ARTICLE IN PRESS Social Science & Medicine 62 (2006) 1685–1696 Stigmatizing experience and structural discrimination associated with the treatment of schizophrenia in Hong Kong Sing Lee a,Ã , Marcus Y.L. Chiu b , Adley Tsang c , Helena Chui a , Arthur Kleinman d a Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong b Department of Social Work, Baptist University, Hong Kong c Hong Kong Mood Disorders Center, The Chinese University of Hong Kong, Hong Kong d Department of Anthropology, Harvard University, USA Available online 19 September 2005 Abstract This research examines the experience of stigma associated with psychiatric treatment among Chinese patients with schizophrenia in Hong Kong. In focus groups patients described stigma experiences related to clinic visits and the side effects of antipsychotic medications. Additionally, they revealed various adverse treatment experiences during hospitalization which point to the presence of structural discrimination. Based on the focus group findings, a questionnaire was developed and completed by 320 and 160 patients with schizophrenia and diabetes mellitus, respectively. Results showed that patients with schizophrenia were more likely to anticipate stigma, conceal illness, and default on clinic visits than patients with diabetes. Medication-induced stigma occurred in 48% of patients with schizophrenia. It brought about the unwelcome disclosure of illness, workplace difficulties, family rejection, and treatment non-adherence. Adverse experiences during hospitalization were reported by 44% of patients with schizophrenia. They included negative staff attitudes, excessive physical/chemical restraints, inadequate information/ complaint systems, and limited rights. We conclude that stigma, at both individual and structural levels, represents a central experience of the treatment of schizophrenia in Hong Kong. Because inequitable health policy, resource allocation, and service organization privilege service providers’ control over users, treatment-related stigma may be a prime example of the social production of stigma and discrimination based on power difference between the stigmatizers and the stigmatized. To examine this critically we need to redirect stigma research to tractable clinical circumstances and structural mechanisms that produce and maintain stigmatizing and discriminatory psychiatric practice. Destigmatization programs must be evaluated not only by change in public attitudes but also by how much they reduce structural stigma and improve patients’ lives. r 2005 Elsevier Ltd. All rights reserved. Keywords: Schizophrenia; Stigma; Antipsychotic medication; Non-adherence; Structural discrimination; China; Hong Kong www.elsevier.com/locate/socscimed 0277-9536/$ - see front matter r 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2005.08.016 Ã Corresponding author. Tel.: +852 2144 6996; fax: +852 2144 5129. E-mail addresses: singlee@cuhk.edu.hk (S. Lee), mchiu@hkbu.edu.hk (M.Y.L. Chiu), adley@cuhk.edu.hk (A. Tsang), helenachui@gmail.com (H. Chui), kleinman@wjh.harvard.edu (A. Kleinman).