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정신질환에 대한 편견이 사회적 낙인에 미치는 영향 : 보호 요인의 역설적 매개 효과와 한국적 조절 기제 검증

The Effects of Prejudice toward Mental Illness on Social Stigma

  • 김국주 (kim kuk ju, 서강대학교 일반대학원)

초록(요약문)

본 연구는 정신질환에 대한 편견이 사회적 낙인으로 전이되는 과정에서 한국적 문화 기제가 어떻게 작동하는지를 검토하였다. 기존 낙인 연구는 서구 이론을 한국 사회에 직접 적용하거나 편견과 낙인의 개념적 경계를 충분히 구분하지 못한 경우가 많아, 회복 강조나 사회적 지지 확대와 같은 반낙인 개입이 한국적 맥락에서 기대대로 작동하지 않을 가능성을 남겨 두었다. 이러한 문제의식에서 본 연구는 보호 요인으로 간주되어 온 변인들이 특정 문화적 조건에서 역설적으로 작동할 수 있다는 명제를 전제가 아니라 검증의 대상으로 설정하였다. 이를 위해 편견을 내적 인지·정서 신념 체계로, 사회적 낙인을 행동적 낙인과 구조적 통제의도로 구성되는 이층 구조로 구분하여 측정하고, 가시적 지지와 회복가능성 인식이 체면중시·가족주의·능력주의 담론과 결합할 때 기대대로 작동하는지 또는 다르게 작동하는지를 검증하였다. 본 연구는 볼거와 아마렐（Bolger ＆ Amarel, 2007）의 지지 가시성 이론과 앤서니（Anthony, 1993）의 회복 패러다임을 이론적 기반으로 삼아, 두 가지 역설 경로를 검증할 가설로 설정하였다. 하나는 가시적 지지가 수혜자의 자율성을 침해하여 무능력 지각을 강화할 수 있다는 가설이며, 다른 하나는 회복가능성 인식이 낙인을 직접 완화하면서도 능력주의 담론과 결합할 때 개인 책임 귀인으로 전환될 수 있다는 가설이다. 분석 모형은 두 개의 병렬 매개 경로에 체면중시·가족주의·헬스뉴스 이용의 조절 효과를 통합하였으며, 크랜들과 에슐만（Crandall ＆ Eshleman, 2003）의 정당화-억제 모델（JSM）을 통해 체면 규범의 억제 기제를 함께 검토하였다. 만 19세에서 64세 성인 500명을 대상으로 엠브레인 패널을 통해 수집한 온라인 설문 자료를 구조방정식모형（SEM）으로 분석하였다. 정신질환에 대한 편견은 사회적 낙인에 가장 큰 직접 효과를 미치는 동시에 회복가능성 인식을 약화시키는 것으로 나타났으며, 이는 이미 형성된 부정적 인식이 낙인을 완화할 수 있는 인식의 형성 조건을 제약할 수 있음을 시사한다. 그러나 검증 대상이었던 역설 경로는 부분적으로만 지지되었다. 회복가능성 인식은 낙인을 직접 완화하는 보호（완충） 요인으로 기능하였으며, 책임 귀인을 높이는 경로와 연결되었으나 책임 귀인은 다시 사회적 낙인을 유의하게 예측하지 않아 회복가능성 인식에서 낙인으로 이어지는 역설 경로는 완결되지 않았다. 가시적 지지가 무능력 지각에 미치는 직접 경로 역시 유의하지 않았다. 가족주의는 가시적 지지가 무능력 지각으로 이어지는 경로를 조절하였으나 증폭이 아니라 약화시키는 방향이었으며, 이는 서구 개인주의 맥락에서 의존의 신호로 읽히는 지지가 한국의 돌봄 문화에서는 다르게 해석될 수 있음을 시사한다. 책임 귀인에서 낙인으로의 비유의 경로는 JSM의 억제 기제를 통해 잠정적으로 해석되었으며, 이는 낙인의 소멸이 아니라 침묵과 간접적 배제로의 이동 가능성으로 이해할 수 있다. 헬스뉴스 이용의 조절 효과는 유의하지 않았고 낙인에 대한 직접 효과도 유의하지 않았으며, 헬스뉴스 이용과 낙인 간에 정적 상관이 관찰되었으나 이러한 상관만으로는 미디어 효과를 확정할 수 없어, 본 연구의 자료는 헬스뉴스 이용이 낙인 형성에서 갖는 역할에 관한 결론을 지지하지 않는다. 이상의 결과는 보호 요인의 역설이 일률적으로 작동하는 것이 아니라 한국적 문화 맥락에서 조건적으로만 성립하며, 가족주의의 사례에서처럼 증폭이 아니라 완충되는 경우도 있음을 보여 준다. 본 연구는 정신질환 낙인이 개인 태도의 단순한 산물이 아니라 문화적 맥락에 따라 조건화되는 현상일 수 있음을 시사하고, 서구 이론이 전제한 보호 요인이 한국적 문화 규범과 결합할 때 다른 방식으로 작동할 수 있음을 보여 준다는 점에서 학문적 의의를 가진다. 나아가 본 연구는 편견 구조와 지지 방식을 함께 겨냥하는 다층적 반낙인 개입 전략의 필요성을 제안하며, 가족주의와 체면 문화를 극복 대상으로만 보기보다 낙인 완화의 잠재적 자원으로 활용하는 문화적 접근을 제언한다.

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초록(요약문)

This study investigated how Korean cultural mechanisms operate in the process by which prejudice toward mental illness transfers into social stigma. Existing stigma research has often applied Western theoretical frameworks directly to Korean society or has not clearly differentiated the conceptual boundaries between prejudice and stigma, leaving open the possibility that anti-stigma interventions—such as emphasizing recovery or expanding social support—may not function as expected in Korean contexts. Building on this concern, the study set out to examine, rather than to assume, a central proposition: that protective factors widely regarded as stigma-reducing may, under certain cultural conditions, operate paradoxically. Using a design that separates prejudice as an internal cognitive-affective belief system from stigma as a dual structure comprising behavioral stigma and structural control intention, the study tested whether visible support and recovery possibility awareness function as expected or differently when combined with Korean norms of face-consciousness, familism, and meritocratic discourse. Drawing on Bolger and Amarel's （2007） support visibility theory and Anthony's （1993） recovery paradigm as theoretical foundations, the study conceptualized two potential paradoxical pathways as hypotheses to be tested: that visible support, while originating from benevolent intentions, might reinforce perceptions of incompetence by undermining recipients' autonomy, and that recovery possibility awareness, while directly reducing stigma, might also become linked to a logic of individual blame when combined with meritocratic discourse. The analytical model integrated two parallel mediation pathways with the moderating effects of face-consciousness, familism, and health news use, and additionally examined the suppression mechanism of face norms through Crandall and Eshleman's （2003） Justification-Suppression Model （JSM）. Online survey data from 500 adults aged 19 to 64, collected through the Embrain panel, were analyzed using structural equation modeling （SEM）. Prejudice exerted the largest direct effect on stigma while also inhibiting recovery possibility awareness, suggesting that already-formed negative beliefs may constrain the conditions under which stigma-reducing cognitions can develop. The hypothesized paradoxical pathways, however, were only partially supported. Recovery possibility awareness functioned primarily as a protective （buffering） factor that directly reduced stigma; although it was positively associated with responsibility attribution, responsibility attribution did not, in turn, significantly predict stigma, and thus the paradoxical pathway from recovery beliefs to stigma was not completed. The direct path from visible support to perceived incompetence was also non-significant. Familism moderated the pathway through which visible support relates to perceived incompetence, but in the direction of weakening rather than amplifying it, suggesting that support interpreted as a signal of dependency in Western individualist contexts may be understood differently within Korean caring culture. The non-significant path from responsibility attribution to stigma was interpreted, tentatively, through the suppression mechanism predicted by JSM—understood not as the disappearance of stigma but as its possible displacement into silence and indirect exclusion. The moderating effect of health news use was not statistically significant, and its direct effect on stigma was also non-significant; although health news use showed a positive bivariate correlation with stigma, this association alone does not establish a media effect, and the present data do not support conclusions regarding the role of health news use in stigma formation. Taken together, these findings indicate that the paradox of protective factors does not operate uniformly but holds only conditionally within the Korean cultural context—at times buffered, as in the case of familism, rather than amplified. The study contributes theoretically by suggesting that mental illness stigma may function as a conditional phenomenon shaped by cultural context rather than a simple product of individual attitudes, and by showing that protective factors assumed by Western theory can operate in different ways when conditioned by Korean cultural norms. It further proposes the necessity of multifaceted anti-stigma intervention strategies that simultaneously address prejudice structure and support modality, and suggests a culturally informed approach that draws on familism and face culture as potential resources for stigma reduction rather than solely as obstacles to be overcome.

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목차

목 차

Ⅰ. 서론 ··············································································· 1
1. 연구의 배경 및 필요성 ···················································· 1
1） 정신건강 위기의 사회적 맥락과 치료 간극의 구조적 원인 ······· 1
2） 한국적 문화 가치와 낙인 형성의 독특성 ··························· 5
2. 연구의 목적 및 연구문제 ················································ 11
3. 연구의 범위 및 방법 ······················································ 14
4. 논문의 구성 ································································ 16

Ⅱ. 이론적 배경 및 선행연구 검토 ············································· 18
1. 정신질환 낙인의 개념적 구조와 편견의 선행성 ····················· 18
1） 정신장애의 임상적 정의와 범주화 ·································· 18
2） 조현병 스펙트럼 장애와 우울·불안장애의 낙인 구조 ············ 18
3） 편견의 다차원적 구성 요소 ·········································· 20
4） 낙인의 형성 모델: 행동적 낙인과 구조적 통제의도 ·············· 21
2. 낙인의 귀인 기제와 체면중시의 억제 조건 ·························· 23
1） 코리건의 낙인 모델과 와이너의 귀인 이론 ······················· 23
2） 정당화-억제 모델과 귀인-낙인 전이의 조건성 ··················· 24
3） 체면중시의 억제 기제: 낙인의 소멸이 아닌 표출의 차단 ······· 25
3. 지지 가시성의 역설과 가족주의의 조절 조건 ························ 26
1） 보호 요인의 역설: 서구 연구에서의 선행 논의 ··················· 26
2） 스트레스-완충 모델의 이론적 성과와 한계 ······················· 27
3） 지지 가시성 이론: 심리적 비용 메커니즘과 적용 범위 ·········· 28
4） 가시적 지지의 역설적 낙인 강화 경로 ····························· 30
5） 가족주의의 조절 조건: 지지 의미의 문화적 재해석 ·············· 31
4. 회복 패러다임의 양면성과 능력주의 담론의 증폭 조건 ············ 32
1） 서구 회복 연구에서 이미 발견된 역설 ····························· 32
2） 앤서니의 회복 패러다임과 와이너의 귀인 이론 사이의 긴장 ··· 33
3） 한국의 능력주의 담론과 회복 역설의 증폭 조건 ················· 34
5. 낙인 커뮤니케이션과 헬스뉴스의 배양 효과 ························· 35
1） 낙인 커뮤니케이션 모델（MSC）과 미디어의 구조적 역할 ········ 35
2） 배양 이론과 헬스뉴스의 일화적 프레임 ··························· 37
3） 알고리즘 환경과 필터 버블의 낙인 증폭 기제 ···················· 38
6. 선행연구 검토 및 본 연구의 위치 ····································· 39
1） 서구적 보호 요인 연구의 성과 ······································ 39
2） 한국적 맥락 적용의 이론적 한계 ··································· 39
3） ‘역설적 매개 모델’을 통한 이론적 확장 ··························· 40

Ⅲ. 연구 모형 및 가설 설정 ····················································· 43
1. 연구 모형의 설계 ·························································· 43
1） 병렬 이중 매개 모형: 지지 가시성 경로와 책임 귀인 경로 ····· 43
2） 직접 경로의 이론적 근거와 부분 매개 구조의 설정 원리 ······· 50
2. 연구 가설의 설정 ·························································· 52
1） 편견과 사회적 낙인의 직접 효과 가설 ····························· 52
2） 가시적 지지 매개 경로의 가설 ······································ 54
3） 회복가능성 인식 경로의 가설 ······································· 56
4） 조절 효과 가설 ························································ 58
3. 변수의 조작적 정의 및 측정 도구 ····································· 62
1） 정신질환 편견（내적 인지 및 정서） ································· 62
2） 가시적 지지, 무능력 지각, 회복가능성 인식 및 책임 귀인 ····· 63
3） 사회적 낙인（행동적 낙인 및 구조적 통제의도） ··················· 65
4） 체면중시, 가족주의, 헬스뉴스 이용 및 접촉 경험 ················ 66

Ⅳ. 연구 방법 ······································································· 69
1. 연구대상 ···································································· 69
1） 조사 대상 및 표집 방법 ············································· 69
2. 자료수집 절차 ······························································ 71
3. 측정도구 ···································································· 72
1） 정신질환 편견 ························································· 72
2） 가시적 지지, 무능력 지각, 회복가능성 인식, 책임 귀인 ········· 74
3） 체면중시, 가족주의, 헬스뉴스 이용 ································· 77
4） 사회적 낙인 ···························································· 79
4. 자료분석 ···································································· 80

Ⅴ. 연구 결과 ······································································· 83
1. 주요 변수의 기술통계 ···················································· 83
2. 주요 변수 간 상관관계 ··················································· 84
3. 측정모형 검증 ······························································ 88
1） 확인적 요인분석 및 모형 적합도 ···························· 88
2） 수렴타당도 검증 ··········································· 88
3） 변별타당도 검증 ··········································· 90
4. 연구가설 검증 ······························································ 91
1） 편견의 직접 경로（가설 1·2·3） ······································· 92
2） 지지 가시성 경로（가설 4·5） ········································· 93
3） 회복 패러다임 경로（가설 6·7·8） ···································· 94
4） 조절 효과（가설 9·10·11） ············································· 94
5. 매개효과 검증 ······························································· 97
6. 조절 효과 양상 ····························································· 98
7. 가설 검증 요약 ····························································· 99

Ⅵ. 논의 및 결론 ·································································· 101
1. 연구 요약 ·································································· 101
2. 이론적 함의 ······························································· 103
1） 서구 역설 이론의 계보와 한국적 변형 ··························· 104
2） 편견의 구조적 우위와 낙인 형성의 비대칭성 ···················· 104
3） 보호요인의 조건부 작동과 한국적 재맥락화 ····················· 105
4） 회복가능성 인식의 효과와 책임화 가능성 ······················· 106
5） 체면 규범의 억제 기능과 선택적 표출 ··························· 106
6） 가족주의의 재해석: 억압의 규범인가, 완충의 자원인가 ········ 107
7） 헬스뉴스 이용 결과의 해석과 후속 과제 ························· 108
3. 실천적 및 정책적 함의 ·················································· 109
1） 편견 구조 자체를 겨냥하는 반낙인 교육의 강화 ················ 109
2） 회복 담론의 재프레이밍과 책임 전가 방지 ······················ 109
3） 지지의 방식과 공개성에 대한 세분화된 개입 ···················· 110
4） 가족주의를 억제 대상이 아니라 실천 자원으로 활용 ·········· 110
5） 체면 규범을 포용 규범으로 전환하는 사회문화적 전략 ········ 111
6） 미디어 보도 준칙과 정신건강 커뮤니케이션의 개선 ············ 111
4. 연구의 한계 및 후속 연구 방향 ······································· 112
5. 결론 ········································································· 114

참고문헌 ············································································ 116
설문지 ·············································································· 124
Abstract ··········································································· 133

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