According to Sofia Andrade at UC Berkeley, people often think of mental health as a very personal matter that has to do only with the individual. However, mental illnesses and mental health in general are affected by the combination of biological and genetic factors, psychology, and society. This intersectionality is important, but the heavy influence of societal factors often goes ignored. An interesting aspect of society is its diversity in cultures and backgrounds that affect an individual’s mental health related experiences.
According to the report “Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General,” there are many ways in which culture showed its influence on a diversity of experiences. For instance, culture affects the way in which people describe their symptoms, such as whether they choose to describe emotional or physical symptoms. Essentially, it dictates whether people selectively present symptoms in a “culturally appropriate” way that won’t reflect badly on them. For instance, studies have shown that Asian patients tend to report somatic symptoms first and then later describe emotional afflictions when further questioned or asked more specifically. Furthermore, cultures differ in the meaning and level of significance and concern they give to mental illness. Every culture has its own way of making sense of the highly subjective experience that is an understanding of one’s mental health. Each has its opinion on whether mental illness is real or imagined, an illness of the mind or the body or both, who is at risk for it, what might cause it, and perhaps most importantly, the level of stigma surrounding it. Mental illness can be more prevalent in certain cultures and communities, but this is also largely determined by whether that particular disorder is rooted more in genetic or social factors. For example, the prevalence of schizophrenia is consistent throughout the world, but depression, post-traumatic stress disorder, and suicide rates have been shown to be more attributed to cultural and social factors.
Based on these cultural influences and ideals, people decide how they are going to cope with mental illness and seek treatment (whether that be by seeing a psychiatrist, psychologist, social worker, primary care practitioner, clergy member, or traditional healer, etc.). For instance, some Asian groups have been shown to prefer avoidance of upsetting thoughts with regards to personal problems rather than outwardly expressing that distress. African American groups have been shown to be more likely than whites to handle personal problems and distress on their own, or to turn to rely on their spirituality for support. Cultural factors often determine how much support people have from their families and communities in seeking help. This is particularly important because mental illnesses cannot simply be ignored and left untreated — doing so significantly impacts a person’s quality of life and can cause severe distress and secondary health effects.
Furthermore, research has shown that the mental health experience of minorities has been greatly affected by culture and how society at large views that culture. Racial and ethnic minorities in the U.S. are less likely than white people to seek mental health treatment, or to delay treatment until symptoms are severe. This finding has been largely attributed to mistrust due to the history of discrimination and racism and a fear of being mistreated due to assumptions about their background. This goes hand in hand with the issue of clinical stereotyping — that is, the biases that practitioners or mental health professionals have about certain cultures may influence a diagnosis. The Commonwealth Fund Minority Health Survey found that 43% of African Americans and 28% of Latinos, versus 5% of whites, expressed feeling that they were treated badly in the clinical setting because of their background. Another issue is that poor physical health affects mental health, and minorities tend to have higher rates of chronic physical illness, which is often a risk factor for disorders such as depression and anxiety. Yet another arising issue is that of language barriers. This is an issue because aside from pharmacological treatments, a primary component of other mental health services is face-to-face communication. Educational materials may not be accessible in other languages, so for communities that are ethnically diverse, this can make it difficult for non-English speakers to access the full breadth of services. Furthermore, affordability and insurance coverage of mental health services is also an area of concern.
At UC Berkeley, Student to Student Peer Counseling (SSPC), a student-run organization on campus that offers confidential peer counseling and puts together mental health-related events, hosted a safe space to talk about this relationship between mental health and culture. “Stigma & Culture: A Mental Health Discussion” took place in 2016. Ali Manrique, a third-year psychology major and SSPC coordinator, was very excited about the event and explained, “There were about 10 of us in the room. We didn’t have much time to advertise it, so there could have been more publicity, but overall, it was great! We came prepared with questions such as ‘How do you think your culture affects your point of view in mental health?’ and other questions that we put in a little basket and then we had people answer them. It was a really safe environment and we also had community agreements. We really bonded over how most of our cultures have a stigma towards mental health and we even talked about the difficulty of accessing mental health resources being a minority.” The group concluded that although it might be the case that certain cultures may have more stigma regarding mental health than others do, every culture had a unique perspective on mental health. Starting the dialogue about mental health and the many factors that can affect it is the first step in the right direction toward a more stigma-free world in which resources are made available to anyone who needs them.
According to the National Alliance on Mental Illness (NAMI), our culture, beliefs, sexual identity, values, race and language all affect how we perceive and experience mental health conditions. In fact, cultural differences can influence what treatments, coping mechanisms and supports work for us. It is therefore essential for culture and identity to be a part of the conversation as we discuss both mental health and mental health care.
A person must feel comfortable and understood by their mental health professional for a therapeutic relationship to be effective. This includes feeling their mental health professional understands their identity and being comfortable addressing it openly. When a mental health professional understands the role that cultural differences play in the diagnosis of a condition and incorporates cultural needs and differences into a person’s care, it significantly improves outcomes. Mental health care must be tailored to the individual — to their identity, culture and lived experience.
As an individual or caregiver, don’t be afraid to advocate for yourself or the needs of your loved one. While it’s not always possible, finding the right provider is essential to ensure the dimensions of culture and language do not get in the way of healing or recovery. Instead, your culture — those shared community values and experiences, along with dimensions of faith and spirituality, resiliency, key relationships, family bonds and pride in where you came from— becomes a source of strength and support.
This article is provided by Dr. Ralph Kueche (Child Psychologist). Dr. Kuechle is a Child and Adolescent Clinical Psychologist who specializes in treating children and their families who may be struggling with mood and behavioral issues. Learn more about Dr. Kuechle.