, the health insurance system seems to condone lengthy hospitahzations, other factors such as identifying the need for service or lack of alternative services could also be contributing factors. The fact that
patients requiring psychiatric attention will wait from 2 days to 20 years before seeking out treatment is an area previously examined by various researchers12 16 1. All of these studies have dealt with the important role the family plays in relation to a mentally ill individual and also suggest the strong stigma concerning mental illness as山e rationale for why Japanese choose their particular pathway of seeking psychiatric help. In Okinawa,山e belief in ancestral spirits and the ongoing practice of consulting a Yuta (shaman) for all types of problems, including mental disturbances, ex-plains in part the delay in seeking psychiatric help and explains why the Okinawans indicated their belief in supernatural causation more than either the Kochi or Canadian subjects
The Canadians may have seen the mentally ill in-dividual as more violent than subjects from Okinawa and Kochi due to the fact that only individuals who are severely
iH or no 一onger manageable in the community will be hospitalized and 血erefore they may be more out of control. Once admitted to the hospital, a patient can exercise his personal right to refuse treatment, such as medication or therapy, whether he/she is an involuntary
patient or not. Medication or treatment can be
adminis-tered without a patient s consent if and when a psychiatrist
assesses him仙er to be a danger to him/herself or others. The other factor that may influence a difference in responses is related to the fact that once individuals are admitted to the hospita一 in Japan, they tend to be much more compliant. The Japanese patient and family often defer to the psychiatr-ist for advice and deve一op a dependent relationship on the
psychiatrist .
The results of the case vignettes implied that the Japanese subjects were apt to identify the disordered person as being strange, yet were less inclined to label the individual described as being mentally ill, except in the case of mental retardation, epilepsy, and depressive neurosis. These findings are consistent with Terashima s finding in 1969 , and imply that the Japanese, 26 years later, remain reluctant to label someone as mentally ill. Generally, the Japanese subjects were more optimistic about curability, whereas the Canadians recognized that problems or difficul-ties may be encountered. Concerning the Japanese re-sponse to causality of the various case vignettes, the majority of their responses reflected the impression that, depending on the case, a psychological factor was a cause of mental illness.
CONCLUSION
In conclusion, although the results obtained are only
reflective of a small samp一ing of the Japanese and Canadian
populations, the findings suggest that a difference does exist between the two popu】ations with respect to attitudes toward mental illness. It is important when examining attitudes that the background context of subjects be recognized, not only in terms of location and size, but more importantly in
172 Attitudes toward mental illness: A cross-cultural comparison
terms of the larger picture, i.e. the total sociocultural perspective. These findings suggest that both Canadian and Japanese attitudes toward the mentally ill could be greatly improved. If, for example, Japan intends to expand its services as has been recommended and stated in the new
Mental Health Law78', then the reasons for the existing
attitudes regarding mental illness need to be understood. This understanding is necessary at bo山a government policy (funding) level as well as at the care giver and consumer levels. The results of this study support the concept that cross-cultural studies can provide a clearer insight into ongins of negative attitudes toward mental iHness and the mentally ill. Such insight can in turn contribute to the deve】opment of an educational approach which would bring about positive changes in the attitudes not only of the general public and policy makers but of mental health professionals as well. It is important to recognize not only the mf】uence of culture on attitudes toward mental illness, but also the inte汀elationship that exists between culture,
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