At The Intersection of Culture and Mental Health

Culture and mental health intersect. That thought speaks volumes to professionals and practitioners everywhere-all across the globe. If it doesn’t, it ought to! Have we considered how many times that life-altering mental health diagnoses have been wrong?

A PhD. psychology student, in her early internship/practicum, saw a male client who presented with symptoms of feeling insects crawling under his skin. Yes, insects! The doctoral student consulted with her supervising professor, as she was leaning towards a diagnosis of schizophrenia.

The professor asked a key question of his student. “Was this person Nigerian?” That question may sound irrelevant. However, when making determinations of life- impacting proportions, this is a wise question. A wrong diagnosis can negatively impact one’s life quality.

The intern answered affirmatively.  But why was that a critical consideration before diagnosis? Nigerian culture recognizes a phenomenon called Ode Ori. In Yoruba, this form of acute distress is manifested by a crawling sensation in the head and under the skin, heart palpitations and noises in the ear. These symptoms are expressions of and accompany anxiety.

Anxiety calls for different treatment protocol than schizophrenia, a psychotic disorder. Fortunate for everyone, especially the client, the distinction was made before being subjected to erroneous and ultimately harmful treatment. In the West, those symptoms are most closely associated with schizophrenia, and absent a broadened view of culture and mental health, a relatively normal neurosis may be diagnosed more severely.

Culture shapes who we are, so it follows that it would also shape our manifestations of stress, mental disorder, and emotion. Yet, that also implies a kind of messiness that modern psychology and psychiatry, particularly the American kind, have been struggling to ‘clean up’. 

Delivering the best care for individuals requires a more adaptable model-one which transcends culture, while not ignoring cultural influences, traditions and expressions of wellness. One culture’s expression of distress might look different from another’s. We must cease making these expressions of emotional distress so exotic.

Clinicians, educators, practitioners and everyday people are now called to be more fluent in the varying manifestations of emotional distress, in whatever language they present in translation. The Diagnostic and Statistical Manual 5th Ed.[DSM-5], the bible of psychological disorders and conditions, has rightfully moved from a simple list of ‘culture-bound disorders’ to what’s now called ‘cultural concepts of distress’.

In Western cultures, we are socialized to regularly ask ourselves how we feel and to name our emotional states from very early ages. This thinking can’t dominate our perceptions or diagnoses of individuals or culturally diverse groups of individuals.

Phenomenological awareness is subjective reality. What is cold to you may not be cold to me. People who hear voices in their heads would typically characterize a major symptom of schizophrenia. However, folks from Ghana and India tend to report having positive spiritual relationships with their voices. Thus, a psychotic disorder can not apply across the board here.

Since their founding, psychology and psychiatry have striven to standardize the diagnosis and treatment of mental disorders, indeed a difficult task. Culture and social environment can predict, and shape common mental disorders such as depression and anxiety. It is still uncertain whether the fundamental mechanisms of mental health are the same across humanity and it’s the expression of disorder that vary across cultures…or whether they are distinct culturally-mediated disorders.

With that in mind, it behooves professionals in all social psychological and education fields to use caution when assessing degree of wellness or intelligence. Capacity and the assessment and perception of adaptive behaviors also fall into this area of well-advised caution. Because there are culturally diverse individuals in American society, we must constantly be mindful of the ways culture and mental health intersect.