CHAPTER 16: CULTURE + MENTAL HEALTH
Culture affects the expression, experience, interpretation, course and outcome of various mental
disorders. Further, culture influences individual resilience, coping mechanisms and social responses that
are crucial for recovery from mental health problems.
Only in the past 15 years have psychologists and psychiatrists begun to pay attention to culture in clinical
practice. → One reason for this is that culture can be easily missed in one’s own cause and only noticed
in the cause of others.
Culture affects every part of our existence, and so we often forget or take for granted that we live within
particular frameworks of values, beliefs and symbols.
In this respect, it is important to address this blind spot in order to grasp the connections between culture
and mental health. We need to overcome the tendency to see culture only in other people’s categories
and practices, and not in our own.
None of this denies the real nature of mental disorders and suffering, and the biological causes of distress
and symptoms, which are often powerful. → Rather, culture has a profound effect on all aspects of mental
disorders to the extent that, in many cases, it may even have a more significant influence on the
experience and course of suffering than the underlying biological factors.
Today culture is seen more like a group of ecosystems that merge into each other. It is also
acknowledged that an individual’s preferences are not entirely determined by their culture; instead,
individuals choose to accept or reject certain cultural symbols and meanings throughout their lives.
UNIT 1: UNIVERSALITY + CULTURAL PARTICULARITY OF MENTAL DISORDERS
The beginnings of the interest in the connections between culture and mental health are attributed to Emil
Kraepelin’s 1903 voyage to the island of java. → He coined the term dementia praecox, the precursor to
the term schizophrenia.
After his visit to Java, Kraeplin concluded that dementia praecox was very common, with differences in
presentation limited to the severity, and not the type of symptoms. → Dementia praecox, he suggested,
is a ‘generic illness’ that develops in slightly different ways.
In 1904 Cecil Seligman led an expedition to New Guinea and reported that psychosis was not observed
among the natives of the island. → Later, as cases comparable to schizophrenia appeared in New
Guinea, he was criticised for missing a universal pattern of illness because local understanding included it
in some more general pattern of ritual.
These two contrasting early accounts represent, respectively, a universalist and a culturally particularist
position with regard to culture and mental disorders.
Culture psychiatry and psychology typically address this question through empirical research methods
that involve the application of diagnostic interview schedules to patients in research centres around the
world.
16.1.1 THE WORLD HEALTH ORGANIZATION STUDIES
A number of studies conducted by the World Health Organization concluded that schizophrenia is a
condition found across the globe.
62
, In the first of these studies, researchers were able to establish that symptoms of schizophrenia cluster in
the same way in both non western and western societies, thus supporting the hypothesis that
schizophrenia is a universal disease category.
In the case of depression, and after reviewing the cross-cultural record at the time, Singer concluded that
there is 'insufficient evidence to support the prevalent view that depressive illness in primitive and certain
other non-Western cultures has outstanding deviant features'.
The methodology of trans-cultural research was criticised for downplaying and trivialising cultural
differences (and their influences) in its search for universal symptoms. This criticism was initiated by
Arthur Kleinman.
The methodology employed in such research, it was argued, betrayed the original aim of the researchers,
which was to discover universals in psychiatric disorders and downplay cultural differences. By employing
standardised questionnaires to identify a core schizophrenic syndrome, cross-cultural researchers
excluded other presentations in favour of a reliable syndrome.
The cross-cultural existence of this syndrome would then support the idea that schizophrenia and
depression are universal disorders, occurring with a similar structure in diverse cultures.
16.1.2 DO PSYCHIATRIC CATEGORIES HAVE CROSS CULTURAL VALIDITY?
Reliability: refers to the potential for making consistent observations.
Validity: concerns whether such categories actually do ‘pick up’ what they state they will do.
Critics of the WHO research questioned the cross - cultural validity of psychiatric categories. They argued
that psychiatric categories are not culture - free entities that we can go and find somewhere else, but they
have histories and are culturally embedded.
Category fallacy: mistaking reliability for validity.
Kleinman was not necessarily ruling out the possibility that schizophrenia might have validity for other
cultures, but the point is that this is an empirical question and we cannot assume this validity, as the
WHO researchers had done. → It is important to know that some cultures have particular ways of
understanding psychological changes. These changes have spiritual or religious explanations.
The question of the validity of the category of schizophrenia is further complicated by the fact that
psychiatry has become a reality in many communities around the world, together with other elements of
modernisation.
While clinical psychiatry and diagnostic categories such as schizophrenia may become available in
different cultural contexts, existing explanations and understandings of behavioural and psychological
changes will not necessarily be replaced.
This does not mean that some mental health diagnoses are invalid in some cultures.
Despite the poor cross-cultural validity of psychiatric categories, there seem to be recurring patterns of
affect, thought and behaviour that can be identified across cultures. → If we do not assume that there is a
63
Culture affects the expression, experience, interpretation, course and outcome of various mental
disorders. Further, culture influences individual resilience, coping mechanisms and social responses that
are crucial for recovery from mental health problems.
Only in the past 15 years have psychologists and psychiatrists begun to pay attention to culture in clinical
practice. → One reason for this is that culture can be easily missed in one’s own cause and only noticed
in the cause of others.
Culture affects every part of our existence, and so we often forget or take for granted that we live within
particular frameworks of values, beliefs and symbols.
In this respect, it is important to address this blind spot in order to grasp the connections between culture
and mental health. We need to overcome the tendency to see culture only in other people’s categories
and practices, and not in our own.
None of this denies the real nature of mental disorders and suffering, and the biological causes of distress
and symptoms, which are often powerful. → Rather, culture has a profound effect on all aspects of mental
disorders to the extent that, in many cases, it may even have a more significant influence on the
experience and course of suffering than the underlying biological factors.
Today culture is seen more like a group of ecosystems that merge into each other. It is also
acknowledged that an individual’s preferences are not entirely determined by their culture; instead,
individuals choose to accept or reject certain cultural symbols and meanings throughout their lives.
UNIT 1: UNIVERSALITY + CULTURAL PARTICULARITY OF MENTAL DISORDERS
The beginnings of the interest in the connections between culture and mental health are attributed to Emil
Kraepelin’s 1903 voyage to the island of java. → He coined the term dementia praecox, the precursor to
the term schizophrenia.
After his visit to Java, Kraeplin concluded that dementia praecox was very common, with differences in
presentation limited to the severity, and not the type of symptoms. → Dementia praecox, he suggested,
is a ‘generic illness’ that develops in slightly different ways.
In 1904 Cecil Seligman led an expedition to New Guinea and reported that psychosis was not observed
among the natives of the island. → Later, as cases comparable to schizophrenia appeared in New
Guinea, he was criticised for missing a universal pattern of illness because local understanding included it
in some more general pattern of ritual.
These two contrasting early accounts represent, respectively, a universalist and a culturally particularist
position with regard to culture and mental disorders.
Culture psychiatry and psychology typically address this question through empirical research methods
that involve the application of diagnostic interview schedules to patients in research centres around the
world.
16.1.1 THE WORLD HEALTH ORGANIZATION STUDIES
A number of studies conducted by the World Health Organization concluded that schizophrenia is a
condition found across the globe.
62
, In the first of these studies, researchers were able to establish that symptoms of schizophrenia cluster in
the same way in both non western and western societies, thus supporting the hypothesis that
schizophrenia is a universal disease category.
In the case of depression, and after reviewing the cross-cultural record at the time, Singer concluded that
there is 'insufficient evidence to support the prevalent view that depressive illness in primitive and certain
other non-Western cultures has outstanding deviant features'.
The methodology of trans-cultural research was criticised for downplaying and trivialising cultural
differences (and their influences) in its search for universal symptoms. This criticism was initiated by
Arthur Kleinman.
The methodology employed in such research, it was argued, betrayed the original aim of the researchers,
which was to discover universals in psychiatric disorders and downplay cultural differences. By employing
standardised questionnaires to identify a core schizophrenic syndrome, cross-cultural researchers
excluded other presentations in favour of a reliable syndrome.
The cross-cultural existence of this syndrome would then support the idea that schizophrenia and
depression are universal disorders, occurring with a similar structure in diverse cultures.
16.1.2 DO PSYCHIATRIC CATEGORIES HAVE CROSS CULTURAL VALIDITY?
Reliability: refers to the potential for making consistent observations.
Validity: concerns whether such categories actually do ‘pick up’ what they state they will do.
Critics of the WHO research questioned the cross - cultural validity of psychiatric categories. They argued
that psychiatric categories are not culture - free entities that we can go and find somewhere else, but they
have histories and are culturally embedded.
Category fallacy: mistaking reliability for validity.
Kleinman was not necessarily ruling out the possibility that schizophrenia might have validity for other
cultures, but the point is that this is an empirical question and we cannot assume this validity, as the
WHO researchers had done. → It is important to know that some cultures have particular ways of
understanding psychological changes. These changes have spiritual or religious explanations.
The question of the validity of the category of schizophrenia is further complicated by the fact that
psychiatry has become a reality in many communities around the world, together with other elements of
modernisation.
While clinical psychiatry and diagnostic categories such as schizophrenia may become available in
different cultural contexts, existing explanations and understandings of behavioural and psychological
changes will not necessarily be replaced.
This does not mean that some mental health diagnoses are invalid in some cultures.
Despite the poor cross-cultural validity of psychiatric categories, there seem to be recurring patterns of
affect, thought and behaviour that can be identified across cultures. → If we do not assume that there is a
63
