The Culture of Mental Health
By: Abby Kerner, Peer Educator
February 11th, 2021
Please note that this blog was written to encourage more research on cultural differences in perception of mental health in general. This blog should not serve as a comprehensive understanding of this issue, but rather, an introduction into this area of knowledge. We at RISE encourage you to take more time to research and reflect on these findings.
The awareness of mental health has risen over the years, which is a substantial feat from where we used to be as a society. While we are making strides in raising awareness, we must remember that there is still significant ground to cover. The clinical history of mental health research and treatment in the United States has largely been white-washed. Alongside this, mental health in western medicine has been based on and defined by the experiences of white people. This begs the question about how we fundamentally define mental health and how our definition of mental health applies to the experiences of BIPOC communities. It's time we begin to question how we fundamentally define mental health to be more culturally affirmative of all.
The influence of culture and society dramatically affects the mental well-being of people all over the world. In this blog, let's talk about prevalent mental health stigmas within different communities and action steps researchers can take moving forward to be more inclusive.
Sometimes the rates of reporting mental health are influenced by how "people communicate their symptoms and which ones they report." Each patient has a different set of pre-existing beliefs about mental health when walking into the waiting room, and some may have been taught that mental health is imagined and is a not real concern.
A study by DHHS in 1999 discovered that 20% of adults and children in the United States were diagnosable of mental disorders across all demographics. The rates of reporting, however, were found to be lower among non-white individuals. Researchers began questioning why a higher percentage of people in non-white demographics were not actually diagnosed.
This discrepancy between rates of diagnoses and the number of people diagnosable may be linked to cultural differences, such as dynamics of family life. The intricate family bonding in culturally Mexican households may be related to lower rates of seeking mental health treatment due to fear of criticism and disappointment from family members. Studies conducted suggested that people who were found to be at higher risk of schizophrenia lived "with family members who expressed... criticism, hostility or emotional involvement."
Family is the most important part of one's life in many cultures; this dynamic may lead children to not want to disappoint parents and grandparents, so they may pretend nothing is wrong to avoid confrontation or judgment. By intentionally ignoring mental health concerns to avoid family conflict, cases may go unnoticed. To combat this, researchers may take the approach of using smaller samples to conduct in-depth research to see how mental illnesses affects individuals in cultures with a high prevalence of family bonding.
Coping mechanisms in a variety of culturally Asian groups may contribute to and affect the rates of mental health diagnoses. In some culturally Asian families, there may be a tendency to not dwell on upsetting thoughts and using avoidance to remain outwardly unphased when upset.
With differing coping mechanisms in mind, researchers did a study on how different cultures foster coping mechanisms by comparing reactions of children in the U.S and Thailand when faced with conflict. The Thai children were reported to have been twice as likely to not talk back and to respect their elders compared to American childrens' reactions of overtly screaming and fleeing when faced with conflict (McCarty et al., 1999). This research leads us to believe that the way mental health is viewed by different cultures can affect the way an individual copes with life and all of its influences.
In Indigenous ethnic groups, many rely on a variety of healing techniques for addressing mental illnesses. One unique approach toward mental health care in Indigenous communities is to rely on a combination of traditional healers and licensed mental health practitioners. In this approach, tribal mental health programs may combine tenants from combine traditional medicine with clinical mental health applications.
Practitioners That Look Like Me
Across cultural groups, many prefer to seek help from someone of the same race or ethnicity. This approach shows the power that culturally affirmative mental health care can have on the rates of individuals seeking the care they may need. This approach can also break stigmas people may have about different treatments of mental health by learning from a practitioner that understands their lived experiences.
What can we learn from our differences?
One of the most influential reasons mental health in many communities may be underreported boils down to a general sense of distrust. Identified by the SGR, mistrust for mental health care may be due to a variety of causes, from historical persecution and forced medical testing to present-day racism and discrimination in medical settings.
This distrust toward mental health care in general relates to how western science and medicine still base most the vast majority of their knowledge on mental health on white experiences. To better serve and treat mental illnesses for individuals all cultures, doctors and psychologists must understand the different cultural pressures and historical implications individuals face when discussing their mental health.
We won't begin to change the issue of negative perceptions of mental health 'as the
most formidable obstacle to future progress in the arena of mental illness and health'
(DHHS, 1999) until we begin to understand different cultural attitudes and beliefs
toward mental health. Once we have acknowledge the importance of culturally affirmative
health care and its importance in working toward destigmatizing and demystifying mental
health care, we can begin to change the world.
Cooper-Patrick, L., Gallo, J. J., Gonzales, J. J., Vu, H. T., Powe, N. R., Nelson, C., & Ford, D. E. Race, gender, and partnership in the patient-physician relationship. 282, Journal of the American Medical Association (1999):583–589.
Cooper-Patrick, L., Gallo, J. J., Powe, N. R., Steinwachs, D. M., Eaton, W. W., & Ford, D. E. Mental health service utilization by African Americans and whites: The Baltimore Epidemiologic Catchment Area follow-up. 37, Medical Care (1999):1034–1045.
Dwight-Johnson, M., Sherbourne, C. D., Liao, D., & Wells, K. B. Treatment preferences among primary care patients. 15, Journal of General Internal Medicine (2000):527–534.
McCarty, C. A., Weisz, J. R., Wanitromanee, K., Eastman, K. L., Suwanlert, S., Chaiyasit, W., & Band, E. B. Culture, coping, and context: Primary and secondary control among Thai and American youth. 40, Journal of Child Psychology and Psychiatry (1999):809–818.
National Institutes of Health. (2001) ORMH Mission. www1.od.nih.gov/ormh/mission.html.
Office of the Surgeon General (US). (n.d.). Chapter 2 Culture Counts: The Influence of Culture and Society on Mental Health. Retrieved February 02, 2021, from https://www.ncbi.nlm.nih.gov/books/NBK44249/
U.S. Department of Health and Human Services. (1999) Mental health: A report of the Surgeon General. Rockville, MD.