Mental illness is perceived differently across various cultures and countries of the world. While some may attribute mental illness to supernatural causes, others will deny its existence completely. Even today, there are several cultures that associate mental illness as anything but an actual disease that may require treatment.
As per the World Health Organization (WHO), health is defined as: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. “
Therefore, lack of mental health should be as much a source of concern as lack of physical health. As per a world health report from WHO, one in four people will suffer a mental disorder at some point in their lives. With an annual suicide rate of 800,000 and one death happening every 40 seconds, deteriorating mental health needs to be taken seriously. Ignorance and varying perceptions across cultures prevent this from happening. The existence of culture bound syndromes further complicates the matter and prevents a deeper understanding of how mental health works and how these illnesses can be treated.
Mental Health Perceptions around the Globe
In the Haiti community, the cultural explanation for various mental illnesses is described under Maladi Moun. Haitians believe that mental illness is caused by a person’s hatred, envy or jealousy over someone’s success. An attractive, intelligent or wealthy person, for example, is more susceptible to attack from enemies who may envy their visible success. Under Maladi Moun, mental disorders are considered as ‘sent illnesses’.
In China, mental illness may be perceived as possession by an evil spirit. Buddhism dictates a person’s suffering to be a result of previous misdeeds. Subsequently, mental illness is also considered as a punishment for deviant behavior, and this lack of awareness prevents family members of people with mental illnesses from disclosing about their state or seeking help. This is more prevalent in rural areas. The Vietnamese have a similar outlook. According to their belief, Karma causes mental illnesses. Mental illness is seen as a form of punishment for those who have sinned in their previous lives.
There is no concept of psychological problems in the Afghan culture and sufferers are considered to be mad or possessed by Djinns. Rather than seeking out professional help, they are mostly cared for at home by their families. The Japanese, on the other hand, perceive mental illness as a form of weakness instead of an actual disease. They consider it to be exceptionally undesirable. The resulting shame and stigma prevent people from seeking outside help. Arab communities stigmatize mental illnesses as well, and most Christian and Muslim Arabs rely on strong religious principles for healing psychological problems. In Arabic families, even though there is a strong preference in providing support to family members when needed, it also creates pressure on the sufferer to ensure they comply with the norms dictated and uphold family values. Due to this immense social pressure, efforts will be made to avoid disclosing about a family member’s suffering and their battle with a mental illness. Families also play a fundamental role in determining whether sufferers may seek professional help or not. For the most part, while cultural perceptions regarding mental illness may vary in these parts of the world and mental illness may be sourced to demons, karma or some other source, the stigma attached is universal. Seeking professional help is sometimes treated as a last resort. In some cases, it is not even considered.
Mental Healthcare in the U.S.A
As per an 18-month long study in 2010, the attitude towards mental illness in America is slightly different. While European Americans were observed to have beliefs that aligned mental illness with biomedical perspectives of the disease, African Americans and Latino participants in the study were more inclined towards non-biomedical interpretations for mental illness symptoms. All three ethnic groups were also subjected to varying levels of social stigma, but it was noted to be less for European Americans. The use of medication to treat psychiatric conditions also remained a topic of controversy amongst the three ethnic groups. Where European Americans participants considered the use of medication for treatment to be necessary, African American participants held an opposing view and were against mental health professionals focusing only on medication for treatment. Latino participants, on the other hand, perceived a clinical diagnosis with respect to mental health as socially damaging and chose to describe their conditions more generally in order to avoid stigma.
In a different study, which was conducted in 2011, African Americans also exhibited a negative attitude toward health care professionals. Along with distrust of the medical profession, religious beliefs and communication barriers also contributed to an increased wariness of mental health services amongst African Americans. With African Americans largely viewing depression as a personal weakness and with only one-third of people reporting that they would accept medication for depression, it is possible to conclude that African Americans are less likely to receive proper diagnosis and treatment for mental illnesses. Therefore, they more likely to have a mental illness for a longer period. These cultural and ethnic distinctions and the subsequent trouble for people belonging to different ethnicities and cultures in seeking out professional help should be taken into account. Holistic solutions are required if people of all ethnicities are to be given adequate access to healthcare.
Culture and Mental Health: Is there a link?
While perceptions of mental health vary across cultures, there are some mental illnesses as well that are considered specific to certain countries and cultures. These are called culture bound syndromes. The traditional definition of a culture bound syndrome is:
“Culture-bound syndrome, culture-specific syndrome, or folk illness is a combination of psychiatric and somatic symptoms that are considered to be a recognizable disease only within a specific society or culture.”
At present, the Diagnostic and Statistical Manual of Mental Disorders classifies a total of 26 syndromes as culture-bound syndromes, which are found across various countries and cultures.
Some of these are Koro, Amok, Latah, Wendigo, Dhat, Taijin Kyufushu, Piblokto, Shenjing shuairuo, Shinbyeong, Hwabyeong, Susto.
Koro is found to be prevalent in South-East Asia. Most of the sufferers are Chinese. Indonesian and Malaysian populations are also included. Koro patients are usually male. The condition leads them to believe that their genital organs are withdrawing inside their body (into the abdomen to be specific). This causes a state of panic and the patient believes they will die once the organ has completely retracted inside of their body. Remedies for Koro involve tying the penis with strings. It also involves getting help from family and friends. Psychiatrists describe Koro as an anxiety state and not one of delusion. It can occur individually as well as in epidemics.
Amok occurs in Philippines and Malaysia. Like Koro, it is confined to males. The condition involves blind, murderous violence that is a result of extremely heightened emotions. Men suffering from Amok are seen brooding for several days after a real or imaginary insult. This is followed by blind fury, which results in them attempting to kill anyone they encounter. The frenzy is only brought under control when the sufferer is killed or is captured and placed in confinement instead. Sufferers of Amok will experience amnesia later and will not recall their actions.
Latah is another culture bound syndrome that occurs in Malaysia and affects the Malay and Iban population. It is found to predominantly affect women. Psychiatrically, the symptoms of Latah are similar to dissociative phenomena. Women suffering from Latah will exhibit hypersensitivity to sudden fright, echopraxia, automatic responses to commands, echolalia and dissociative behavior. Other cultures and countries like Burma, Thailand, Philippines, Siberia, Lapland and the French Canadians of Maine have exhibited similar behaviors as well.
Wendigo occurs in North America and sufferers are found to be Native Americas of the Cree, Ojibway and Salteaux tribes. The name of the syndrome is derived from a cannibalistic ice spirit of the same name. Sufferers of Wendigo will initially experience distaste for food. If the condition persists, it results in the development of anxiety, which rapidly reaches a climax. The repugnance for food is evidence that the sufferer is turning into a wendigo. In psychiatric terms, Wendigo is primarily an anxiety state.
Taijin Kyufushu is a culture bound syndrome that is found in Japan. It is similar to social phobia but with significant differences. Taijin Kyufushu is characterized by an individual’s intense fear that their body is embarrassing. Symptoms include blushing, inappropriate eye contact, shaking, difficulty in speaking, sweating, gastrointestinal distress and a strong desire to escape the situation. Taijin Kyufushu differs from social phobia in subtle ways. This difference is also derived from the Japanese culture where the good of the group takes precedence over the desires of an individual. Where social phobia involves a fear of experiencing embarrassment in front of others, sufferers of Taijin Kyufushu are afraid of embarrassing others by being in their presence. Some debate is present as to whether the condition is specific to the Japanese culture or found in other populations as well.
Another type of culture bound syndrome is Sinbyeong. In origin, it is Korean and afflicts Korean shamans. Sinbyeong is described as possession of a Shaman’s spirit by a god and is considered to be a part of the Korean shamanic tradition. It involves both physical pain and psychosis. There is a loss of appetite and insomnia. The sufferer will experience dreams where they communicate with gods or spirits. Hallucinations result when the dreams begin to interfere with reality. Some cases are so extreme that the shaman will leave home and wander through mountains and rice fields. As per believers, there is no normal medical treatment available and full communion with the spirit is the only cure. The period of illness can last for months or years.
Ataque de nervios is a psychological syndrome that is most often found amongst Spanish speaking people from the Carribean. It is also known as “Puerto Rican syndrome”. Ataque de nervios translates into “attack of nerves”. The syndrome includes uncontrollable screaming, crying, dissociative experiences, verbal and physical aggression, and sensations of heat rising in the chest and head. The syndrome is compared to a panic attack, but investigators have identified Nervios as an individual syndrome with differences found in anxiety sensitivity.
Susto is another cultural illness that is found to be predominant in Latin American cultures. Latin American people will label susto as a spirit attack. In medical terms, Susto is described as “chronic somatic suffering stemming from emotional trauma or from witnessing traumatic experiences lived by others“. Symptoms of susto include nervousness, anorexia, fever, depression, insomnia, listlessness and diarrhea.
A Step Forward
Keeping in mind the cultural diversification with respect to mental illnesses and their respective perceptions, it is important to present mental health care services in ways that are culturally sensitive. Local beliefs about mental health will often be different from the biomedical perspective of the West. As a result, the use of medical treatment for these illnesses and disorders is infrequent. A change in perception is required across cultures to help recognize mental illness and separate it from religious beliefs that primarily attribute the patient’s suffering to punishment, karma or a spirit attack involving demons and Djinns. Increased awareness regarding the source of a person’s mental distress and the subsequent mental treatment that is required for recovery is a necessity. In order to make progress, it is also required to make allowances and show respect for the patient’s belief systems. Making use of traditional methods of healing can assist in the patient’s recovery as well. Spiritual and religious practices, meditation, yoga, massage and following special diets all greatly contribute to a patient’s well being.
Where cultural diversification occurs, having access to a multicultural therapist can greatly increase the effectiveness and usage of mental health care services. A therapist with a deeper understanding of your culture will automatically treat you with an increased amount of empathy, compassion and care. This can result in a more positive & therapeutic outcome.