Many of the theories of mental health that have been developed in psychology and psychiatry come from western culture – mainly from North American and European countries. However, the more recent study of mental health across cultures has shown that it is not the same everywhere. As globalization takes over and as each country become increasingly connected and diverse, it is important to understand this and adapt our diagnosis and treatment methods to a multicultural world. Applying a universal template to deal with these illnesses is not only ineffective, but also counterproductive. Two important reasons can help us understand why.
First, mental illnesses vary in prevalence and symptoms around the world. For example, the widely known major depressive disorder (MDD) is less frequently diagnosed in other countries, particularly in China (though it remains unclear if this is a difference in actual prevalence or in official diagnosis). Some countries have even higher rates of depression than we normally see in countries like the United States and Canada. This raises the question of how a specific culture influences a disorder’s cause and diagnosis. Furthermore, MDD manifests through different symptoms across cultures. For example, somatization – the expression of symptoms through physical ills such as tiredness, headaches, and poor appetite – is more common in East Asian countries. Conversely, in the West, symptoms are more often psychological, such as an inability to experience pleasure, and depressed mood.
The underlying cause of such differences is hard to pin down. One theory is that the stigma associated with mental illness differs across cultures, and so its expression differs as well. Moreover, it is possible that people simply pay attention to different kinds of symptoms, and thus report some and not others. For example, some cultures may be less attentive to their moods and emotions because they are socialized to be that way.
A second reason for the counter-productivity of a universal mental health template is that some mental disorders are considered “culture-bound syndromes”, meaning they only exist in a particular region or culture and are reflections of certain cultural norms experienced by affected individuals. Thus, to understand culture-bound syndrome, it is imperative to recognize the culturally specific ways of thinking that cause it. An example of such a syndrome is amok, an acute condition experienced mostly by males in East Asians countries. It involves an outburst of violence and homicidal attacks followed by amnesia, and is most likely caused by stress, lack of sleep, and alcohol consumption. Another example is frigophobia (mostly seen in China), an excessive fear of catching a cold, which results in affected individuals wearing heavy coats and scarves even in warm weather.
Two widely known disorders in the West are actually considered to be culture-bound: bulimia and anorexia. Evidence that they are influenced by culture includes the fact that their prevalence have increased in the last 50 years, and that they affect an increasingly younger population. This reflects a cultural influence because cultures do not only vary across regions – they vary across time and age groups as well. These two disorders also don’t exist everywhere. In fact, bulimia is almost only found in modern western culture, or in regions that are particularly influenced by it. This may be explained by the fact that there is a strong cultural message in these countries that thin bodies are the beauty standard. While anorexia does exist outside of this particular culture and time, it appears to be less prevalent and have a different cause. An example is “holy anorexia,” a condition where people starve themselves because they believe it to be a divine intervention. Also known as anorexia mirabilis, it was very common in the middle age in the western world.
Studying mental health in different cultures has taught us a lot about its nature and influences. For one, certain symptoms may express themselves in a culturally relevant way, but actually have an underlying cause unrelated to it. For example, anorexia exists in other parts of the world but is not always accompanied with an obsession to be thin or fear of gaining weight as it is often in North American countries. Instead, people may starve themselves without thinking about their weight at all. It suggests that anorexia may not necessarily be about an obsession to be thin, but only manifests this way in our culture. Additionally, individuals with different cultural backgrounds may not experience the same symptoms when diagnosed with the same mental disorder.
Thus, it is important to consider cultural differences in both diagnosis and treatment. This requires mental health professionals to be “culturally competent”. Specifically, this means they should be aware of their own cultural bias, have knowledge of the patient’s cultural background, and be able to develop a treatment program that is tailored to this background. This is especially important today, as a country like Canada is now more diverse than ever before, and mental health is an urgent issue to address.
The information in this article was taken in Cultural Psychology (W. W. Norton & Company, 3rd edition, August 2015) by Steven J. Heine
