Mental health was not a topic of conversation growing up; in fact, it was a taboo subject. Even after all this time and conversation in the media about mental health, there is a feeling of shame and humility that weighs heavily in the room when I bring up mental health and mental illness.
Interestingly, there is a remarkable contrast about mental health on my social media feed and with my friends compared with the conversations (or lack of conversations) taking place at home. I've seen posts, stories, and captions that take a deep dive into someone's personal challenges and wins, as well as educational posts and online resources. We've even discussed these topics in my lectures and classroom forums.
Improving mental health has been a highlighted topic of discussion and action item for quite some time. However, much of what we know and what we practice is predicated upon Western values and perspectives. Resources tailored for different groups seem to be few and far between. The lack of specificity and directionality in turn results in diminished effectiveness and power of established therapies. Taken together, greater attention needs to be placed upon the intersection of culture and mental health.
I'm a second-generation Canadian. While I'm surrounded by Western culture which focuses on the individual, I also grew up with strong ties back home where the focus was on community and family. The way we communicate and perceive information, as well as express ourselves and understand our identity, is likely to vary from culture to culture. Consequently, a Western approach to improved mental health will not always align well across different groups. It's important to recognize that when understanding differences in health-seeking behaviors and engaging with others to arrive at solutions.
Stigma and shame are often common sources of tension and inner conflict that arise when we discuss mental health. Individuals may be unlikely or resistant to seek help due to pressure from external figures (eg, family, friends). Shame may be rooted in an attempt to preserve dignity, confidence, and/or reputation. Accordingly, these feelings are often not mutually exclusive with disgrace, disapproval, and/or rejection by loved ones and community members.
Cultural differences may lead to power imbalances between healthcare providers and patients. For example, healthcare providers may misinterpret or disregard aspects of an interaction, leading to over- or underdiagnosis. Greater understanding of culture and perspective could be key in ensuring a balance of power in the relationship as well as avoiding mistakes (eg, biases, stereotyping). There should be a greater emphasis on cultural diversity when we consider the therapeutic relationship between the provider and patient.
Boiling it down to the basics, it's not always about "who knows more" or "who has been in the field the longest" but someone who can understand the challenges and concerns. Like everything else in the world, mental health is multidimensional and should not be approached as "one-size-fits-all." Having conceptual tools and frameworks that accord with various groups is necessary to work toward sustainable solutions.
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Cite this: Leanna M.W. Lui. Context Matters: The Intersection of Culture and Mental Health - Medscape - Apr 15, 2022.