Cultural Influences on Mental Health

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Cultural Influences on Mental Health

• Second National Conference of
• General Practitioners working with Refugees and
  Asylum Seekers
• Birmingham 23 February 2006
• Professor S.P.Sashidharan
• National Centre for Research in Ethnicity and
  Mental Health
• University of Warwick

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Outline

• How culture shapes mental health
• Cross Cultural assessment
• Diagnosis and professional attribution
• Implications for clinicians

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Culture

• A set of values and beliefs that are shared
  across whole populations
• Culture as a set of social, historical and
  material relations in the context of the personal
  narrative
• Culture informs the very notion of the self

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Why culture is important in mental health

• General medical conditions are directly about the
  body and indirectly about the self
• Psychiatric illnesses are a direct commentary on
  the self and of the self
• Psychological experience and social behaviour
  together compose self
• Selves are not enduring, bounded, inner entities
  but are a creation of acting and understanding
  which is derived from culture

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Cultural Influences on Mental Health

• More important in psychiatry than in other areas
  of human health
• Notions of mental health and mental illness are
  culturally determined
• What requires/merits treatment is also culturally
  determined

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Cultural Determinants of Mental Illness

• Universality of mental illness (form and content)
• Culture bound syndromes
• Category Fallacy
• Cultural underpinnings of the material of
  psychiatry
• Cultural differences in presentation, course and
  outcome
• Explanatory Models

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Need for cultural sensitivity in mental health
assessment

• It is all too easy to repeat the colonising
  process by imposing a therapeutic ideology rooted
  in the culture of the host community, giving
  meaning to the survivors experience in the
  language and symbols of that host community and
  its professionals, and failing to recognise the
  rich sources of meaning and symbolism available
  to the survivor from his or her own culture
  Blackwell 1989

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How culture influences the expression of mental
distress

• Symptoms, idioms and metaphors used to describe
  mental distress
• Differences in the idioms of mental distress
  thinking too much in my heart, sinking heart,
  soul loss, heart ache, low mood, stressed
• These are core experiences of the illness and not
  just symptoms

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Metaphors

• I feel depressed
• Butterflies in the stomach
• Sinking into a whirlpool
• Insides turning to stone
• Funny feeling in my head silver dust floating in
  front of my eyes
• My body feels all weak and I fall into a spell
  and go into another world

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Assessment

• Language
• Cultural distance
• Reliability and validity of psychiatric diagnosis
• Categories and Context
• Attribution based on stereotyping

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Context

• Displacement, usually forced
• Difficulties within family and personal
  relationships
• Experience of racism
• Difficulties in employment and housing
• Financial difficulties and
• Poor physical health

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Implications for clinical practice

• Transforming Practice
• Challenging cultural assumptions including the
  knowledge base
• Context and Meaning including Racism
• Engagement and mediation