The idea that our cultural framework – beliefs, expectations, norms, taboos etc–influence who we are, what we think, and what we do is central to the study of human behavior and the meanings we assign to our thoughts and actions. It therefore should not be surprising that culture would influence our physical and mental health in a complex interplay of factors that vary not only individually but also in the collective. These factors include everything from our diet, social activities, symptomatic expression (and therefore diagnosis), perception of mental illness, resources to treat and diagnose, and work habits among others.
This blog will explore the relationship between culture and mental health. Grounded in contemporary research, current events and personal experiences, I will write about how our perceptions of self, our place in the world and our notions of health, well-being and illness, influence our experience of our minds.
For example, seen through different cultural lens, the drinking practices of the British may seem unhealthy. So too may the exhausting work habits of people living in the USA. In some cultures, pill-taking for mental health issues is normalized and in others it is seen as a sign of weakness. Support groups work well in cultures where self-revelation is encouraged (like in the USA) and may not be an appropriate strategy for cultures (like the UK) in which privacy and a 'stiff upper lip' is highly prized.
Therefore, social structures that provide social support may be more accessible in some cultures more than others, especially within the context of the degree of individual autonomy that is a hallmark in some cultures more than others. Furthermore, in some cultures, being 'different' (as expressed in 'unusual' behaviors) is not a cause for mental health assessment or application of a diagnosis. Instead of being 'pathological', difference in thought/behavioral patterns may be perceived as eccentricity and instead of being marginalized, the 'eccentric' may have a certain social cachet.
If the definition of mental health/illness exists within a cultural framework, does this mean that mental illness is relative?
I don't know, but I would love to know what you think. If treatment for mental illness must account for cultural salience, does this mean that mental health treatment is not well-defined? Or does it speak to the cultural sources for our thoughts and behaviors.
Unlike diabetes or hypertension there are no standardized physiological tests for mental illness. Instead it is the expressed thoughts and behaviors of the mentally ill that define their illness. Therefore, because social expectations and norms shape our expression, then culture is highly relevant to the issue of mental health.
In December 2010, the Washington Post explored the issue of culture and mental health when a Filipina grandmother was charged with killing her grandchild. The article explored the role of shame and stigma in shaping how mental illness is understood, diagnosed and treated and the cultural influences on how those with mental illness are perceived by their friends, families, and the world around them. Culture not only influences the motivation to seek help but also impacts how mental illness is experienced. Symptoms are sometimes expressed differently and mental health professionals may not be able to decipher the symptoms rooted in the brain but localized in other parts of the body, such as headaches and stomach complaints.
An editorial that appeared in a Ugandan newspaper last Mental Health Day (October 10, 2010) described how people in Uganda will ridicule people with a mental illness but find the ridicule of the physically sick to be abhorrent. This results in families going to great lengths to hide the mental illness of their loved ones. In Uganda, this is also reflected in the small (5%) allotment of fiscal resources allotted to mental health services by the Ugandan government. If there are no resources to diagnose mental illness then its existence within a particular society will not be accurately reported in health data and amount of resources given to mental health will reflect that reality.
In the exploration of these issues, I will include, as relevant, my own experience of having a diagnosis of bipolar affective disorder (I prefer the more descriptive term 'manic depressive illness' or manic depression) within the cultural frameworks of my profession, race and ethnicity. I would like to hear your stories, investigate your questions and engage in a highly relevant and important dialogue about an area of health that is one of the leading causes of disability in the world. Because of the high cost to individuals, families, productivity and society at large, understanding the unique role of culture to the physical reality of mental illness is time and energy well spent.