Specific Cultural Examples

Cambodians and Laotians

There are similarities and differences among cultures with respect to how mental illness is viewed. Information in the remainder of this lesson (from Adaskin, et al., 1990) describes how eight cultures view mental illness. Cambodians and Laotians, for example, believe that an individual who has mental health problems brings disgrace and shame to his or her family. As a consequence, mental illness is usually feared and denied. Frequently, individuals suffering from mental health problems are sheltered and hidden by family members until the family can no longer cope. At that point, they may seek professional help. Mental illness may be attributed to evil spirits or “bad karma”. Karma relates to the consequences of deeds committed in a previous life.

In Southeast Asian culture, where not showing emotion is a virtue and emotional weakness is unacceptable, “somatic complaints represent a cultural means of expressing psychological and emotional distress” (San Duy Nguyen, 1984). Somatic complaints are psychological problems displayed by a variety of physical symptoms such as headaches, insomnia, aches and pains, fatigue, and dizziness. Because the complaints are somatic, people tend to seek help from medical practitioners rather than mental health professionals — and people generally expect to receive medication.

Most mental health problems among Cambodians and Laotians in Canada are linked to severe loss, the difficulty of cultural adjustment upon emigration, and uncertainty about the future. For example, refugees have typically gone through many traumatic experiences in rapid succession with little time to adjust. Often, only after they have begun to settle into their new environment is the full impact of the losses and experiences felt. Some may suffer “survivor guilt”; they may feel they have no right to be alive or to live well when other family members and compatriots have died. Added to the stresses rooted in the past are those of the present: culture shock, language difficulties, social isolation, financial problems, and unemployment or underemployment. Not surprisingly, depression is one of the most common mental health problems among Southeast Asian refugees such as the Cambodians or Laotians.

Central Americans

Similar to the plight of many immigrants, people new to North America from Central America experience stress related to the immigration process, finding work, securing housing, learning English as a second language, and so forth. As time passes, the roles of husband and wife and parent and child begin to diverge from the models familiar in Central America. Many husbands are depressed in the early years of adjustment as they see their traditional family position eroding. In some cases, the wife might find a menial job more easily than the husband and, therefore, she becomes the breadwinner. Although spouses do not habitually discuss intimate topics with each other, if encouraged to do so, they may find that stress is lessened. After a period of adjustment, many individuals find that their depression lifts and anxiety dissipates. For serious mental illness in Central America, people are institutionalized with the expectation that they will never recover or be discharged.

Chinese

The Chinese are more likely to explain the causes of mental illness in terms of external factors or events and the problem is usually presented in the form of somatic complaints. For instance, an elderly lady may say that her heart hurts and may go to the coronary care unit for help when she is actually suffering from depression. Traditionally, different emotions are perceived to be closely related to different organs. For example, anger is associated with the liver, and joy and depression with the heart (Li, 1987). Consequently, clients may seek relief of physical symptoms but not discuss mental health problems. Patients may also attribute their illnesses to supernatural forces such as evil spirits or excessively cold winds. They may not understand the therapies used in Canada; talking about problems may not be an acceptable form of treatment.

Family members have a great influence on how mental health is viewed. Some families may be overprotective of, and give refuge to, their mentally ill members, and the illness becomes a family secret. They may also refuse treatment because they view mental illness as bringing shame on the family. Families may also fear that the mental health problems are genetically inherited. Consequently, people who do have mental health problems may be reluctant to seek help and may delay doing so (Lee, 1986).

Health professionals must find ways to ensure that clients have access to good care but they must also try to be understanding so as to win the family’s trust. Reassurances about strict confidentiality may comfort family members, as might genetic counselling for clients whose families believe that mental health problems are inherited (Lee, 1986).

Iranians

Iranians generally resist seeking help from psychiatrists and other professionals in mental health agencies mainly because of the stigma associated with mental illness. In the educated middle and upper classes, mental illness is often attributed to heredity or physical dysfunction (e.g., disorders of the nervous system). Many people in Iran also attribute mental illness to evil spirits. The majority of families tend to conceal such problems for fear of jeopardizing their children’s chances of marriage (Lipton and Meleis, 1983). Often, a person may be very sick before a psychiatrist’s help is sought.

Iranians are much more comfortable with physical illnesses than with mental illnesses. The first reaction of many Iranians to a diagnosis requiring mental health treatment is denial. For this reason, the advice of neurologists is often sought when emotional health problems arise. For the same reason, medication is more readily accepted than non-pharmaceutical treatments. A very small minority of Iranians with emotional problems may prefer counsellors and psychotherapists to medical doctors.

Japanese

As with many cultures, Japanese culture stigmatizes mental illness. Mental illness is feared and families tend to hide members experiencing mental health problems. They are ashamed to seek help and, therefore, treatment is only sought when individuals become too difficult to handle. Mental illness is often expressed through physical ailments including fatigue, insomnia, stomachaches, and headaches. If pressured to succeed, young people may resort to suicide instead of disappointing their families with failure. If treatment is sought, “talk” is only used to gather information about physical problems, not emotional issues. The individual is encouraged to accept and adjust to his or her situation, not change or modify it.

South Asians

In South Asia, mental illness is sometimes believed to have supernatural causes, particularly spells or curses cast by jealous relatives or acquaintances. These problems are addressed by visiting temples or shrines. Astrologers may also be consulted for a prognosis of the problem. As with many other cultures, symptoms of mental illness are often physical. Because somatic complaints are more acceptable, a person may complain of headaches, stomach-aches, and burning bodily sensations, rather than anxiety or depression. Although mental illness is stigmatized, ill family members are not ignored or rejected, but rather hidden. It is usually when the afflicted person is severely ill that he or she is taken to a health care professional – sometimes after an attempt at suicide.

In some families, the pressure for children to behave one way at home (parental pressure) and another way at school (peer pressure) results in stress, guilt, and depression. Talking about such problems is not usually compatible with South Asian beliefs or expectations. The physician is expected simply to tell the ill person what to do – not help the ill person find his or her own solution.

Vietnamese

For people in Vietnam, mental illness generally means severe disorders – not minor problems such as depression or anxiety. If a person becomes mentally ill, family members feel shame because such individuals are feared and rejected by society. Families care for the affected individual at home. The illness is often linked to the transgressions of ancestors, being born under an “unlucky” star, or malevolent (evil) spirits. An ill person may ask a Buddhist priest for help, or he or she may obtain the services of an exorcist.

Families are hesitant to allow minor problems (such as school-related difficulties) to be treated by a health care professional. Consulting a psychiatrist is equivalent to declaring a family member crazy! Also, to many Buddhists, “all life is suffering,” so people need to learn to cope with stress without burdening others with their problems. It is also not acceptable to talk about family with others. Patients want to be told what to do, not to combine efforts with their doctors to find a solution to their problems. Vietnamese people expect mental health care professionals to be authoritative and direct.

West Indians

Mental illness in the West Indies is stigmatized and viewed with shame. Families keep the mentally ill at home and out of public view. If a person has to be institutionalized, family members are unlikely to visit them. With depression, however, individuals often recover with the support of close friends with whom they can talk. Both physical and psychological pain, however, will be kept hidden from the general public. A show of strength is often presented in social situations because showing weakness is viewed with shame.

One can conclude from the previous information that North American and European cultures have much in common with other cultures regarding how mental illness was, and continues to be, viewed. Fear and stigmatization remain as reactions to the mentally ill. The causes and reasons for mental illness are often complicated and not fully understood. Generally speaking, many people fear what they do not understand.