Learn how social factors promote mental health, influence the onset and course of mental illness, and affect how mental illnesses are diagnosed and treated. This course explores how our understanding of mental health and illness has been influenced by social attitudes and social developments in North America and around the world. The course begins by situating our contemporary mental health practices in historical context, then looks at different aspects of mental health, mental illness and mental health services and their connections to what’s going on in our social environment.
4.1 culture mental health mental illness
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En provenance du cours de University of Toronto
The Social Context of Mental Health and Illness
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Culture, mental health and mental illness
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Charmaine WilliamsAssociate Professor
Faculty of Social Work
>> Alright. So, let's start by talking about culture.
We used to see definitions of culture that focused on things like language, symbols,
artifacts, etc. This was a reflection of earlier
associations of culture as something mostly associate with ethnicity and
practice within ethnic groups. Now, you tend to see more inclusive
definitions of culture. The focus on its role as a way of
describing how groups of people live. Here I talk about the ways of living built
up by a group that are socially transmitted between people.
I think of culture as being like a guiding system that helps people to navigate their
way though life. And as I say here, it is framework for the
interpretation of experience. When we think about culture in the context
of mental healthcare, we need to have an understanding of culture in mental
healthcare, because so much of our decision making about mental health and
illness depends on being able to interpret peoples' behavior appropriately.
Knowledge of the cultural context helps us to make sense of whether the behavior we
observe is appropriate or indicative of illness.
A knowledge of culture is also necessary for being able to communicate effectively
with people in ways that can facilitate a shared understanding of what's going on
with them. And it's also necessary for building
relationships that can be effective in providing help.
In the same way that culture helps to make sense of everyday life, it also provides
ways to make sense of unusual circumstances in life, like mental health
and mental illness. Culture provides the means by which to
express distress, to communicate it to others, and evoke helping responses.
It's not possible to ask for help or receive it, if there's not some way of
communicating the, the request and the need.
A cultural context attaches meaning to these experiences and devices ways of
supporting and providing solutions to the problems they create.
In addition, the beliefs and expectations that the cultural context has about an
experience like mental illness, has a powerful influence on how mental illness
is experienced. Those beliefs and expectations can
actually construct outcomes because people live out the experience of mental illness
or disorder within the constraints and opportunities that the culture can provide
for them. So, I know that those were some pretty
heavy ideas. So, I want to take moment here to just
pause and try to go over them, using an example.
So, let's take the example of depression. Something that we know happens no matter
where you are in the world, no matter what group you're from.
We know that there are lots of people that experience depression.
Now I remember, that we used to talk about how depression was experienced differently
in different cultural groups. Referring to the fact that in the west or
I'll say, North America, for example, when we were be talking about depression, we
would normally talk about things like people having low self-esteem feelings of
guilt, feelings of worthlessness, not having pleasure, not experiencing pleasure
for things that they usually did. These are the kinds of things, it was very
much about people's mood and their, and the way they were thinking, right?
And this, I am going to suggest to you, was a reflection of the way the culture
thought about how mental distress or how distress is experienced.
Experiences, it's experienced as something that makes you feel poorly about yourself,
makes you feel like you can't engage in the usual kind of activities, all that
sort of thing, right? Now in contrast to that, we would discuss
how in Asian cultures people somatized their depression.
This was referring to the fact that when people from the cultural backgrounds that
were Asian, mostly we're taking about East Asian, when they would experience what we
call depression, they wouldn't talk about self-esteem and feelings of worthlessness
and guilt and that sort of thing. Their description has more to do with
things like feeling pain and feeling you know, stomach upsets and not being able to
work, and that sort of thing, right? So, they had what we called different
idioms of distress. And they would talk more about what was
happening in their body rather than what was happening in their head.
So, the interesting thing is that we now know because of brain research, that the
neural, the neural pathways that are associated with depression affect both the
way that you're thinking and feeling, and the way that you're physically feeling.
So, depression is something that's happening with you mood and your thoughts
but its also happening in your body. And it's interesting me, to me now to look
back and think that actually in retrospect, the these Asian patients that
we're talking about pain and stomach upset and migraines and all that, actually had
an understanding of the illness that we did not have yet, right?
But the thing is, in both situations patients were using the, the language and
the idioms they had available to them to explain what was happening in their body.
Something was happening in their body that was affecting the way they were feeling,
emotionally, physically, whatever. And in an Asian context, the language that
was available to you, the, the framework for understanding that was one that was
based in physical and a physiological understanding.
And in the West, in North America, the language that was available to you was one
that was based more in an understanding of how one feels about their self and their
self-esteem, and their self-efficacy and things like that.
Very much a cultural difference. And the thing is that cultural difference
that, of course, translates into different ways of responding.
So, in an environment where depression is understood as something that affects the
way you feel about yourself and your ability to engage in relationships and
your feelings of being a worth while person, it makes sense that then the
treatment for that would be some kind of talking cure that's focused on those
issues of self-worth and guilt and feelings of worthlessness.
In the East, where your depression was something that was, was causing problems
with the way your body was functioning and the way that you were able to deal with
pain and the way that you were able to work, it made sense that then the solution
the people sought out had to do with trying to strengthen the body.
Dealing with issues like diet, dealing with issues like supplements and other
kinds of treatments that would help the body run more effectively.
Now, both of these things probably helped people with depression and continue to
help people with depression, but because they're in different cultural context,
people respond to them differently. There are different people called in to
help. There are different solutions available.
Hopefully, part of what's happening as the world becomes more global is that we're
able to take from all of these different, these different contexts, and bring it
together to find solutions that can work across the spectrum.
Or that give people more choice in terms of what they're able to do.
But what we're going to be talking about as the lecture goes on, is how culture and
cultural differences and cultural, culturally different ways of responding to
mental health, mental illness, and mental disorder have actually played out
internationally and in multi-cultural environments.
And at the end, maybe we can think about is there the potential for us to have
better systems, richer systems of mental healthcare because we have all these
different ways of thinking about what constitutes mental health and how you deal
with mental illness.
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