How cultural contexts can shape mental illness

4 January 2017

‘Bedlam: the asylum and beyond’ is now in its final weeks, closing on 15 January. The exhibition traces the rise and fall of the mental asylum and how it has shaped the complex landscape of mental health today. For this post we adjust our focus as Sarah Jellenc takes a more global view of mental health. 

As a student of literature, I’ve spent a lot of time studying cultural narratives – the stories we tell ourselves in order to make sense of our reality. Browsing through the Hearing Voices Café newspapers at Wellcome Collection’s ‘Bedlam’ exhibition the other day got me thinking: what bearing might cultural narratives surrounding mental illness have on an individual’s expression and experience of psychopathology?

Clinicians have been learning more and more in recent years about how things like geographic location, worldview, ethnicity, religious beliefs, societal expectations, culturally specific ideas about interdependence versus individuality, family structure and availability of resources can all influence the types, rates and prognoses of mental illnesses across cultures. Considering mental illness within relevant cultural contexts can provide clues about the kinds of symptoms people might experience; the degree to which they will have to contend with social stigmas; the presence or absence of a support network at home; the likelihood that they will seek help; and the effectiveness of different treatment or management strategies. What have we been culturally conditioned to think about mental health and, by extension, ourselves?

The fourth version of the Diagnostic and Statistical Manual of Mental Disorders (Western psychiatry’s authoritative mental health reference manual) contained a list of twenty-five culture-bound syndromes. The DSM-V has since replaced that oversimplified definition with the three concepts of cultural syndromes, cultural idioms of distress and cultural explanations of distress. Some syndromes have been found to be less localised than previously thought, and have instead been identified by different names or variations in expression across cultures.

Examples include a condition characterised by hyperstartling (unusually exaggerated physiological and behavioural responses to being startled), which goes by the name latah in Malaysia and Indonesia, imu among the Ainu in Japan, and jumping within a French-Canadian population in Maine. Another example is sleep paralysis (occasionally accompanied by visual or auditory hallucinations), called uqamairineq by the Yupil Eskimos and old hag in parts of Newfoundland, Canada. Others really do seem to be culturally specific, like taijin kyofusho, a form of social anxiety disorder unique to East Asia.

Of course, there is a biological unity among humankind underlying more universal conditions. Schizophrenia, for example, has been shown to have strong biological and genetic bases. Studies from the World Health Organization reveal that “syndromes of schizophrenia occur in all cultures and geographical areas investigated” and that “their rate of incidence is very similar in the different populations.” Even so, recent studies have illustrated the considerable variation in the expression and experience of schizophrenia across cultures.

According to a 2014 study by Stanford anthropologist Tanya Luhrmann, for instance, the differences in perceptual processing between traditionally collectivist and individualist cultures help to determine the number, frequency and nature of auditory hallucinations in patients with schizophrenia. Her team interviewed adults with schizophrenia from the United States, Ghana and India. They found that participants from the U.S. were far more likely to describe the voices they heard as violent or threatening and viewed them as evidence of a diseased mind. The participants in India and Ghana, on the other hand, generally had more personal and positive experiences with their voices. The Indian participants often characterised them as playful or identified them as the voices of kin, while those in Ghana often identified them as voices of the divine.

Though globalisation has made it possible to do this kind of research and broaden our understanding of mental health issues across the full spectrum of humanity, it has also resulted in increasing cultural hybridisation. We must also take into account that most of the diagnostic tools and definitions utilised by mental health professionals around the world were developed in the West. According to Dr. Laurence J. Kirmayer, Director of the Division of Social and Transcultural Psychiatry at McGill University, “[g]lobalization has brought with it many ironies for cultural psychiatry: Transnational migrations have resulted in cultural hybridization at the same time as ethnicity has become more salient; the call for evidence-based medicine has been used to limit the impact of cultural research; and cultural psychiatry itself has been co-opted by pharmaceutical companies to inform marketing campaigns to promote conventional treatments for new populations.”

In any case, increased understanding of the relationship between culture and mental illness may have important implications regarding treatment and stigma reduction, and could also go a long way towards helping us better understand ourselves and each other.

Sarah Jellenc is an independent scholar with an MSc in Literature & Society from The University of Edinburgh.

Bedlam: the asylum and beyond‘ is on until 15 January 2017.