How Culture Influences Mental Health

Individual mental health is a complex interaction of biological, psychological, social, and cultural factors. While most discussions of mental health focus on biological and psychological influences, socio-cultural factors deserve as much attention.

Such factors can influence how a mental illness manifests – for instance, while the prevalence of certain mental illnesses like schizophrenia, bipolar disorder, panic disorder are fairly consistent worldwide, symptoms like visual and auditory hallucinations vary greatly across cultures.

Other illnesses, like depression and PTSD, also seem closely tied to cultural differences. Even micro-cultures, like family units, can affect mental health, depending on power dynamics, shared values, and emotional support. Shared experiences of trauma, financial instability, and illnesses can also influence how a person perceives and experiences mental health. 

Studies have also shown that when groups of people are stigmatised, the individuals are much more likely to face mental health struggles. While research in India is lacking, studies of LGBTQ+ groups elsewhere show they face higher rates of depression and suicide due to societal bias. Discrimination due to caste and religion also seems to make people more vulnerable to mental health struggles. 

While much of our understanding of, definitions, and research on mental health is dominated by Western sources and culture, socio-cultural factors affect mental health everywhere; the degrees and ways just vary. 

Culture affects how we experience mental health struggles

Societal structures and culture affect mental health and mental health care in roughly three ways.

Despite increasing awareness, mental health challenges are still considered a weakness and something to hide in India and elsewhere. Asian cultures, in particular, hold ideas of family honour, pride and collectivism in such high regard that acknowledging and accepting mental distress can be a source of shame.

Recent surveys and studies have shown that strong exclusionary attitudes towards people with mental health struggles continue to exist. This can make it particularly challenging for people to seek out support and care. Saving face and avoiding disapproval often takes priority over getting help for one’s challenges.  

The way people speak about their mental health symptoms and struggles can vary depending on cultural context, too. Asian patients, for instance, are far more open in talking about physical effects, such as somatic pain, instead of sharing emotional symptoms.  Stigmas around mental health at home or across cultures also exist for certain terms like “depression”, “trauma”, and “anxiety.” This can create an atmosphere in which people are not comfortable sharing their experiences honestly or lack the language to accurately representing what they are going through. 

Additionally, there is growing evidence to suggest that mental health symptoms can be culture-specific, too. Depression tends to manifest as unexplainable chronic pain more in Indians than in people from elsewhere, possibly due to the stigma against expressing mental pain and seeking help for it. 

Culture affects how we seek and receive mental health care

Whether and how we seek mental health care is determined by support systems and coping mechanisms developed under the influence of culture, family, financial constraints, and availability.  Coping styles in Asian cultures tend to promote not focusing on negative thoughts; avoidance is considered better than outward expression. Further, a cultural mistrust and misunderstanding of mental health care makes many people reluctant to seek it. 

Psychiatry – that is, medical treatment of mental illness – is not trusted and often seen as a last resort. Stereotypes and media depictions of psychologists as eccentric and clinically incompetent abound due to a largely unregulated field.Therapy is still seen as a taboo in many families.

In India, as opposed to elsewhere, family doctors (GPs) are often frontline caregivers who are often not aware or well trained in mental health and care. Research has shown that non-psychiatric doctors have found it difficult to identify symptoms and discuss solutions with patients. Referral rates from these doctors to psychologists and psychiatrists remain significantly low.

Furthermore, religion and faith are often conflated with mental health care in India and similar cultures. Studies and surveys have shown a significant number of people in India prefer faith healing over traditional methods of therapy. The efficacy of these faith-based methods are unproven, keeping people from evidence-based, effective care.   

Even when people do seek mental health care, the cultural and social background of the caregiver also matters. Psychiatrists, psychologists, counsellors, and family doctors (GPs) are all products of their environment and are not immune to socio-cultural influences. In some ways, this is beneficial; practitioners understand first-hand the context in which their patients are struggling. But it can also mean that women, LGBTQIA+ people, gender diverse people, people from disadvantaged castes and classes, and people who face other stigmas may receive subpar treatment as a result of biased caregivers. In such cases, the so-called ‘care’ can lead to more harm than good.

Creating culture-informed options for mental health care is crucial. Mental health practitioners require expanded resources and training to incorporate approaches that give people more agency over their treatment. Training in the use of non-directive and non-authoritative language that does not reflect cultural biases is essential. 

And innovative caregiving models that make use of new technology can also make mental health care services responsive to an individual’s context. This is what we at Mitsu are striving to achieve.