Perception of and Attitude towards Mental Illness in Oman

Abstract

As conceptions of mental illness are often dictated by prevailing socio-cultural factors and the philosophy of the time, there is little research to substantiate how mental illness is perceived in the Arab world in the light of both traditional and more recent modernization and acculturation processes.
To examine whether social factors exert an influence on a person's attitude towards people with mental illness (PWMI) in the rapidly changing country of Oman.
This study compares the response elicited from medical students, relatives of psychiatric patients and the general Omani public on the causes of mental illness, attitudes toward PWMI and the care and management of people with mental illness.
This study found no relationship between attitudes towards PWMI, and demographic variables such as age, educational level, marital status, sex and personal exposure to people with mental illness. Both medical students and the public rejected a genetic factor as the cause of mental illness; instead they favoured the role of spirits as the aetiological factor for mental illness. There were favourable responses on statements regarding value of life, family life, decision-making ability, and the management and care of mental illness. However, both medical students and the public thought that PWMI tend to have peculiar and stereotypical appearances and the majority preferred that facilities for psychiatric care should be located away from the community. Although the relatives of psychiatric patients were concerned about the welfare of mental patients, their responses varied and were often contingent upon their expectations.
The data suggest that neither socio-demographic factors nor previous exposure to PWMI was related to attitudes towards PWMI. Although the attitudes of Omanis toward PWMI appear to fluctuate in complex ways, traditional beliefs on mental illness have yet to be eroded by exposure to a biomedical model of mental illness. This study largely supports the view that the extent of stigma varies according to the cultural and sociological backgrounds of each society.

Full text

PERCEPTION OF AND ATTITUDE TOWARDS MENTAL ILLNESS
IN OMAN
SAMIR AL-ADAWI, ATSU S.S. DORVLO, SUAD S. AL-ISMAILY,
DALAL A. AL-GHAFRY, BALQUIS Z. AL-NOOBI, AHMED AL-SALMI,
DAVID T. BURKE, MRUGESHKUMAR K. SHAH, HARITH GHASSANY
& SUMA P. CHAND
ABSTRACT
Background: As conceptions of mental illness are often dictated by prevailing
socio-cultural factors and the philosophy of the time, there is little research to sub-
stantiate how mental illness is perceived in the Arab world in the light of both
traditional and more recent modernization and acculturation processes.
Aims: To examine whether social factors exert an in¯uence on a person's attitude
towards people with mental illness (PWMI) in the rapidly changing country of
Oman.
Methods: This study compares the response elicited from medical students, rela-
tives of psychiatric patients and the general Omani public on the causes of mental
illness, attitudes toward PWMI and the care and management of people with
mental illness.
Results: This study found no relationship between attitudes towards PWMI,
and demographic variables such as age, educational level, marital status, sex
and personal exposure to people with mental illness. Both medical students
and the public rejected a genetic factor as the cause of mental illness; instead
they favoured the role of spirits as the aetiological factor for mental illness.
There were favourable responses on statements regarding value of life, family
life, decision-making ability, and the management and care of mental illness.
However, both medical students and the public thought that PWMI tend to have
peculiar and stereotypical appearances and the majority preferred that facilities
for psychiatric care should be located away from the community. Although the
relatives of psychiatric patients were concerned about the welfare of mental
patients, their responses varied and were often contingent upon their
expectations.
Conclusions: The data suggest that neither socio-demographic factors nor
previous exposure to PWMI was related to attitudes towards PWMI. Although
the attitudes of Omanis toward PWMI appear to ¯uctuate in complex ways, tradi-
tional beliefs on mental illness have yet to be eroded by exposure to a biomedical
model of mental illness. This study largely supports the view that the extent of
stigma varies according to the cultural and sociological backgrounds of each
society.
International Journal of Social Psychiatry. Copyright & 2002 Sage Publications (London, Thousand Oaks and
New Delhi) Vol 48(4): 305±317. [0020±7640 (200212)48:4;305±317;029543]

INTRODUCTION
There has been limited research in the area of stigma and mental illness in the Arab world.
In the traditional Arab world, the word `madness' is often associated with possession and
sorcery and some precipitating factors are considered to be intimately linked to social
relationships (Al-Adawi et al., 2001a; Al-Sharbati et al., 2001; El-Islam & Abu-Dagga,
1992). As conceptions of insanity are often dictated by the philosophy of the time, there is
a dearth of research to substantiate how mental illness is perceived in the Arab world in
the light of recent modernization and acculturation (Harpham, 1994).
Despite distinctive improvements in the standards for health care in developing countries,
recent reports suggest that services for mental illness often are limited to only custodial care
(Okasha & Karam, 1998). This poor state of aairs continues to prevail despite the rising inci-
dence of psychological disorders (Murray & Lopez, 1996; Goldberg et al., 2000). Although
various explanations, such as the change in demographics and the lack of resources, might
contribute to the rudimental services, one possible explanation impeding provision for
people with mental illness (PWMI) is the prevailing opinions shaping public attitudes
towards PWMI (Kirmayer et al., 1997; Ng, 1997; Li et al., 1999; Littlewood, 1998). Attitudes
are major determinants of behaviour and have a wide-ranging in¯uence on society (Sussman,
1997; Al-Adawi et al., 2000).
Mental illness can often disenfranchise people, reduce their status and disempower them
(Callaghan et al., 1997). Historical and cross-cultural studies have reported active discrim-
ination and harassment of PWMI which exacerbated their psychosocial dysfunction
(Dols, 1992). Although some studies have found a positive public attitude towards PWMI
(Brockington et al., 1993; Madianos et al., 1999), generally PWMI tend to experience victim-
ization from all strata of society (Bhugra, 1989; Phelan & Link, 1998). It has been suggested
that social attitudes can be more devastating than the disorder itself. In addition, other family
members suer because an immediate family member has mental illness (Killian & Killian,
1990; Nicholson et al., 1998). Studies from developing countries suggest that societal attitudes
vary and ¯uctuate in a complex way (Ruscho, 1992; Arkar & Eker, 1997).
The main aim of this paper is to investigate attitudes of Omanis towards PWMI in Oman,
an Arab-Islamic country that lies on the eastern side of the Arabian peninsula. It is bordered
on the east by the Indian Ocean and on the west by Saudi Arabia and the United Arab
Emirates. Oman is mainly desert with the population centres along the coast. Due to its
isolation and because of the mainly desert terrain, Oman developed its own history and sub-
culture (Al-Adawi, Burjorjee & Al-Issa, 1997). Oman oers an interesting study area since its
diverse culture has experienced rapid acculturation, a phenomenon often equated with a rise
in psychosocial stress (Ghubash et al., 1994). In a developing country like Oman, the treat-
ment of mental illness is often the prerogative of traditional healers as psychiatric services
have been only recently introduced (Burjorjee & Al-Adawi, 1992). As groundwork for the
development of psychiatric services in Oman, this paper surveys societal attitudes towards
PWMI.
A speci®c interrelated aim of the present study is to examine whether demographic and
social factors exert an in¯uence on a person's attitude towards PWMI. Previous researches
have suggested that previous contact with PWMI in¯uences one's attitude (Lam et al.,
1996; Angermeyer & Matschinger, 1997; Roth et al., 2000). The ®nal aim of this study is
306 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 48(4)

to contrast the attitudes toward PWMI of three dierent groups of people: medical students
who have completed their secondment/rotation in psychiatry; relatives of psychiatric
patients; and the general public.
METHODS
1. Subjects
There were three groups studied. The ®rst consisted of medical students from Sultan Qaboos
University who had completed a behavioural science course for their medical science degree
and also completed an attachment in psychiatry as part of their clinical training. The second
group consisted of relatives of psychiatric patients who accompanied them to the outpatient
psychiatric clinic or visited their psychiatrically ill relatives in the inpatient unit at the Sultan
Qaboos University Hospital. The third group consisted of members of the public that were
recruited from the community in Muscat, Sultanate of Oman.
2. Measures
The questionnaire used in this study was adapted from Weller and Grunes' (1988), Attitude
Towards Mental Illness Questionnaire (ATMIQ). It was revised to re¯ect the socio-cultural
aspects of Omani society (e.g. on the cause of mental illness). Psychometric data have shown
that ATMIQ has a reliability of 0.79 (Weller & Grunes, 1988). The modi®ed ATMIQ
consisted of a 16-item Likert-type scale. The scores range from 0 to 32, with a higher score
suggesting a more favourable attitude. For brevity, each item was accompanied by three
response choices: `agree', `neutral' and `disagree'. The modi®ed ATMIQ also contained
items on demographic information, attributed cause of mental illness, attitudes towards
people with mental illness, and care and management of people with mental illness.
STUDY DESIGN
The ATMIQ was translated into Arabic, using a method of back-translation (Al-Adawi et al.,
2001b). A conscious eort was made to ensure conceptual, semantic and technical equiva-
lency between the source measures and the target measures. During the preparation for the
study, interviewers (7th year medical students) were trained to reliably read out the items
of the ATMIQ in the local spoken Arabic dialect and rate the response accordingly. As a
result, there was substantial inter-rater agreement on the various items of the questionnaire.
Informed consent was obtained after a brief explanation of the study was given and the
participants were assured that the data would remain con®dential.
Medical students were invited during class time to assist with this study. However, it was
explicitly stated that their participation or responses would have no in¯uence on their grades
or class performance. The students were not allowed to discuss the statements among them-
selves in an eort to avoid peer in¯uence.
The relatives in this study were individuals accompanying their family members to the out-
patient psychiatric clinic or visiting them in the inpatient psychiatric unit. Relatives were
AL-ADAWI ET AL.: PERCEPTION OF MENTAL ILLNESS IN OMAN 307

explicitly told that their co-operation would not in¯uence the therapeutic intervention for the
patients. Privacy for the subjects was attempted while administering the questionnaire.
The general public group was recruited from the Sultan Qaboos University and the satellite
towns around it. The questionnaires were distributed and collected by a research assistant.
Those subjects with known sensory or cognitive impairments that would aect proper com-
pletion of the questionnaire were excluded from the sample. The selected sample mirrored the
general population according to sex, age and educational level (Annual Statistical Report,
1999). There was no reason to suggest that the demographic details of non-respondents
were dierent from those of the respondents.
A single composite score was computed using the ATMIQ. Analysis of Variance was used
to statistically analyse the data for the demographic variables. The chi-square test was used to
analyse the homogeneity of the groups in their perception towards PWMI.
RESULTS
A. Demographic Description
Table 1 gives the demographic characteristics of all the samples. Altogether 468 people
returned the questionnaire. The overall response rate was 95% for the medical student
group, 90% for the relatives group and 79% for the general public. Among all the groups
there were 226 males (48%) and 242 females (52%). In the medical students group there
were 173 students (37%), with 57 being male (mean age  21:68  1:88) and 116 female
(mean age  20:96  1:72). Approximately 5% of the medical students were married. All
had completed their medical sciences degree and their attachment in psychiatry. A total of
Table 1
Characteristics of the sample: medical students, relatives and general public
Whole
group
Medical
students
Relatives of
patients
General
public
Sample size 468 173 64 231
Sex
Males
Females
226
242
57
116
41
23
128
103
Mean age (SD) 22:504:83 21:201:80 27:507:75 22:114:49
Marital status
Single
Married
Divorced
373
94
1
164
9
33
30
1
176
55
Educational level
Koran
Elementary
Preparatory
Secondary
Higher
1
3
9
52
403
0
0
0
0
173
1
3
9
36
15
0
0
0
16
215
308 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 48(4)

64 (13.8%) relatives were recruited in this study. The group consisted of 41 males (mean
age  27:95  8:40) and 23 females (mean age  26:70  6:52). Approximately 47% were
married, one was divorced, and the rest were single. Approximately 76% had completed at
least secondary school education and the rest had sought further education on completion
of their secondary education. There were 231 members of the public (49.4%) who took
part in this study; 128 males (mean age  22:95  5:13) and 103 females (mean
age  21:08  3:29). Approximately 24% were married. The majority had completed more
than 12 years of education.
B. Eect of demographic variables on attitudes towards mental illness
The results of the ANOVA are presented in Table 2. The mean response for the composite
ATMIQ score for the three groups were 24.41  4.11 (students), 23.66  4.88 (relatives)
and 24.19  4.43 (public). There was no statistical dierence between the mean responses
of the groups ( p-value  .498). The other demographic parameters: sex (p-value  0.234),
marital-status (p-value  .166), and years of education (p-value  .425) had no eect on
the attitude towards PWMI. However there was a slight age eect ( p-value  .081). The
Table 2
Results of one-way ANOVA of demographic variables on attitudes towards mental illness
Variable n Mean F p-value
Respondent
Students 172 24.41 0.70 0.498
Relatives 64 23.66
Public 231 24.19
Sex
Males 226 23.85 1.42 0.234
Females 241 24.52
Marital status
Single 373 24.34 1.92 0.166
Married 95 23.64
Years of education
1±6 176 24.10 0.86 0.425
7±12 94 23.79
12+ 197 24.48
Age
<27 363 24.31 2.52 0.081
28±39 75 24.32
>39 30 22.47
Contact
Maximum 149 24.37 0.29 0.746
Median 187 24.22
None 131 23.97
AL-ADAWI ET AL.: PERCEPTION OF MENTAL ILLNESS IN OMAN 309

notion that previous contact with PWMI has an eect on one's attitude was not supported by
this study. The mean scores for the maximum, medium and no-contact groups, 24.37  3.98,
24.22  4.47 and 23.97  4.68 respectively, are not signi®cantly dierent (p-value  .746).
These values are however high, which implies a favourable disposition towards the PWMI
of all the groups.
C. Cause, knowledge and attitude towards mental illness
(i) Cause of mental illness
The results for causes of mental illness are presented in Table 3. The three groups perceive
mental illness as not being genetic ( p-value  .085). The students and the public suggest
that spirits cause mental illness. The majority of relatives (45.9%) think that spirits do not
cause mental illness.
(ii) Knowledge of people with mental illness
The results for knowledge of PWMI are presented in Table 4. The student group was equally
divided on whether or not a PWMI could be identi®ed by physical appearance. The public
(57.1%) said they could identify a PWMI by their physical appearance and only 26.6% of
relatives said they could not tell a PWMI by their physical appearance. Overall, the groups
were evenly split on whether a PWMI could tell the dierence between right and wrong.
While 39% agreed with the statement, 41% disagreed and the remaining 20% were un-
decided. Even though the distribution of the responses was the same for the groups
(p-value  .34) in their judgement of whether a PWMI can tell the dierence between right
and wrong, more of the relatives (48.4%) disagreed with this statement. The students and
relatives agreed that PWMI are capable of true friendship, while the public (51.5%) were
undecided. About 47% of the respondents thought positively towards PWMI on these ques-
tions, while 36% did not. The rest were undecided or neutral.
(iii) Attitude towards people with mental illness
The results for attitude towards PWMI are presented in Table 5. The majority of respondents
agreed that PWMI should lead a normal life, with 64.7% of the group of students, 53.1% of
Table 3
Cause of mental illness
Statement Disagreed
n (%)
Neutral
n (%)
Agreed
n (%)
Chi p-value
Mental illness is genetic Students 95 (54.9) 46 (26.6) 32 (18.5) 8.17 0.085
Relatives 40 (62.5) 8 (12.5) 16 (25.0)
Public 147 (63.6) 47 (20.3) 37 (16.0)
Mental illness is caused by
spirits Students 35 (20.2) 65 (37.6) 73 (42.2) 20.35 0.000
Relatives 27 (42.2) 22 (34.4) 15 (23.5)
Public 68 (29.5) 57 (24.7) 106 (45.9)
310 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 48(4)

Table 4
Knowledge of people with mental illness
Statement Disagreed
n (%)
Neutral
n (%)
Agreed
n (%)
Chi p-value
One can always tell a mentally
ill person by his or her physical
appearance
Students
Relatives
Public
74 (42.8)
17 (26.6)
81 (35.1)
19 (11.0)
23 (35.9)
18 (7.8)
80 (46.2)
24 (37.5)
132 (57.1)
40.17 0.000
The mentally ill, with a number
of exceptions, cannot tell the
dierence between good and
bad
Students
Relatives
Public
76 (43.9)
31 (48.4)
85 (36.8)
32 (18.5)
10 (15.6)
51 (22.1)
65 (37.6)
23 (35.9)
95 (41.1)
4.04 0.401
Very few, in any, mentally ill
are capable of true friendships
Students
Relatives
Public
63 (36.4)
19 (29.7)
64 (27.7)
36 (20.8)
11 (17.2)
48 (51.5)
74 (42.8)
34 (53.1)
119 (20.8)
4.70 0.320
Students  medical students who had completed behavioural science courses and an attachment in psychiatry;
relatives  relatives accompanying psychiatrically ill patients at the hospital; public  member of the Omani
general public.
Table 5
Attitude towards people with mental illness
Statement Disagreed
n (%)
Neutral
n (%)
Agreed
n (%)
Chi p-value
Life has no value for the
mentally ill
Students
Relatives
Public
112 (64.7)
34 (53.1)
168 (72.7)
44 (25.4)
16 (25.0)
37 (16.0)
17 (9.8)
14 (21.9)
26 (11.3)
13.87 0.008
The mentally ill should be
prevented from having
children
Students
Relatives
Public
124 (71.7)
42 (65.6)
146 (63.2)
39 (22.5)
15 (23.4)
51 (22.1)
10 (5.8)
7 (10.9)
34 (14.7)
8.37 0.079
The mentally ill should not get
married
Students
Relatives
Public
124 (71.7)
45 (70.3)
156 (67.5)
44 (25.4)
14 (21.9)
55 (23.8)
5 (2.9)
5 (7.8)
20 (8.7)
5.88 0.208
Mentally ill people should be
prevented from walking freely
in public places
Students
Relatives
Public
113 (65.3)
40 (62.5)
146 (63.2)
42 (24.3)
13 (20.3)
44 (19.0)
18 (10.4)
11 (17.2)
41 (17.7)
5.21 0.267
One should avoid all contact
with the mentally ill
Students
Relatives
Public
161 (93.1)
54 (84.4)
202 (87.4)
9 (5.2)
7 (10.9)
19 (8.2)
3 (1.7)
3 (4.7)
10 (4.3)
5.23 0.265
The mentally ill should not be
allowed to make decisions,
even those concerning routine
events
Students
Relatives
Public
142 (82.1)
46 (71.9)
174 (75.3)
24 (13.9)
10 (15.6)
27 (11.7)
7 (4.0)
8 (12.5)
30 (13.0)
10.48 0.033
AL-ADAWI ET AL.: PERCEPTION OF MENTAL ILLNESS IN OMAN 311

the relatives and 72.7% of the public considering that life was meaningful for a PWMI.
Between 63% and 72% of each group responded favourably to the idea that PWMI
should be able to procreate. Also over 62% of each group thought that PWMI should not
be prohibited from walking freely in public places. All groups disagreed with the suggestion
that contact with PWMI should be avoided. Similarly, disagreements were expressed on the
suggestion that PWMI should not be allowed to decide for themselves even in matters
concerning routine events.
(iv) Care and management of people with mental illness
The results for the care of PWMI are presented in Table 6. There was a consensus (68±78%)
among all three groups that there were people who had never received psychiatric treatment
but who were more disturbed than some who were in a mental hospital. All three groups (78±
90%) also thought that one should not hide one's mental illness from one's family.
Although there was a generally unfavourable response to the suggestion that PWMI
should live only among their own kind, there was no consensus for the suggestion that
psychiatric hospitals should not be located in residential areas.
Finally, all three groups disagreed with the suggestion that mental illness cannot be cured.
However there was general agreement that PWMI should not be institutionalized. Only
about 34% of the relatives thought that PWMI should be institutionalized.
Table 6
Care and management of people with mental illness
Statement Disagreed
n (%)
Neutral
n (%)
Agreed
n (%)
Chi p-value
One should hide his/her mental
illness from his/her family
Students
Relatives
Public
154 (89.6)
50 (78.1)
200 (86.6)
13 (7.5)
6 (9.4)
24 (10.4)
5 (2.9)
8 (12.5)
7 (3.0)
13.26 0.010
The mentally ill should live
only among themselves
Students
Relatives
Public
165 (95.4)
54 (84.4)
217 (93.9)
6 (3.5)
7 (10.9)
13 (5.6)
6 (1.2)
3 (4.7)
1 (0.4)
12.44 0.014
Psychiatric hospitals should
not be located in residential
areas
Students
Relatives
Public
75 (43.4)
28 (43.8)
81 (35.1)
46 (26.6)
12 (18.8)
60 (26.0)
52 (30.1)
24 (37.5)
90 (39.0)
5.64 0.228
There are people who were
never in a mental hospital and
are more disturbed than those
who are in a mental hospital
Students
Relatives
Public
11 (6.4)
6 (9.4)
24 (10.4)
37 (21.4)
8 (12.5)
48 (20.8)
125 (72.3)
50 (78.1)
159 (68.8)
4.55 0.337
Mental illness cannot be cured Students
Relatives
Public
164 (94.8)
52 (81.3)
215 (93.1)
9 (5.2)
5 (7.8)
13 (5.6)
0 (0.0)
7 (10.9)
3 (1.3)
29.20 0.000
Every mentally ill person
should be in an institution
where he/she will be under
supervision and control
Students
Relatives
Public
135 (78.0)
35 (54.7)
143 (61.9)
22 (12.7)
7 (10.9)
45 (19.5)
16 (9.2)
22 (34.4)
43 (18.6)
26.96 0.000
312 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 48(4)

DISCUSSION
The primary aim of this study was to examine whether social factors relate to attitudes
towards PWMI. Previous reports have suggested that certain social and demographic
characteristics tend to arouse distinctive attitudes towards PWMI (Sou® & Raoof, 1992;
Littlewood, 1998; S'evigny et al., 1999). Ojanen (1992) and Parra (1985) have reported edu-
cational level to be strongly related to attitudes. In other words, the older and less schooled
the subjects, the more negative their attitudes are. On the basis of age, education, marital
status and sex, no relationship was found with indices of attitude towards PWMI, gauged
by the Attitude Towards Mental Illness Questionnaire (Weller & Grunes, 1988).
Research indicates that a higher incidence of contact with PWMI increases a person's
understanding towards them (Angermeyer & Matschinger, 1997). However this study
found that contact did not aect respondents' attitudes towards PWMI. In addition, relatives
of psychiatric patients appear to harbour a negative attitude towards PWMI ± for example,
they agreed that PWMI are incapable of dierentiating between right and wrong as well as
not being able to form genuine relationships. These results are inconsistent with previous
assertions that contact increases mutual understanding as postulated by the `contact
hypothesis' (Lam et al., 1996).
The second related aim of this study was to compare the attitudes of medical students with
those of the relatives of the patients and the public. Reports from developing countries have
revealed that health professionals tend to perceive the cause of mental disorders from a tradi-
tional/cultural perspective (Abiodun, 1991; Panter-Brick, 1991). Our data revealed that
medical students and the general public share similar views on the cause of mental disorders.
Both rejected a genetic predisposition and, instead, favoured the role of sensate agents as the
aetiological factor for mental illness. Therefore, our data seem to suggest that student health
professionals still hold cultural views as causes of mental illness. At face value, such attri-
butions, which are a re¯ection of a culture, may not necessarily translate into a negative
attitude. Previous studies have shown that alternative explanations like `biological mental ill-
ness metaphor' (Hill & Bale, 1980) tend to associate PWMI with unpredictability and stigma
(Read & Law, 1999). It is worth discussing why our sample largely holds on to a supernatural
explanation for mental illness. It has been suggested by El-Islam and Abu-Dagga (1992)
that a supernatural explanation seems to be too deeply imprinted during upbringing to be
erased by education. Despite this situation on the ground, the relatives of patients objected
to the suggestion that supernatural forces cause mental illness. Were our respondents there-
fore more subjective than factual, perhaps `trying to put their best foot forward in the light of
subtle demand characteristic' (being under biomedical care)? Although this possibility exists,
therapeutic eectiveness towards their relatives and possible previous failure of traditional
intervention may have contributed to such an idiosyncrasy. Individuals with a poor response
to traditional intervention are common in psychiatric hospitals (Jacob, 1999).
In developing countries, reports have suggested that psychiatric patients tend to be more
disturbed and are often in custodial care (Kleinman & Cohen, 1997). Others have suggested
that the closer the facilities were to the subjects, the more negative were their attitudes
(Callaghan et al., 1997). In agreement with this view, our respondents thought that facilities
for PWMI ought to be located far away from the community suggesting, fear and non-
acceptance or the `not in my backyard phenomenon' (Chou et al., 1996; Sussman, 1997).
AL-ADAWI ET AL.: PERCEPTION OF MENTAL ILLNESS IN OMAN 313

Other attitudinal parameters were generally positive for all three sample groups. There
were favourable responses to questions on value of life, family life, and decision-making
ability. In addition, all respondents suggested that PWMI ought not to be restricted in
terms of where they want to traverse. Finally, most of our respondents endorsed the idea
that mental illness is treatable and that PWMI should be integrated into the community.
They also believed that one should not hide one's mental illness since there are others in
the community who may be equally disturbed and yet are not labelled as mentally ill.
Some of the limitations of this study should be highlighted. First, data collection by
questionnaire is not without problems (Al-Adawi et al., 2000). Although some structured
questionnaires are easy to apply, studies have found that dierent cultures vary in the way
they conceive reality (Al-Adawi, 1993; Klono & Landrine, 1994; Cinnirella & Loewenthal,
1999). It is dicult to rely on instruments developed in one culture and then blindly apply
them to another. When studying attitudes in cross-cultural samples, qualitative interviews
are likely to be more fruitful (Patel et al., 1997). Second, this study can be criticized on the
grounds that it did not utilize the more commonly used questionnaires such as the Opinion
about Mental Illness Scale (Cohen & Struening, 1962). However, the questionnaire used,
the Attitude Towards Mental Illness Questionnaire (Weller & Grunes, 1988) is easily
administered and contains only 16 items. It was originally validated for a multicultural setting
(Weller & Grunes, 1988) and more recently, it was found to have adequate lexical compar-
ability and conceptual equivalence in other cross-cultural populations (Callaghan et al.,
1997). Finally, attitudes vary from action and the question remains whether these attitudes
translate into any form of discrimination against PWMI (Fisher & Farina, 1979).
CONCLUSION
This study has tested the hypotheses that certain social backgrounds and previous contact
with a person with mental illness would be likely to elicit certain reactions. Our data revealed
that neither social factors nor previous exposure to PWMI were related to attitudes towards
PWMI. This study elicited the attitudes of medical students, relatives of patients attending the
psychiatric clinic and the general public. Both medical students and the public rejected a
genetic cause of mental illness and favoured the role of sensate agents as the aetiological
factor for mental illness. Our groups thought they could distinguish psychiatric patients
based on physical characteristics and preferred that facilities for psychiatric care should be
located away from the community. However, the study groups had favourable responses
on statements for value of life, family life, decision-making abilities, and the management
and care of PWMI.
ACKNOWLEDGEMENT
We are grateful to Charles Co®e Asante for reading the manuscript and making suggestions
that improved the readability of the paper.
314 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 48(4)

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Dr Samir Al-Adawi, Mr Ahmed Al-Salmi, Dr Harith Ghassany & Dr Suma P. Chand, Department of Behavioural
Sciences and Psychiatry, College of Medicine, Sultan Qaboos University, PO Box 35, Al-Khoudh 123, Muscat,
Sultanate of Oman
Dr Atsu S.S. Dorvlo, Department of Mathematics and Statistics, Sultan Qaboos University, PO Box 36, Al-Khoudh
123, Muscat, Sultanate of Oman
316 INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY 48(4)

Dr Suad S. Al-Ismaily, Dr Dalal A. Al-Ghafry & Dr Balquis Z. Al-Noobi, Department of Family & Com-
munity Health, College of Medicine, Sultan Qaboos University, PO Box 35, Al-Khoudh 123 Muscat,
Sultanate of Oman
Dr Mrugeshkumar K. Shah & Dr David T. Burke, Department of Physical Medicine and Rehabilitation,
Spaulding Rehabilitation Hospital, Harvard Medical School, 125 Nashua Street, Boston, MA 02114-
1198, USA
Correspondence to Dr Samir Al-Adawi, Department of Behavioural Sciences and Psychiatry, College of
Medicine, Sultan Qaboos University, PO Box 35, Al-Khoudh 123, Muscat, Sultanate of Oman. Tel/
Fax: (968) 545203; email: adawi@squ.edu.om
AL-ADAWI ET AL.: PERCEPTION OF MENTAL ILLNESS IN OMAN 317