Culture, gender and health care stigma: Practitioners’ response to facial masking experienced by people with Parkinson’s disease

Abstract

Facial masking in Parkinson’s disease is the reduction of automatic and controlled expressive movement of facial musculature, creating an appearance of apathy, social disengagement or compromised cognitive status. Research in western cultures demonstrates that practitioners form negatively biased impressions associated with patient masking. Socio-cultural norms about facial expressivity vary according to culture and gender, yet little research has studied the effect of these factors on practitioners’ responses toward patients who vary in facial expressivity. This study evaluated the effect of masking, culture and gender on practitioners’ impressions of patient psychological attributes. Practitioners (N=284) in the United States and Taiwan judged 12 Caucasian American and 12 Asian Taiwanese women and men patients in video clips from interviews. Half of each patient group had a moderate degree of facial masking and the other half had near-normal expressivity. Practitioners in both countries judged patients with higher masking to be more depressed and less sociable, less socially supportive, and less cognitively competent than patients with lower masking. Practitioners were more biased by masking when judging the sociability of the American patients, and American practitioners’ judgments of patient sociability were more negatively biased in response to masking than were those of Taiwanese practitioners. Practitioners were more biased by masking when judging the cognitive competence and social supportiveness of the Taiwanese patients, and Taiwanese practitioners’ judgments of patient cognitive competence were more negatively biased in response to masking than were those of American practitioners. The negative response to higher masking was stronger in practitioner judgments of women than men patients, particularly American patients. The findings suggest local cultural values as well as ethnic and gender stereotypes operate on practitioners’ use of facial expressivity in clinical impression formation.

Thin-Slice Judgments in the Clinical Context

“…A number of studies have shown that practitioners form inaccurate and negatively biased impressions of patients' personalities (relative to patients' self-reports) (Lyons, Tickle-Degnen, Henry, & Cohn, 2004;Tickle-Degnen, Zebrowitz & Ma, 2011). Compared to rehabilitation professionals, rehabilitation students were particularly likely to rate patients with high levels of masking as less extraverted .…”

Preserving dignity in patient caregiver relationships using moral emotions and robots

“…The frozen position of pressed or slack lips and an unbroken stare creates the impression, regardless of its accuracy, of an asocial, cold, incompetent or apathetic person who fails to reciprocate others' feelings of warmth, concern, interest or excitement [9]. The mask interferes with social observers' formation of accurate impressions regardless of whether the observer is a layperson or a health care practitioner [15,35]. The experience for people with masking is an imprisonment of the self in an unresponsive face and body [3], feeling misunderstood, isolated and lonely [32].…”

“…This indecipherability sets the stage for social response biases and stereotype activation as the social observer attempts to understand an ambiguous situation. The lack of predictability and the reduced perceived trustworthiness of the facially masked patient in comparison to more expressive patients may explain why observers have negative responses to facial masking [35]. People who are more expressive are liked more and viewed as more trustworthy than are less expressive individuals [8].…”

“…The attribute is the muting of facial expressivity and the stereotype is observers' preconceptions about the meaning of muted expressivity. The health care stigmatization of facial masking has been documented in both western and eastern cultures, yet the quality of the stigmatization is characterized by local moral codes, suggesting that masking violates the implicit moral norms of social interaction [35,40].…”

Effects of the Lee Silverman Voice Treatment (LSVT®LOUD) on Hypomimia in Parkinson's Disease

“…Aside from affecting the facial expressivity of individuals with PD, hypomimia may color how others perceive these individuals (Monrad-Krohn, 1957;Tickle-Degnen, Zebrowitz, & Ma, 2011). After viewing the silent videorecordings of PD participants, raters judged them to be more anxious.…”