Human psyche and mental health are some of the most researched and still undiscovered areas of science. While there has been much progress made in terms of understanding the actual distresses, there is still so much more that we don’t know about how they materialize and how they will impact the person.
This is so because humans are unique creatures. Each person on this planet has is a mix of various physical and mental traits that combine together to shape their personality. Besides that, their cultural and socio-economic conditions and beliefs all impact how they function. Hence, it is common sense to assume that the cultural aspects of a person, in fact, do count when it comes to mental health.
In fact, experts suggest that various sets of cultures even respond differently to mental health. In this piece, we will take a look into what culture really means in the context of mental health and how the prevalence of mental health varies within American demographics.
Culture in itself is an all-encompassing and vexed term that has many definitions. Depending on the use of the term in a particular field, its meaning is adapted to fit the context. But according to most subject experts, culture is a layered term that conceptualizes with influences of gender, religion, class, nationality, language, and other factors.
From a more sociological perspective, culture is a set of essential values that people of a certain group hold. These values also include the norms and rules they follow for moving in society and creating material things. Overall, culture is a set of identities that individuals belonging to a certain group use to define themselves.
In the context of mental health and diversity, culture is a set of these multi-dimensional factors that include religion, gender identity, racial identity as a social construct, language, and ethnicity. Collectively, all these factors are connected to a particular group’s existence and functioning in the society. As such, it impacts every area of their lives including their mental health.
Practice and Theory of Mental Health and Culture
According to Suman Fernando’s understanding, active practice and understanding of mental health as an umbrella term, psychology and psychiatry are Western concepts. In his books, Suman explains that the concept of mental health first emerged from Western culture. In that, it created a focus on just the Western understanding of mental health and the human psyche.
Over the years in research and clinical studies, the concepts from this understanding have been central to the mental health systems that are in place today. They have allowed experts to create frameworks and other tools that help identify ways people can alleviate various kind of mental distress.
But these variables root from majorly a Western understanding of mental health. This means that the practices and understanding are relatively monocultural. While they are an achievement, they do create some gaps and problems when it comes to their application in non-Western cultural settings.
According to an article written by Suman Fernando, these one-sided applications lack any consideration for cultural diversity and complexity. They often don’t have room for adapting the approach when working across cultures that exist within the same society.
In her research, Rachel Tribe suggests that the Western approach to mental health is predicated on a more individualistic pathology of the human psyche. While this has helped people identifying and belonging with this cultural identity, it excludes other communities and individuals. For instance, most Eastern cultures and traditions are based on community and familial pathology.
This is one of the most major flaws when it comes to understanding mental health for a more diverse community that countries like the US now boast. From mental health institutes to research, an intersection between mental health and a diverse range of cultures is essential to create a balanced representation of diversity.
In their conceptual study of mental health and cultural competence, Hernandez et al. suggest that culture has a significant impact on mental health. According to their study, cultural values held across the world influences how and what people perceive as a problem.
Along with that, culture also defines how society members, health professionals and mental health systems all perceive mental health as an issue. For instance, Western cultures are more inclined to accept and understand mental health distress as a legitimate illness than Eastern cultures. In fact, there are various communities that disregard the concept of mental health awareness overall. This is prevalent in cultures that mostly exist in third-world countries.
Since their first priority is obtaining basic facilities and resources to survive, mental health and distress don’t register as a priority. For such people, focusing on mental is a waste of time that could’ve been spent elsewhere.
This real-life example proves that culture and cultural identity create very distinct patterns of values and practices that implicate the understanding of mental health. Not just that, but it also influences how their response and eagerness to seek mental health advice.
Different Coping Styles
You can observe how culture impacts culture by looking at their preferred style of coping with mental health on a day-to-day basis. Even though some communities might reject mental health as a legitimate concern, research has proven that mental health concerns prevail in all communities. But the way they cope with these distresses is what identifies their attitude towards it.
For instance, in a lot of Asian (and American Asian) communities, there is a huge cultural emphasis on abstaining themselves from dwelling on negativity. They believe in maintaining social harmony. And to do that, they rely on avoiding the recognition and outward expression of internal struggles. This is a pattern you will also observe in African American communities as well.
These perceptions impact their willingness to actually seek help for their mental health. When their traditions teach them otherwise, coping with their internal struggles becomes a personal struggle they go through themselves. While this might influence them to put aside problems and push through, it also teaches them negligence when it comes to mental distress.
One of the most central values cultural traditions forge is individualistic versus community/family-based pathology. Outside and even within the US, Asian, African-American, Latino, and Native communities have a strong family and community orientation. The traditional values these communities identify with suggest family as the first source of assistance in distressing situations.
Some cultures that are impacted strongly by religion assume mental health struggles as spiritual weakness. For example, some African communities seek guidance from spiritual healers and religious figures whenever they face mental health issues.
Since religion is often a source of comfort and joy for many people as it brings discipline and gives a sign of hope, people rely on it to maintain their mental health. Some religious communities take mental health disorders like depression as a sign that they need realignment with God and prayer.
As we mentioned previously, culture also influences how people who adhere to it experience the discomfort that comes with recognizing and expressing mental distress. The way of expression is sometimes referred to as ‘idioms of distress’. These idioms of distress represent the values and beliefs their society and culture of origin holds.
These idioms are different for both Western and non-Western cultures.
Like we mentioned previously, the majority of mental health understanding originates from Western studies. Many disorders and illnesses identified within Western cultures are often unheard of in other cultures. In third-world countries eating disorders such as Anorexia are associated with an occidental idealization of a certain body type. In cultures where beauty standards are non-existent or the complete opposite of the West, it would be less likely to find an incidence of Anorexia.
Similarly, when it comes to PTSD, Western-based studies have identified it as a set of patterns that appear after someone suffers a trauma. PTSD is commonly seen to be brought on in people who have suffered an accident, rape and abuse victims, and military personnel. Symptoms associated with it include memory loss (partial or complete), night terrors, anxiety, flashbacks, detachment, and often violent streaks. But these symptoms vary from culture to culture as well. If the Western understanding was the only one to be true, the victims of the 2004 Tsunami would have exhibited these symptoms. But surprisingly, there are barely any PTSD cases recorded.
According to Ann-Marie Yamada and Anthony Marsella, culture-bound syndromes are a mirror for Western-based assumptions of mental illnesses. While many symptoms of various mental illnesses are generalized, culture-bound symptoms are limited and localized to a particular community or culture.
The Diagnostic and Statistical Manual of Mental Disorders or DSM, published by the American Psychiatric Association, defines culture-bound syndromes as “recurrent, locality-specific patterns of aberrant behavior and troubling experience”.
For example, one Culture-bound syndrome seen in men from Southwest Asia is known as Koro. People afflicted with this disorder fear that they are in the face of death because their penis is shrinking and retracting into their body. Patients then go to great lengths in order to halt the retraction.
Some resources report that this condition among Chinese is localized to the Yangtze valley where people fear supernatural forces and death. There are several speculations that mostly ties in with Taoism.
Another example would be the Japanese culture-bound symptom referred to as Taijin Kyofusho. People diagnosed with this syndrome have an irrational fear that their bodily functions might offend others around them. It is a social phobia that stems from anxiety and emotional trauma.
Now that we understand that cultural differences indeed do have an impact on how people understand and approach mental health, let’s take look into some examples from within the US. Over the years, immigration has led people of various cultural backgrounds to populate the country. Besides the white population, the main divisions include African Americans, Asian Americans and Pacific Islanders, Hispanic or Latino Americans, and Native Americans.
The paragraphs below give a brief explanation of how each group utilizes mental health serviced due to their cultural differences.
Approximately 14 percent of the total population in the US consists of African Americans. Although the number is small compared to the 77 percent that counts for white people, the prevalence of mental health issues among African Americans is higher.
The difference is credited to the socioeconomic disparity between the two groups. Along with that, there is a lot of historical cultural influence that stems from the time before the civil war and before segregation ended around the country.
The lack of trust in the system and healthcare providers due to cases of racism and clinical bias tend to create delays in African Americans seeking treatment.
Asian Americans and Pacific Islanders
Asian Americans and Pacific Islanders make up around 6% of the total US population. Asian cultures have a strong influence from religion, which makes it hard for them to find culturally-appropriate services. Besides that, Asian cultures are prone to view mental health issues as embarrassing incidences, creating a stigma around seeking help. Over the years, this cultural tradition had led to a low number of Asian Americans and Pacifica Islanders to seek treatment for mental health problems.
According to various studies, the Hispanic population within the US reports a similar number when it comes to the prevalence of mental health issues and treatment-seeking behaviors. But a major difference from general white Western-culture is that many Hispanic cultures are family oriented instead of individualistic.
In a blog we posted not too long ago, we mentioned that suicide and depression rates in the Native American community are significantly high. Besides these, alcohol and substance abuse of various narcotics is also alarmingly high.
Generational trauma from the colonial times, continuous alienation along with acculturation from their own culture to adopt a more mainstream alternative all plays a role in these rising numbers. Combined with lack of self-realization, embarrassment to seek help and mistrust in mental health professionals all contribute to a low percentage of help-seeking Native Americans.
It is of utmost importance that mental health professionals regardless of their own cultural orientation consider the intersections between mental health and cultural diversity. In order to provide help and engage with any kind of patient effectively, it is necessary that more resources are put into studying how cultures impact areas of mental health.