Cultures and Mental Illness
Cultures and Mental Illness
Is there much variation in clinical mental disorders among different cultures or ethnicities?
There can be considerable differences in particular disorders, but other disorders can be quite similar in the prevalence of them among different ethnicities. There are some disorders that are particularly unique to particular cultures. Some examples are that among dark-skinned people there is a reported 23.4% who have phobias compared to 9.7% of white-skinned people. A percentage of 8.0% among white-skinned people have a mood disorder while with dark-skinned people it is a lesser amount of 6.3% (Ref. E.P). Some disorders are quite similar in prevalence such as Antisocial Personality Disorder which has rates of 2.6% among white-skinned people and 2.3% among dark-skinned people although this particular disorder is not the easiest for researchers to gauge. Another example is that there is a variation in the rate of depression among different cultures. In one study in 1996, over 20% of females and over 10% of males in France reported having depression at some stage in their lives compared to 1.5% of men and women combined in Taiwan (Ref. E.P).
According to the statistics above, it is clear to see that there can be variations of the prevalence of particular disorders or illness around the world, and also there are specific terms within particular cultures such as ‘Susto’ which is found in Latin America. Some of the major types of disorders or illnesses such as depression and schizophrenia occur world-wide and the symptoms are manifested much the same such as incoherent speech in relation to schizophrenia. Particular disorders can be culture-bound though, and a part of this can be attributed to the acknowledgement that various cultures have various sources of stress and in turn, produces various ways of coping. A classic example of this is the fact that Anorexia Nervosa and Bulimia as we know are certainly not all that uncommon in Western cultures compared to other cultures such as African. Here are a few types of disorders or terminology specific to particular cultures:
* Taijin-kyofusho: This is an anxiety disorder or a culturally distinctive phobia in Japan which partly resembles social phobia as listed in the DSM. This Japanese syndrome is listed in Japan’s diagnostic system for mental disorders and it refers to a person’s intense fear that his or her body (or parts or functions) instigates others to feel embarrassed, displeased or offended. A person with this disorder combines social anxiety about one’s appearance with a readiness to blush and includes a fear or apprehension of eye contact.
* Susto: Severe anxiety, restlessness and a fear of black magic found in Latin America.
* Dhat: This is a term used in India which refers to severe anxiety and hypochondriacal concerns in relation to discharge of semen, whitish discoloration of urine and feelings of weakness and exhaustion.
* Shin-byung: A syndrome in Korea which involves initial phases of anxiety and bodily complaints such as dizziness, gastrointestinal problems, and general weakness. With these symptoms comes dissociation and possession by ancestral spirits.
* Amok: This is an episode which is dissociative and is characterized by a period of brooding which is followed by an outburst of violent, aggressive, or homicidal behaviour which is directed at others or at objects. This disorder is far more rampant among males and has original reports from Malaysia referring to this term. However, similar patterns of behaviour are recognized in Laos, Papua New Guinea and others cultures such as the Philippines.
* Mal de ojo: This is found in Mediterranean cultures and elsewhere around the globe. Translated into English, it means ‘evil eye’ and children are more at risk than others. This syndrome or concept is characterized by fitful sleep, crying for no apparent cause, diarrhea, vomiting and fever in a child or infant. At times, adults can have this condition; more-so males.
These are only a few syndromes or disorders among other cultures. Briefly, other syndromes include Ghost Sickness, Koro, Locura, Nervios, Brain Fag and more. This topic may be expanded on at a later stage.
It is a valid point to note that most mental health workers now attribute influences not only such as genetic predispositions, but also cultural circumstances to be contributing elements for the development of disorders within society (it is generally accepted now that disorders are influenced by genetic predispositions, psychological states, inner-psychological dynamics, social circumstances, and also cultural circumstances). This relates directly to today’s bio-psycho-social perspective. The point here is that cultural elements do appear to play a valid role. Mental health problems are now recognised to be embodied in a whole ‘body-mind-social’ outlook. The social element could be broadly expanded into cultural aspects, and cultural elements can play a part in the occurrence of particular disorders in various parts of the world. There are other factors involved such as genetic factors which has long been recognized. Such factors can run in families with particular disorders such as depression. The risk of Major Depression and Bipolar Disorder increases if a person has a depressed parent or sibling (Ref E.P.). Along with this, if one identical twin is diagnosed with Major Depressive Disorder, then there are chances of about 1 in 2 that at some point the other twin will be similarly diagnosed (or experience Major Depressive Disorder).
Even though depression is wide-spread throughout the world, other problems which are sometimes related to depression such as suicide, does vary in statistics throughout the world. For example, the suicide rates in England, Italy and Spain are a little over half of that from other cultures such as in Australia, Canada and the United States. Within Europe itself, Lithuanians are about fifteen times more likely to end their lives than the Portuguese. Another point of relevance is that white-skinned Americans are almost twice as likely to end their life as black-skinned Americans. One more point about suicide and depression is that when a person is in the depths of depression such as Major Depressive Disorder, it is actually not too often that people end their life as their energy and initiative are so low, but suicide is more likely to occur when they begin to rebound and are more capable of following through on ideas of suicide.
As we can see, suicide rates do vary somewhat between particular cultures. What about other problems though? We are all aware that alcohol and drugs are rampant and this is evident by alcohol abuse or dependence being recorded at around 13.6% in white-skinned people and at around 13.8% in dark-skinned people respectively as published in 2005. Generalized anxiety was recorded at being around 3.4% in white-skinned people and 6.1% in dark-skinned people, and with schizophrenia, rates were 1.4% and 2.1% respectively. Obsessive Compulsive Disorder (OCD) was closely matched at 2.6% and 2.3%.
Other points to note relating to cultural differences is that cultures can certainly interpret symptoms of a disorder differently. Take Major Depressive Episode as an example in that it can communicated differently such as that it can be referred to as problems of the ‘heart’ in Middle Eastern cultures, compared to complaints of ‘nerves’ and head-aches in Latino and Mediterranean cultures. Chinese and Asian cultures describe it as weakness, tiredness or ‘imbalance’, and among Hopi, major depressive episode can be described as being ‘heartbroken’. Cultures can also vary in their interpretation of the seriousness of the expression or experience of dysphoria as in some cultures sadness or withdrawal is not deemed as serious as irritability.
As mentioned earlier, cultural circumstances can have a bearing on particular mental disorders and one example is that of PTSD (Post Traumatic Stress Disorder) in which individuals who have recently emigrated from areas of substantial social unrest and civil conflict may have elevated rates of developing this disorder. Another disorder known as Somatization Disorder has variations in its prevalence throughout cultures in the world. Somatization Disorder is quire rare in the United States, yet in Greece and Puerto Rica there are more reports of the frequency of this disorder.
Anorexia Nervosa seems to be far more common in industrialised societies. Anorexia is probably most common in the United States, Canada, Europe, Australia, New Zealand, South Africa and Japan. Immigrants may develop Anorexia Nervosa more so than in their original cultures and this can be attributed to immigrants assimilating thin-body ideals if such immigrants emigrate from cultures in which the disorder is rare and if they find themselves living in a culture where there are thin-body ideals.
It is apparent to see that cultures do hold various ideals and also perceptions of mental disorders themselves such as in relation to Nightmare Disorder, some cultures attribute such symptoms of this disorder to spiritual or supernatural phenomena, where others may hold views of nightmares indicating mental or physical disturbance. It could also be argued that particular cultures ‘encourage’ particular disorders (or because of environmental factors within particular cultures or societies, one may be more prone to the development of particular disorders) such as pathological gambling in where there are considerable variations in the prevalence of this problem. Community studies have estimated that the life-time prevalence of pathological gambling ranges from 0.4% to 3.4% in adults, but yet in particular cultures such as Australia and Puerto Rico it may be as high as 7%.
Social and cultural influences are now recognised among today’s psychologists in where they contend that behaviour as a whole, whether it is deemed normal or disordered, permeates as a result of inter-twined influences of nature which is genetic, and physiological factors, and nurture referring to past and present experiences, and a part of these experiences can be how cultures interpret disorders or what is deemed desirable attributes (such as the thin-body ideal relating to influences in the development of Anorexia in industrialised societies) which can contribute to the development of particular disorders. Cultures can vary in what is deemed as a person being ‘mentally ill’ and with a presumption, which sometimes due to cultural influences, can attribute a person’s ‘illness’ to an internal problem, when perhaps at times this ‘internal problem’ may be better accounted for by a difficulty in a person’s environment among other factors such as the lack of social skills. As mentioned earlier, Taijin- kyofushoin Japanese culture has elements of social anxiety about one’s appearance which can share underlying dynamics such as anxiety as in other cultures, yet differ in the symptoms and this correlates with the modern bio-psycho-social perspective. The biological element involves individual genes, brain structure and chemistry; psychological elements include stress, trauma, learned helplessness, and mood-related perceptions and memories; and social elements involve roles, expectations, and the definition of normality and disorder, and this is where cultural influences fit in. It now seems evident that disorders and illnesses today are now seen not as a result of only ‘factors in the mind’, or ;mixed-up brain chemistry’ alone, but a combination of multiple factors, and one of these can be (to some degree) cultural influences s indicated in the ‘social’ element of the bio-psycho-social perspective of modern-day practice.
If you feel you have something to ad to this discussion for the benefit of others, please leave a message 🙂
Article written by Paul Inglis.
Myers, Exploring Psychology.